HomeMy WebLinkAboutAgenda - 02-21-2006-9a2ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: February 21, 2006
Action Agenda
Item No. 9-q-~
SUBJECT: Adult Care Home Community Advisory Committee- One New Appointment
DEPARTMENT: Board of Commissioners PUBLIC HEARING: (YIN) No
ATTACHMENT(S): Under Separate Cover INFORMATION CONTACT:
Membership Roster Clerk's Office, 245-2130
Letter of Recommendation from Advisory
Board
Application(s)/Resume(s) of Person(s) Being
Recommended
Interest List
Application(s)/Resume(s) of Person(s) on the
Interest List
PURPOSE: Ta consider making one appointment to the Adult Care Home Community Advisory
Committee.
BACKGROUND: There are two vacant At-Large positions on the Adult Care Home Community
Advisory Committee, The Adult Care Home Community Advisory Committee is recommending Peggy
Cohn for one of these positions.
FINANCIAL IMPACT: None..
RECOMMENDA'TION(S): Consider making one new appointment to the Adult Care Home Community
Advisory Committee.
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Page 1 of 1
Monica Evans • nomination for Adult Care Home Advisory Committee
From: <JMPASSMORE@aohcom>
To: <mevans@co.orange,nc.us>
Date: 1/20/20061.30 PM
Subject: nomination far Adult Care Home Advisory Committee
CC: <Ideloye@hotmail.com>, <kleith@co.orange,nc.us>
Hi, Monica,
The Adult Care Home Advisory Committee wishes to submit the following nomination far their committee:
The nominating committee for the Orange County Adult Care Home Community Advisory Committee
has nominated Peggy Cohn for an open position on the committee. This nomination was agreed to by the
greater committee. Ms. Cohn has served the community for many years in the field of community health
nursing and geriatric care management. She has worked with residents of nursing and adult care homes. The
committee members are pleased she has chosen this committee as a means of continuing her much valued
community service,
Peggy has applied for the committee. Please let me know if you need any additional information,
Have a great weekend!
Jill
Jill V. Passmore
Region J Lead LTC Ombudsman
Triangle J Area Agency on Aging
Triangle J Council of Governments
PO Box 12276
RTP, NC 27709
Voicemail: 558.9401
Cell: 423,1444
file://G:1Documents and SettingslAdministratorlLocal SettingslTemplGW}00003.HTM 2l3/2006
~P
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:
Ms. Peggy Cohn
Peggy
10 Bayswater Place
Chapel Hill NC 27517
919-489-6624
same
peggycohn 1 @earthlink. net
retired
Geriatric Care Manager
Township of Residence: Chapel Hill
Zone of Residence: C.H, City Limits
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 8/28/1938
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Nursing Home Community Advisory Committee
Advisory Board on Aging
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, Coltambia 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: 2/7/2006
Applicant Interest Listing
by Board Name and by Applicant Name
Contact Person: Katherine Leith
f~[t[llt Cal'B FI0/12B COIZZIitIIIZlry.'ll~VlSOIy COIlt1lZLflBC Contact Phone: 919-968-2082
MS. I{aTBTI CaI1 Day Phone: 919-419-4920 Sox: Female
204 Forest Ridge Drive Evening Phone: Race: Caucasian
Chapel Flitt NC 27514 FAX: Township: Chapel hilt
E-mail: kcarrl4@ncm com Dale Applied: 10/30/2005
Skills: Community Service Volunteer Also Serves On:
Skills: Graphic Arts Also Serves On:
MS..Ieanette Cjai'IC Day Phone: 919-620-8662 Sex: Female
221 Rencher St Apt 3 Evening Phone: 732-7856 Race: Afrcan American
Hillsborough NC 27278 FAX: 6208662 Township: Hillsborough
E-mail: Date Applied: 02/23/2005
Skills: Nursing Home Experience Also Serves On:
MS. Peggy CO$n Day Phone: 919-489-6624 Sex: Female
10 Bayswater Place Evening Phone: same Race: Caucasian
Chapel HiII NC 27517 FAX: Township: Chapel Hitl
E-mail: peggycobnl @earthlink net Date Applied: 10/10/2005
Skills: Geriavic Care Atso Serves On:
MS Capna HalTiS Day Phone: 9t9-732-7483 Sex: Female
327 Fon~est Street Evening Phone: 919-923-6318 Race: African American
I-titlsbourgh NC 27278 FAX: Township: 1-Iillsborough
E-mail: Rorograndbabyl7@aol com Date Applied: 09/09/2004
Skins: Fasl Food Service Also Serves On:
MS .IOllallria .I011Sen Day Phone: 225-1925 Sex: Female
2201 Baycourt Trail Evening Phone: 245-1637 Race: Caucasian
Hillsborough NC 27276 FAX: Township: Hillsborough
E-mail: jjensenj@mindspring com Date Applied: 11/09/2003
Skills: Medical Technologist Also Serves On:
Ms. Patricia I{och
1540 Ferrell Rd
Chapel Hill NC 27517
Skills: Retired
Skills: School Volunteer
Day Phone: 942-6637
Evening Phone: same
FAX:
E-mail: pkoch@mindspring com
Also Serves On:
Also Serves On:
Sex: Female
Race: Caucasian
Township: Chapel Hilt
Date Applied: 07/12/2005
Pucsday; February 07, 2006 Pagc t of 2
Applicant Interest Listing by Board Name and by Applicant Name
Contact Person: Katherine L eidi
Adult Care Hoztte Coutmuxity Adnisozy Conzxzittee Contact Phone: 919-968-2082
Sl:itls: Teacher Also Serves On:
MI-. JOrighOOri L88 Day Phone: 919-360-1422 Sex: Male
111 Howell St Apt B Evening Phone: Race: Asian American
Chapel Hill NC 27514 FAX: Township: Chapel Hill
E-mail: jlee5@cmail mu edu Date Applied: 12/27/2003
Skills: Habitat for Humanity Also Serves On:
MS. Rllp3 Sh1.t~C13 Day Phone: 962-2143 Sex: Female
601 loves Feny RD A-5 Evening Phone: 270- 3707 Race: Asian American
Caaboro NC 27510 FAX: Township: Chapel Hill
E-mail: shukla@email unc edu Date Applied: 09/26/2004
Skills: Coach Also Serves On:
Skills: Sales Also Serves On:
Skills: Special Olympics - N C Also Serves On:
IVIT. /i. ~Ollll Vogt Day Phone: 919-96G-0189 Sex; Male
713 W Barbee Chapel Rd Evening Phone: 919-929-8646 Race: Caucasian
Chapel Hill NC 27517 FAX: 919-962-0654 Township: Chapel Hill
E-mail: vogt@iogmailiog unc edu Date Applied: 07/03/2005
Skills: Ptuent in Spanish Also Serves On: Human Relations Commission
Also Serves On: Master Aging Plan Iaskforce-Severely Impaired/Institut
Skills: Former member/7&E Committee Also Serves On: Human Relations Commission
Also Serves On: Master Aging Ptan Iaskforce-Severely Impaired/Institut
Skills: Institute of Gov't Professor Also Serves On: Human Relations Commission
Also Scrves On: Muster Aging Ptan Iaskforce-Severely Impaired/Institut
Tuesday, February 07, 2006 Page 2 of 2
9
Page 1 of 1
Karen Carr
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. Karen Carr
204 Forest Ridge Drive
Chapel Hill NC 27514
919-419-4920
kcarr14@nc.rr.com
Program Director
Chapel Hill
At-Large
Female
Caucasian
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Program Director far a retirement community, Coordinator for Outreach Ministries
(homeless, poor with various backgrounds and ages),
Graphic Design (corporate identities, logo design, letterhead, multimedia-print and video,
Administrative Assistant
Volunteer Experience:
1990-current Youth Ministry Leader, 2005 -graphic designs for a new program in Faith
and Culture Series in Chapel Hill
Education:
Associates in Medical Assisting,
BSBA with Management Major
Other Comments:
I have worked with various age groups of people and socio-economic backgrounds. I am
interested in more information on the adult care home advisory committee or another
committee that deals with the aging population in our community. Thank you, STAFF
COMMENTS: Orignally applied for Adult Care Home Community Adv, Committee
10/31/2005. ADDRESS VERIFICATION: 204 Forest Ridge Drive is in Orange County in
the Chapel Hill township, outside the city limits and ETJ.
This application was current on: 10/30/2005 130:04 PM Date Printed: 2/7/2006
~o
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:
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
Sex: Female
Ethnic Background: African American
Date of Birth: 7/8/1955
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Adult Care 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 pate Printed: 2/7/2006
Page 1 of 1
Capria Harris
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 Capria Harris
327 Forrest Street
Hillsbourgh NC 27278
919-732-7483
919-923-6318
Rorograndbabyl7@aol.com
Township of Residence: Hillsborough
Zone of Residence: Hillsborough Town Limits
Sex:
Ethnic Background:
Date of Birth:
Female
African American
8/31 /1986
Boards/Commissions applied for:
Adult Care Nome Community Advisory Committee
Hillsborough Planning Board
Board of Social Services
Human Relations Commission
Work Experience:
I have worked at the Holiday Inn, the KFC and Hardees.
Volunteer Experience:
I have volunteerd at the Center for Volunteer Caregiving and at the Sportsplex and Tom
Thumb Daycare Center in Salemburg When I was attending school I also volunteerd at
two Nursing Homes in Salemburg.! also have 150 hours in community service from
school.
Education:
I attended Tarheel Challenge in Salemburg where I received my GED, June,11,2004
Other Comments:
I grew up here then I went to school in Salemburg. I am back home now looking for a job
or a place to volunteer. I hope that you will give me a call and let me voluteer for you or
offer me a job thank you. STAFF COMMENTS: Originally applied for Adult Care Home
Oommunity Advisory Committee, Hillsborough Planning Board and Board of Social
Services, ADDRESS VERIFICATION: 327 Forrest Street is in Hillsborough City Limits.
This application was current on: 9/9!2004 3:25:52 PM Date Printed: 2/7/2006
is
Page 1 of t
Johanna Jensen
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
.lob Title:
Ms Johanna Jensen
2201 Baycourt Trail
Hillsborough NC 27278
225-1925
245-1637
jjensenj@mindspring.com
Medical Technologist
Township of Residence: Hillsborough
Zone of Residence: -
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 9/19/1963
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Duke University Hospital, Medical Technologist, 5/1990- present
Volunteer Experience:
Education:
BS in Medical Technology, Medical College of Virginia
Other Comments:
STAFF NOTES: 10/03 Original appl. For CFW; ACHCAC, ADDRESS VERIFICATION:
2201 Baycourt Trail, Hillsborough is in Beckett's Ridge Subd, in Hillsborough City Limits,
In Hillsborough Township, MOAD/ncg ,
This application was current on: 11/9/2003 [)ate Printed: 2/7/2006
13
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Patricia Koch
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. Patricia Koch
Pat
1540 Ferrell Rd
Chapel Hill NC 27517
942-6637
same
pkoch@mindspring.com
retired
Teacher
Chapel Hill
C.H. City Limits
Female
Caucasian
12/4/ 1930
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Nursing Home Community Advisory Committee
Work Experience:
Tataght school for 41 years
Volunteer Experience:
Volunteer at Carrboro Elementary School and Britthaven Nursing Home
Education:
B,A,and M,A.
Other Comments:
I spent over 10 years visiting my aunt in Carol Woods, She was in assisted living for the
last 10 years of her life, I also understand that .John Vogt is no longer on the board and
there is an opening. STAFF COMMENTS: Originally applied for Adult Care Home CAC
and Nursign Home CAC 7/12/2005. 1540 Ferrell Rd is in Chapel Hill township in the
Chapel Hill City limits,
Thls application was current on: 7/12/2005 Date Printed: 2/7/2006
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Page 1 of 1
Jonghoon Lee
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, Jonghoon Lee
111 Howell St. Apt B
Chapel Hill NC 27514
919-360-1422
jlee5@email.unc,edu
Township of Residence: Chapel Hill
Zone of Residence: C.H, City Limits
Sex: Male
Ethnic Background: Asian American
Date of Birth: '7/28/1977
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Board of Health
Nursing Home Community Advisory Committee
Work Experience:
Hardee's Restaurant
UNC-CH Libraries
Pantry
Dental Research Center
Volunteer Experience:
Dental Research Center
Orange County Habitat for Humanity
Education:
Sanderson High School-Raleigh, NC
UNC-CH; Chemistry Major, Math Minor
Other Comments:
STAFF COMMENTS: Original) applied for Adult Care Home Comm, Adv. Committee;
Board of Health; and Nursing Home Comm, Adv, Committee. ADDRESS
VERIFICATION: 111 Howell St Apt B is in the Chapel Hill township in the Chapel Hill
City Limits.
This application was current on: 12/27/2003 2:27:55 PM Date Printed: 2/7/2006
IS
Page i of 2
Rupa Shukla
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
.lob Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Rupa Shukla
601 Jones Ferry RD A-5
Carrboro NC 27510
962-2143
270- 3707
shukla@email,unc,edu
UNC- GH Lineberger Comprehensive Cancer Cent
Research Technician/ Lab Manager
Chapel Hill
Carrboro City Limits
Female
Asian American
4/11/1981
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Carrboro Planning Board
Southern Orange Senior Center (New) -Design Co
Work Experience:
University of North Carolina at Chapel Hill-- Lineberger Cancer Center
Ann Taylor Loft, Sales Associate
Volunteer Experience:
Orange County Special Olympics-- Swim Coach
Trinity Adult Day Care Center (Tullahoma, TN)
Relay- for- Life
Education:
BA History and BA Chemistry from UNC- Chapel Hill
Other Comments:
I have helped out in my mother's adult day care center for the past 10 years. The center
specialized in Alzheimer's care, but also allows patrons with other physical ailments to
participate, The Trinity Adult Care Center is a great place for caregivers to comfortably
leave their loved ones while they are at work, The center provides meals, physical
exercises, as well as games that strengthen the participants' minds-- working on their
recall skills and helping to sharpen their minds. The knowledge I have gained through
this experience would definitely help me to serve on either the Adult Gare Home
Community Adivsory Committeee or the Southern Orange Senior Center Design
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Page 2 of 2
Rupa Shukla
Committee! Thanks! STAFF COMMENTS: Originally applied for Adult Care Home
Community Advisory Committee, Carrboro Planning BDard and Southern Orange Senior
Center Desaign Committee. ADDRESS VERIFICATION: 601 Jones Ferry Rd is in
Chapel Hill Township, in the Carrboro City Limits.
This application was current on: 9/28/2004 10:11:58 AM Date Printed: 2/7/2006
11
Page 1 of 2
A. John Vogt
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:
Mr. A. John Vogt
Jack
713 W. Barbee Chapel Rd
Chapel Hill NC 27517
919-966-4189
919-929-8646
919-962-0654
vogt@iogmail.iog,unc.edu
Institute of Gov't
Public Finance Professor
Chapel Hill
C.H. Gity Limits
Male
Caucasian
9/29/1941
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Orange-Person-Chatham Area Programs Board
Work Experience:
I have taught Public Finance at the UNC Institute and School of Government for a little
over 30 years, This had involved providing advice to county budget, finance, and
administrative staff, In the 1960's, I lived and worked in Venezuala for 2.5 years. Our
oldest child was born there. At that time, I became fluent in Spanish. Although my
Spanish is rusty, I am able to converse with Hispanics and Lationos in Spanish,
Volunteer Experience:
For the last six years I have been on the County's Nursing Home Community Adv,
Committee, serving as chair three years ago. I rotated off this board June 30,
Education:
PhD in Public Administration, Cornell University; MPIA, School of Public and
International Affairs, University of Pittsburgh; B.S. School of Foreign Service,
Georgetown University,
Other Comments:
Our family is bi-racial. My wife and I have 3 children and 8 grandchildren. Of the
grandchildren, four are bi-racial (African-American and Caucasian) and four are
Caucasian, This family background and a familiarity with the Spanish language underlie
my interest in serving on the Human Rights Commission. If that is not availiable, prior
service on the Nursing Home Committee contributes to my interest in the Adult Care
Home Community Adv, Committee, I am also interested in Mental Health issues which is
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Page 2 of 2
A.. Jahn Vogt
why I am interested in OPC Area Programs Board. STAFF COMMENTS: Reapplied
7/3/2005 for HRC Adult Care Hame Community Advisory Committee and OPC Area
Board. App. 1/12/2000 for Innovation and Efficiency Committee ADDRESS
VERIFICATION: 713 W. Barbee Chapel Road is in Orange County in Chapel Hills City
Limits. Previous address-402 Yorktown Drive Chapel Hill.
This application was current on: 7/3/2005 Date Printed: 2/7/2006