Orange County NC Website
Community Advisory Committee <br />Quarterly/Annual Visitation Report <br />County: Orange Facility Type: Family Care Home <br /> Nursing Home xAdult Care Home <br />Facility Name/Address: Carol Woods, 750 Weaver Dairy Road, <br />Chapel Hill, NC 27514 <br />Visit Date: 08/13/2019 Time spent in facility: 1 hr min Arrival time: 1:40 am x pm <br />Name of person exit interview was held with: <br />Interview was held: x in Person Phone <br /> Admin. SIC (Supervisor in Charge) Other Staff Rep. <br /> Bethany XXXXX <br /> (Name & Title) <br />Committee Members Present: MaryLou Gelblum, Shade Little, Karen Green-McElveen Report Completed by: Shade Little <br />Number of Residents who received personal visits from committee <br />members: 6 <br />Resident Rights Information is clearly visible:x Yes No Ombudsman Contact Info is correct and clearly posted: Yes XNo <br />The most recent survey was readily accessible: Yes No <br />(Required for Nursing Homes Only) <br />Staffing information clearly posted: x Yes No <br /> Resident Profile Yes/No/NA Comments/Other Observations <br />Do the residents appear neat, clean and odor free? Y <br />Did residents say they receive assistance with personal care activities? Ex. <br />brushing their teeth, combing their hair, inserting dentures or cleaning <br />their eyeglasses? <br />Y <br />Did you see or hear residents being encouraged to participate in their care <br />by staff members?N <br /> Were residents interacting with staff, other residents & visitors?Y <br />Did staff respond to or interact with residents who had difficulty <br />communicating or making their needs known verbally?Y <br />Did you observe restraints in use?N/A <br />If so, did you ask staff about the facility’s restraint policies? N/A <br />Resident Living Accommodations Yes/No/NA Comments/Other Observations <br />1.Did residents describe their living environment as homelike?Y Resident pleased to have P/T available in room <br />when needed. <br />2.Did you notice unpleasant odors in commonly used areas?N <br />3.Did you see items that could cause harm or be hazardous?N <br />4.Did residents feel their living areas were too noisy?N <br />5.Does the facility accommodate smokers? <br />Where? X Outside only Inside only Both Inside/Outside <br />Y <br />6.Were residents able to reach their call bells with ease?N/A <br />7.Did staff answer call bells in a timely & courteous manner? <br />If no, did you share this with the administrative staff? <br />N/A <br />Resident Services Yes/No/NA Comments/Other Observations <br />8.Were residents asked their preferences or opinions about the <br />activities planned for them at the facility? <br />Y <br />9.Do residents have the opportunity to purchase personal items of <br />their choice using their monthly needs funds? <br />Can residents access their monthly needs funds at their <br />convenience? <br />Y <br />10.Are residents asked their preferences about meal/snack choices? <br />Are they given a choice about where they prefer to dine? <br />Y They can also store personal food items in a <br />pantry area. <br />11.Do residents have privacy in making and receiving phone calls?Y <br />12.Is there evidence of community involvement from other civic, <br />volunteer or religious groups? <br />Y A wide of community groups (religious, musical, <br />civic) visits the facility. <br />13.Does the facility have a Resident’s Council? <br />Family Council? <br />Y