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Home My WebLink AboutAgenda - 06-24-2008-10dORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: June 24, 2008 Action Agenda Item No. !Q -G~ SUBJECT: Nursing Home Community Advisory Committee-New 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) Recommended Interest List Application(s)/Resume(s) of Person(s) on the Interest List INFORMATION CONTACT: Clerk's Office, 245-2130 PURPOSE: To consider making one new appointment to the Nursing Home Community Advisory Committee. BACKGROUND: The Clerk's office has received a recommendation from the Nursing Home Community Advisory Committee for Tiffany Washington. If appointed she will be serving aone- yeartraining term, which will end on 6/24/2009. FINANCIAL IMPACT: None. 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N 1 U ~ N ~. ~ { ~ [~ ~ N ? ; F-1 .- + .N- i a 0 0 N O~ O G O -----Original Message----- From: Mary Ann Peter [mailto:maryannpeter@earthlink.net] Sent: Monday, June 09, 2008 8:52 AM To: Donna Baker Cc: Jill Passmore Subject: Tiffany Washington nomination for nursing home committee To: Orange County Board of County Commissioners .Barry Jacobs, Chairman From: Mary Ann Peter Chair, Orange County Nursing Home Community Advisory Committee Re: Nomination for OCNHCAC June 9, 2008 We are pleased to recommend Tiffany Washington for membership on the committee. Ms Washington is a PhD student in the UNC-Chapel Hill School of Social Work and is a resident of Orange County. She has attended a committee meeting and has submitted her application stating her interest. We would be very fortunate to have someone with her qualifications and interest in long term care as a member of this committee. We hope that you will appoint her at the next opportunity. Thank you most sincerely for your support of this committee. 1 .; r ~~. ., Page 1 of 2 Tiffany Washington Volunteer Application Orange County Advisory Boards and Commissions Name: Ms. Tiffany Washington Name Called: Home Address: 515 Hinton James Drive #138 (mail: PO Box 746) Chapel Hill NC 27514 Phone: (Day) (336)339-8144 Phone: (Evening) Fax: Email: twashing@email.unc.edu Place of Employment: UNC Chapel Hill - DHRE Job Title: Community Manager Township of Residence: Chapel Hill Zone of Residence: Does not apply Sex: Ethnic Background: Date of Birth: Female African American 5/29/1978 Boards/Commissions applied for: Nursing Home Community Advisory Committee Adult Care Home Community Advisory Committee Advisory Board on Aging Work Experience: 02-05 Medical Social Worker Northside Dialysis Center Winton Salem 03-05 Medical Social Worker Amedisys Home Health Winston Salem 05-07 Patient Services Coordinator, Southeastern Kidney Council Raleigh 05-07 Medical Social Worker, Gentiva Home Health, Raleigh, NC Volunteer Experience: National Kidney Foundation UNC Kidney Center March of Dimes Buckle up America American Red Cross Education: 1996-2000 UNC Chapel Hill - BA 2000-2002 UNC Greensboro/NCA&TSU - Master of Social Work 2007-present UNC Chapel Hill -PhD in Social Work Other Comments: I have 2 years experience investigating complaints and grievances of dialysis and transplant patients in North Carolina, South Carolina, and Georgia. My research area is n Page 2 of 2 Tiffany Washington health and aging. I enjoy volunteer work and community service. STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Committee, Adult Care Home Community Advisory Committee and Advisory Board on Aging on 5/5/2008. ADDRESS VERIFICATION: 515 Hinton James Drive #138 is in Chapel Hill township UNC jurisdiction. This application was current on: 5/5/2008 11:12:32 PM Date Printed: 6/9/2008 g Applicant Interest Listing Nursing Home Community Advisory Committee by Board Name and by Applicant Name Contact Person: Vibeke Talley, OTR/L Contact Phone: 919-968-2087 Mr. Blalce Burldin Day Phone: 919-812-4394 Sex: .Male 117 Creel St. Evening Phone: 919-812-4394 Race: Caucasian Chapel Hill NC 27516 FAX: Township: Chapel Hill E-mail: burklin@email.unc.edu Date Applied: 02/03/2008 Skills: Habitat for Humanity Also Serves On: Skills: Sociology Major Also Serves On: Ms. Jeanette Clark 221 Rencher St Apt 3 Hillsborough NC 27278 Skills: Nursing Home Experience Ms. Peggy Cohn 10 Bayswater Place Chapel Hill NC 27517 Skills: Geriatric Care Day Phone: 919-620-8662 Evening Phone: 732-7856 FAX; 6208662 E-mail: Also Serves On: Sex: Female Race: African American Township: Hillsborough Date Applied: 02/23/2005 Day Phone:, 919-489-6624 Sex: Female Evening Phone: same Race: Caucasian g~}{; Township: Chapel Hill E-mail: peggycohnl@earthlink.net Date Applied: 10/10/2005 Also Serves On: Adult Care Home Community Adv isory Committee Also Serves On: Advisory Board on Aging MS. ELIZABETH CRONER 1605 N. GREENBOROUGH ROAD CARRBORO NC 27510 Skills: Retired Day Phone: 919.933.862. Evening Phone: FAX: E-mail: Also Serves On: Sex: Female Race: African American Township: Chapel Hill Date Applied: 11/05/2005 Mr Ed Flowers Day Phone: 919-357-9256 Sex: Male 2813 Beclcett's Ridge Drive Evening Phone: 919-357-9256 Race: Caucasian Hillsborough NC 27278 FAX: Township: Hillsborough E-mail: ED_FLOWERS@YAHOO.COM Date Applied: 11/18/2007 Skills: Children's Issues Also Serves On: Skills: Nuclear Physicist Also Serves On: Monday, June 09, 2008' Page 1 of 2 1 Applicant Interest Listing Nursing Home Community Advisory Committee Ms. Jane Powell Day Phone: 910-474-9083 Sex: Female 656 Craige Dorm Evening Phone: 919-914-4924 Race: African American UNC Chapel Hill FAX: Township: Chapel Hill Chapel Hill NC 27514 E-mail: japo@email.unc.edu Date Applied: 09/30/2004 Skills: Cashier Also Serves On: Skills: Community Service Volunteer Also Serves On: Skills: Customer Service Also Serves On: Ms. Ta1~liny Tllaclcer Day Phone: 638-4387 Sex: Female 517 N. Hill Street Evening Phone: Race: African American Hillsborough NC 27278 FAX: Township: Hillsborough E-mail: gr8tpay@yahoo.com Date Applied: 02/14/2006 Skills: Certified Nurses Aide Also Serves On: by Board Narne and by Applicant Name Contact Person: Vibeke Talley, OTR/L Contact Phone: 919-968-2087 Ms. Tiffany Washington 515 Hinton James Drive #138 (mail: PO Box 746) Chapel Hill NC 27514 Skills: Social Worker Day Phone: (336)339-8144 Evening Phone: FAX: E-mail: twashing@email.unc.edu Also Serves On: Sex: Female Race: African American Township: Chapel Hill Date Applied: 05/05/2008 Monday, June 09, 2008 Page 2 of 2 ~V Page 1 of 1 Blake Burklin 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. Blake Burklin 117 Creel St. Chapel Hill NC 27516 919-812-4394 919-812-4394 burklin@email.unc.edu Johnny T Shirt Township of Residence: Chapel Hill Zone of Residence: Chapel Hill Twnsp Sex: Male Ethnic Background: Caucasian Date of Birth: 11/15/1983 Boards/Commissions applied for: Orange County Planning Board Nursing Home Community Advisory Committee Work Experience: Harris Teeter Triangle Sportsplex Johnny T Shirt Volunteer Experience: UNC Hospital Habitat for Humanity Education: B.A. in Sociology from the University of North Carolina at Chapel Hill Other Comments: As an undergraduate sociology major I was able to design and implement IRB approved social research on stigmatized populations confidentially. (believe as a life long resident of the Chapel Hill/ New Hope area, that I will have some insight the Board might find valuable. STAFF COMMENTS: Originally applied for Orange County Planning Board & Nursing Home Community Advisory Committee on 2/3/2008. ADDRESS VERIFICATION: 117 Creel St, Chapel Hill, is Chapel Hill township in CHPL jurisdiction. This application was current on: 2/3/2008 10:53:29 PM Date Printed: 6/9/2008 Page 1 of 1 Jeanette Clark Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Ms. Jeanette Clark 221 Rencher St Apt 3 Hillsborough NC 27278 919-620-8662 732-7856 6208662 Central Family Care Supervisor in Charge Hillsborough Hillsborough ETJ Female African American 7/8/1955 Boards/Commissions applied for: Nursing Home Community Advisory Committee Joint Orange Chatham Community Action Agency Work Experience: I have been in the medical experience for about 12 yrs. I am a certified nurse assistant, and a certified medical technician. I have nursing home and adult care home experience. I supervise a group home now for mental residents Volunteer Experience: I have no volunteer experience but I have done outreach before and I have a certificate for a class I took as an outreach worker. Education: GED Other Comments: STAFF COMMENTS: Originally applied for Nursing Home CAC and Adult Care Home Community Advisory Committee and JOCCA. ADDRESS VERIFICATION: 211 Rencher St is in Orange County in Hillsborough Township in Hillsborough ETJ. This application was current on: 2/23/2005 Date Printed: 6/9/2008 ~a Page 1 of 1 Peggy Cohn Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Ms. Peggy Cohn Peggy 10 Bayswater Place Chapel Hill NC 27517 919-489-6624 same peggycohn1 @earthlink.net retired Geriatric Care Manager Chapel Hill C.H. City Limits Female Caucasian 8/28/1938 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: Community Health Nursing educator UNC and Penn State University Director of Family Ties, Geriatric Care Management, State College PA Volunteer Experience: Nursing Home visitation Non profit Boards in PA Education: BA, Wellesley BSN, Columbia University MPH, UNC PhD, Penn State University College of Health and Human Developmenet Other Comments: STAFF COMMENTS: Originally applied for Adult Care Home Community Advisory Committee and NHCAC and Adv. Board on Aging 10/10/2005. ADDRESS VERIFICATION: Mailing address listed above. Residence is 233 McCauley Street in Chapel Hill city limits. This application was current on: 10/10/2005 11:34:21 AM Date Printed: 6/9/2008 (3 Page 1 of 1 ELIZABETH CRONER Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: MS. ELIZABETH CRONER 1605 N. GREENBOROUGH ROAD CARRBORO NC 27510 919.933.862 RETIRED Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Ethnic Background: Date of Birth: Female African American 5/14/1934 Boards/Commissions applied for: Advisory Board on Aging Nursing Home Community Advisory Committee Work Experience: RETIRED FROM STATE OF OHIO, CLEVELAND DEVELOPMENTAL CENTER; STAFF SUPV. Volunteer Experience: CURRENTLY ASSISTING ABUNDANT LIFE CHURCH PANTRY Education: HIGH SCHOOL; CONTINUED EDUCATION; Other Comments: STAFF COMMENTS: Originally applied for Adv. Board on Aging, Nursing Home CAC, and Board of Social Services 11/8/2005. ADDRESS VERIFICATIO~~: 1605 N. Greensboro St is in Carrboro City Limits in Orange County in the Chapel Hill Township. This application was current on: 11/5/2005 11:28:47 AM Date Printed: 6/9/2008 Iy Page 1 of 2 Ed Flowers Volunteer Application Orange County Advisory Boards and Commissions Name: Mr Ed Flowers Name Called: Home Address: 2813 Beckett's Ridge Drive Hillsborough NC 27278 Phone: (Day) 919-357-9256 Phone: (Evening) 919-357-9256 Fax: Email: ED_FLOWERS@YAHOO.COM Place of Employment: Duke University Hospital Job Title: Senior Nuclear Medicine Technologist Township of Residence: Hillsborough Zone of Residence: .. . Sex: Male Ethnic Background: Caucasian Date of Birth: 2/10/1944 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: 1965 - 1970 Nuclear Medicine Technologist NC Baptist Hospital 1970 - 1976 Chief Nuclear Medicine Technologist Duke Medical Center 1976 - 1991 Technical Administrator -Nuclear Medicine -Duke Medical Center 1991 - prestnt Senior Nuclear Medicine Technologist Volunteer Experience: Durham Congregations in Action Yokefellows -Durham County - Alamance/Orange Counties Durham Nursery School Advisary Committee Blowing Rock Conference Center Board of Directors -Treasurer Education: Nigh School -Southwest Forsyth College -Mars Hill Radiologic Technology -North Carolina Baptist Hospital Nuclear Medicine Technology -North Carolina Baptist Hospital Other Comments: Extensive experience with regulatory agencies. (e.g., JCAHO, N.C.Radiation Safety, OSHA, Nuclear Regulatory Commission) STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Community Advisory Committee on 11/18/2007. ADDRESS VERIFICATION: 2813 Beckett's Ridge Drive, is Hillsborough Township. (~ Page 1 of 1 Jane Powell Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Ms. Jane Powell 656 Craige Dorm UNC Chapel Hill Chapel Hill NC 27514 910-474-9083 919-914-4924 japo@email.unc.edu Wynnsong 15 Theatre Cashier Chapel Hill Chapel Hill Township within C.H. city limits Female African American 10/18/1983 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: Ocean Beach Club: waitress and secretary, Dairy Queen: cashier, Wynnsong 15: cashier Volunteer Experience: Volunteer with Public Service Scholars. Volunteer at Dobbins Hill apartments on Mondays, Volunteer at UNC Hospital on Mondys. DO other volunteering when needed. Education: High School-Lumberton Senior High School, attending UNC Chapel, BS Nursing Other Comments: STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Committee, Affordable Housing Advisory Board, and Animal Shelter Operations Task Force. ADDRESS VERIFICATION: 656 Craige Dorm is on the campus of UNC-Chapel Hill and is located off of Manning Drive in Orange County, in the Chapel Hill Township in the City Limits. This application was current on: 9/30/2004 Date Printed: 6/9/2008 ~W Page 1 of 1 Tammy Thacker Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Ms. Tammy Thacker 517 N. Hill Street Hillsborough NC 27278 638-4387 gr8tpay@yahoo.com Aryzen Health and Wellness President and CAN II Hillsborough Hillsborough Town Limits Female African American 5/31 /1968 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: I have been in Health Care for over 15 years and I have a good knowledge base about the elderly. I understand people need and what it takes to live in a safe environment. Volunteer Experience: I have volunteered in the classrooms of my children. Education: Certified CNA I and II. Certified EKG technician and Certified Medication Technician. Other Comments: STAFF COMMENTS: Originally applied for Adult Care Home and Nursing Home Care Advisory Boards and Advisory Board on Aging 2/14/2006. ADDRESS VERIFICATION: 517 Hill Street is in the Town of Hillsborough in Orange County. This application was current on: 2/14/2006 Date Printed: 6/912008