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Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Co Facility Type: Family Care Home Nursing Home Adult Care Home Facility Name/Address: Signature Nursing Home 1602 E. Franklin St. Chapel Hill, N 27514 Visit Date: 8/28/2019 Time spent in facility: 55 min Arrival time: 9 : 30 am pm Name of person exit interview was held with: Carissa Campbell, MSW Interview was held: in Person Phone Admin. SIC (Supervisor in Charge) Other Staff Rep. Director of Social Services Committee Members Present: Bill Morgan, Jacqulyn Podger Report Completed by: Bill Morgan Number of Residents who received personal visits from committee members: 9 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 Note: there was a report indicating number & type of staff as well as census, but it was from the previous day (8/27/19), 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 2. Yes – residents we talked to indicated they received the care they needed. 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 9. Did you notice unpleasant odors in commonly used areas? No 9. Facility smelled neutral, staff were actively cleaning when we arrived 10. Did you see items that could cause harm or be hazardous? No 10. Med carts not in use were locked, as well as storage closets 11. Did residents feel their living areas were too noisy? No 11. there was minimal noise during our visit. No resident we visited complained about noise 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 14 residents we interviewed indicated they could use the call bells when they needed assistance and felt the response times were adequate. During the visit we overheard 1 resident call for help from another room