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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 10/25/2016, Tuesday Time spent in facility 1 hour Arrival time 10 AM Name of person(s) with whom exit interview was held: Turner Prickett, CEO Interview was held in person Committee members present: Glenda Floyd, Vibeke Talley Number of residents who received personal visits from committee members 6 Report completed by: Vibeke Tal- ley 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 re- cent survey posted) : 5/17-20/2016 Staffing information clearly posted? Yes Resident Profile Yes No N/A Comments/Other Observa- tions (please number comments) 1. Do the residents appear neat, clean and odor free? Ye s 2.Did residents say they receive assistance with personal care activi- ties? (i.e. brushing their teeth, combing their hair, inserting den- tures or cleaning their eyeglasses) Ye s 3. Did you see or hear residents being encouraged to participate in their care by staff members? Ye s 4.Were residents interacting with staff, other residents & visitors? Ye s 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? Ye s 6. Did you observe restraints in use? No 7. If so, did you ask staff about the facility’s restraint policies? Note: Do not ask about confidential information without consent