NH-Signature HealthCARE of CH 2025-12-05

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Co munity Advisory Committee Quarter) /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: 12/05/2025 Timespent in facility: 85 min. Arrival time: 2:00 ❑ am ® pm Name of person exit interview was held with: Candi Alvin Interview was held: ® in Person ❑ Phone ❑Admin. ® SIC Supervisor in Charge) ❑ Other Staff Rep. Committee Members Present: Alicia Reid, Shade Little Report Completed by: Shade Little/Alicia Reid Number of Residents who received personal visits from committee members: 16 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 Nursing Homes Onl Resident • •/NA Comments/Other Observations 1. Do the residents appear neat,clean and odor free? Y The whole facility was active, lots of movement in the 2. Did residents say they receive assistance with personal care activities? halls and several activities in the large room: movie, Ex.brushing their teeth, combing their hair,inserting dentures or cleaning NA hot chocolate, basketball toss. their eyeglasses? 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. Tf so,did you ask staff about the facility's restraint policies? NA Resident Living Accommodations Yes/NoINA Comments/Other Observations 1. Did residents describe their living environment as homelike? Y The heat problem is resolved. We received no 2. Did you notice unpleasant odors in commonly used areas? N complaints about cold rooms. 3. Did you see items that could cause harm or be hazardous? N New Xmas trees around, music playing. 4. Did residents feel their living areas were too noisy? N 5. Does the facility accommodate smokers? Y Where? ® Outside only❑ Inside only❑ Both Inside/Outside 6. Were residents able to reach their call bells with ease? Y 7. Did staff answer call bells in a timely&courteous manner? NA 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 The Activity Board is up to date and busy. activities planned for them at the facility? The Rehab room and staff received several 2. Do residents have the opportunity to purchase personal items of Y compliments. their choice using their monthly needs funds? Can residents access their monthly needs funds at their Y convenience? 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 • • /NA Exit Summary Are there resident issues or topics that need follow-up or review at a later N Exit interview completed with Candi Alvin. No time or during the next visit? concerns to escalate. 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.