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Co munity Advisory Committee Quarterly/Annual Visitation Report XYes County: Facility Type: Facility Name/Address: ORANGE Family Care Home Cates Family Care Home 116 Collums Road, Chapel Hill, NC 27514 Visit Date: Nov 10, 2025 1 Time spent in facility: 30 minutes Arrival time: 9:00 am • Name of person exit interview was held with: Interview was held: ® in Person • ❑x SIC(Supervisor in Charge) Nuva Serwaa, PCA • Committee Members Present:Jackie Podger, Shade Little • Report Completed by: Shade Little/ Jackie Podger Number of Residents who received personal visits from committee members: 2 Resident Rights Information is clearly visible: p Yes Ombudsman Contact Info is correct and clearly posted: ®Yes The most recent survey was readily accessible:_Yes X No Staffing information clearly posted: Re uired for Nursinq Homes On! Familyare Home Resident Profile � Yes/No/NA Comments/Other Observations 1. Do the residents appear neat,clean and odor free? Y 2. Did residents say they receive assistance with personal care activities? We observed two residents in this family care home. Ex.brushing their teeth, combing their hair,inserting dentures or cleaning their NA One gentleman was seated in the family common area eyeglasses? watching TV. He had just had his breakfast and 3. Did you see or hear residents being encouraged to participate in spoke when asked questions. The other gentleman their care by staff members? Y was departing for a walk with an escort. The facility 4. Were residents interacting with staff,other residents&visitors? Y provides a walking escort two times a day because the 5. Did staff respond to or interact with residents who had difficulty resident is very active and enjoys movement.He Y spoke happily about his upcoming walk. The facility communicating or making their needs known verbally? is expecting a third resident in the coming days. 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 The facility appeared very comfortable with inside 2. Did you notice unpleasant odors in commonly used areas? N and outside activity space. Bedrooms were large and 3. Did you see items that could cause harm or be hazardous? N appeared to be comfortable. One of the gentleman had assisted in trimming the tree and the facility was 4. Did residents feel their livingareas were too noisy? NA very festive. The outdoor space was very welcoming 5. Does the facility accommodate smokers? NA with gardens and tables and chairs for outdoor dining Where? ❑x Outside only ❑ Inside only ❑ Both Inside/Outside and vising with family and friends. 6. Were residents able to reach their call bells with ease? NA 7. Did staff answer call bells in a timely&courteous manner? v If no, did you share this with the administrative staff? Resident •/NA Comments/Other Observations 1. Were residents asked their preferences or opinions about the Y Resident families visit loved ones in a very pleasant activities planned for them at the facility? homelike atmosphere. The staff prepares meals, 2. Do residents have the opportunity to purchase personal items of NA cleans,and develops the activity calendar for the their choice using their monthly needs funds? month. The facility is very clean and welcoming. Can residents access their monthly needs funds at their convenience? NA 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? NA 5. Is there evidence of community involvement from other civic, Y volunteer or religious groups? 6. Does the facility have a Resident's Council? NA Family Council? Areas of • Yes/No/NA Exit Summary