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HomeMy WebLinkAboutAgenda - 02-19-2013-11a ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date:February 19, 2013 Action Agenda Item No.11-a SUBJECT: Orange County Nursing Home Community Advisory Committee –Appointment DEPARTMENT:PUBLIC HEARING: (Y/N)No Board of Commissioners ATTACHMENT(S): INFORMATION CONTACT: Under Separate Cover 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 makinganappointment to the Orange County Nursing Home Community Advisory Committee. BACKGROUND: The following appointmentisfor Board consideration: Appointment to a first fullterm for Dr. Tracey Yap.Dr. Yap completed a one-year training term as of 01/30/2013. If appointed Dr. Yap willbe serving a first full term expiring 01/30/2016. Position NumberSpecial RepresentationExpiration Date 1Dr. Tracey YapAt-Large01/30/2016 FINANCIAL IMPACT: None RECOMMENDATION(S): Consider making an appointmentto the Orange County Nursing HomeCommunity Advisory Committee. 2 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee 11 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. Dr. Tracey Yap 834 Providence Glen Drive Chapel Hill NC 27514 Mr Elijah (Ed) Flowers, III 2 Chair 2813 Beckett's Ridge Drive Hillsborough NC 27278 Day Phone: 502.686.0016 Evening Phone: 919.240.4793 FAX: E -mail: tracey.yap@duke.edu Day Phone: 919 - 357 -9256 Evening Phone: 919 - 357 -9256 FAX: E -mail: ed_ flowers @yahoo.com Day Phone: (919) 241 -4071 Evening Phone: Same FAX: N/A E -mail: prevelsOOI@nc.rr.com Day Phone: 919 - 479 -5661 Evening Phone: same FAX: E -mail: Sharon.karnash @gmail.com Day Phone: Evening Phone: FAX: E -mail: Sex: Female First Appointed: 12/13/2011 Race: Caucasian Current Appointment: 12/13/2011 Township: Chapel Hill Expiration: 01/30/2013 Resid /Spec Req: At -Large Number of Terms: Special Repr: At -Large Sex: Male First Appointed: 03/06/2008 Race: Caucasian Current Appointment: 02/21/2012 Township: Hillsborough Expiration: 03/31/2015 Resid /Spec Req: At -Large Number of Terms: 2 Special Repr: At -Large Sex: Female First Appointed: 03/06/2008 Race: Caucasian Current Appointment: 02/21/2012 Township: Hillsborough Expiration: 03/31/2015 Resid /Spec Req: At -Large Number of Terms: 2 Special Repr: At -Large Sex: Female First Appointed: 06/12/2007 Race: Caucasian Current Appointment: 04/19/2011 Township: Little River Expiration: 06/30/2014 Resid /Spec Req: At -Large 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 Friday, February 08, 2013 Page 1 3 Board and C 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. Ms. Vicki Barringer Day Phone: 919 - 971 -9333 Sex: Female First Appointed: 03/22/2012 6 Evening Phone: 919 - 971 -9333 Race: Caucasian Current Appointment: 03/22/2012 3612 Old Vine Trail FAX: Township: Eno Expiration: 03/31/2013 Hillsborough NC 27278 E -mail: vbarringer @gmail.com Resid /Spec Req: At -Large Number of Terms: Special Repr: Nursing Home Administration VACANT Day Phone: Sex: First Appointed: 7 Evening Phone: Race: Current Appointment: FAX: Township: Expiration: 06/01/2014 E -mail: Resid /Spec Req: At -Large Number of Terms: Special Repr: At -Large Dr. Mario Battigelli Day Phone: 919 - 942 -5756 Sex: Male First Appointed: 03/16/2010 8 Evening Phone: Race: Caucasian Current Appointment: 04/19/2011 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 9 Evening Phone: 919 - 479 -0574 Race: Caucasian Current Appointment: 03/22/2012 5512 Quail Hollow Drive FAX: 919 - 956 -7703 Township: Little River Expiration: 04/19/2015 Hillsborough NC 27278 E -mail: susiedeter @yahoo.com Resid /Spec Req: At -Large Number of Terms: 1 Special Repr: At -Large Dr Mary Ann Peter Day Phone: 919 - 732 -6073 Sex: Female First Appointed: 01/24/2012 10 Evening Phone: Race: Caucasian Current Appointment: 01/24/2012 118 W. Tryon St. FAX: Township: Hillsborough Expiration: 06/30/2013 Hillsborough NC 27278 E -mail: maryannpeter @earthlink.net Resid /Spec Req: At -Large Number of Terms: 1 Special Repr: At -Large Friday, February 08, 2013 Page 2 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: Sex: First Appointed: 11 Evening Phone: Race: Current Appointment: FAX: Township: Expiration: 12/31/2010 E -mail: Resid /Spec Req: At -Large Number of Terms: Special Repr: Nursing Home Administration VACANT Day Phone: Sex: First Appointed: 12 Evening Phone: Race: Current Appointment: FAX: Township: Expiration: 12/31/2010 E -mail: Resid /Spec Req: At -Large Number of Terms: Special Repr: Nursing Home Administration Friday, February 08, 2013 Page 3 Page 1 of 1Tracey Yap Volunteer Application Orange County Advisory Boards and Commissions Dr. Tracey Yap Name: Name Called: 834 Providence Glen Drive Home Address: Chapel Hill NC 27514 502.686.0016 Phone (Day): 919.240.4793 Phone (Evening): Phone (Cell): tracey.yap@duke.edu Email: Duke University School of Nursing Place of Employment: Assistant Professor Job Title: 2011 Year of OC Residence: Chapel Hill Township of Residence: - Zone of Residence: Female Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Board of Health Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Deputy-Director of Nursing for NIOSH sponsored Research Center, University of Cincinnati Funded research grants related to long-term care Education: RN, PhD Other Comments: STAFF COMMENTS: 09/20/2011 applied for Nursing Home Community A Committee, Advisory Board on Aging, and Board of Health. ADDRES 834 Providence Glen Drive is CH Township. 9/20/2011 3:41:57 PM2/6/2013 This application was current on:Date Printed: 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 919-732-1242Male Day Phone: Mr.Jack S. Chestnut Sex: 4303 Hope Valley Drive919-732-1242Caucasian Evening Phone: Race: Hillsborough NC 27278Hillsborough Cell Phone:Township: E-mail:jackchestnut@!aol.com Date Applied:05/24/2010 Skills:Also Serves On: . C.H. SENIOR CNTR. PROGR. PART Skills:Also Serves On: Carol Woods Retirement Center Skills:Also Serves On: HUD202 Housing for Elderly Board Me 919 732-6974Female Day Phone: Ms.T. L. Crews Sex: 4921 Guess Rd Evening Phone:919 732-6974African American Race: Rougmeont NC 27572 Cell Phone:Township:Little River crewsez@aol.com08/21/2011 E-mail:Date Applied: Skills:Also Serves On: School PrincipalAdult Care Home Community Advisory Committee Skills: Tutor Day Phone:919 966-4995Female Dr.Beverly Foster Sex: 2454 Springview Trail Evening Phone:919 967-2930Caucasian Race: Chapel Hill NC 27514Chapel Hill Cell Phone:Township: Bev_Foster@unc.edu02/10/2011 E-mail:Date Applied: Skills:Also Serves On: Nursing Management Education Day Phone:(919)425-3597Female MsJoyce Jefferies Sex: 4820 NC Hwy 54 West Evening Phone:(919)720-6115African American Race: Chapel Hill NC 27516Chapel Hill Cell Phone:Township: joyce_jefferies@dentistry.unc.edu11/03/2010 E-mail:Date Applied: Skills:Also Serves On: Administrative Assistant Day Phone:828-668-9628Female Ms.Sandra Jones Sex: 600 West Poplar Ave., Apt. 239 Evening Phone:Caucasian Race: Carrboro NC 27510828-712-2362Chapel Hill Cell Phone:Township: None01/22/2013 E-mail:Date Applied: Skills:Also Serves On: Skills:Also Serves On: Geriatric Care Skills:Also Serves On: Nurse Wednesday, February 06, 2013Page 1 of 2 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 9199718385Female Day Phone: Ms.Sandra Lemons Sex: 1321 Brookhollow Road9199718385Caucasian Evening Phone: Race: Efland NC 27243Cheeks Cell Phone:Township: E-mail:SandraL@umrh.org Date Applied:02/11/2011 Skills:Also Serves On: Administrative Assistant 9196497937Male Day Phone: Mr.Max Mason Sex: 821 Tinkerbell Rd.Caucasian Evening Phone: Race: Chapel Hill NC 27517Chapel Hill Cell Phone:Township: E-mail:maxomason@yahoo.com Date Applied:01/25/2011 Skills:Also Serves On: Long-Term CareAdult Care Home Community Advisory Committee Skills:Public Health 9197329083Male Day Phone: Mr.Charles McMullen Sex: 108 Jones Avenue9192603879Caucasian Evening Phone: Race: Hillsborough NC 27278 Cell Phone:Township:Hillsborough E-mail:cmcmullen1@nc.rr.com Date Applied:02/10/2011 Skills:Nursing ProfessionAlso Serves On: 919-491-1073Female Day Phone: Ms.Vickie Webb Sex: 150 Lawndale Ave919-241-4482African American Evening Phone: Race: Hillsborough NC 27278 Cell Phone:Township:Hillsborough E-mail:jb29@nc.rr.com Date Applied:02/10/2011 Skills:Accounting ExperienceAlso Serves On: 919-969-8583Female Day Phone: Ms.Tiki Windley Sex: 119 Cynthia Drive919-942-4392African American Evening Phone: Race: Chapel Hill NC 27514 Cell Phone:Township:Chapel Hill E-mail:tiki_windley@yahoo.com Date Applied:05/27/2010 Skills:Financial AdvisorAlso Serves On: Wednesday, February 06, 2013Page 2 of 2 Page 1 of 2Jack S. Chestnut Volunteer Application Orange County Advisory Boards and Commissions Mr. Jack S. Chestnut Name: Name Called: 4303 Hope Valley Drive Home Address: Hillsborough NC 27278 919-732-1242 Phone (Day): 919-732-1242 Phone (Evening): Phone (Cell): jackchestnut@!aol.com Email: Retired Place of Employment: Job Title: Year of OC Residence: Hillsborough Township of Residence: . . . Zone of Residence: Male Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Director, Community Contact/Special Project, Ca Retirement Center. 21 years at Carol Woods Retirement Community Residential services. Responsible for housing issues- maintenanc worked for Carol Woods Retirement Center for 30 years. The first Director of Facility Services . The last 10 years I was the Dire and Special Projects. Volunteer Experience: Chair of the Advisory Board on Aging; OC A Board; Chapel Hill Friends Board. (Current 1/13/04) ; Board Memb Housing (HUD 202) - 8 years; Rotarian- 9 years- volunteer repair homes; Friends of the Chapel Hill Senior Center -board, Chapel H Rotary Board Member, Orange County Capital Needs Task Force Memb springs Homeowners Association Board Member, North Carolina Inde with services advisory committee.Attended Yuba City College, Hav work shops. 30 years of experience working with Seniors.Attended Have had many training work shops. 30 years of experience workin Seniors.Attended Yuba City College, Have had many training work experience working with Seniors. have served on the Advisory Boa Senior Center Boards, Senior Care of Orange County Adult Day Hea Page 2 of 2Jack S. Chestnut other boards. Education: High School - Diploma - Kansas City, KS Yuba City Co American Association of Homes and Services for the Aging - certi Housing Professionals Attended Yuba City College, Have had many 30 years of experience working with Seniors. Other Comments: Awarded title of Retirement Housing Professional by the American and Services to the Aging Awarded Environmental Services Award i Carolina Association of Non-Profit Homes for the Aging Awarded R 1998 for the Chapel Hill/Carrboro Sunrise Rotary. STAFF NOTES: R 1/12/04 for Southern Orange Senior Center (New) Design Committee for AHAB. Renewed application 12/14/2000 for Advisory Board on A application 08/16/00 for Commissioners Affordable Housing Task F 09/30/1999 for Master Aging Plan Task Force. Applied for Nursin Advisory Committee 5/24/2010. ADDRESS VERIFICATION: 4203 Hope V Hillsborough is in Chapel Hill Township and Orange County Jurisd 5/24/20102/6/2013 This application was current on:Date Printed: Page 1 of 2T. L. Crews Volunteer Application Orange County Advisory Boards and Commissions Ms. T. L. Crews Name: Name Called: 4921 Guess Rd Home Address: Rougmeont NC 27572 919 732-6974 Phone (Day): 919 732-6974 Phone (Evening): Phone (Cell): crewsez@aol.com Email: Retired Public School Adminstrator Place of Employment: Senior Director Programs for Exceptional Children Job Title: 1996 Year of OC Residence: Little River Township of Residence: - Zone of Residence: Female Sex: African American Ethnic Background: Boards/Commissions applied for: Human Relations Commission Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Currently serving as Executive Director for the Complex Durham Public Schools worked in adminstrative leadership in the Program. Retired in 2005 as Director of the system's Exceptiona the request of the superintendent I returned to provide training Director when appointed. Volunteer Experience: Worked with children in placement through Services and court system. I reviewed files and collected relev 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 Page 2 of 2T. 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 assistanc young adults, those at risk, and senior citizens. As a result o in several nursing homes sitting with elderly parents and relati understanding and compassion for elderly residents and workers i STAFF COMMENTS: 08/23/2011 Applied to serve on Human Relations Adult Care Home Community Advisory Committee, and Nursing Home C Advisory Committee. ADDRESS VERIFICATION: 4921 Guess Road is in Township, Orange County Jurisdiction. 8/21/2011 11:48:53 AM2/6/2013 This application was current on:Date Printed: Page 1 of 2Beverly Foster Volunteer Application Orange County Advisory Boards and Commissions Dr. Beverly Foster Name: Name Called: 2454 Springview Trail Home Address: Chapel Hill NC 27514 919 966-4995 Phone (Day): 919 967-2930 Phone (Evening): Phone (Cell): Bev_Foster@unc.edu Email: UNC-Chapel Hill School of Nursing Place of Employment: Faculty and Undergraduate Program Director Job Title: 1981 Year of OC Residence: Chapel Hill Township of Residence: Does not apply Zone of Residence: Female Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Preparation of undergraduate baccalaureate stud licensure and practice; program administration and teaching. Dir areas of adult acute care and maternal child. Volunteer Experience: Orange County Board of Health, member and 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 active locally. My mother was rather briefly in two skilled nur County prior to her death a few years ago, and I became aware of Page 2 of 2Beverly Foster monitoring and service improvement in this area. At my age I rea these services myself! I believe my background in nursing educat regulation may be of use to the committee. STAFF COMMENTS: Ori Nursing Home Community Advisory Committee 2-10-2011. ADDRESS JU 2454 Springview Trail, CH, is in CH Township and CH Jurisdiction 2/10/2011 7:20:17 AM2/6/2013 This application was current on:Date Printed: Page 1 of 2Joyce Jefferies Volunteer Application Orange County Advisory Boards and Commissions Ms Joyce Jefferies Name: Name Called: 4820 NC Hwy 54 West Home Address: Chapel Hill NC 27516 (919)425-3597 Phone (Day): (919)720-6115 Phone (Evening): Phone (Cell): joyce_jefferies@dentistry.unc.edu Email: UNC School of Dentistry Place of Employment: Administrative Assistant Job Title: Year of OC Residence: Chapel Hill Township of Residence: Does not apply Zone of Residence: Female Sex: African American Ethnic Background: Boards/Commissions applied for: Adult Care Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Employed by UNC Hospitals and UNC-Chapel Hill s a dietary assistant now an Administrative Assistant in Dentistry of functions including accounting, billing, preparing check requ travel, coordinating meetings, preparing meeting agendas, orderi preparing reports, drafting letters, etc. I would like to serve because I am experiencing first-hand, in regards to my elderly m affordable assisted-living facility in good standard that really best interest of their residents. Also the assurance of knowin being governed by guidelines, rules and regulations that they ha there are committees to visit these faciliteis to ensure that th carry out. It is difficult enough to have to place our elderly but having the reassurance in knowing that they are being well t transition a lot more bearable. Volunteer Experience: I volunteer at my church, Hospitality- ser and greeting members as they enter the church, Sisters of Jubile prisons in Raleigh, organizing birthday parties, prayer and fell shut in. Page 2 of 2Joyce Jefferies Education: I received my GED from Durham Technical Institute and Business Administration Associate Degree Program, also at Durham Other Comments: I feel that I am at the place in my life mentally, physically an to offer in reaching out and assisting others through community at volunteering as a personal committment just as rewarding to m am volunteering in. I get a joy in being able to be a contribut make a difference. I enjoy working with others in like causes a though having different approaches but seeking to reach the same COMMENTS: Originally applied 11-3-2010 for Adult Care Home Comm Committee, Nursing Home Community Advisory Committee, Advisory B ADDRESS VERIFICATION: 4820 NC Highway 54 West is in Bingham Tow Orange County Jurisdiction. 11/3/2010 2:36:29 PM2/6/2013 This application was current on:Date Printed: Page 1 of 2Sandra Jones Volunteer Application Orange County Advisory Boards and Commissions Ms. Sandra Jones Name: Name Called: 600 West Poplar Ave., Apt. 239 Home Address: Carrboro NC 27510 828-668-9628 Phone (Day): Phone (Evening): 828-712-2362 Phone (Cell): None Email: Retired Place of Employment: RN, Teacher Job Title: 2012 Year of OC Residence: Chapel Hill Township of Residence: Carrboro City Limits Zone of Residence: Female Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee I have been an RN for 50 years with my specialty being geriatrics been in many positons in Nursing Homes from charge nurse, to supervisory, inservice director, Director of Nursing and I was l Michigan as a Nursing Home Administrator. I also have degree in Education (Allied Health). Advisory Board on Aging I am aged - recently became 70 - and I am slightly handicapped a senior independent apartment complex where I see the reality o every level - economically, socially, healthwise, mentally, emot my background in geriatrics I can be very discerning as to the b problems of aging. Community Activities/Organizational Memberships: Volunteer at McDougle Elementary School - 2nd Grade Reading and Volunteer Leukemia & Lymphoma Society Volunteer Ronald McDonald House (UNC Childrens Hospital) Volunteer Literacy Council-Tutoring in Reading & Math for a 70 y Active in my church. Active in my Church Past Service on Orange County Advisory Boards: None Page 2 of 2Sandra Jones Other Comments: STAFF COMMENTS: Originally applied for Nursing Home Committee a Board on Aging 01/24/2013. ADDRESS VERIFICATION: 600 West Popl 239, is Carrboro Jurisdiction, Carrboro City Limits, Chapel Hill 1/22/20132/6/2013 This application was current on:Date Printed: Page 1 of 1Sandra Lemons Volunteer Application Orange County Advisory Boards and Commissions Ms. Sandra Lemons Name: Name Called: 1321 Brookhollow Road Home Address: Efland NC 27243 9199718385 Phone (Day): 9199718385 Phone (Evening): Phone (Cell): SandraL@umrh.org Email: Croasdaile Village Place of Employment: Administrative Assistant Plant Operations Job Title: 1955 Year of OC Residence: Cheeks Township of Residence: - Zone of Residence: Female Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: UNC-CH Medical School Admissions Office 16 yrs; Schools 7 yrs; Croasdaile Village 3 yrs Volunteer Experience: School and Church Education: Chapel Hill High School; King's College, Charlotte NC Raleigh NC Other Comments: Working for a large retirement center with several levels of car I know the importance of quality care for residents. I am requir development on Resident Rights, Preventing Resident Abuse, Sexua HIPPA, Corporate Compliance; Alzheimer's; Slips, Trips and Falls that I could serve Orange County with this knowledge to make sur our county give the best quality care and safest living environm COMMENTS: Originally applied for Nursing Home Community Advisor 02/11/2011. ADDRESS VERIFICATION: 1321 Brookhollow Road, Eflan Orange County Jurisdiction, Cheeks Township. 2/11/2011 8:48:46 AM2/6/2013 This application was current on:Date Printed: Page 1 of 2Max Mason Volunteer Application Orange County Advisory Boards and Commissions Mr. Max Mason Name: Name Called: 821 Tinkerbell Rd. Home Address: Chapel Hill NC 27517 9196497937 Phone (Day): Phone (Evening): Phone (Cell): maxomason@yahoo.com Email: Principle Long Term Care, Inc. Place of Employment: Development Coordinator Job Title: 1978 Year of OC Residence: Chapel Hill Township of Residence: Does not apply Zone of Residence: Male Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Development Coordinator for one of NC's largest providers. Plan for development of nursing facilities, hospices Administrator for residential recovery facility for pregnant wom substance abuse. Volunteer Experience: Serve on the Community Grantmaking Committ Community Foundation. Board Member, Chrysalis Foundation for Mental Health Member of APPLES Service Learning program at UNC-Chapel Hill as Education: BA, History, UNC-Chapel Hill MA, Slavic Languages & Literatures, UNC-Chapel Hill Current student (part-time): Masters of Healthcare Administratio Gillings School of Public Health Other Comments: As noted, I am presently a student in public health and currentl term care; thus, I have a great interest in the issues affecting Given my experience and familiarity with this segment of the hea believe I would be a valuable addition to this committee. STAFF Page 2 of 2Max Mason Originally applied (1/24/2011) for Nursing Home Community Adviso ADDRESS VERIFICATION: 821 Tinkerbell Road is in Chapel Hill Town 1/25/2011 9:11:51 AM2/6/2013 This application was current on:Date Printed: Page 1 of 1Charles McMullen Volunteer Application Orange County Advisory Boards and Commissions Mr. Charles McMullen Name: Name Called: 108 Jones Avenue Home Address: Hillsborough NC 27278 9197329083 Phone (Day): 9192603879 Phone (Evening): Phone (Cell): cmcmullen1@nc.rr.com Email: retired Place of Employment: Job Title: 1993 Year of OC Residence: Hillsborough Township of Residence: Does not apply Zone of Residence: Male Sex: Caucasian Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Board of Health Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: Almost 50 yrs in various fields of nsg. Other Comments: STAFF COMMENTS: Originally applied for Nursing Home Community A Committee, Adult Care Home Community Advisory Committee, and Boa 02/10/2011. ADDRESS VERIFICATION: 108 Jones Avenue is in Hills Jurisdiction, Hillsborough Township. 2/10/2011 10:59:02 AM2/6/2013 This application was current on:Date Printed: Page 1 of 2Vickie Webb Volunteer Application Orange County Advisory Boards and Commissions Ms. Vickie Webb Name: Name Called: 150 Lawndale Ave Home Address: Hillsborough NC 27278 919-491-1073 Phone (Day): 919-241-4482 Phone (Evening): Phone (Cell): jb29@nc.rr.com Email: City of Durham Place of Employment: Billing Specialist Job Title: 1989 Year of OC Residence: Hillsborough Township of Residence: Does not apply Zone of Residence: Female Sex: African American Ethnic Background: Boards/Commissions applied for: Nursing Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: My work experience is limited to providing in h who wish to remain in their homes as long as possible. I provide with medication, and personal hygiene, as well as food preparati Volunteer Experience: My volunteer experience is limited to the facility in which my mother was a resident, and I would go in a companionship of some selected residents Education: I have a high school diploma, and am currently enroll obtain an Associates degree in Arts with a foundation in busines graduate in September 2011. Other Comments: I am interested in serving on this committee because I care abou care about the people who can not longer care, or speak for them mothers stay at a local nursing home, I was an advocate for her residents who either had no family or distant family. I got alon facility and was very much respected as well as showing respect performed. STAFF COMMENTS: Originally applied for Nursing Home Advisory Committee 02/10/2011. ADDRESS VERIFICATION: 150 Lawnd Page 2 of 2Vickie Webb in Hillsborough Jurisdiction, Hillsborough Township. 2/10/2011 10:20:40 PM2/6/2013 This application was current on:Date Printed: Page 1 of 2Tiki Windley Volunteer Application Orange County Advisory Boards and Commissions Ms. Tiki Windley Name: Name Called: 119 Cynthia Drive Home Address: Chapel Hill NC 27514 919-969-8583 Phone (Day): 919-942-4392 Phone (Evening): Phone (Cell): tiki_windley@yahoo.com Email: MDC, inc. Place of Employment: Program Manager Job Title: 2007 Year of OC Residence: Chapel Hill Township of Residence: . . . Zone of Residence: Female Sex: African American Ethnic Background: Boards/Commissions applied for: Board of Social Services Nursing Home Community Advisory Committee Adult Care Home Community Advisory Committee Community Activities/Organizational Memberships: Past Service on Orange County Advisory Boards: Work Experience: MDC, Inc. 2006 to Present Program Manager whos meeting facilitation, training, free tax preparation, asset-buil presentations. Prior experience includes teaching financial lite students and their families, housing counseling, working with ex community engagement and organization. Current experience inclu facilitation, training, oral presentations, community engagement Prior experience includes teaching financial literacy to high sc education, free tax preparation an housing counseling. Volunteer Experience: Meeting facilitation, event planning, volu 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 Page 2 of 2Tiki Windley NC Indian Economic Development Initiative Project G-7 Steering Committee Assets Educator: Community Success Initiative NC Second Chance Alliance Escort, Project Homeless Connect (Ora 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 Cou 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 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 the community. STAFF COMMENTS: Originally applied for Commission f of Social Services & Adult Care Home Community Advisory Committe for Human Relations Commission, Board of Social Services, & Nurs Community Advisory Committee 05/27/2010. ADDRESS VERIFICATION: Drive, Chapel Hill is Chapel Hill township, CH jurisdiction. 5/27/20102/6/2013 This application was current on:Date Printed: