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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 ❑x Adult Care Home 100 Lanark Rd, Chapel Hill, NC 27517 Visit Date: 9/5/2023 Time spent in facility: 50 min Arrival time: 12:00 Elam ❑x m Name of person exit interview was held with: Interview was held: ❑x in Person ❑Phone ❑Admin. ❑x SIC (Supervisor in Charge) ❑Other Staff Rep. Jessicia Werner Committee Members Present: Karen Green-McElveen; Shade Little Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 14 Resident Rights Information is clearly visible: ❑x Yes❑No Ombudsman Contact Info is correct and clear) posted: ❑x Yes❑No The most recent survey was readily accessible: ❑Yes❑No Staffing information clearly posted: Z Yes❑No Re uired for Nursinq 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 There were NO complaints about the food. 2. Did you notice unpleasant odors in commonly used areas? N They have two bulletin boards on display with what 3. Did you see items that could cause harm or be hazardous? N they call their"hero's", one for the residents and 4. Did residents feel their living areas were too noisy? N one for staff. It's good to show people that they are 5. Does the facility accommodate smokers? Y appreciated. Where?❑x 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 Services Yes/No/NA Comments/Other Observations 1. Were residents asked their preferences or opinions about the Y Many of the residents were out with the"Lunch activities planned for them at the facility? Buddy"group which has started back up again. 2. Do residents have the opportunity to purchase personal items of Y They take the residents to a restaurant of their their choice using their monthly needs funds? choosing every Tuesday.We spoke with four Can residents access their monthly needs funds at their Y residents,that didn't go, and they all were happy to convenience? be back to a normal routine. 3. Are residents asked their preferences about meal/snack choices? Y 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.