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Community Advisory Committee Quarterly/Annual Visitation Report County:Orange Facility Type: Facility Name/Address: Signature Healthcare, 1602 E Franklin St, ❑Family Care Home X Nursing Home Chapel Hill, NC 27514 ❑Adult Care Home ❑Combination Home Visit Date 08/16/2023 Time spent in facility: 1hr 15 min Arrival time: 1 pm Name of person exit interview was held with: Moses Muhairwe, Administrator Interview was held: X in Person Committee Members Present: Shade Little, Jackie Podger, Vibeke Talley Report Completed by: Vibeke Talley Number of Residents who received personal visits from committee members: 10 Resident Rights Information is clearly visible: Yes Ombudsman Contact Info is correct and clearly posted:Yes The most recent survey was readily accessible: Yes Staffing information clearly posted: Yes (Required for Nursing Homes Only) Resident Profile Yes/No/NA Comments/Other Observations 1. Do the residents appear neat, clean and odor free? Yes 2. Did residents say they receive assistance with personal care activities?Ex. brushing their teeth, combing their hair, Yes inserting dentures or cleaning their eyeglasses? --------—- 3. Did you see or hear residents being encouraged to NA participate in their care by staff members? ---------- 4. Were residents interacting with staff, other residents & Yes visitors? ---------- 5. Did staff respond to or interact with residents who had difficulty communicating or making their needs known Yes verbally? ---------- 6. Did you observe restraints in use? No --------—- 7. If so, did you ask staff about the facility's restraint policies? Resident Living Accommodations Yes/No/N Comments/Other Observations 8. Did residents describe their living environment as Yes homelike? 9. Did you notice unpleasant odors in commonly used areas? No No odors noted but one resident stated that she would like her room to be cleaner. The resident didn't think it looked clean even after it had just been cleaned.