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Community Advisory Committee Quarterly/Annual Visitation Report County Orange Facility Type Family Care Home Adult Care Home X Nursing Home Facility Name: 68/80 Census – current/licensed: Visit Date and day of the week Tues., May 16, 2017 Time spent in facility 1 hr. 15 min. Arrival time 10:30 am Name of person(s) with whom exit interview was held Josh Stevens, Administrator Interview was held Yes Committee members present: Teri Driscoll, Jerry Schreiber and Jerry Gregory Number of residents who received personal visits from committee members 6 Report completed by: Teri Driscoll Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly posted: Yes The most recent survey was readily accessible Yes (Required for NHs only – record date of most recent sur- vey posted) : Oct. 2016 Staffing information clearly posted? Yes Resident Profile Yes No N/A Comments/Other Observations (please num- ber comments) 1. Do the residents appear neat, clean and odor free? Yes 2.Did residents say they receive assistance with personal care ac- tivities? (i.e. brushing their teeth, combing their hair, inserting dentures or cleaning their eyeglasses) Yes 3. Did you see or hear residents being encouraged to par- ticipate in their care by staff members? Yes 4.Were residents interacting with staff, other residents & visitors? Yes 5.Did staff respond to or interact with residents who had difficulty communicating or making their needs known verbally? N/A 6. Did you observe restraints in use? No 7. If so, did you ask staff about the facility’s restraint poli- cies? Note: Do not ask about confidential information without consent N/A