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Com unity Advisory Committee Quarter/ /Annual Visitation Report County: Facility Type: Facility Name/Address: Orange ❑Family Care Home Ft—/]Nursing Home Parkview Health&Rehab Center, 1716 Legion Rd., ❑Adult Care Home ❑ Chapel Hill, 27517 Visit Date: 12 //22;/25 Time spent in facility: hr 40 min Arrival time: 8 : 00 ❑✓ am ❑ pm Name of person exit interview was held with: Interview was held: ❑✓ in Person ❑ Phone 0 Admin. ❑ SIC (Supervisor in Charge) 0 Other Staff Rep. Name/Title Sandy Callihan, Director of Rehabilitation Committee Members Present: Report Completed by: Shade Little,MaryLou Gelblum �MaryLou Gelblum Number of Residents who received personal visits from committee members:2 Resident Rights Information is clearly visible: 0 Yes ❑✓ No Ombudsman Contact Info is correct and clearly posted: Z 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 O Our visit took place early in the 2. Did residents say they receive assistance with personal care morning starting at 8:00am. Turns out activities?Ex. brushing their teeth, combing their hair, inserting N/A O all residents receive breakfast in their dentures or cleaning their eyeglasses? rooms. We observed residents dozing, 3. Did you see or hear residents being encouraged to participate in Yes O just getting up, some eating or being their care by staff members? assisted with eating, but all, except 4. Were residents interacting with staff, other residents&visitors. Yes O one, were observed still in their rooms 5. Did staff respond to or interact with residents who had difficulty communicating or making their needs known verbally? Yes O with staff handing out meds and 6. Did you observe restraints in use? No O assisting with ADLs. 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? N/A O The building was decorated for the 9. Did you notice unpleasant odors in commonly used areas? No O holidays. There were no unpleasant 10. Did you see items that could cause harm or be hazardous? Yes O odors.Rooms are personalized. One 11. Did residents feel their living areas were too noisy? No O concern that we have commented on 12. Does the facility accommodate smokers? No O before is the presence of unlocked Where? ❑ Outside only❑ Inside only E] Both Inside/Outside med carts in hallways with no one 13. Were residents able to reach their call bells with ease? Yes O around. Wespotted 2. 14. Did staff answer call bells in a timely&courteous manner? Yes O 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 Yes O Daily activities and daily menus are activities planned for them at the facility? posted on bulletin boards in the 16. Do residents have the opportunity to purchase personal items of hallways. Residents are given choices their choice using their monthly needs funds? Yes O of foods at mealtimes and activities Can residentaccess their monthly needs funds at their each day. convenience? 17. Are residents asked their preferences about meal/snack choices? Yes O Are they given a choice about where they prefer to dine? 18. Do residents have privacy in making and receiving phone calls? Yes O 19. Is there evidence of community involvement from other civic, volunteer or religious groups? N/A O 20. Does the facility have a Resident's Council? FamilyCouncil? Yes 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? N0 O as well as any changes observed during the visit Med carts were found left in two hallways unattended We did find at our last exit meeting and unlocked. that there is an active Resident's Council. Today we met with the Director of Rehabilitation. She is proud of their 5 star rating, and said she would bring up the issue of unlocked med carts at the next staff meeting. 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