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Com unity Advisory Committee Quarter) /Annual Visitation Report County: Facility Type: Facility Name/Address: Orange ❑Family Care Home ❑Nursing Home ©Adult Care Home ElGraceful Living -624 Jones Ferry Rd, Carboro, NC Visit Date: 06 /23 /25 Time spent in facility: hr 55 min Arrival time: 3 :45 ❑ am ❑✓ pm Name of person exit interview was held with: Interview was held: ❑✓ in Person ❑ Phone 0 Admin. ❑ SIC(Supervisor in Charge) ❑ Other Staff Rep. Name/Title AmyFox,Executive Diretor Committee Members Present: Report Completed by: Stephanie Boswell, Marylou Gelblum Stephanie Boswell Number of Residents who received personal visits from committee members: 10 Resident Rights Information is clearly visible: 0 Yes ❑✓ No Ombudsman Contact Info is correct and clearly posted: 0 Yes ❑ No The most recent survey was readily accessible: ❑Yes❑✓ No Staffing information clearly posted: ❑Yes ✓❑ No (Required for Nursing Homes Only) Resident Profile I Comments/Other Observations 1. Do the residents appear neat, clean and odor free? Yes Most residents were clean, dressed 2. Did residents say they receive assistance with personal care well. Most residents were in their activities?Ex. brushing their teeth, combing their hair, inserting N/A room. A few residents were outside in dentures or cleaning their eyeglasses? their wheel chairs. There are several 3. Did you see or hear residents being encouraged to participate in No 0 new resdients in the facility. Several their care by staff members? residents report satisfaction with their 4. Were residents interacting with staff, other residents&visitors? No 0 rooms and feel supported from staff. 5. Did staff respond to or interact with residents who had difficulty N/A communicating or making their needs known verbally? 6. Did you observe restraints in use? No O 7. If so, did you ask staff about the facility's restraintpolicies? N/A Resident Living Accommodations Yes/No/NA Comments/Other Observations 8. Did residents describe their living environment as homelike? Yes O The familiar somewhat unpleasant 9. Did you notice unpleasant odors in commonly used areas? Yes 0 odor continues to permeate the whole 10. Did you see items that could cause harm or be hazardous? No O building, cause unknown. One 11. Did residents feel their living areas were too noisy? No O resident noted that call bells are not 12. Does the facility accommodate smokers? Yes O answered timely at night. It is noted Where? 0 Outside only❑ Inside only❑ Both Inside/Outside that the facility has "hotel" call bells in 13. Were residents able to reach their call bells with ease? Yes 0 each room. No central/electronic call 14. Did staff answer call bells in a timely&courteous manner? N/A O bell system in place. If no, did you share this with the administrative staff? Resident •/NA Comments/Other Observations 15. Were residents asked their preferences or opinions about the No O Several residents commented on how activities planned for them at the facility? good the food is now. Menu is listed 16. Do residents have the opportunity to purchase personal items of outside dining room. Residents report their choice using their monthly needs funds? Yes there is good variety of food. One Can residents access their monthly needs funds at their resident remarked that there are no convenience? outings offered. Activity calendar is 17. Are residents asked their preferences about meal/snack choices? N/A O posted in several locations around Are they given a choice about where they prefer to dine? the facility. ED states there is no AD 18. Do residents have privacy in making and receiving phone calls? N/A O on site at this time. They are activtely 19. Is there evidence of community involvement from other civic, working to hire a new AD. volunteer or religious groups? Yes O 9 20. Does the facility have a Resident's Council? Yes O Family Council? Areas of • • /NA Exit Summary Are there resident issues or topics that need follow-up or review at a later Discuss items from "Areas of Concern"Section time or during the next visit? as well as any changes observed during the visit We mentioned the overall smell that is stronger some Discussed ordor with executivedirector. They are working on making places than others, and unpleasant when strong. repairs and cosmetic updates that Call bells do not connect to central staff area. Staff they hope will help with the smell. must be close by the hear the call bell, causing delay in Owner is getting quotes for new call care (hard to hear those that are in rooms far away bell system. from main area and if patient doors are closed). 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. Revised 1/21/2020