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Community Advisory Committee <br />Quarterly/Annual Visitation Report <br />County Orange Facility Type <br />Family Care Home <br />Adult Care Home <br />Nursing Home <br />Facility Name: Carillon <br /> <br /> <br />Census – current/licensed: 63/96 <br />Visit Date and day of the week <br />Tuesday Sept 13, 2016 <br />Time spent in facility <br />1 hours 40 minutes <br />Arrival time 1:00pm <br />Name of person(s) with whom exit interview was held <br />Tonya, Business Manager & Laurie Sawyer, Exec. Director <br /> <br />Interview was held in person <br />Committee members present: Gloria Brown Suzanne Haff Deborah Stewart <br /> <br />Number of residents who received personal visits from committee members 6 Report completed by: Deborah Stewart <br /> <br />Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly posted: Yes <br /> <br />The most recent survey was readily accessible N/A <br />(Required for NHs only – record date of most recent <br />survey posted) : <br />Staffing information clearly posted? Yes <br /> <br />Resident Profile Yes <br />No <br />N/A <br />Comments/Other Observations (please <br />number comments) <br /> 1. Do the residents appear neat, clean and odor free? Yes 1. Residents are well-groomed and social. Their <br />rooms are well-kept as well. 2.Did residents say they receive assistance with personal care <br />activities? (i.e. brushing their teeth, combing their hair, inserting <br />dentures or cleaning their eyeglasses) <br />Yes <br />3. Did you see or hear residents being encouraged to participate <br /> in their care by staff members? N/A <br />4.Were residents interacting with staff, other residents & visitors? Yes <br />5.Did staff respond to or interact with residents who had <br />difficulty communicating or making their needs known verbally? Yes <br />5a Did staff members wear nametags that are easily read by <br /> residents and visitors? No <br />6. Did you observe restraints in use? No <br />7. If so, did you ask staff about the facility’s restraint policies? <br />Note: Do not ask about confidential information without consent N/A <br /> <br />Resident Living Accommodations Yes <br />No <br />N/A <br />Comments/Other Observations (please <br />number comments) <br /> 8. Did residents describe their living environment as homelike? Yes 8 & 9. Facility remains clean and tidy. <br /> <br />14. Residents primarily walk to the staff offices <br />to make verbal reports about their needs. <br /> 9. Did you notice unpleasant odors? No <br />10. Did you see items that could cause harm or be hazardous? No <br />10a. Were unattended med carts locked? Yes <br />10b. Were bathrooms clean, odor-free and free from hazards? Yes <br />10c. Were rooms containing hazardous materials locked? Yes <br />11. Did residents feel their living areas were kept at a reasonable <br /> noise level? <br />Yes <br />12. Does the facility accommodate smokers? <br />Note: By regulation smoking is only permitted outside of the <br /> Building <br />N/A <br />13. Were residents able to reach their call bells with ease? Yes <br />14. Did staff answer call bells in a timely & courteous manner? N/A <br />14a If no, did you share this with the administrative staff? <br /> *** N/A equals not applicable, not asked, not observed