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Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type: Family Care Home X Nursing Home Adult Care Home Combination Home Facility Name/Address: Signature HealthCARE of Chapel Hill 1602 E Franklin St, Chapel Hill, NC 27514 Visit Date: 03 /15 /2018 Time spent in facility: 1 hr 40 min Arrival time: 10:00 X am pm Name of person exit interview was held with: Interview was held: X in Person Phone X Admin, Jacqueline Miller SIC (Supervisor in Charge) X Director of Nursing, Onjie Whitt Committee Members Present: Vibeke Talley, Molly Stein, Karen Macklin, Jacqulyn Podger Report Completed by: Jacqulyn Podger Number of Residents who received personal visits from committee members: 6 Resident Rights Information is clearly visable. X Yes No Ombudsman Contact Info is correct and clearly posted: X Yes No The most recent survey was readily accessible: X Yes No (Required for Nursing Homes Only) Staffing information clearly posted: X Yes No Resident Profile Yes/No/NA Comments/Other Observations 1. Do the residents appear neat, clean and odor free? Yes 2. Did residents say they receive assistance with personal care activities? Ex. 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? Yes 6. Did you observe restraints in use? No 7. If so, did you ask staff about the facility’s restraint policies? N/A Resident Living Accommodations Yes/No/NA Comments/Other Observations 8. Did residents describe their living environment as homelike? Yes 9. Did you notice unpleasant odors in commonly used areas? No 10. Did you see items that could cause harm or be hazardous? No 11. Did residents feel their living areas were too noisy? No 12. Does the facility accommodate smokers? Where? X Outside only Inside only Both Inside/Outside Yes 13. Were residents able to reach their call bells with ease? Yes 14. Did staff answer call bells in a timely & courteous manner? If no, did you share this with the administrative staff? Yes Yes One resident commented that he had to wait too long for assistance with toileting. Resident Services Yes/No/NA Comments/Other Observations 15. Were residents asked their preferences or opinions about the activities planned for them at the facility? Yes Resident outings are quite popular. The next scheduled trip will be to Washington, D.C. 16. Do residents have the opportunity to purchase personal items of their choice using their monthly needs funds? Can residents access their monthly needs funds at their convenience? Yes Yes