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Com unity Advisory Committee Quarterly/Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ❑Family Care Home ❑Nursing Home Carlisle at Carrboro (Crescent Green) ®Adult Care Home 624 Jones Ferry Rd Carrboro, NC 27510 Visit Date: 4/4/2023 Timespent in facility:45 min. Arrival time: 12:45 ❑ am ® pm Name of person exit interview was held with: Interview was held: ® in Person ❑ Phone ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. Laticia Beatty Committee Members Present: Shade Little; Karen Green-McElveen Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 9 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 Re uired for Nursing Homes Onl 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 dentures or cleaning NA 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 y 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 restraint policies? I NA Resident Living Accommodations Yes/No/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? Y All rooms now have new mattresses and blinds. 2. Did you notice unpleasant odors in commonly used areas? Y Housekeeping alerted about a smelly area. 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 Worst outside door now NO-reentry,to funnel 6. Were residents able to reach their call bells with ease? NA smokers to supervised,safe,front area. 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 N activities planned for them at the facility? 2. Do residents have the opportunity to purchase personal items of NA their choice using their monthly needs funds? Can residents access their monthly needs funds at their NA convenience? 3. Are residents asked their preferences about meal/snack choices? N Are they given a choice about where they prefer to dine? N 4. Do residents have privacy in making and receiving hone calls? NA 5. Is there evidence of community involvement from other civic, N volunteer or religious rou s? Low community involvement at present. 6. Does the facility have a Resident's Council? NA Family Council? Areas of • • Are there resident issues or topics that need follow-up or review at a later Y time or during the next visit? his Document is PUBLIC RECORD.Do not identify any Resident(s)by name or inference on this form. Bottom Copy is for the CAC's Records.