HomeMy WebLinkAboutAgenda - 10-18-2011 - 12fORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 18, 2011
Action Agenda
Item No. - a _ -F
SUBJECT: Orange County Nursing Home Community Advisory Committee -Appointment
DEPARTMENT: Board of Commissioners
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Cover INFORMATION CONTACT:
Membership Roster Clerk's. Office, 245-2130
Letter Of Recommendation
Application(s)/Resume(s) of Person(s) for
consideration
Applicant Interest List
Application(s)/Resume(s) of Person(s) on
the Interest List
PURPOSE: To consider making an appointment to the Orange County Nursing Home
Community Advisory Committee.
BACKGROUND: The following appointment is for Board consideration:
• Appointment to a one year training term for Verna Dunn. If appointed Ms. Dunn will be
serving cone-year training term expiring 09/30/2012.
Position Number S ecial Re resentation Ex iration Date
6 Verna Dunn Nursin Home Administration 09/30/2012
FINANCIAL IMPACT: None
RECOMMENDATION(S): Consider making an appointment to the Orange County Nursing
Home Community Advisory Committee.
Board and Commission Members
And Vacant Positions
Nursing Home Community Advisory Committee
Meeting Times: 5:30 p.m. Every other 1st Monday starting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MSW
Meeting Place: Seymour Center Positions: 12 Length: 3 years Contact Phone: 919-558-9401
Description: All appointments are made by the Board of Commissioners. This committee helps to maintain the intent of the Residents' Bill of Rights, promotes community involvement and
provides public education on long-term care issues. The regional ombudsman with Triangle J Council of Governments provides specialized training and support.
Mr. Arthur St. John
1
101 Hayworth Drive
Chapel Hill NC 27517
Day Phone: 919-968-3003 Sex: Male
Evening Phone: 919-968-3003 Race: Caucasian
FAX: Township: Chapel Hill
E-mail: st1299@bellsouth.net Resid/Spec Req: At-Large
Special Repr: At-Large
Mr Elijah (Ed) Flowers, III Day Phone: 919-357-9256 Sex: Male
Chair Evening Phone: 919-357-9256 Race: Caucasian
2
2813 Beckett's Ridge Drive FAX Township: Hillsborough
Hillsborough NC 27278 E-mail: ED_FLOWERS@YAHOO.COM Resid/Spec Req: At-Large
Special Repr: At-Large
Mrs. Patricia Revels Day Phone: (919) 241-4071 Sex: Female
Evening Phone: Same Race: Caucasian
3
329 West King Street FAX: N/A Township: Hillsborough
Hillsborough NC 27278 E-mail: preve1s001@nc.rr.com Resid/SpeC Req: At-Large
Special Repr: At-Large
Ms. Sharon Karnash Day Phone: 919-479-5661 Sex: Female
Evening Phone: same Race: Caucasian
4
5513 Quail Hollow Drive FAX: Township: Little River
Hillsborough NC 27278 E-mail: Sharon.kamash@gmail.com Resid/Spec Req: At-Large
VACANT
5
Day Phone:
Evening Phone:
FAX:
E-mail:
First Appointed: 01/24/2005
Current Appointment: 03/17/2009
Expiration: 01/30/2012
Number of Terms: 2
First Appointed: 03!06/2008
Current Appointment: 03/17/2009
Expiration: 03/31 /2012
Number of Terms: 2
First Appointed: 03/06/2008
Current Appointment: 03/17/2009
Expiration: 03/31 /2012
Number of Terms: 1
First Appointed: 06/12/2007
Current Appointment: 04/19/2011
Expiration: 06/30/2014
Number of Terms: 2
Special Repr: At-Large
Sex: First Appointed:
Race: Current Appointment:
Township: Expiration: 06/30/2008
Resid/Spec Req: At-Large Number of Terms:
Special Repr: Nursing Home Administration
Wednesday, September 28, 2011
Page 1 N
Board and Commission Members
And Vacant Positions
Nursing Home Community Advisory Committee
Meeting Times: 5:30 p.m. Every other 1st Monday stazting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MSW
Meeting Place: Seymour Center Positions: 12 Length: 3 years Contact Phone: 919-558-9401
Description: All appointments are made by the Board of Commissioners. This committee helps to maintain the intent of the Residents' Bill of Rights, promotes community involvement and
provides public education on long-term care issues. The regional ombudsman with Triangle J Council of Governments provides specialized training and support.
VACANT Day Phone: Sex: First Appointed:
Evening Phone: Race: Current Appointment:
6 FAX: Township: Expiration: 09/30/2011
E-mail: Resid/Spec Req: At-Large Number of Terms:
Special Repr: Nursing Home Administration
Ms Sarah Lowman Day Phone: 919-259-0053 Sex: Female First Appointed: 06/01/2010
Evening Phone: same Race: Caucasian Current Appointment: 04/19/2011
7 316 Standish Drive FAX: Township: Chapel Hill Expiration: 06/01/2014
Chapel Hill NC 27517 E-mail: sarah_lowman@med.unc.edu Resid/Spec Req: At-Large Number of Terms: 1
Special Repr: At-Large
DT. Mario Battigelll Day Phone: 919-942-5756 Sex: Male First Appointed: 03/16/2010
Evening Phone: Race: Caucasian Current Appointment: 04/19/2011
8 1307 Wildwood Drive FAX: Township: Chapel Hill Expiration: 03/16/2014
Chapel Hill NC 27514 E-mail: mcbattigelli@gmail.com Resid/Spec Req: At-Large Number of Terms: 1
__ Special Repr: At-Large
Ms. Susan Deter Day Phone: 919-682-4124 Sex: Female First Appointed: 04/19/2011
Evening Phone: 919-479-0574 Race: Caucasian Current Appointment: 04/19/2011
9 5512 Quail Hollow Drive FAX: 919-956-7703 Township: Little River Expiration: 04/19/2012
Hillsborough NC 27278 E-mail: susiedeter@yahoo.com Resid/Spec Req: At-Large Number of Terms:
Special Repr: At-Large
MS. Patrlcla KOCh Day Phone: 942-6637 Sex: Female First Appointed: 06/19/2006
Evening Phone: same Race: Caucasian Current Appointment: 10/19/2010
10 1540 Ferrell Rd FAX: Township: Chapel Hill Expiration: 06/30/2013
Chapel Hill NC 27517 E-mail: pkoch003@nc.rc.com Resid/Spec Req: At-Large Number of Tetras: 2
Special Repr: At-Large
Wednesday, September 28, 2011 Page 2 W
Board and Commission Members
And Vacant Positions
Nursing Home Community Advisory Committee
Meeting Times: 5:30 p.m. Every other 1st Monday starting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MSW
Meeting Place: Seymour Center Positions: 12 Length: 3 years Contact Phone: 919-558-9401
Description: All appointments are made by the Board of Commissioners. This committee helps to maintain the intent of the Residents' Bill of Rights, promotes community involvement and
provides public education on long-term care issues. The regional ombudsman with Triangle J Council of Governments provides specialized training and support.
VACANT Day Phone:
11 Evening Phone:
FAX:
E-mail:
VACANT Day Phone:
12 Evening Phone:
FAX:
E-mail:
Sex: First Appointed:
Race: Current Appointment:
Township: Expiration: 12/31/2010
Resid/Spec Req: At-Large Number of Terms:
Special Repr: Nursing Home Administration
Sex: First Appointed:
Race: Current Appointment:
Township: Expiration: 12/31/2010
Resid/Spec Req: At-Large Number of Terms:
Special Repr: Nursing Home Administration
Wednesday, September 28, 2011
Page 3 .p
Page 1 of 1
Jeanette Jones
From: Charlotte Terwilliger [cterwilliger@tjcog.org]
Sent: Wednesday, September 14, 2011 10:32 AM
To: Jeanette Jones
Cc: Donna Baker
Subject: Appointment for Nursing Home CAC
Dear Jeanette,
The Nursing Home Community Advisory Committee would like to recommend Verna Dunn for a one year
training term. Ms Dunn has a strong interest in improving the quality of life for Orange County residents living in
long term care facilities and she would be a valuable addition to the work of this committee.
I also wanted to inform you that Ed Flowers has been elected to serve as the chair for this committee.
Please let me know if you need additional information to move Ms Dunn's appointment recommendation
forward.
Thank you.
Sincerely,
Charlotte
Charlotte Terwilliger
Ombudsman -Orange and Chatham Counties
Area Agency on Aging
Triangle J Council of Governments
PO Box 12276 / RTP, NC 27709
(o) 919-558-9401 / (f) 919-998-8101
cterwilliger@t~cog,org / www.~~.org
Street Addresss:
4307 Emperor Blvd., Suite 110, Durham, NC 27703
E-Mail correspondence to and from this address is subject to the North Carolina Public Records Act and
may be disclosed to third parties unless made confidential under applicable law.
5
9/27/2011
6
Page 1 of 1
Verna Dunn
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms Verna Dunn
503 Carl Drive
Chapel Hill NC 27516
281-855-8551
281-855-8551
springfinal@gmail.com
unemployed
2008
Chapel Hill
Female
Caucasian
11 /11 /1946
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
13 years as a legal secretary/legal assistant
15 years developing documentation for software
1 year as a secretary for Physical therapists in nursing homes
Volunteer Experience:
crisis hotline; professional organizations
Education:
Bachelors Degree in Professional Writing
Other Comments:
STAFF COMMENTS: 6/16/2011, originally applioed for Nursing Home CAC. ADDRESS
VERIFICATION: 503 Carl Drive is CH Township, OC Jurisdiction.
This application was current on: 6/16/2011 3:47:53 PM Date Printed: 9/27/2011
7
AppllCant Interest Llst111g by Board Name and by Applicant Name
Contact Person: Charlotte Terwilliger, MSW
Nursing Home Community Advisory Committee Contact Phone: 919-558-9401
Mr. Jack S. Chestnut Day Phone: 919-732-1242 Sex: Male
4303 Hope Valley Drive Evening Phone: 919-732-1242 Race: Caucasian
Hillsborough NC 27278 FAX: Township: Hillsborough
E-mail: jackchestnut@!aol.com Date Applied: 05/24/2010
Skills: . C.H. SENIOR CNTR PROGR. PART Also Serves On:
Skills: Cazol Woods Retirement Center Also Serves On:
Skills: HUD202 Housing for Elderly Board M Also Serves On:
Ms. T. L. Crews
4921 Guess Rd
Rougmeont NC 27572
Skills: School Principal
Skills: Tutor
Day Phone: 919 732-6974
Evening Phone: 919 732-6974
FAX:
E-mail: crewsez@aol.com
Also Serves On:
Also Serves On:
Sex: Female
Race: African American
Township: Little River
Date Applied: 08/21/2011
Ms Verna Dunn
503 Carl Drive
Chapel Hill NC 27516
Skills: Legal Assistant
Day Phone: 281-855-8551
Evening Phone: 281-855-8551
FAX:
E-mail: springfinal@gmail.com
Also Serves On:
Sex: Female
Race: Caucasian
Township: Chapel Hil]
Date Applied: 06/16/2011
Dr. Beverly Foster Day Phone: 919 966-4995 Sex: Female
2454 Springview Trail Evening Phone: 919 967-2930 Race: Caucasian
Chapel Hill NC 27514 FAX: 919 843-6212 Township: Chapel Hill
E-mail: Bev_Foster@unc.edu Date Applied: 02/10/2011
Skills: Nursing Management Education Also Serves On:
Ms Joyce Jefferies Day Phone: (919)425-3597 Sex: Female
4820 NC Hwy 54 West Evening Phone: (919)720-6115 Race: African American
Chapel Hill NC 27516 FAX: (919)425-3529 Township: Chapel Hill
E-mail: Joyce_Jefferies@dentistry.unc.edu Date Applied: 11/03/2010
Skills: Administrative Assistant Also Serves On:
Wednesday, September 28, 2011 Page 1 of 2
8
Applicant Interest Listing by Board Name and by Applicant Name
Contact Person: Charlotte Terwilliger, MSW
Nursing Home Community Advisory Committee Contact Phone: 919-558-9401
Ms. Sandra Lemons Day Phone: 9199718385 Sex: Female
1321 Brookhollow Road Evening Phone: 9199718385 Race: Caucasian
Efland NC 27243 FAX: Township: Cheeks
E-mail: SandraL@umrh.org Date Applied: 02/11/2011
Skills: Administrative Assistant Also Serves On:
Mr. Max Mason Day Phone: 9196497937 Sex: Male
821 Tinkerbell Rd. Evening Phone: Race: Caucasian
Chapel Hill NC 27517 FAX: Township: Chapel Hill
E-mail: maxomason@yahoo.com Date Applied: 01/25/2011
Skills: Long-Term Caze Also Serves On: Adult Care Home Community Advisory Committee
Skills: Public Health
mr Charles mcmullen Day Phone: 9197329083 Sex: Male
108 Jones ave Evening Phone: 9192603879 Race: Caucasian
hiiisborough NC 27278 FAX: Township: Hillsborough
E-mail: cmcmullenl@nc.tr.com Date Applied: 02/10/2011
Skills: Nursing Profession Also Serves On: Adult Care Home Community Advisory Committee
Ms. Vickie Webb Day Phone: 919-491-1073 Sex: Female
150 Lawndale Ave Evening Phone: 919-241-4482 Race: African American
Hillsborough NC 27278 FAX: 919-560-1107 Township: Hillsborough
E-mail: jb29@nc.rr.com Date Applied: 02/10/2011
Skills: Accounting Experience Also Serves On:
Ms. Tikt Windley Day Phone: 919-969-8583 Sex: Female
t 19 Cynthia Drive Evening Phone: 919-942-4392 Race: African American
Chapel Hill NC 27514 FAX: Township: Chapel Hill
E-mail: tiki_windley@yahoo.com Date Applied: 05/27/2010
Skills: Also Serves On:
Dr. Tracey Yap Day Phone: 502.686.0016 Sex: Female
834 Providence Glen Drive Evening Phone: 919.240.4793 Race: Caucasian
Chapel Hill NC 27514 FAX: Township: Chapel Hill
E-mail: tracey.yap@duke.edu Date Applied: 09/20/2011
Skills: Director Also Serves On:
Skills: Nurse Also Serves On:
Wednesday, September 28, 2011 Page 2 of 2
9
Page 1 of 2
Jack S. Chestnut
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Mr. Jack S. Chestnut
4303 Hope Valley Drive
Hillsborough NC 27278
919-732-1242
919-732-1242
jackchestnut@!aol.com
Retired
Hillsborough
Male
Caucasian
12/6/1944
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Director, Community Contact/Special Project, Carol Woods Retirement Center. 21 years
at Carol Woods Retirement Community as Director of Residential services. Responsible
for housing issues- maintenance, remodeling, etc.l worked for Carol Woods Retirement
Center for 30 years. The first 20years I was the Director of Facility Services .The last 10
.years I was the Director of Community Contacts and Special Projects.
Volunteer Experience:
Chair of the Advisory Board on Aging; OC Affordable Hosing Board; Chapel Hill Friends
Board. (Current 1/13/04) ;Board Member- Adailade Walters Housing (HUD 202) - 8
years; Rotarian- 9 years- volunteer repair of low income elderly homes; Friends of the
Chapel Hill Senior Center -board, Chapel Hill/Carrboro Sunrise Rotary Board Member,
Orange County Capital Needs Task Force Member, New Hope springs Homeowners
Association Board Member, North Carolina Independent Housing with services advisory
committee.Attended Yuba City College, Have had many training work shops. 30 years of
experience working with Seniors.Attended Yuba City College, Have had many training
work shops. 30 years of experience working with Seniors.Attended Yuba City College,
Have had many training work shops. 30 years of experience working with Seniors. have
served on the Advisory Board on Aging, Both Senior Center Boards, Senior Care of
Orange County Adult Day Health Program and other boards.
10
Page 2 of 2
Jack S. Chestnut
Education:
High School -Diploma -Kansas City, KS Yuba City College- graduate study; American
Association of Homes and Services for the Aging -certification for Retirement Housing
Professionals Attended Yuba City College, Have had many training work shops. 30 years
of experience working with Seniors.
Other Comments:
Awarded title of Retirement Housing Professional by the American Association of Homes
and Services to the Aging Awarded Environmental Services Award in 1997 by the North
Carolina Association of Non-Profit Homes for the Aging Awarded Rotarian of the Year in
1998 for the Chapel Hill/Carrboro Sunrise Rotary. STAFF NOTES: Renewed application
1/12/04 for Southern Orange Senior Center (New) Design Committee. Renewed 5/24/01
for ARAB. Renewed application 12/14/2000 for Advisory Board on Aging. Renewed
application 08/16/00 for Commissioners Affordable Housing Task Force. Applied
09/30/1999 for Master Aging Plan Task Force. Applied for Nursing Home Community
Advisory Committee 5/24/2010. ADDRESS VERIFICATION: 4203 Hope Valley Drive,
Hillsborough is in Chapel Hill Township and Orange County Jurisdiction.
This application was current on: 5/24/2010 Date Printed: 9/28/2011
11
Page 1 of 2
T. L. Crews
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. T. L. Crews
4921 Guess Rd
Rougmeont NC 27572
919 732-6974
919 732-6974
crewsez@aol.com
Retired Public School Adminstrator
Senior Director Programs for Exceptional Children
1996
Little River
Female
African American
Boards/Commissions applied for:
Human Relations Commission
Adult Care Home Community Advisory Committee
Nursing Home Community Advisory Committee
Work Experience:
Currently serving as Executive Director for the Little River Community Complex
Durham Public Schools worked in adminstrative leadership in the Exceptional Children's
Program. Retired in 2005 as Director of the system's Exceptional Children's Program; at
the request of the superintendent I returned to provide training and assistance to the new
Director when appointed.
Volunteer Experience:
Worked with children in placement through Durham Social Services and court system. I
reviewed files and collected relevant data for attorneys to use in court custody and
placement hearings
Tutored young adults and children
Volunteered in a university sponsored child development center
Currently Executive Director of Little River Community Complex
12
Page2of2
T. L. Crews
Education:
M.ED in Special Education
BA in history with minor in education
Hold Principal Certification
State Licensed in areas of LD/BED/DD
Other Comments:
I have spent most of my life working to better provide assistance to infants, children,
young adults, those at risk, and senior citizens. As a result of spending days and nights
in several nursing homes sitting with elderly parents and relatives, I've gained a deeper
understanding and compassion for elderly residents and workers in nursing facilities.
STAFF COMMENTS: 08/23/2011 Applied to serve on Human Relations Commission,
Adult Care Home Community Advisory Committee, and Nursing Home Community
Advisory Committee. ADDRESS VERIFICATION: 4921 Guess Road is in Little River
Township, Orange County Jurisdiction.
This application was current on: 8/21/2011 11:48:53 AM Date Printed: 9/28/2011
13
Page 1 of 2
Beverly Foster
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Dr. Beverly Foster
2454 Springview Trail
Chapel Hill NC 27514
919 966-4995
919 967-2930
919 843-6212
Bev Foster@unc.edu
UNC-Chapel Hill School of Nursing
Faculty and Undergraduate Program Director
1981
Chapel Hill
Does not apply
Female
Caucasian
1/13/1943
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Preparation of undergraduate baccalaureate students for nursing licensure and practice;
program administration and teaching. Direct patient care in the areas of adult acute care
and maternal child.
Volunteer Experience:
Orange County Board of Health, member and chair.
Senior Center Wellness Advisory Board, member and chair.
North Carolina Board of Nursing, member and chair.
Governor's Task Force for Healthy Carolinians (current).
Foundation for Nursing Excellence, member and chair (current)
Program accreditor for nursing (CCNE) (current)
Education:
BSN (1964), Syracuse University
MSN (1976), UCLA
MPH,(1981), University of Hawaii
PhD,(1993), UNC-Chapel Hill
Other Comments:
I have not recently been involved in local community service and wish to again become
active locally. My mother was rather briefly in two skilled nursing facilities in Orange
County prior to her death a few years ago, and I became aware of the needs for
14
Page 2 of 2
Beverly Foster
monitoring and service improvement in this area. At my age I realize I may be a user of
these services myself! I believe my background in nursing education, accreditation and
regulation may be of use to the committee. STAFF COMMENTS: Originally applied for
Nursing Home Community Advisory Committee 2-10-2011. ADDRESS JURISDICTION:
2454 Springview Trail, CH, is in CH Township and CH Jurisdiction.
This application was current on: 2/10/2011 7:20:17 AM Date Printed: 9/28/2011
15
Page 1 of 2
Joyce Jefferies
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms Joyce Jefferies
4820 NC Hwy 54 West
Chapel Hill NC 27516
(919)425-3597
(919)720-6115
(919)425-3529
joyceJefferies@dentistry.unc.edu
UNC School of Dentistry
Administrative Assistant
1962
Chapel Hill
Does not apply
Female
African American
7/23/1955
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Nursing Home Community Advisory Committee
Advisory Board on Aging
Work Experience:
Employed by UNC Hospitals and UNC-Chapel Hill since 1973 first as a dietary assistant
now an Administrative Assistant in Dentistry where I perform a variety of functions
including accounting, billing, preparing check requests to pay bills, arranging travel,
coordinating meetings, preparing meeting agendas, ordering supplies, budgeting,
preparing reports, drafting letters, etc. I would like to serve on the Advisory Boards
because I am experiencing first-hand, in regards to my elderly mother, in trying to find an
affordable assisted-living facility in good standard that really uphold the care and the
best interest of their residents. Also the assurance of knowing that these facilities are
being governed by guidelines, rules and regulations that they have to adhere to and that
there are committees to visit these faciliteis to ensure that these guidelines are being
carry out. It is difficult enough to have to place our elderly family members in a facility
but having the reassurance in knowing that they are being well taken care of makes this
transition a lot more bearable.
Volunteer Experience:
I volunteer at my church, Hospitality- serving guests of the Pastor and greeting members
as they enter the church, Sisters of Jubilee- visiting the Women prisons in Raleigh,
organizing birthday parties, prayer and fellowship, visiting the sick and shut in.
16
Page 2 of 2
Joyce Jefferies
Education:
I received my GED from Durham Technical Institute and enrolled in the Business
Administration Associate Degree Program, also at Durham Tech.
Other Comments:
I feel that I am at the place in my life mentally, physically and spiritually where I have a lot
to offer in reaching out and assisting others through community involvement, etc. I look
at volunteering as a personal committment just as rewarding to me as to the area that I
am volunteering in. I get a joy in being able to be a contributor and not just an on-looking
in seeing what needs to be done or what can be done but never makein an effort to try
and make a difference. I enjoy working with others in like causes and like minds, even
though having differenc appreaches but seeking to reach the same goal. STAFF
COMMENTS: Originally applied 11/03/2010 for Adult Care Home community Advisory
Committee, Nursing Home Communtiy Advisory Colmmittee, and Advisory Board on
Aging. ADDRESS VERIFICATION: 4820 NC Hwy 54 West is in Bingham Township and
Orange County Jurisdiction.
This application was current on: 11/3/2010 2:36:29 PM Date Printed: 9/28/2011
17
Page 1 of 1
Sandra Lemons
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Sandra Lemons
1321 Brookhollow Road
Efland NC 27243
9199718385
9199718385
SandraL@umrh.org
Croasdaile Village
Administrative Assistant Plant Operations
1955
Cheeks
Female
Caucasian
10/6/1955
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
UNC-CH Medical School Admissions Office 16 yrs; Orange County Schools 7 yrs;
Croasdaile Village 3 yrs
Volunteer Experience:
School and Church
Education:
Chapel Hill High School; King's College, Charlotte NC; King's College, Raleigh NC
Other Comments:
Working for a large retirement center with several levels of care including skilled nursing,
I know the importance of quality care for residents. I am required to complete online staff
development on Resident Rights, Preventing Resident Abuse, Sexual Harassment,
HIPPA, Corporate Compliance; Alzheimer's; Slips, Trips and Falls to name a few. I feel
that I could serve Orange County with this knowledge to make sure that the facilities in
our county give the best quality care and safest living environment to residents. STAFF
COMMENTS: Originally applied for Nursing Home Community Advisory Committee
02/11/2011. ADDRESS VERIFICATION: 1321 Brookhollow Road, Efland, NC is in
Orange County Jurisdiction, Cheeks Township.
This application was current on: 2/11/2011 8:48:46 AM Date Printed: 9/28/2011
18
Page 1 of 2
Max Mason
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Mr. Max Mason
821 Tinkerbell Rd.
Chapel Hill NC 27517
9196497937
maxomason@yahoo.com
Principle Long Term Care, Inc.
Development Coordinator
1978
Chapel Hill
Does not apply
Male
Caucasian
7/27/1977
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Development Coordinator for one of NC's largest long term care providers. Plan for
development of nursing facilities, hospices, and home health agency. Administrator for
residential recovery facility for pregnant women who struggled with substance abuse.
Volunteer Experience:
Serve on the Community Grantmaking Committee at the Triangle Community Foundation.
Board Member, Chrysalis Foundation for Mental Health
Member of APPLES Service Learning program at UNC-Chapel Hill as undergraduate.
Education:
BA, History, U NC-Chapel Hill
MA, Slavic Languages & Literatures, UNC-Chapel Hill
Current student (part-time): Masters of Healthcare Administration, UNC-Chapel Hill
Gillings School of Public Health
Other Comments:
As noted, I am presently a student in public health and currently work in the field of long
term care; thus, I have a great interest in the issues affecting nursing facility residents.
Given my experience and familiarity with this segment of the health care system,
believe I would be a valuable addition to this committee. STAFF COMMENTS:
Originally applied (1/24/2011) for Nursing Home Community Advisory Committee.
ADDRESS VERIFICATION: 821 Tinkerbell Road is in Chapel Hill Township.
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Max Mason
This application was current on: 1/25/2011 9:11:51 AM Date Printed: 9/28/2011
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charles mcmullen
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
mr charles mcmullen
108 jones ave
hillsborough NC 27278
9197329083
9192603879
cmcmullen1 @nc.rr.com
retired
1993
Hillsborough
Does not apply
Male
Caucasian
8/22/1946
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Board of Health
Work Experience:
almost 50 yrs in various fields of nsg.
Volunteer Experience:
Education:
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home Community Advisory
Committee, Adult Care Home Community Advisory Committee, and Board of Health
02/10/2011. ADDRESS VERIFICATION: 108 Jones Avenue is in Hillsborough
Jurisdiction, Hillsborough Township.
This application was current on: 2/10/2011 10:59:02 AM Date Printed: 9/28/2011
21
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Vickie Webb
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Vickie Webb
150 Lawndale Ave
Hillsborough NC 27278
919-491-1073
919-241-4482
919-560-1107
jb29@nc.rr.com
City of Durham
Billing Specialist
1989
Hillsborough
Does not apply
Female
African American
9/28/1956
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
My work experience is limited to providing in home care to the elderly who wish to remain
in their homes as long as possible. I provided basic daily assistance with medication, and
personal hygiene, as well as food preparation.
Volunteer Experience:
My volunteer experience is limited to the time I spent in a nursing facility in which my
mother was a resident, and I would go in a help with feedings and companionship of
some selected residents
Education:
I have a high school diploma, and am currently enrolled in an online course to obtain an
Associates degree in Arts with a foundation in business, and am due to graduate in
September 2011.
Other Comments:
I am interested in serving on this committee because I care about people. I especially
care about the people who can not longer care, or speak for themselves. During my
mothers stay at a local nursing home, I was an advocate for her as well as other
residents who either had no family or distant family. I got along well with the staff of the
facility and was very much respected as well as showing respect for the jobs they
performed. STAFF COMMENTS: Originally applied for Nursing Home Community
Advisory Committee 02/10/2011. ADDRESS VERIFICATION: 150 Lawndale Avenue is
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Vickie Webb
in Hillsborough Jurisdiction, Hillsborough Township.
This application was current on: 2/10/2011 10:20:40 PM Date Printed: 9/28/2011
23
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Tiki Windley
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Ms. Tiki Windley
119 Cynthia Drive
Chapel Hill NC 27514
919-969-8583
919-942-4392
tiki Windley@yahoo.com
MDC, inc.
Program Manager
2007
Chapel Hill
Female
African American
Date of Birth: 11/6/1971
Boards/Commissions applied for:
Board of Social Services
Nursing Home Community Advisory Committee
Work Experience:
MDC, Inc. 2006 to Present Program Manager whose duties include meeting facilitation,
training, free tax preparation, asset-building and making presentations. Prior experience
includes teaching financial literacy to high school students and their families, housing
counseling, working with ex-offenders and community engagement and organization.
Current experience includes meeting facilitation, training, oral presentations, community
engagement and organization.
Prior experience includes teaching financial literacy to high school students, asset
education, free tax preparation an housing counseling.
Volunteer Experience:
Meeting facilitation, event planning, volunteer supervision Site coordinator for free tax
preparation site
Escort for Project Homeless Connect (Orange County)
smith Middle School School Improvement Team
Triangle United Way Orange Accountability Committee
Triangle United Way Regional Initiative Task Force
NC Indian Economic Development Initiative Project G-7
Steering Committee
Assets Educator: Community Success Initiative
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Tiki Windley
NC Second Chance Alliance Escort, Project Homeless Connect (Orange County) 2009
Chairman, Guest Outreach, Project Homeless Connect, 2010
Triangle United Way Orange Accountability Committee
Triangle United Way Regional Task Force Initiative
Assets educator, Community Success Initiative
Project G-7 Steering Committee, NC Indian Economic Development
NC Second Chance Alliance
NC Assets Alliance Escort, Project Homeless Connect (Orange County) 2009
Chairman, Guest Outreach, Project Homeless Connect, 2010
Triangle United Way Orange Accountability Committee
Triangle United Way Regional Task Force Initiative
Assets educator, Community Success Initiative
Project G-7 Steering Committee, NC Indian Economic Development
NC Second Chance Alliance
NC Assets Alliance
Escort, Project Homeless Connect (Orange County) 2009
Chairman, Guest Outreach, Project Homeless Connect, 2010
Triangle United Way Orange Accountability Committee
Triangle United Way Regional Task Force Initiative
Assets educator, Community Success Initiative
Project G-7 Steering Committee, NC Indian Economic Development
NC Second Chance Alliance
NC Assets Alliance
Education:
Bachelor of Science, Elizabeth City State University 1997
Master of Public Administration, NC Central University, 2010
Elizabeth City State University, 1997
Master in Public Administration
NC Central University, December 2010
Other Comments:
I would like to provide a voice for those citizens who feel they are unheard in our
communoury. STAFF COMMENTS: Originally applied for Commission for Women,
Board of Social Services & Adult Care Home Community Advisory Committee 10/6/09.
Aopplied for Human Relations Commission, Boad of Social Services, & Nursing Home
Community Advisory Committee 05/27/2010. ADDRESS VERIFICATION: 119 Cynthia
Drive, Chapel Hill is Chapel Hill township, CH jurisdiction.
This application was current on: 5/27/2010 Date Printed: 9/28/2011
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Tracey Yap
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Year of OC Residence:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Dr. Tracey Yap
834 Providence Glen Drive
Chapel Hill NC 27514
502.686.0016
919.240.4793
tracey.yap@duke.edu
Duke University School of Nursing
Assistant Professor
2011
Chapel Hill
Female
Caucasian
7/13/1968
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Advisory Board on Aging
Board of Health
Work Experience:
Deputy-Director of Nursing for NIOSH sponsored Education and Research Center,
University of Cincinnati
Funded research grants related to long-term care
Volunteer Experience:
Education:
RN, PhD
Other Comments:
STAFF COMMENTS: 09/20/2011 applied for Nursing Home Community Advisory
Committee, Advisory Board on Aging, and Board of Health. ADDRESS JURISDICTION:
834 Providence Glen Drive is CH Township.
This application was current on: 9/20/2011 3:41:57 PM Date Printed: 9/28/2011