NH-Signature HealthCARE of CH 2025-08-22

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Co munity Advisory Committee Quarterly/Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ❑Family Care Home ®Nursing Home Signature HealthCARE of Chapel Hill ❑Adult Care Home 1602 East Franklin Street, Chapel Hill, NC 27514 Visit Date: 08/22/2025 Timespent in facility: 115 min. Arrival time: 9:25 ® am ❑ pm Name of person exit interview was held with: Catherin Maynard Interview was held: ® in Person ❑ Phone ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. Catherine Maynard, Interim Administrator from corporate Committee Members Present: Alicia Reid, Shade Little Report Completed by: Shade Little/Alicia Reid Number of Residents who received personal visits from committee members: 15 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 Nursinq Homes Onl Resident • •/NA Comments/Other Observations 1. Do the residents appear neat,clean and odor free? Y Many rooms on the rehab side had caution signs. The 2. Did residents say they receive assistance with personal care activities? explanation was that there is quick turnover in rehab, Ex. brushing their teeth, combing their hair,inserting dentures or cleaning NA and the signs are used especially when the resident their eyeglasses? first comes in and they may be vulnerable to infection. 3. Did you see or hear residents being encouraged to participate in N 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 NA 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? NA Resident Living Accommodations Yes/No/NA Comments/Other Observations 1. Did residents describe their living environment as homelike? Y COLD was the topic in many rooms. We were 2. Did you notice unpleasant odors in commonly used areas? N fortunate to see the maintenance people and 3. Did you see items that could cause harm or be hazardous? N convinced them there was a problem in that area. 4. Did residents feel their living areas were too noisy? N They did go and reported back that the thermostat had 5. Does the facility accommodate smokers? Y be set at 69. They corrected it and thanked us. A Where? ® Outside only❑ Inside only❑ Both Inside/Outside follow up for the guard over the thermostat will be in 6. Were residents able to reach their call bells with ease? Y our next visit. 7. Did staff answer call bells in a timely&courteous manner? NA Activity boards are in transition to September. If no, did you share this with the administrative staff? Resident • • Observations 1. Were residents asked their preferences or opinions about the Y Some residents did not know of the "always available activities planned for them at the facility? menu (burgers, hot dogs, chefs salad,fried, grilled 2. Do residents have the opportunity to purchase personal items of Y cheese, soup of the day)",which can be had if ordered their choice using their monthly needs funds? at least 30 minutes before a meal. Can residents access their monthly needs funds at their Y Free Wi-Fi is available and easy to connect to. convenience? Bluetooth connections are being looked into. 3. Are residents asked their preferences about meal/snack choices? Y Are they given a choice about where they prefer to dine? Y 4. Do residents have privacy in making and receiving hone calls? Y 5. Is there evidence of community involvement from other civic, Y volunteer or religious groups? 6. Does the facility have a Resident's Council? Y Family Council? Areas of • Yes/No/NA Exit Summary Are there resident issues or topics that need follow-up or review at a later N The administrator will investigate lock-boxes for the time or during the next visit? thermostats to keep the temperature from being changed easily. They will highlight the available menu. his Document is PUBLIC RECORD.Do not identify any Resident(s)by name or inference on this form.t Bottom Copy is for the CAC's Records.