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Com unity Advisory Committee Quarterly/Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ®Family Care Home ❑Nursing Home Cedar Grove Family Care Home# 1,#2 ❑Adult Care Home 313, 317 Saw Mill Rd, Cedar Grove, NC 27231 Visit Date: 09/11/2024 Time spent in facility: ?? Arrival time: 10:25 ® am ❑ pm min Name of person exit interview was held with: Interview was held: ® in Person ❑ Phone ®Admin. ❑ SIC Supervisor in Charge) ❑ Oth er Staff Rep. Committee Members Present: Shade??Little???? Karen Green-McElveen Report Completed by: Shade Little Number of Residents who received personal visits from committee members: 5 Resident Rights Information is clearly visible: ® Yes❑ No Ombudsman Contact Info is correct and clear) posted: ®Yes ❑ No The most recent survey was readily accessible: ❑Yes ❑ No Staffing information clearly posted: ❑Yes ® No Required for Nursing Homes Onl 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 dentures or cleaning NA their eyeglasses? 3. Did you see or hear residents being encouraged to participate in y 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 y 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? NResident Living Accommodations Yes/No/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? NA The residents feel this is their home and it has that 2. Did you notice unpleasant odors in commonly used areas? N feeling. They move around with ease. 3. Did you see items that could cause harm or be hazardous? N We found the rooms and hallways better lighted 4. Did residents feel their living areas were too noisy? NA than in other visits. 5. Does the facility accommodate smokers? y On a very nice day most of the residents were Where? ® Outside only❑ Inside only❑ Both Inside/Outside 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 '/NA Comments/Other Observations 1. Were residents asked their preferences or opinions about the N activities planned for them at the facility? Several rwsidents mentioned the food as being 2. Do residents have the opportunity to purchase personal items of NA very good. They are served immediately when the their choice using their monthly needs funds? food is ready. Can residents access their monthly needs funds at their NA convenience? 3. Are residents asked their preferences about meal/snack choices? N Are they given a choice about where they prefer to dine? N Snacks are placed out for the residents. 4. Do residents have privacy in making and receiving phone calls? NA 5. Is there evidence of community involvement from other civic, N volunteer or religious groups? 6. Does the facility have a Resident's Council? NA 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? 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.