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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: 01/17/2019 Report has been provided as a summary of a fourth quarter visit, delayed from the 2018 visiting period. Time spent in facility: 1 hour Arrival time: 5:00 am X pm Name of person exit interview was held with: Interview was held: X in Person Phone Admin. SIC (Supervisor in Charge) Other Staff Rep. Carissa Campbell, MSW Committee Members Present: Karen Macklin, Stephanie Boswell, Stephanie Miller Report Completed by: Stephanie Miller Number of Residents who received personal visits from committee members: 9 residents Resident Rights Information is clearly visable: Yes Ombudsman Contact Info is correct and clearly posted: Yes The most recent survey was readily accessible: Yes (Required for Nursing Homes Only) Staffing information clearly posted: Yes 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? 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? N/A Resident Living Accommodations Yes/No/NA Comments/Other Observations 8. Did residents describe their living environment as homelike? N/A Overall, residents who spoke with CAC members seemed moderately satisfied with the living conditions. None had strong complaints nor strong praise for the facility. 9. Did you notice unpleasant odors in commonly used areas? No 10. Did you see items that could cause harm or be hazardous? Yes A closet on the 200 hall marked with a biohazard sign was unlocked. 11. Did residents feel their living areas were too noisy? N/A 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* *One resident indicated that he was unhappy with the staff response time, while others interviewed said staff responded in an adequate amount of time to their requests. While we were visiting, we observed a resident used the call bell. Staff responded quickly and courteously. Resident Services Yes/No/NA Comments/Other Observations