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Com unity Advisory Committee Quarterly/Annual Visitation Report <br /> County: ORANGE Facility Type: Facility Name/Address: <br /> ❑Family Care Home ❑Nursing Home Carlisle at Carrboro (Crescent Green) <br /> ®Adult Care Home 624 Jones Ferry Rd Carrboro, NC 27510 <br /> Visit Date: 1/30/2023 Timespent in facility: hr Arrival time: 1:45 ❑ am ® prn <br /> Name of person exit interview was held with: Interview was held: ® in Person ❑ Phone <br /> ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. Laticia Beatty <br /> Committee Members Present: Shade Little; Karen Green-McElveen Report Completed by: Shade Little <br /> Number of Residents who received personal visits from committee members: 7 <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 /> Re uired for Nursing Homes Onl <br /> Resident Profile Yes/No/NA Comments/Other Observations <br /> 1. Do the residents appear neat,clean and odor free? y <br /> 2. Did residents say they receive assistance with personal care activities? <br /> Ex.brushing their teeth, combing their hair, inserting dentures or cleaning NA <br /> their eyeglasses? <br /> 3. Did you see or hear residents being encouraged to participate in y <br /> their care by staff members? <br /> 4. Were residents interacting with staff,other residents&visitors? y <br /> 5. Did staff respond to or interact with residents who had difficulty y <br /> communicating or making their needs known verbally? <br /> 6. Did you observe restraints in use? N <br /> 7. If so,did you ask staff about the facility's restraint policies? NA <br /> Resident Living Accommodations Yes/No/NA Comments/Other Observations <br /> 1. Did residents describe their living environment as homelike? Y The rooms are being renovated, new mattresses <br /> 2. Did you notice unpleasant odors in commonly used areas? N and blinds. <br /> 3. Did you see items that could cause harm or be hazardous? N Open and unattended medicine room brought to <br /> 4. Did residents feel their living areas were too noisy? NA director's attention. <br /> 5. Does the facility accommodate smokers? y Smokers use unsanctioned,woody areas. One <br /> Where? ® Outside only❑ Inside only❑ Both Inside/Outside way doors to be installed. <br /> 6. Were residents able to reach their call bells with ease? NA <br /> 7. Did staff answer call bells in a timely&courteous manner? NA <br /> If no, did you share this with the administrative staff? <br /> Resident • • Observati• <br /> 1. Were residents asked their preferences or opinions about the N <br /> activities planned for them at the facility? <br /> 2. Do residents have the opportunity to purchase personal items of NA <br /> their choice using their monthly needs funds? <br /> Can residents access their monthly needs funds at their NA <br /> convenience? <br /> 3. Are residents asked their preferences about meal/snack choices? N <br /> Are they given a choice about where they prefer to dine? N <br /> 4. Do residents have privacy in making and receiving hone calls? NA <br /> 5. Is there evidence of community involvement from other civic, Y <br /> volunteer or religious groups? <br /> 6. Does the facility have a Resident's Council? NA <br /> Family Council? <br /> Areas of • • <br /> /NA Exit Summary <br /> Are there resident issues or topics that need follow-up or review at a later N The rat, roaches, bedbugs infestation from <br /> time or during the next visit? previous administration is now under control. <br /> his Document is PUBLIC RECORD.Do not identify any Resident(s)by name or inference on this form. <br /> Bottom Copy is for the CAC's Records. <br /> Crescent Green notes <br />