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Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type Nursing Home Facility Name: Signature Healthcare Census – current/licensed: 90/108 Visit Date and day of the week 7/26/2016, Tuesday Time spent in facility 1 hour Arrival time 11 AM Name of person(s) with whom exit interview was held Andrea Miller, ADON Interview was held in person Committee members present: Jerry Gregory, Vibeke Talley Number of residents who received personal visits from committee members 14 Report completed by: Vibeke Talley Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly posted: Yes The most recent survey was readily accessible (Required for NHs only – record date of most recent survey posted) : 5/17-20/2016 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? Yes 6: Facility continues to have one resident who has hands restrained to prevent removal of 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) Yes 3. Did you see or hear residents being encouraged to participate 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 5a Did staff members wear nametags that are easily read by residents and visitors? Yes 6. Did you observe restraints in use? Yes * 7. If so, did you ask staff about the facility’s restraint policies? Note: Do not ask about confidential information without consent Resident Living Accommodations Yes, No N/A Comments/Other Observations (please number comments)