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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: Signature Healthcare Census – current/licensed: 82/108 (previous days num- bers were used) Visit Date and day of the week Thursday, 6/15/17 Time spent in facility: 1.5 hours Arrival time: 8AM Name of person(s) with whom exit interview was held Lee W. Cole, Administrator Interview was held in person Committee members present: Carol Kelly, Jackie Podger, Molly Stein Number of residents who received personal visits from committee members: 12 Report completed by: Molly Stein 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) : April 26th, 2017 Staffing information clearly posted? No 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 participate in their care by staff members? N/A 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 policies? Note: Do not ask about confidential information without consent N/A