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Com unity Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type: Facility Name/Address: Carlisle at Carboro ❑Family Care Home ❑Nursing Home 624 Jones Ferry Road, Carboro, NC XAdult Care Home ❑Combination Home Visit Date 12/27/23 Time spent in facility: hr 50 min Arrival time: 10:55am ❑am ❑ pm Name of person exit interview was held with: Interview was held: ❑ in Person ❑ Phone ❑Admin. X SIC(Supervisor in Charge) ❑ Other Staff Rep. (Name& Title) Doris Coleman,Assistant Administrator Committee Members Present: Mary Lou Gelblum, Stephanie Boswell TReport Completed by: Stephanie Boswell Number of Residents who received personal visits from committee members: 8 Resident Rights Information is clearly visible:X Yes ❑ No Ombudsman Contact Info is correct and clearly posted:X Yes ❑ No The most recent survey was readily accessible:XYes ❑ No Staffing information clearly posted: X Yes ❑ No Re uired for Nursing Homes Onlo :1 Resident • •/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 Y 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 restraint policies? NA Resident Living Accommodations 1� Comments/Other Observations 8. Did residents describe their living environment as homelike? Y 9. Did you notice unpleasant odors in commonly used areas? Y 9.Residents were clean,well dressed and no ordor was noted from any one individual. The facility has a consistent odor throughout the hallways/areas. The odor was the same throughout the building and was present throughout the visit. 10. Did you see items that could cause harm or be hazardous? Y 10: Janitor closet was unlocked with chemicals inside (sign of door stated door should be locked at all times). 11. Did residents feel their living areas were too noisy? Y 11. One resident complained about other residents being too loud. 12. Does the facility accommodate smokers? Y Where?X Outside only❑ Inside only❑ Both Inside/Outside 13. Were residents able to reach their call bells with ease? NA 14. Did staff answer call bells in a timely&courteous manner? NA If no, did you share this with the administrative staff? Resident •/NA Comments/Other Observations 15. Were residents asked their preferences or opinions about the Y activities planned for them at the facility? 16. 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 convenience? 17. Are residents asked their preferences about meal/snack choices? 17. Majority of residents report they like the food Are they given a choice about where they prefer to dine? N and the portion sizes are adequate. Residents report a lack of alternatives to main dish. 18. Do residents have privacy in making and receiving hone calls? N 19. Is there evidence of community involvement from other civic, Y 19.A volunteer group was leading a bible study volunteer or religious groups? during our visit. 20. Does the facility have a Resident's Council? Y Family Council? Areas of • •