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Com unity Advisory Committee Quarterly/Annual Visitation Report <br /> County: ORANGE Facility Type: Facility Name/Address: <br /> ®Family Care Home ❑Nursing Home Livewell Assisted Living <br /> ❑Adult Care Home 202 N.Elliot Rd,Chapel Hill,NC 27514 <br /> Visit Date: 09/23/2024 Time spent in facility: ?? Arrival time: 10:00 ® am ❑ pm <br /> min <br /> Name of person exit interview was held with: Cassandra Cox, house manager Interview was held: ® in Person ❑ Phone <br /> ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. <br /> Committee Members Present: Shade Little; Karen??GreenMcElveen Report Completed by: Shade Little <br /> Number of Residents who received personal visits from committee members: 5 <br /> Resident Rights Information is clearly visible: ® Yes❑ No Ombudsman Contact Info is correct and clear) posted: ® Yes ❑ No <br /> The most recent survey was readily accessible: ❑Yes ❑ No Staffing information clearly posted: ®Yes ❑ No <br /> Required for Nursing Homes Only) <br /> Resident Profile Yes/No/NA Comments/Other Observations <br /> 1. Do the residents appear neat,clean and odor free? Y There was an unpleasant odor in one room. <br /> 2. Did residents say they receive assistance with personal care activities? Two clients were low-responsive, the others had <br /> Ex.brushing their teeth, combing their hair, inserting dentures or cleaning NA long conversations. <br /> their eyeglasses? One client undergoing physical therapy and <br /> 3. Did you see or hear residents being encouraged to participate in Y another on their computer. <br /> their care by staff members? <br /> 4. Were residents interacting with staff,other residents&visitors? Y <br /> 5. Did staff respond to or interact with residents who had difficulty y <br /> communicating or making their needs known verbally? <br /> 6. Did you observe restraints in use? N <br /> 7. If so,did you ask staff about the facility's restraint policies? NA <br /> Resident Living Accommodations Yes/No/NA Comments/Other Observations <br /> 1. Did residents describe their living environment as homelike? NA The rooms are airy with large windows. <br /> 2. Did you notice unpleasant odors in commonly used areas? N Cameras are in ALL rooms of the home. <br /> 3. Did you see items that could cause harm or be hazardous? N <br /> 4. Did residents feel their living areas were too noisy? N <br /> 5. Does the facility accommodate smokers? Y <br /> Where? ® Outside only❑ Inside only❑ Both Inside/Outside <br /> 6. Were residents able to reach their call bells with ease? NA <br /> 7. Did staff answer call bells in a timely&courteous manner? NA <br /> If no, did you share this with the administrative staff? <br /> Resident '/NA Comments/Other Observations <br /> 1. Were residents asked their preferences or opinions about the N All meals are planned and eaten either in bed (one <br /> activities planned for them at the facility? client)or in the dining area. <br /> 2. Do residents have the opportunity to purchase personal items of NA <br /> their choice using their monthly needs funds? <br /> Can residents access their monthly needs funds at their NA <br /> convenience? Snacks are placed out for the residents. <br /> 3. Are residents asked their preferences about meal/snack choices? N <br /> Are they given a choice about where they prefer to dine? N <br /> 4. Do residents have privacy in making and receiving phone calls? NA We met the nurse for Livewell (8 homes)and she <br /> 5. Is there evidence of community involvement from other civic, N spoke well of this facility. <br /> volunteer or religious groups? I The house manager has been here 4 months. <br /> 6. Does the facility have a Resident's Council? NA <br /> Family Council? <br /> Areas of • • <br /> /NA Exit Summary <br /> Are there resident issues or topics that need follow-up or review at a later Y House manager was aware of the odor in one <br /> time or during the next visit? room, said the client had an accident overnight, <br /> they had changed all linen, and were airing the <br /> room out. <br /> This Document is PUBLIC RECORD.Do not identify any Resident(s)by name or inference on this form. <br /> Top Copy is for the Regional Ombudsman's Record.Bottom Copy is for the CAC's Records. <br />