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<br /> <br />Community Advisory Committee <br />Quarterly/Annual Visitation Report <br />County Orange Facility Type <br />Nursing Home <br />Facility Name: Brookshire <br />Census – current/licensed: 67/80 <br />Visit Date and day of the week <br />2/22/17 Wednesday <br />Time spent in facility <br />One hour <br />Arrival time 10:15 a.m. <br />Name of person(s) with whom exit interview was held <br />Betty Stevens, Executive Director <br />Interview was held x in person <br />Committee members present: Jerry Schreiber Jerry Gregory and Vibeke Talley <br />Number of residents who received personal visits from committee members 15 Report completed by: Jerry Schreiber <br />Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly posted: Yes <br />The most recent survey was readily accessible Yes <br />(Required for NHs only – record date of most recent survey <br />posted) : 10/27/2016 <br />Staffing information clearly posted? Yes <br /> <br />Resident Profile Yes No <br />N/A <br />Comments/Other Observations (please <br />number comments) <br /> 1. Do the residents appear neat, clean and odor free? yes <br />2.Did residents say they receive assistance with personal care activities? (i.e. <br />brushing their teeth, combing their hair, inserting dentures or cleaning their <br />eyeglasses) <br />yes <br />3. Did you see or hear residents being encouraged to participate <br /> in their care by staff members? Yes <br />4.Were residents interacting with staff, other residents & visitors? yes <br />5.Did staff respond to or interact with residents who had difficulty communi- <br />cating or making their needs known verbally? NA <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 No <br />N/A <br />Comments/Other Observations (please <br />number comments) <br /> 8. Did residents describe their living environment as homelike? Yes 10c: One janitorial closet was unlocked. <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? No* <br />11. Did residents feel their living areas were kept at a reasonable noise level? yes <br />12. Does the facility accommodate smokers?Note: By regulation smoking is <br />only permitted outside of the building <br />no