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Corn unity Advisory Committee Quarter) /Annual Visitation Report <br /> County: Facility Type: Facility Name/Address: <br /> Orange ❑Family Care Home ❑Nursing Home Graceful Living, 624 Jones Ferry Rd., Carrboro 27 <br /> ❑✓Adult Care Home ❑ <br /> Visit Date: 02 / 25 /25 Time spent in facility: hr 40 min Arrival time: 3 : 30 ❑ am ❑✓ pm <br /> Name of person exit interview was held with: Interview was held: ❑✓ in Person ❑ Phone <br /> ❑✓ Admin. ❑ SIC(Supervisor in Charge) ❑ Other Staff Rep. Name/Title Director: Lisa McDougal <br /> Committee Members Present: Report Completed by: <br /> Stephanie Boswell, MaryLou Gelblum Marylou Gelblum <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 clearly 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 I Comments/Other Observations <br /> 1. Do the residents appear neat, clean and odor free? Yes Residents appeared clean, neat and <br /> 2. Did residents say they receive assistance with personal care <br /> activities?Ex. brushing their teeth, combing their hair, inserting N/A odor free. <br /> dentures or cleaning their eyeglasses? <br /> 3. Did you see or hear residents being encouraged to participate in N/A <br /> their care by staff members? <br /> 4. Were residents interacting with staff, other residents&visitors? Yes <br /> 5. Did staff respond to or interact with residents who had difficulty N/A <br /> communicating or making their needs known verbally? <br /> 6. Did you observe restraints in use? No <br /> 7. If so, did you ask staff about the facility's restraintpolicies? N/A <br /> Resident Living Accommodations Yes/No/NA Comments/Other Observations <br /> 8. Did residents describe their living environment as homelike? Yes There was a marked improvement in <br /> 9. Did you notice unpleasant odors in commonly used areas? No <br /> 10. Did you see items that could cause harm or be hazardous? No the overall appearance & smell of the <br /> 11. Did residents feel their living areas were too noisy? No facility. New management's focus on <br /> 12. Does the facility accommodate smokers? Yes eliminating odors, painting & repairing <br /> Where? ❑✓ Outside only❑ Inside only❑ Both Inside/Outside ceilings, adding lighting, & moving the <br /> 13. Were residents able to reach their call bells with ease? N/A outside smoking area to back side of <br /> 14. Did staff answer call bells in a timely&courteous manner? N/A building, all contributed. Several <br /> If no, did you share this with the administrative staff? <br /> Resident •/NA Comments/Other Observations <br /> 15. Were residents asked their preferences or opinions about the <br /> activities planned for them at the facility? <br /> N/A There were daily activities listed <br /> 16. Do residents have the opportunity to purchase personal items of including limited community <br /> their choice using their monthly needs funds? Yes involvement (church services) on the <br /> Can residents access their monthly needs funds at their monthly calendar posted in the <br /> convenience? hallway. We saw the snack and <br /> 17. Are residents asked their preferences about meal/snack choices? Yes beverage cart making the rounds in <br /> Are they given a choice about where they prefer to dine? the afternoon. <br /> 18. Do residents have privacy in making and receiving phone calls? No There is only one public phone in the <br /> 19. Is there evidence of community involvement from other civic, Yes hallway for the men and one in the <br /> volunteer or religious groups? <br /> 20. Does the facility have a Resident's Council? women's hallways. <br /> N/A <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 NDiscuss items from "Areas of Concern"Section <br /> time or during the next visit? O as well as any changes observed during the visit <br /> At our exit interview a member of the <br /> administration and the owner's wife <br /> both expressed the desire to attract <br /> more elderly clients. <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 /> Revised 1/21/2020 <br />