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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 />X Nursing Home <br />Facility Name: Carol Woods <br /> <br /> <br />Census: 24 out of 30 <br />Visit Date and day of the week <br />Wednesday, March 2, 2016 <br />Time spent in facility <br />1 hour15 minutes <br />Arrival time 10:15am <br />Name of person(s) with whom exit interview was held <br />DON <br /> <br />Interview was held X in person <br />Committee members present: <br /> Number of residents who received personal visits from committee members: 2 <br />(some residents were sleeping, with the majority at activities off the floor) <br />Report completed by: <br /> <br />Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly <br />posted: Yes <br />The most recent survey was readily accessible Yes <br />(Required for NHs only – record date of most recent survey <br />posted): 12/18/15 <br />Staffing information clearly posted? Yes <br /> <br />Resident Profile Yes <br />No <br />N/A <br />Comments/Other Observations <br />(please number comments) <br /> 1. Do the residents appear neat, clean and odor free? Yes 6. Carol Woods has a no restraint <br />policy. They develop work-arounds <br />including the use of companions to <br />avoid the need for restraints. <br />2. Did residents say they receive assistance with personal care <br />activities? (i.e. brushing their teeth, combing their hair, <br />inserting dentures or cleaning their eyeglasses) <br />Yes <br />3. Did you see or hear residents being encouraged to participate in <br />their care by staff members? No <br />4. Were residents interacting with staff, other residents & visitors? Yes <br />5. Did staff respond to or interact with residents who had difficulty <br />communicating or making their needs known verbally? Yes <br />5a. Did staff members wear nametags that are easily read by <br />residents and visitors? Yes <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 <br />consent) <br />Yes <br /> <br />Resident Living Accommodations Yes No <br />N/A <br />Comments/Other Observations <br />(please number comments) <br /> 8. Did residents describe their living environment as homelike? N/A 10b. 2 weeks into 3 month <br />renovations to enlarge all bathing <br />areas so that residents can change <br />clothes in the area rather than before <br />entering,changing out thermostats and <br />replacing overhead lighting with LED <br />lights <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? Yes <br />12a. Where? (Outside / inside / both) Outside <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? N/A <br /> *** N/A equals not applicable, not asked, not observed <br />