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3 <br /> DEPARTMENT OF HEALTH AND HUMAN SERVICES <br /> DIVISION OF AGING AND ADULT SERVICES <br /> OFFWE OF THE STATE LONG-TERM CARE O:�IB DS.NLAN <br /> MNIMUNITY ADVISORY C'OtI-NIITTEE <br /> ORIENTATION TRAINING STATUS <br /> Applicant's Name: Sandra Okeke Bates Quarter: Fal <br /> Regional Ombudsman's Name: Autumn Cox <br /> Region:J County: Orange <br /> Date:December 12,2024 <br /> County Committee: Q Adult Care Home ❑' Nursing Hume ®Joint <br /> Beginning Date of Orientation Training: November 6.2024 <br /> Assigned Group: Croup D <br /> ra"AD cKa so rreupcC1 <br /> wwfts&y a 'tom T yr•Wedaay.Tbxsdw Tw5day a w.a a s■ <br /> IlMa=-3:399AL5: -T30 10AWL-S3D 9 1 Seoeea�er 11.IQZi SgMmser it 203a Ocsobsr A 2024 Oaabw f,mea ad*"NI,Iosi OCNAW 19 M oa"Si.2MM4 Nov�mptr L M4 a New fterT lE�i <br /> mea :_ -W Paga_ Pft <br /> a soap New.a xoya . <br /> -! a � aceobe.ri u 0001W 2a:� o�O a soli _ - _• 3?°4` ¢. oma- -_,1..... .:.- <br /> Applicants are expected to complete all of the Communit} Advisory Committee(CAC)Orientation training berorc <br /> being certified.designated.and appointed as a CAC volunteer•me-nnber. The training consists of three phases in the <br /> follo%%ing order: <br /> ' Phase I Pbase II Phase III <br /> Iade�rend�nt Study _ _Field Work Orientation _ Classroom Orientation _ <br /> (7)hours of independent 110 14)hour%o!facility:N isitation to E (16- 20)hours est State 011ice classr000m <br /> stud}'homework-(independent. speak«ith staff members and residents of orientation <br /> n eb-based,rrebinan i the facilities you will be sen'ing. 1. Modules 1 - 10 <br /> At leant half,(4-?)hours of l�ae ility 2 Depending on Group Schedule <br /> isitation roust be completed prior tosell ctiuns available.classes can run <br /> entering Phase III of training. from 1 <br /> Ait facility hours must be completed <br /> bef--tht clad of Phase III. <br /> As a CAC applicant.an attestation form was signed expressing orientation training must be completed within 90 days <br /> of application.lk-low is a sumrnar-=of your application status. <br /> Summary: You have successfully completed the:required 36-hours of CAC orientation training. Congratulations,on <br /> becoming a CAC volunteer! <br /> Application Status: Apprejvcd <br /> 2l'4CAC Applicant's Sgnatum: DATE <br /> SLTC"O Trainer's Sip trattttu: � V-) DATE: �'� <br />