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Community Advisory Committee Quarterly/Annual Visitation Report <br /> County: Orange Facility Type: Facility Name/Address: Signature Healthcare, 1602 E Franklin <br /> ❑ Family Care Home X Nursing Home St, Chapel Hill, NC 27514 <br /> ❑ Adult Care Home ❑ Combination <br /> Home <br /> Visit Date: May 18,2023 Time spent in facility 1.5 hrs Arrival time: 10 am <br /> Name of person exit interview was held with: Interview was held: X in Person <br /> ❑Admin. SIC(Supervisor in Charge) Other Staff Rep:X(Name& Title) Ebony Harrison, Director of Nursing <br /> Committee Members Present: Jackie Podger, Shade Little Report Completed by: Jackie Podger <br /> Number of Residents who received personal visits from committee members: 10 <br /> Resident Rights Information is clearly visible: Yes Ombudsman Contact Info is correct and clearly posted:Yes <br /> The most recent survey was readily accessible: Yes Staffing information clearly posted: Yes <br /> (Required for Nursing Homes Only) <br /> Resident Profile Yes/No/NA Comments/Other 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, <br /> inserting dentures or cleaning their eyeglasses? <br /> Yes <br /> F----------- <br /> 3. Did you see or hear residents being encouraged to NA <br /> participate in their care by staff members? <br /> 4. Were residents interacting with staff, other residents & Yes <br /> visitors? <br /> 5. Did staff respond to or interact with residents who had <br /> difficulty communicating or making their needs known Yes <br /> verbally? <br /> 6. Did you observe restraints in use? No <br /> 7. If so, did you ask staff about the facility's restraint <br /> policies? <br /> Resident Living Accommodations Yes/No/ Comments/Other Observations <br /> NA <br /> 8. Did residents describe their living environment as Yes <br /> homelike? <br />