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Community Advisory Committee Quarterly/Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ❑Family Care Home ❑Nursing Home Brookdale Meadowmont ®Adult Care Home 100 Lanark Rd, Chapel Hill, NC 27517 Visit Date: 4/4/2023 Timespent in facility: ???? min Arrival time: 2:35 ❑ am ® pm Name of person exit interview was held with: Interview was held: ® in Person ❑ Phone ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. Jessicia Werner Committee Members Present: Karen??GreenMcElveen???? Shade Little Report Completed by: Shade??Little Number of Residents who received personal visits from committee members: 8 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 Staffing information clearly posted: ® Yes❑ No (Required for Nursing Homes Only) Resident Profile Yes/No/NA Comments/Other Observations 1. Do the residents appear neat,clean and odor free? Y 2. Did residents say they receive assistance with personal care activities? Ex. brushing their teeth, combing their hair, inserting NA dentures or cleaning their eyeglasses? 3. Did you see or hear residents being encouraged to participate in N their care by staff members? 4. Were residents interacting with staff, other residents&visitors? Y 5. Did staff respond to or interact with residents who had difficulty NA communicating or making their needs known verbally? 6. Did you observe restraints in use? N 7. If so, did you ask staff about the facility's restraintpolicies? NA Resident Living Accommodations Yes/No/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? Y 2. Did you notice unpleasant odors in commonly used areas? N 3. Did you see items that could cause harm or be hazardous? N 4. Did residents feel their living areas were too noisy? N 5. Does the facility accommodate smokers? Y Where? ® Outside only❑ Inside only❑ Both Inside/Outside 6. Were residents able to reach their call bells with ease? NA 7. Did staff answer call bells in a timely&courteous manner? NA If no, did you share this with the administrative staff? Resident • • Observations 1. Were residents asked their preferences or opinions about the Y The residents were concerned that they aren't given activities planned for them at the facility? any activities to stimulate them. Some would like to 2. Do residents have the opportunity to purchase personal items of Y venture out but there is no bus available.They do their choice using their monthly needs funds? have a van that takes them places twice a week like Can residents access their monthly needs funds at their Y Walmart,grocery stores. This is done ONLY on convenience? Mondays and Wednesdays. Public transportation 3. Are residents asked their preferences about meal/snack choices? Y difficult with nearby construdtion. Are they given a choice about where they prefer to dine? Y 4. Do residents have privacy in making and receiving hone calls? Y 5. Is there evidence of community involvement from other civic, Y volunteer or religious groups? 6. Does the facility have a Resident's Council? N Family Council? Areas of • • /NA Exit Summary Are there resident issues or topics that need follow-up or review at a later N time or during the next visit? Community Advisory Committee Quarterly/Annual Visitation Report 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.