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Community Advisory Committee Quarterly/Annual Visitation Report County Orange Facility Type Family Care Home Adult Care Home Nursing Home Facility Name: Signature Healthcare Census – current/licensed: 101/108 Visit Date and day of the week 02/11/16 Thursday Time spent in facility 1 hours 30 minutes Arrival time 3:00 Name of person(s) with whom exit interview was held Director of Nursing Interview was held in person Committee members present: Number of residents who received personal visits from committee members 10 Report completed by: 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 survey posted) : July 7-9 2015 Staffing information clearly posted? Yes Resident Profile Yes No N/A Comments/Other Observations (please number comments) 1. Do the residents appear neat, clean and odor free? Y 4: Residents were lounging in common areas and were active in the hallways. 5a: More than half of the staff members present were not wearing nametags. 7/8. Restraints are only used when absolutely necessary. A resident's hands were restrained to prevent the resident from removing his/her tracheostomy tube. 2.Did residents say they receive assistance with personal care activities? (i.e. brushing their teeth, combing their hair, inserting dentures or cleaning their eyeglasses) Y 3. Did you see or hear residents being encouraged to participate in their care by staff members? Y 4.Were residents interacting with staff, other residents & visitors? Y* 5.Did staff respond to or interact with residents who had difficulty communicating or making their needs known verbally? N/A 5a Did staff members wear nametags that are easily read by residents and visitors? N* 6. Did you observe restraints in use? Y* 7. If so, did you ask staff about the facility’s restraint policies? Note: Do not ask about confidential information without consent Y* Resident Living Accommodations Yes No N/A Comments/Other Observations (please number comments) 8. Did residents describe their living environment as homelike? Y* 8. A resident who has been at the nursing home for many years reported it as being like his/her home. Another resident stated that this was "the best place I have lived in decades." 14. When asked, most residents said that call bells were not met in a timely manner. It reportedly took staff 10-15 minutes to answer a call bell. One resident who needed help using the restroom stated that by the time a staff member answered the call bell, the resident had soiled herself (See Exit Summary). 9. Did you notice unpleasant odors? N 10. Did you see items that could cause harm or be hazardous? N 10a. Were unattended med carts locked? Y 10b. Were bathrooms clean, odor-free and free from hazards? Y 10c. Were rooms containing hazardous materials locked? Y 11. Did residents feel their living areas were kept at a reasonable noise level? Y 12. Does the facility accommodate smokers? Note: By regulation smoking is only permitted outside of the Building Y 13. Were residents able to reach their call bells with ease? Y 14. Did staff answer call bells in a timely & courteous manner? N* 14a If no, did you share this with the administrative staff? Y *** N/A equals not applicable, not asked, not observed