NH-Signature HealthCARE of CH 2026-02-03

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Co munity Advisory Committee Quarter) /Annual Visitation Report County: ORANGE Facility Type: Facility Name/Address: ❑Family Care Home NNursing Home Signature HealthCARE of Chapel Hill ❑Adult Care Home 1602 East Franklin Street, Chapel Hill, NC 27514 Visit Date: 02/03/2026 Time spent in facility: 120 min. Arrival time: 1:30 ❑ am 0 pm Name of person exit interview was held with: Dr. Laticia Beatty Interview was held: 0 in Person ❑ Phone ❑Admin. 0 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: 18 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: 0 Yes ❑ No Staffing information clearly posted: 0 Yes ❑ No (Required for Nursing Homes Only) Resident Profile Yes/No/NA Comments/Other Observations 1. Do the residents appear neat, clean and odor free? y The weekly Bible Study in the main room had 8 2. Did residents say they receive assistance with personal care activities? participants. Ex.brushing their teeth, combing their hair,inserting dentures or cleaning NA We talked with Supv. of house keeping regarding new their eyeglasses? employees and attention to cleaner rooms noted. 3. Did you see or hear residents being encouraged to participate in N We talked with several visitors of residents who their care by staff members? commented they were`pleased'with interactions with 4. Were residents interacting with staff,other residents&visitors? y and responses from the staff. 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 The halls and rooms were heated comfortably. 2. Did you notice unpleasant odors in commonly used areas? N One resident said they were late answering a call bell, 3. Did you see items that could cause harm or be hazardous? N but thought that was reasonable since it was during a 4. Did residents feel their living areas were too noisy? N shift change. 5. Does the facility accommodate smokers? Y One resident complained about the food, and the Where? 0 Outside only ❑ Inside only ❑ Both Inside/Outside nutritionist came and satisfied their complaint. 6. Were residents able to reach their call bells with ease? Y An added activity(Sure Shot)was noticed in the 7. Did staff answer call bells in a timely&courteous manner? NA activity room. Residents were playing on it. 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 had 3 satisfied (working)short term 2. Do residents have the opportunity to purchase personal items of Y residents. their choice using their monthly needs funds? There was a phone (with dial tone) in the hall phone Can residents access their monthly needs funds at their Y room.Activities planned encouraged all residents to convenience? participate.The activity director regularly asks for input 3. Are residents asked their preferences about meal/snack choices? Y from residents when planning activities. Conversations Are they given a choice about where they prefer to dine? Y with many residents eating in the dining area said they 4. Do residents have privacy in making and receiving hone calls? y enjoyed the social interaction and preferred it. 5. Is there evidence of community involvement from other civic, Y Volunteers assist residents in several ways volunteer or religious groups? (ex:assistance room, sorting clothes). Comfortable 6. Does the facility have a Resident's Council? y reaching out if needed. Commented `appreciate Family Council? knowing the Ombudsman exists'. Areas of • • /NA Exit Summary Are there resident issues or topics that need follow-up or review at a later N 7 'there were no issues for the Supervisor this visit. time or during the next visit? We need ask more about call bell response. 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.