Charles House Winmore 2019-09-17

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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: Charles House Winmore 121 Della Street Chapel Hill NC 27516 Census – current/licensed: 5/6 Visit Date: 9 /17 /2019 Time spent in facility: hr 50 min Arrival time: 2:30 am pm Name of person exit interview was held with: Interview was held: in Person Phone Admin. SIC (Supervisor in Charge) Other Staff Rep. Heather Committee Members Present: Karen Green-McElveen, Shade Little Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 2 Resident Rights Information is clearly visible: 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 Do the residents appear neat, clean and odor free? Yes 3 residents at Day Care. 1 sat on couch fairly unresponsive, received a visit from a friend. She also receives piano lessons. 1 mobile, verbal (with staff and CACers), “helping” in kitchen. Did residents say they receive assistance with personal care activities? Ex. brushing their teeth, combing their hair, inserting dentures or cleaning their eyeglasses? No Did you see or hear residents being encouraged to participate in their care by staff members? No Were residents interacting with staff, other residents & visitors? YesNo Did staff respond to or interact with residents who had difficulty communicating or making their needs known verbally? Yes Did you observe restraints in use? No If so, did you ask staff about the facility’s restraint policies? NA Resident Living Accommodations Yes/No/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? NA 1. WE observed the environment as homelike. 4. WE observed a very quiet house. 2. Did you notice unpleasant odors in commonly used areas? No 3. Did you see items that could cause harm or be hazardous? No 4. Did residents feel their living areas were too noisy? NA 5. Does the facility accommodate smokers? Where? Outside only Inside only Both Inside/Outside No 6. Were residents able to reach their call bells with ease? NA 7. Did staff answer call bells in a timely & courteous manner? If no, did you share this with the administrative staff? NA Resident Services Yes/No/NA Comments/Other Observations 8. Were residents asked their preferences or opinions about the activities planned for them at the facility? 9. Due to the level of dementia for these residents, they do not manage their own finances. 11. Residents are unable to communicate on the phone. 13. The residents cannot have a council due their dementia. 12. Heather is very appreciative of visits from community members. Nursing students doing their internships are welcomed and especially help with activities. 9. 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 10. Are residents asked their preferences about meal/snack choices? Are they given a choice about where they prefer to dine? No No 11. Do residents have privacy in making and receiving phone calls? NA 12. Is there evidence of community involvement from other civic, volunteer or religious groups? Yes 13. Does the facility have a Resident’s Council? Family Council? No No 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? No Discuss items from “Areas of Concern” Section as well as any changes observed during the visit 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.