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Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type: Family Care Home Nursing Home Adult Care Home Facility Name/Address: Carol Woods Retirement Community 750 Weaver Dairy Road Chapel Hill, NC 27514 Census: Building 5 – 30/35 Building 6 – 10/12 Building 7 – 8/12 Visit Date: 12 / 20 / 2018 Time spent in facility: 1 hr 30 min Arrival time: 5:30 am pm Name of person exit interview was held with: Michael Drake Interview was held: in Person Phone Admin. SIC (Supervisor in Charge) Other Staff Rep. (Name & Title) Committee Members Present: Shade Little, Nancy McCormick, Michael Zuber Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 5 Resident Rights Information is clearly visable: Yes No Ombudsman Contact Info is correct and clearly posted: Yes No The most recent survey was readily accessible: Yes No (Required for Nursing Homes Only) Staffing information clearly posted: Yes No Resident Profile Yes/No/NA Comments/Other Observations 1. Do the residents appear neat, clean and odor free? Yes 1. We arrived around dinner time. There appeared to be more staff visible in the common areas than residents. Most apartment doors were closed. The residents we did meet appeared to be well groomed and served by staff. 2/3/5. We witnessed staff assisting, communicating and cleaning two residents who had difficulty feeding themselves. The staff were caring and professional in all interactions we observed. 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? NA Resident Living Accommodations Yes/No/NA Comments/Other Observations 8. Did residents describe their living environment as homelike? Yes 8. Yes. The residents we spoke with provided no feedback on how to improve the living conditions. They were very positive about their living conditions and enjoyed living at Carol Woods. 10. No medical, cleaning supplies or hazardous materials were visible in the hallways or located on carts. 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? 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 NA 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 17. One resident enjoys baking birthday cakes for fellow residents and staff. When the Carol Woods President was notified the kitchen oven wasn’t working properly, they had it replaced immediately. 19. A calendar of events are posted as wells as a community wall showcasing fliers for specific upcoming gatherings, movies, and shows. 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? NA NA 17. Are residents asked their preferences about meal/snack choices? Are they given a choice about where they prefer to dine? Yes No 18. Do residents have privacy in making and receiving phone calls? Yes 19. Is there evidence of community involvement from other civic, volunteer or religious groups? 20. Does the facility have a Resident’s Council? Family Council? Yes Yes Areas of Concern Yes/No/NA Exit Summary Are there resident issues or topics that need follow-up or review at a later time or during the next visit? We asked Michael Drake to properly post Autumn Cox’s (Ombudsman) name and phone number in buildings 6 & 7. Yes Discuss items from “Areas of Concern” Section as well as any changes observed during the visit None. This Document is PUBLIC RECORD. Do not identify any Resident(s) by name or inference on this form. Top Copy is for the Regional Ombudsman’s Record. Bottom Copy is for the CAC’s Records.