The URL can be used to link to this page

Home My WebLink AboutAgenda - 12-13-2011 - 12EORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 13, 2011 Action Agenda Item No. ~ a - e SUBJECT• Orange County Nursing Home Community Advisory Committee -Appointment DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Under Separate Cover Membership Roster 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 INFORMATION CONTACT: Clerk's Office, 245-2130 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 Dr. Tracey Yap. If appointed Dr. Yap will be serving cone-year training term expiring 01/30/2013. Position Number S ecial Re resentation Ex iration Date 1 Dr. Trace Ya At-Lar e 01/30/2013 FINANCIAL IMPACT: None RECOMMENDATION(S): Consider making an appointment to the Orange County Nursing Home Community Advisory Committee. 2 ~ ~ ~ o o~ o o ~ o ~ ~ .~ C - N t N N O N N ~p ~ ~ [~ '. N O ~ ~p O ~ r O ~ ~--i ..r N N N T N O N O ~ O ~ i N ~ ~ \ O ~ \ +' M O cn ~ -, c~ ` cn . -i ~ .r d' c+i ~ ~ O O O M O t 1 O O O O~ O O O O ~ O 'b LA ~ y b N Y ~ Q ~ ~ C .. ~y ~ p ~ ~ w, ri C ~ O N 6~ fi ~ .. h n •o ~ w F, .o ~~ H •o C ~ ~ F a s ~ H a a ~ H ~ ~? a 'o k o a Q 'o k o °' a 'o k o °' ¢ 'o ~' x W o ~'' ¢ p x W o ~ .b ~ Q a W „ p a W Q ,. t a Q W ~ ~ ~ Qo ~, . ~ ^O ^ ¢ i ! C ~ ~ N Q "' N H ~" Vi ! G y z z ti ~ ~ r` V r' V ~1 V _ U _ U y E., S ~ ~ p ~ ^ T/1 V1 p ~ ~ y iA '+ U O+ b Q ~ ~ ~" °> -~ ~ x ~ °° ~ _ O i y y i ~ m a O N a~ ': '" ~ °' ~ ~ ~ ~ ~ Q x h O '~' > eC i ~ ~ ~ ^ ~ ~ b0 i OD s y 'y W p ~0 bD ~ y ~/ hD ~ 00 F.N ~ ~N ~ ~ .L" ~ ~ ~ N c v N p d a ~ L c ~ ~ y c C ~ ~ U U Q Q ~ U x Q Q w U x Q ¢y' ~ w U :a ¢ Q d z ~ .a a i Q • "i c . Xi . hi ¢• ~ R y c~i fi. ~ P. ' aXi c~i 0. y ~ p. aXi c~i °. ~ ~ ~ ~ a ~ a a c . ~ ~ 3 ~ ~ ~ ~ 3 ¢. . O ~ ~--~ h c ^ ^ a~ °~ R ~ ~ N, L/1 ' ~ N ~*~ .~ CJ~ •~ o P-+ ~,; ~ .~ ~ ~ ~.~.~ o U y ~ H ~. ~ o H O o ~ ~ ~ ~ ~ ~ ~ ® t N ,~~+' ~ ~ ~ .. Q` .~ ~ O O A ~ ~ ,~ ~ N ~ V Q~ E h _ p y O ~ °0 ~ 00 ~ ~ ~ y~j O N O ~ n C w N Lt+ c .~ rn ~ rn ~ ~ N M cn ~ W ~ Q a~ ~ ~ Q ~ ~ ~ ~ ~ O „ ~ ~1 ?~ w N rn rn . . y .. rn rn W .. v ~ z n. o, H vz .. ~ p G ~ ~c~ ~ Gp". C .~ A C ~ ~cC ~ ~ cd ~ G ~ ~ O . .y H o ~ o ~ ~ w o ,~ o ¢ .~ w ~ ,~ .°c Gti ~ .~ .~ w ~ .~ .~ rte, , _ •~ ~ . a . s W a s , W a s W a s W a s W y C d ~+ _ Ld Lei [ ~ I~ C'd ~ [ 7 C ~~. • IT"~ `v ~ OU ~ C ~ y w / ~ H ~,~' Q ~ / ~ H 'Ly a~ / ~ I--1 ~ Lei a~ ( ~ ^ Ci o ~ O ~~ Fay. V a~ w e~ w W w W •H N .o r M ~ td LL^ • ~ 1}~ y Y ~ ~ h A F ; N N ~ V o ~ ~ ~ Y ~ C ~ ~ ~ ~ W ~ C ~ ~ U~ ~ 3 A ~ ~ ~ y ~ N ~ ~ .~ ~ ,"' Q N c~ r` ~ O C G ~, ~ '~ N O b N ~ ~ ~ O v ~ o . T 'q ;, ~, A ~ ~, ~' ~ z ~ U ~, z ~ U z h C% ~ O z r~ ~ ~ C _ .'Y~i ~ x ~ C/1 O .. ~ . ~ . ~ '~ ~-+~ -~ o .~ x ~ 'd US A ~ 3A '~ ~ y Z ° ~ ° U `~ x ~ ~ c " .~ ~ W U • ~Q ~ ~ ~ ~ ~ 1~~ ~ ICy . -.. N cn et ~' P. 0 N a 0 z -~ d 3 3 ,~ .O L~ .••-~ C!1 ^^O~ • ~ F""1 ~O V !'~'~ v m H O y ~ 0 3 ~~ ~ ~ h ~ ° v ~ U C z ~ :~ G ~O ~ .Ci.. H rn o 'R ~ ~ R,~ O ~ y^ ca ~y O~ S' N OD U a ~ y. W y C y O b ~ C .~ •> a`i .~ pj ° a w y o. ~ ro ~ °m 0 0 ~ ~ U U ~ o 0 c ~' U it •C ~ j. Y U. N cn .- a~i .C ~ 00 N ~ ~ ~ ~ ao~ ~ ~ H ~ O ~_ s +s 3 ~ m N 0 in ~ ~p O .~ 'y V O rV QI ~ C. L H ~ ~ N JOn N N C ~ c ~1 o F-~., O ~ ~^ V -- .~ 3 ~ ° o ~° U •P: h ~ c ~ ~~ y ~ ? >, M G ~y Op O O p C IV .-yi 0 O ~ O O 7` U y C 'd 0 C N 0 `oW~° E a O C 0. y QOM. NRQ~ .b ~~, ~ ~> 0 ~.° ;;aa ~H w o ~' c ~ .Q •~ ~ ~ A 0 N 0 O ~ ~ ~ ~ O ~ O ~ N . ~ N N N o .-~ ~ ~ o ~., o ~ -~ o ' ~ , ~o -, .. 0 0 0, 0 ~ 0 '~ 0 `0 0 0 0 0 C " N O ~,' w ~ O O Y ~"+ ~ y O E ~ N am. ~q., ~ N ~' d c N a ~ o K ~ w o ~ °' ~ Q o ~ k w o y - Q ~, ~ K R. w o ~ . Q '° Q ~ ¢ Y ~ w ~ ' z s w ~ ~ ~ z w °~' Z ~j ~ U U :~ v _ Q ~~~. _ O eC~d .Ti ~ x00 ~ ~ xi m 000 ~,. 8 ~ ~ ~? ~ E ~ w U U~ z w U U Q Q ie ~ p. o" ~ x °3 a. ~ a, ~ ~ :~ ~ ~ ~n ~ :c ~ ~ ~o a. ~ o. .N ~ •y ~ W 8 0 U .~ ~~b~"0\\ ~ ~ V h ~ 0o a0 ~ ~/'~ ~ 00 00 G M W N N ~ ~ C ~ .~ a a u" ~ w a A 'C W Q ~" N ~~+ /-~ N °' z Ax U ~ M ~. v°-, U a v cn ~ O tCr 3 O~ O h N y T ~„ O~ ~ w Q ~ ~ ~cd w a w ~ w .~ Q ~ W C N Qz o a ~x ~ ~ o. ~ en U r _ ~-+ N O O N N ~ ~ ~ 0 0 0 C ~ ~ o ~ O ~ t-i E"~ a .~ !3' O X O ~ W ~ -° R. ~ ~ ~ z U o ~., O ^~ N ~ N Q~ D\ O N _. r, ~o o ~o 0 0 ~ ~ C y± O ~" G G ~ N ~ ~ .~ ~ a. •o K o d ¢ w ~ A [s, ~ ~ z U i., 0 R xi ~ ~ ~, ~ ~ b00 0M ~ cy .~. 00L0 b0D ~ V U Q Q w U a d Q w U U Q Q ~ ~ ~ ~ ~ ~ ~ ~ ~ o ~ ~ a p; ~ o a •~ o a 'v i O v~ ~ 8 U bd ~O h n h y N ~ ~ ~ ~1r 'v ~ ~ t¢ a a w c Q •o W 0 .~-w >~ Q N ~ ~O U :~ 3 z ~ b x 0 3 ;, .~ ~ ~ U ~.: Q 00 0 U O O d' ~ c~1 T .N-' vri ~ 7 O l~ N O~ ~O W l~ Vl 0 ~D 7 0. ~ 01 O~ 'y N 0\ O\ Q> y Li Ci ~ ~Cd w ' w °° Ga 'a W •y r Q N U ~ a z Q x ~~ 0 a~ ~ h x vi I o. t C ~ O ~O O ~ 0 U O O~ y R Q •~ k. ~ W Q •~ aCi W N ~,[~ n ~ ~ z .~ ~ x U w ;, ""' a o ~ ~ ~ U P1 vi 0 N N a O N 0 v 3 4 0 0 C O' ~ N ~ m ~^ -~ ~" c E o ~ ~ p ~ ~ C o 5 0 . ~ •o ~~, ~ ~ 'c o a ~o ~ ~ ~ ~o F 3 ~ ? v ¢ ~ x W o ~ Q X W n~' o ~ ~ ° Q . ¢ s~ ~, O V~ w ~ ~ ~ C ~ w !" ~ ~ A v~ v 17 T^ Vl ~ O~, ~ y oo d .~ U Q, rn p C G m ~ H 1~ .1 h ('i ~_ ~ bD h0 t0 00 QI QI y 1-~ 7 "'? U ~ U ;, ~ ¢ z ¢ z Q~ a a~ E ~ ~ a ~ y ', ~ ~ g a°i a. U U ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ y ' .... O ~ `~ C," o U ~ ~ ~ G 3 o U "~ a .v ° ° ~" -o a ; ~ v a O ~ r U a C fA V] v! ~ .~ ~ ~ y O T U V1 'n N cn .° F., . s.. H. a^~ ~ C ~ ° F~ ~ U a 3 - ~ p ~ ~ \J ~ C o U.~ ~ V y U O O w a•=~ ti F .~ ~ ° F. o o ¢ ~ o o Q ~ ~ , UY ~~~ ~ ~ w a a w 3 a y 0 c3 b y o~ „° U W W M N ~ W l ~ 'b m- O ~ ~ ~ ° z ~ D C ~ . ° .--1 ~ ° pi O N U a.+ ~ ~ +~ d L' Y d W U d •°- ~Q U a ~~a ~ o ~ ~ ° ~ a:~ ~ vl N ~ > N N Q a. ~ ~ C . ~H w .o ~ ~ ~ ~ .a ~ ~ ~ ~ Q ~ ~ 1 '~+ C~0 - a 0 N b d .D z v -°° ° 3 Page 1 of 1 Jeanette Jones From: Charlotte Terwilliger [cewwilliger@tjcog.org] Sent: Thursday, November 10, 2011 10:36 AM To: Jeanette Jones ' Subject: Recommendation for NH Community Advisory Committee Dear Jeanette, The Nursing Home Community Advisory Committee would like to recommend Dr Tracey Yap for a one year training term. Arthur St John's term will expire in January 2012 and he will be leaving the committee at that time and the committee would like Dr Yap to fill his slot. Dr Yap 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. Her background is geriatrics and she has received research grants related to long term care. Please let me know if you need additional information to move Dr Yap'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 ct_erwilliger@tjcog.o_ rg / vvww.tjcog_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. !+~ 6 Page 1 of 1 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: 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 Sex: Female Ethnic Background: Caucasian Date of Birth: 7/13/1968 BoardslCommissions 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: 11/16/2011 7 Applicant Interest- Listing Nursing Home Community Advisory Committee Mr. Jack S. Chestnut 4303 Hope Valley Drive Hillsborough NC 27278 Skills: . C.H. SENIOR CNTR PROGR PART Skills: Caro] Woods Retirement Center Skills: HUD202 Housing for Elderly Boazd M Ms. T. L. Crews 4921 Guess Rd Rougmeont NC 27572 Skills: School Principal Skills: Tutor Dr. Beverly Foster 2454 Springview Trail Chapel Hill NC 27514 Skills: Nursing Management Education by Board Name and by Applicant Name Contact Person: Charlotte Terwilliger, MSW Contact Phone: 919-558-9401 - Day Phone: 919-732-1242 Sex: Male Evening Phone: 919-732-1242 Race: Caucasian FAX: Township: Hillsborough E-mail: jackchestnut@!aol.com Date Applied: 05/24/2010 Also Serves On: Also Serves On: Also Serves On: Day Phone: 919 732-6974 Sex: Female Evening Phone: 919 732-6974 Race: African American Fpx: Township: Litt]e River E-mail: crewsez@aol.com Date Applied: 08/21/2011 Also Serves On: Also Serves On: Day Phone: 919 966-4995 Sex: Female Evening Phone: 919 967-2930 Race: Caucasian FAX: 919 843-6212 Township: Chapel Hill E-mail: Bev_Foster@unc.edu Date Applied: 02/10/2011 Also Serves On: Ms Joyce Jefferies 4820 NC Hwy 54 West Chapel Hill NC 27516 Stalls: Administrative Assistant Ms. Sandra Lemons 1321 Brookhollow Road Efland NC 27243 Sills: .Administrative Assistant Day Phone: (91925-3597 Evening Phone: (919)720-6115 FAX: (91925-3529 E-mail: joyce_jefferies@dentistry.unc.edu Also Serves On: Day Phone: 9199718385 Evening Phone: 9199718385 FAX: E-mail: SandraL@umrh.org Also Serves On: Sex: Female Race: African American Township: Chapel Hill Date Applied: 11/03/2010 Sex: Female Race: Caucasian Township: Cheeks Date. Applied: 02/11/2011 Wednesday, November 16, 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 MT. 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-Terre Caze Also Serves On: Adult Caze Home Community Advisory Committee Skills: Public Health TT1I ChaTleS 111CT11U~10n Day Phone: 9197329083 Sex: Male 108 Jones ave Evening Phone: 9192603879 Race: Caucasian hillsborough NC 27278 FAX: Township: Hillsborough E-mail: cmcmullenl@nc.rr.com Date Applied: 02/10/2011 Skills: -Nursing Profession Also Serves On: Adult Caze Home Community Advisory Committee Ms. Vickie Webb Day Phone: 919-491-1073 Sex: Female 150 Lawndale Ave Evening Phone: 919-241 X482 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. Tlkl Wlndley Day Phone: 919-969-8583 Sex: Female 119 Cynthia Drive Evening Phone: 919-942-4392 Race: Afi-ican American Chapel Hil] NC 27514 FAX: Township: Chapel Hill E-mail: tiki_windtey@yahoo.com Date Applied: 05/27/2010 Skills: Also Serves On: Dl". Tl'aCey 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 Hilk E-mail: tracey.yap@duke.edu --_ Date Applied: 09/20/2011 Skills: Director Also Serves On: Skills: Nurse Also Serves On: Wednesday, November 16, 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 AHAB. 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: 11/16/2011 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 Page 2 of 2 T. L. Crews Education: NI.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: 11/16/2011 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 Iicensure 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 oft 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: 11/16/2011 15 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: 11/16/2011 16 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, UNC-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, I 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. 17 Page 2 of 2 Max Mason This application was current on: 1/25/2011 9:11:51 AM Date Printed: 11/16!2011 18 Page 1 of 1 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: mr charles mcmullen 108 jones ave hillsborough NC 27278 9197329083 9192603879 cmcmullen1 @nc.rr.com retired Year of OC Residence: 1993 Township of Residence: Hillsborough Zone of Residence: Does not apply Sex: Male Ethnic Background: Caucasian Date of Birth: 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: 11/16/2011 19 Page 1 of 2 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: 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 Township of Residence: Hillsborough Zone of Residence: Does not apply Sex: Female Ethnic Background: African American Date of Birth: 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 20 Page 2 of 2 Vickie Webb in Hillsborough Jurisdiction, Hillsborough Township. This application was current on: 2/1 0/201 1 1 0:20:40 PM Date Printed: 11/16/2011 21 Page 1 of 2 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 22 Page 2 of 2 Tiki Windlev 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 NCAssets 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 Comrments: 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: 11/16/2011