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Community Advisory Committee Quarterly/Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ❑x Family Care Home ❑Nursing Home Cedar Grove Family Care Home ❑Adult Care Home 313-317Saw Mill Road Cedar Grove, NC Census: 9/ 12 Visit Date: 9/22/2023 Time spent in facility: hr 30 min Arrival time: 12:45 ❑am ❑x pm Name of person exit interview was held with: Interview was held: ❑X in Person ❑Phone ❑Admin. ❑x SIC(Supervisor in Charge) ❑Other Staff Rep. Betsy Collins Committee Members Present: Shade Little,Jackie Podger Report Completed by: Jackie Podger Number of Residents who received personal visits from committee members:6 Resident Rights Information is clearly visible: Z Yes❑No Ombudsman Contact Info is correct and clear) posted: El Yes❑x No The most recent survey was readily accessible: El Yes❑No Staffing information clearly posted: ❑Yes❑x No Required for Nursing Homes Onl Resident Profile Yes/No/NA Comments/Other Observations Do the residents appear neat, clean and odor free? Yes Cedar Grove Family Care home is two houses Did residents say they receive assistance with personal care activities? Ex. separated by an outdoor area. Residents are all brushing their teeth, combing their hair, inserting dentures or cleaning NA SSI eligible with referrals to the home from local their eyeglasses? hospitals. On visit date census was 9 residents Did you see or hear residents being encouraged to participate in their care with 12 total, two females, 7 men. The age range by staff members? N0 of residents is 48-70. All residents appeared well Were residents interacting with staff, other residents&visitors Yes cared for, clean and in clean clothes. No mobility Did staff respond to or interact with residents who had difficulty issues but two residents have some dementia communicating or making their needs known verbally? NA issues. Did you observe restraints in use? No If so,did you ask staff about the facility's restraint policies? Resident Living Accommodations Comments/Other Observations 1. Did residents describe their living environment as homelike? NA The feel or environment of the two homes was 2. Did you notice unpleasant odors in commonly used areas? No indeed homelike.The facilities were not brightly lit, 3. Did you see items that could cause harm or be hazardous? No but all residents moved well throughout. Resident 4. Did residents feel their living areas were too noisy? No rooms were clean and tidy. Residents take meals 5. Does the facility accommodate smokers? Yes together at a common dining room table. The Where?❑A Outside only❑Inside only❑Both Inside/Outside kitchen is not locked residents are asked not to 6. Were residents able to reach their call bells with ease? NA enter. Meds are kept in a locked closet. Call bells 7. Did staff answer call bells in a timely&courteous manner? NA were not seen, but the owners live in the house. If no, did you share this with the administrative staff? Resident •/NA Comments/Other Observations 8. Were residents asked their preferences or opinions about the No All meals are served family style given the small activities planned for them at the facility? resident census. Snacks are available at resident 9. Do residents have the opportunity to purchase personal items of request and provided by owners. their choice using their monthly needs funds? Yes Activities include trips to local businesses. Some Can residents access their monthly needs funds at their Yes outside organizations visit residents and help convenience? residents prepare for holidays. 10. Are residents asked their preferences about meal/snack choices? No Are they given a choice about where they prefer to dine? No 11. Do residents have privacy in making and receiving hone calls? NA 12. Is there evidence of community involvement from other civic, Yes volunteer or religious groups? 13. Does the facility have a Resident's Council? Family Council? No Areas of • Yes/No/NA Exit Summary Are there resident issues or topics that need follow-up or review at a later No time or during the next visit?