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HomeMy WebLinkAboutAgenda - 10-07-2014-11cORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: October 7, 2014 Action Agenda Item No. 11 -c SUBJECT: Nursing Home Community Advisory Committee — Appointments DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y /N) No ATTACHMENT(S): Under Separate Cover Membership Roster Recommendations Applications for Persons Recommended Interest List Applications of Persons on the Interest List INFORMATION CONTACT: Clerk's Office, 245 -2130 1 PURPOSE: To consider making appointments to the Nursing Home Community Advisory Committee. BACKGROUND: The following information is for Board consideration: • Appointment to a first full term (Position #3) At -Large for Ms. Teri J. Driscoll ending 09/30/2017. Ms. Driscoll has completed her one year training term. • Appointment to a one year training term (Position #4) At -Large for Mr. Jerry Schreiber ending 10/07/2015. POSITION NO. NAME SPECIAL REPRESENTATIVE EXPIRATION DATE 3 Ms. Terri J. Driscoll At-Large 09/30/2017 4 Mr. Jerry Schreiber At -Large Training 10/07/2015 NOTE - If the individuals listed above are appointed, the following vacancies remain: • Position #8 - -- "At- Large" position - - - -- expiring 03/31/2017. FINANCIAL IMPACT: None. RECOMMENDATION(S): The Board will consider making appointments to the Nursing Home Community Advisory Committee. 2 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Times: 5:30 p.m. Every other 1st Tuesday starting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MS W Meeting Place: United Church of CH - 1321 ML King Blvd 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 Day Phone: 502 - 686 -0016 Sex: Female First Appointed: 12/13/2011 Evening Phone: Race: Caucasian Current Appointment: 02/19/2013 1 834 Providence Glen Drive FAX: Township: Chapel Hill Expiration: 01/30/2016 Chapel Hill NC 27514 E -mail: tracey.yap @duke.edu Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: At -Large Mr Elijah (Ed) Flowers, HI Day Phone: 919- 357 -9256 Sex: Male First Appointed: 03/06/2008 Chair Evening Phone: Race: Caucasian Current Appointment: 02/21/2012 2 2813 Beckett's Ridge Drive FAX: Township: Hillsborough Expiration: 03/31/2015 Hillsborough NC 27278 E -mail: ed_ flowers @yahoo.com Resid/Spec Req: At -Large Number of Terms: 2 Special Repr: At -Large Ms. Teri J. Driscoll Day Phone: 919- 245 -1127 Sex: Female First Appointed: 09/17/2013 Evening Phone: Race: Caucasian Current Appointment: 09/17/2013 3 815 US Hwy 70A East, Apt. 323 FAX: Township: Hillsborough Expiration: 09/30/2014 Hillsborough NC 27278 E -mail: drisco11323 (onc.rr.com Resid/Spec Req: At -Large Number of Terms: Special Repr: At -Large Ms. Sharon Karnash Day Phone: 919 - 479 -5661 Sex: Female First Appointed: 06/12/2007 Evening Phone: Race: Caucasian Current Appointment: 04/19/2011 4 5513 Quail Hollow Drive FAX: Township: Little River Expiration: 06/30/2014 Hillsborough NC 27278 E -mail: Sharon.kamash @gmail.com Resid/Spec Req: At -Large Number of Terms: 2 Special Repr: At -Large Ms. Sandra Jones Day Phone: 828 - 668 -9628 Sex: Female First Appointed: 02/04/2014 Evening Phone: Race: Caucasian Current Appointment: 02/04/2014 5 600 West Poplar Ave., Apt. 239 FAX: Township: Chapel Hill Expiration: 02/04/2015 Carrboro NC 27510 E -mail: None Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: Nursing Home Administration Friday, August 15, 2014 Page 1 3 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Times: 5:30 p.m. Every other 1st Tuesday starting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MS W Meeting Place: United Church of CH - 1321 ML King Blvd 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 Evening Phone: Race: Caucasian Current Appointment: 03/19/2013 6 3612 Old Vine Trail FAX: Township: Eno Expiration: 03/31/2016 Hillsborough NC 27278 E -mail: vbarringer @gmail.com Resid/Spec Req: At -Large Number Of Terms: 1 Special Repr: At -Large Ms. Sandra Lemons Day Phone: 919 - 971 -8385 Sex: Female First Appointed: 02/04/2014 Evening Phone: Race: Caucasian Current Appointment: 02/04/2014 7 1321 Brookhollow Road PAX: Township: Cheeks Expiration: 02/04/2015 Efland NC 27243 E -mail: SandraL@umrh.org Resid/Spec Req: At -Large Number Of Terms: 1 Special Repr: Nursing Home Administration Dr. Mario Battlgelll 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: 03/16/2017 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: Race: Caucasian Current Appointment: 03/22/2012 9 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 Evening Phone: Race: Caucasian Current Appointment: 06/18/2013 10 118 W. Tryon St. FAX: Township: Hillsborough Expiration: 06/30/2016 Hillsborough NC 27278 E -mail: maryannpeter @earthlink.net Resid/Spec Req: At -Large Number Of Terms: 1 Special Repr: At -Large Friday, August 15, 2014 Page 2 0 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee 12 Meeting Times: 5:30 p.m. Every other 1st Tuesday starting with Jan. Terms: 2 Contact Person: Charlotte Terwilliger, MS W Meeting Place: United Church of CH - 1321 ML King Blvd 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 Joanne Wilson 104 Stoneridge Drive Chapel Hill NC 27514 Ms. Vibeke Talley 134 East Tryon Street Hillsborough NC 27278 Day Phone: 919- 810 -2774 Evening Phone: FAX: E -mail: anteel @earthlink.net Day Phone: 968 -2016 Evening Phone: FAX: 968 -2017 E -mail: vtalley @.co.orange.nc.us Sex: Female First Appointed: 02/04/2014 Race: African American Current Appointment: 02/04/2014 Township: Chapel Hill Expiration: 02/04/2015 Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: Nursing Home Administration Sex: Female First Appointed: 05/20/2014 Race: Caucasian Current Appointment: 05/20/2014 Township: Hillsborough Expiration: 12/31/2016 Resid/Spec Req: At -Large Number of Terms: Special Repr: Nursing Home Administration Friday, August 15, 2014 Page 3 Thom Freeman From: Charlotte Terwilliger <cterwilliger @tjcog.org> Sent: Tuesday, August 12, 2014 4:18 PM To: Thom Freeman Cc: Ed Flowers Subject: Reappointment to the Nursing Home Community Advisory Committee Dear Thom, The Nursing Home Community Advisory Committee would like to recommend Teri Driscoll for a first full term. Her current one year appointment will expire on 9/30/2014. During the past year Ms. Driscoll attended 5 out of 5 business meetings and has actively participated in all of her assigned quarterly facility visitations. Ms. Driscoll's strong interest in serving elders and her advocacy skills have been invaluable to the work of this committee. Please let me know if you need anything else from me to move this recommendation forward. Thank you. Best Regards, Charlotte Charlotte Terwilliger, MSW Regional Long Term Care Ombudsman Area Agency on Aging Triangle J Council of Governments 4307 Emperor Blvd., Suite 110, Durham, NC 27703 (o) 919 - 558 -9401 / (f) 919 -998 -8101 cterwilliger @ticog.org / www.ticog.org 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 lave. 1 Thom Freeman From: Charlotte Terwilliger <cterwilliger @tjcog.org> Sent: Friday, September 26, 2014 1:45 PM To: Thom Freeman Subject: Appointment Recommendation to the NH CAC bear Thom, The Nursing Home Community Advisory Committee would like to recommend Mr. Jerry Schreiber for a one year training term. Mr. Schreiber has a passion for ensuring that long term care residents receive the best quality of care in a safe living environment so he would be an excellent choice for this committee. Please let me know if you need any additional information to move this recommendation forward. Best Regards, Charlotte Charlotte Terwilliger, MSW Regional Long Term Care Ombudsman Area Agency on Aging Triangle J Council of Governments 4307 Emperor Blvd., Suite 110, Durham, NC 27703 (o) 919 - 558 -9401 / (f) 919- 998 -8101 cterwilliger @ticog.org / www.ticog.org 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. 7 Page 1 of 2 Teri Driscoll Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Ms Teri Driscoll 422 Hampton Pointe Hillsborough NC 27278 919- 245 -1127 919- 245 -1127 919- 923 -3666 drisco11323 @nc.rr.com Retired Retired 2012 Hillsborough Female Caucasian Community Activities /Organizational Memberships: Orange County Nursing Home Community Advisory Committee Duke Hospice Hillsborough Citizens Police Academy State of NC Notary Public Orange County Department of Aging -make Reassurance Calls on Fri. mornings Past Service on Orange County Advisory Boards: Adult Home Care CAC -had to resign a year ago because my daughter took over as ED of The Carillon and that was considered a conflict of interest Currently serve on Nursing Home CAC Boards /Commissions applied for: Alcoholic Beverage Control Board Background, education and experience relevant to this board: I have 22 years of legal secretarial experience and thought this might be helpful in serving on this board Reasons for wanting to serve on this board: I am retired and have plenty of time to give back to the community; I love living in Hillsborough and have met so many nice people; would not have known about this upcoming vacancy if I had not received an e -mail and I thought this might be an interesting board to serve on. Conflict of Interest: No Supplemental Questions: Page 2 of 2 Alcoholic Beverage Control Board Teri Driscoll Please list /explain your experience, either professionally and /or from other boards /commissions that you have in the areas of budget, personnel, and management. After working in the legal field for 22 years and moving to NC, I was the office manager for an Assisted Living Community owned by Brookdale Senior Living. In that capacity I was responsible for the Human Resources portion of my building and maintaining their Administrative files. I knew about budgets because all of us as managers had budgets that we had to adhere to and submit monthly reports. I was also responsible for the payroll for my building. In addition to the experience listed in the question above, please list the work /volunteer experience /qualifications that would add to your expertise for this board. I volunteered for 18 years in the schools in NJ that all of my children attended. I have been a member of Hospice since 2000 when I moved to NC in Winston - Salem, High Point and now that I live in Hillsborough, Duke Hospice I was the member of the first Citizens Police Academy in Bergen County, NJ; a member of the Winston -Salem Citizens Police Academy and now am involved with the Hillsborough PD Citizens Police Academy. I feel that all of the aforementioned experiences teach you many great values to implement in other volunteer experiences. What do you see as the responsibilities of this board, and what do you hope to accomplish if appointed? Attending initial training and monthly meetings. I certainly have the ability to serve as a secretary to this committee as I did for the Adult Home Care CAC and now do for the Nursing Home CAC as per the request of Mary Fraser from the DOA. I feel I have the knowledge to be able to understand budgeting, hiring of personnel and management that is needed for the ABC Board from my past experiences in my employment. Other Comments: This application was current on: 4/27/2014 2:45:56 PM Date Printed: 4/28/2014 9 Page 1 of 1 Jerry Schreiber Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Mr. Jerry Schreiber 1606 Pathway Dr Carrboro NC 27510 919 967 2962 919 967 2962 919 259 2359 jrogerschreiber @gmail.com retired n/a 2006 Chapel Hill Male Caucasian Community Activities /Organizational Memberships: SCORE Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: My mother -in -law is a current resident in a nursing home and has been a resident in several others. Reasons for wanting to serve on this board: Having seen the shortcomings of care at a number of facilities both here and in Dallas, I believe I can lend a first hand view of what can and should be viewed. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 5/19/2014 1:47:17 PM Date Printed: 5/27/2014 Applicant Interest Listing Nursing Home Community Advisory Committee 10 by Board Name and by Applicant Name Contact Person: Charlotte Terwilliger, MSW Contact Phone: 919 -558 -9401 Ms. Susan Adams Day Phone: 919 - 357 -5541 Sex: Female 211 Hogan Woods Circle Evening Phone: 919 - 357 -5541 Race: Caucasian Chapel Hill NC 27516 Cell Phone: Township: Chapel Hill Also Serves On: Adult Care Home Community Advisory Committee E -mail: jaseradams@gmail.com Date Applied: 10/07/2013 Skills: Consultant Also Serves On: Evening Phone: Race: Ms. Martha Bell Day Phone: 919 - 968 -4674 Sex: Female 100 Macrae Court Evening Phone: as above Race: Caucasian Chapel Hill NC 27516 Cell Phone: N/A Township: Chapel Hill E -mail: mbe11968gyahoo.com Date Applied: 01/09/2014 Skills: Also Serves On: Ms. T. L. Crews 4921 Guess Rd Rougmeont NC 27572 Skills: School Principal Skills: Tutor Nick Galvez 403 N Elliott Road Chapel Hill NC 27514 Skills: Mrs Karen Schnell 4421 Lynch Store Rd Mebane NC 27302 Skills: Consultant Skills: Nurse Mr. Jerry Schreiber 1606 Pathway Dr Carrboro NC 27510 Skills: Day Phone: 919 732 -6974 Sex: Female Evening Phone: 919 732 -6974 Race: African American Cell Phone: Township: Little River E -mail: crewsez@aol.com Date Applied: 08/21/2011 Also Serves On: Adult Care Home Community Advisory Committee Day Phone: 7274189921 Sex: Male Evening Phone: 7274189921 Race: Other Cell Phone: 7274189921 Township: Chapel Hill E -mail: ngalvezl234@gmail.com Date Applied: 01/08/2014 Also Serves On: Board of Health Day Phone: 919 304 5880 Sex: Female Evening Phone: Race: Caucasian Cell Phone: Township: Cedar Grove E -mail: schnellkar @yahoo.com Date Applied: 06/06/2013 Also Serves On: Adult Care Home Community Advisory Committee Day Phone: 919 967 2962 Evening Phone: 919 967 2962 Cell Phone: 919 259 2359 E -mail: jrogerschreiber @gmail.com Also Serves On: Sex: Male Race: Caucasian Township: Chapel Hill Date Applied: 05/19/2014 Friday, August 15, 2014 Page 1 of 2 Applicant Interest Listing Nursing Home Community Advisory Committee Ms. Vibeke Talley 134 E Tryon St Hillsborough NC 27278 Skills: 11 by Board Name and by Applicant Name Contact Person: Charlotte Terwilliger, MSW Contact Phone: 919 -558 -9401 Day Phone: 9197323112 Evening Phone: 9197323112 Cell Phone: 9199718549 E -mail: vibandjoe@hotmail.com Also Serves On: Sex: Female Race: Caucasian Township: Hillsborough Date Applied: 02/05/2014 Friday, August 15, 2014 Page 2 of 2 12 Page 1 of 2 Susan Adams Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Ms. Susan Adams 211 Hogan Woods Circle Chapel Hill NC 27516 919- 357 -5541 919- 357 -5541 jaseradams @gmail.com Self- employed Consultant 2004 Chapel Hill Carrboro City Limits Female Caucasian Community Activities /Organizational Memberships: IFC - Orange County Homeless Shelter, Galloway Ridge - Volunteer, Care Ministry - Newman Center, Coastal Pines of North Carolina - troop 862 - Adult Volunteer, Treasurer 2007 -2012, AARP, GSA - Gerontological Society of America MAC Committee - Mandarin Advisory Council for the Dual Language Program for Chapel Hill Carrboro City School District, Newman center outreach care ministry, MAC -dual language for Mandarin Chinese advisory board for school system, NAHB - National Home Builders Association Orange , Chatham and Durham counties - remodeler s council, National Gerontology Society, AARP, Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Advisory Board on Aging Background, education and experience relevant to this board: I am energized by solving problems and taking on challenges. With over 1 person turning 50 every second due to the dramatic achievements in public health, Orange County is poised to see a 67% increase in persons over 65 and a 43% increase in persons over 85 in the next 10 years. This trend continues through 2030 when persons over 65 will again increase by 42% and over 85 by 70 %. Orange county is a leader in serving its senior population and I want to contribute to preparing and meeting these needs throughout the next 20 years. Although I worked as a chemical engineer for 15 years, I recently returned to school to get a BA in Multidisciplinary studies, with an emphasis on social sciences and the Socio- Ecological Model which shows that the health of an individual is based not just on the person but withing the greater context of his relationships, his community and his society. Because of my interest in the aging process, I am currently completing a Masters in Gerontology from the University of Southern California. Through this program I have been able to receive the training and tools that will aid me in pursuing my goal of improving the disparity in the aging experience between the 13 Page 2 of 2 Susan Adams different economic classes. The research area where I am basing my concentration consists of early depression intervention for the home caregiver. Many home caregivers are thrust into their duties with little to no training and as more residents, especially in the rural areas, are deciding to age in place there will be a need for increased programs to address the adult child or spousal caregiver, many of whom are over 50. I am excited to be beginning this new phase of my life as I turn 50, and consider myself to be a life -long learner who believes that we are all part of something larger and there is purpose to all our lives. My belief system influences all I do and I value responsibility and high ethical standards. I believe that the strategic methods of problem solving I utilized as an engineer allows me to find and evaluate alternatives and seek innovative ways to get things done. I believe in community involvement as I was a member of the School Improvement Team (SIT) committee for McDougle Middle School for 2 years, worked as a volunteer at the Chapel Hill Museum for 3 years, and have been a member of the MAC - Mandarin Advisory Council for the dual language program in CHCCS since it began and my daughter has been part of the program for the past 8 years. As my children are growing up and moving on to new goals, I feel that I too must focus my time and energies on the future. I appreciate your time in considering me for this position. Reasons for wanting to serve on this board: Conflict of Interest: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: I am graduating with my Masters of Arts in Gerontology in May 2014 from the University of Southern California. My BS is multi disciplinary in psychology and public health. My concentration of study is in environmental interventions to decrease agitation in persons with dementia. I currently volunteer at Galloway Ridge and care part time for my elderly parents who I relocated to Chatham County in 2008. Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Other Comments: STAFF COMMENTS: Applied 2/1/2013 for Advisory Board on Aging. Applied 10/4/2013 for Nursing Home CAC. ADDRESS VERIFICATION: 211 Hogan Woods Circle is Chapel Hill Township, Carrboro Jurisdiction, Carrboro City Limits. This application was current on: 10/7/2013 Date Printed: 12/27/2013 14 Page 1 of 2 ILYAMM T7:M11 Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Ms. Martha Bell 100 Macrae Court Chapel Hill NC 27516 919- 968 -4674 as above N/A mbe11968 @yahoo.com Retired Registered Nurse - Director of Nursing 1995 Chapel Hill Female Caucasian Community Activities /Organizational Memberships: Member, Sigma Theta Tau Vice Chair, DVAMC Veterans Mental Health Council Member, The Chapel of the Cross Volunteer, Ambulatory Care, DVAMC Member, Retired Officers Association Member, Army Nurse Corps Association (former Regional Director) Past Service on Orange County Advisory Boards: Nursing Home Community Advisory Committee 111 [•7ism� Rif Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: After retiring from active duty with the Army Nurse Corps in 1995, accepted position of Director of Nursing, Carol Woods Retirement Community, serving in that capacity for 12 years, and then continued in special projects as identified by the President /CEO, Carol Woods, for another 5 years; also eventually had operational responsibility for assisted living, and infection control for the organization. Coordinated clinical assignments in long term care for nursing and nursing assistant students from DCC and NCCU. Taught fundamentals of elder care to staff and students; served as consultant with CARF and AAHSA reviewing health and service delivery standards. Reasons for wanting to serve on this board: Throughout the years at Carol Woods, I met many members of this Cmmunity Committee, through their advisory capacity; always impressed with their respect for the older adult and circumstances that lead a person(s) to seek long term care, I knew I was unable to serve this 15 Page 2 of 2 Martha Bell committee until I retired from the business of elder services. I ve continued to keep my nursing license current, attending related education offerings in the infection control, gerontology and health care for the years since retirement from full time work. While volunteering in Durham, I really want to serve my local community and continue to put my knowledge of aging services and long term care to good use. Conflict of Interest: Board of Health Background, education and experience relevant to this board: RN, BSN, MSN; attendance at 3.5 day infection control in long term care course offered by SPICE every two years; recent course attendance at offering regading CDiff; served as infection control consultant for Carol Woods Retirement Community 12 years while also serving as its Director of Nursing /Health Services. Reasons for wanting to serve on this board: Throughout the years at Carol Woods, I was often involved with Board of Health issues, including outbreak investigation, tuberculosis control, difficulties encountered in Infection Control for the older adult in a long term care /congregate living environment. I purposely kept my nursing license current despite my retirement from full time nurse because I hoped to eventually serve my community in some capacity related to my professional knowledge. I seek only an activity that will use my knowledge rather than any paid position. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 1/9/2014 11:27:53 AM Date Printed: 1/9/2014 16 Page 1 of 2 T. L. Crews Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background 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 Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: 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 17 Page 2 of 2 Currently Executive Director of Little River Community Complex 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: T. L. Crews 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: 12/27/2013 W Page 1 of 2 Nick Galvez Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Nick Galvez 403 N Elliott Road Chapel Hill NC 27514 7274189921 7274189921 7274189921 ngalvez1234 @gmail.com Bayada Home Care Field Clinician /Physican Therapist 2013 Chapel Hill Male Other Community Activities /Organizational Memberships: To Whom It Concerns: I have worked in healthcare for over 15 years and have successfully managed operations and finances for medium and large healthcare organizations. I earned an MBA with a concentration in accounting in 2004. 1 also gained the CMA certification from the Institute of Management Accountants to further my knowledge and prepare for a Director level position. In my current position as a regional manager, I helped develop new markets (Georgia) and new programs for internal and external growth. I assisted the sales team to ensure operations and new business growth was aligned with the companya €TMs long term strategic plan. The region and company has grown significantly due to my focus on new markets and new programs. I have volunteer experiences that have also contributed to my professional development. I enjoyed serving on the Hillsborough County Healthcare Advisory Board for the past 4 years and have contributed to fiscal policy development for the county healthcare plan. I also serves on the Board of Directors for the Health Council of West Central Florida to serve their mission to educate consumers in the region about healthcare issues. I held this position for 2 years while living in Florida. I am excited about getting involved in the Chapel Hill community and sharing my experiences with other like minded citizens to improve out community. Sincerely, 19 Page 2 of 2 Nick Galvez Past Service on Orange County Advisory Boards: none Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Nick Galvez I have a background in healthcare administration and business management. I believe the combination of operations and finances are vital to a successful healthcare organization. I believe local boards need to weigh the benefits and costs of those affected by the decisions by they make. I have a desire to improve our health as a society, in the community and in our family. I believe that I can affect the changes by becoming involved in local boards and talking with other professionals about health. The affordable health care act will inevitably affect those directly and indirectly in the field of health. Reasons for wanting to serve on this board: see above Conflict of Interest: na Nursing Home Community Advisory Committee Background, education and experience relevant to this board: I have a background in healthcare administration and business management. I have worked in nursing homes as a director of therapy and also as a regional director for therapy departments. I have worked with for profit and not for profit companies that own and operate nursing homes. I believe the combination of operations and finances are vital to a successful healthcare organization. I believe local boards need to weigh the benefits and costs of those affected by the decisions by they make. I have a desire to improve our health as a society, in the community and in our family. I believe that I can affect the changes by becoming involved in local boards and talking with other professionals about health. The affordable health care act will inevitably affect those directly and indirectly in the field of health. Reasons for wanting to serve on this board: see above Conflict of Interest: na Supplemental Questions: Other Comments: This application was current on: 1/8/2014 7:47:26 AM Date Printed: 1/9/2014 20 Page 1 of 2 Karen Schnell Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Mrs Karen Schnell 4421 Lynch Store Rd Mebane NC 27302 919 304 5880 schnellkar @yahoo.com Blue Sky Health Concepts Consulting, LLP RN, MSN, LNC 2004 Cedar Grove Agricultural Residential Female Caucasian Community Activities /Organizational Memberships: NCNA Volunteer as Nurse of the Day for the General Assembly PRN Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: As a Master s prepared Advance Practice RN and Legal Nurse Consultant, I have the education and training. With my own business, Blue Sky Health Concepts Consulting LLP, and MBA, I have a strong business background to support my health care background. Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Other Comments: STAFF COMMENTS: 06/06/2013 - Applied for Nursing Home Community Advisory Committee and Solid Waste Advisory Board (Currently Not Accepting Applications). 06/06/2013 ADDITIONAL APPLICATION for Adult Care Home Community Advisory Committee. ADDRESS VERIFICATION: 4421 Lynch Store Road is Orange County Jurisdiction, Cedar Grove Township, and AR (Agricultural Residential). This application was current on: 6/6/2013 4:05:26 PM Date Printed: 12/30/2013 21 Page 2 of 2 Karen Schnell 22 Page 1 of 1 Vibeke Talley Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Ms. Vibeke Talley 134 E Tryon St Hillsborough NC 27278 9197323112 9197323112 9199718549 vibandjoe @hotmail.com Duke HomeCare and Hospice Occupational Therapist 1980 Hillsborough Hillsborough Town Limits Female Caucasian Community Activities /Organizational Memberships: Hillsborough Presbyterian Church, North Carolina Occupational Therapy Association. Past Service on Orange County Advisory Boards: I m not serving on any Advisory Board presently. In the past I have served on the Sportsplex Advisory Committee. Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: As an occupational therapist I have worked in skilled nursing facilities in the past. I worked for the Orange County Department on Aging for 10 years and was a liaison to this committee for a while. Reasons for wanting to serve on this board: The experiences mentioned above made me aware of the need for the community to take an interest in the welfare of the residents in nursing homes. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 2/5/2014 3:36:58 PM Date Printed: 2/6/2014