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Community Advisory Committee Quarterly/Annual Visitation Report <br /> County: Orange Facility Type: Facility Name/Address: <br /> Family Care Home Nursing Home Carol Woods <br /> Adult Care Home 750 Weaver Dairy Rd, Chapel Hill, NC 27514 <br /> Visit Date: 09/06/2022 Time spent in facility: 1 hr 30 min Arrival time: 3:30 am pm <br /> Name of person exit interview was held with: Melanie Johnson Interview was held: in Person Phone <br /> Admin. SIC (Supervisor in Charge) Other Staff Rep. Director of Nursing (Name & Title) <br /> Committee Members Present: Kelly Kester and Jackie Podger Report Completed by: Kelly Kester <br /> Number of Residents who received personal visits from committee members:4 <br /> Resident Rights Information is clearly visible: Yes No Ombudsman Contact Info is correct and clearly posted: Yes No <br /> The most recent survey was readily accessible: Yes No Staffing information clearly posted: Yes No <br /> (Required for Nursing Homes Only) <br /> Resident Profile • Comments/Other <br /> Observations <br /> 1. Do the residents appear neat,clean and odor free? Yes <br /> 2. Did residents say they receive assistance with personal care <br /> activities?Ex. brushing their teeth, combing their hair, inserting Yes <br /> dentures or cleaning their eyeglasses? <br /> 3. Did you see or hear residents being encouraged to participate in Yes <br /> their care by staff members? <br /> 4. Were residents interacting with staff, other residents &visitors? One resident was sitting in a chair in a <br /> common area where she could interact with <br /> Yes staff and visitors. Two staff members were <br /> present and acknowledged the resident and <br /> ensured that she was comfortable. <br /> 5. Did staff respond to or interact with residents who had difficulty Yes <br /> communicating or making their needs known verbally? <br /> 6. Did you observe restraints in use? No <br /> 7. If so, did you ask staff about the facility's restraint policies? N/A <br /> Resident Living Accommodations Yes/No/NA Comments/Other <br /> Observations <br /> 8. Did residents describe their living environment as homelike? Yes One resident described his living environment <br /> as"comfortable"and shared that the view <br /> from his room's window is something he <br /> enjoyed. <br /> 9. Did you notice unpleasant odors in commonly used areas? No <br /> 10. Did you see items that could cause harm or be hazardous? No The common spaces and hallways were very <br /> clean and free of any hazards or equipment. <br /> 11. Did residents feel their living areas were too noisy? No <br />