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Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type: ❑Family Care Home Carol Woods, bldg 5, 6, 7 ❑Nursing Home xAdult Care Home 750 Weaver Dairy Road, Chapel Hill, NC 27514 Visit Date: 5/27/2023 Time spent in facility: 1 hr Arrival time: 10:00 ® am ❑ pm Name of person exit interview was held with: Sharon xiggsbee Interview was held: x in Person ❑ Phone ❑Admin. ® SIC(Supervisor in Charge) ❑ Other Staff Rep. Committee Members Present: MaryLou Gelblum, Jemm Merritt, Shade Little Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 15 Resident Rights Information is clearly visible:x Yes ❑ No Ombudsman Contact Info is correct and clear) posted: ®Yes No The most recent survey was readily accessible: ® Yes ❑ No Staffing information clearly posted: x Yes ❑ No (Required for Nursing Homes Only) Resident Profile Comments/Other Observations Do the residents appear neat, clean and odor free? Y Did residents say they receive assistance with personal care activities? Ex. brushing their teeth, combing their hair, inserting dentures or cleaning Y their eyeglasses? Did you see or hear residents being encouraged to participate in their care N by staff members? Were residents interacting with staff, other residents&visitors? Y Did staff respond to or interact with residents who had difficulty Y communicating or making their needs known verbally? Did you observe restraints in use? N/A If so, did you ask staff about the facility's restraintpolicies? N/A Resident Living Accommodations Yes/Nio/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? Y The residents are very comfortable. 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? N/A 7. Did staff answer call bells in a timely&courteous manner? N/A If no, did you share this with the administrative staff? Resident Services Comments/OtherObservations 8. Were residents asked their preferences or opinions about the Y activities planned for them at the facility? 9. Do residents have the opportunity to purchase personal items of Y their choice using their monthly needs funds? Can residents access their monthly needs funds at their Y convenience? 10. Are residents asked their preferences about meal/snack choices? Y Are they given a choice about where they prefer to dine? 11. Do residents have privacy in making and receiving hone calls? Y 12. Is there evidence of community involvement from other civic, Y/N Piano Concert happened, evidence of other outside volunteer or religious groups? involvement. 13. Does the facility have a Resident's Council? Y Family Council? Areas of • • /NA Exit Summary Are there resident issues or topics that need follow-up or review at a later N The facility is very well maintained. Residents have time or during the next visit? a wide range of activities available.