HomeMy WebLinkAboutBrookshire 2016-05-24
Community Advisory Committee
Quarterly/Annual Visitation Report
County Orange Facility Type Family
Care Home
Adult Care Home
X Nursing Home
Facility Name:Brookshire
Census – current/licensed: 68/80
Visit Date and day of the week
May 24, 2016
Time spent in facility
One hours fifteen minutes
Arrival time 10:00 a.m.
Name of person(s) with whom exit interview was held
Activities director :
Interview was held x in person
Committee members present:
Number of residents who received personal visits from committee members 13 Report completed by:
Resident Rights information is clearly posted? Yes Ombudsman contact information is correct and clearly posted: Yes
The most recent survey was readily accessible Yes
(Required for NHs only – record date of most recent sur-
vey posted) : 3/17/2016 Life Safety Survey.
Staffing information clearly posted? Did not observe
Resident Profile Yes
No
N/A
Comments/Other Observations (please num-
ber comments)
1. Do the residents appear neat, clean and odor free? Yes* 1. Some residents still in night clothing and had
not had their baths at 10:00 AM. 2.Did residents say they receive assistance with personal care ac-
tivities? (i.e. brushing their teeth, combing their hair, inserting
dentures or cleaning their eyeglasses)
Yes
3. Did you see or hear residents being encouraged to par-
ticipate
in their care by staff members?
Yes
4.Were residents interacting with staff, other residents & visitors? Yes
5.Did staff respond to or interact with residents who had difficulty
communicating or making their needs known verbally? N/A
5a Did staff members wear nametags that are easily read
by
residents and visitors?
Yes
6. Did you observe restraints in use? No
7. If so, did you ask staff about the facility’s restraint pol-
icies?
Note: Do not ask about confidential information without
consent
N/A
Resident Living Accommodations Yes
No
N/A
Comments/Other Observations (please num-
ber comments)
8. Did residents describe their living environment as homelike? No* 8. Residents generally pleased with their envi-
ronment
9. Did you notice unpleasant odors? No
10. Did you see items that could cause harm or be hazardous? No
10a. Were unattended med carts locked? Yes
10b. Were bathrooms clean, odor-free and free from hazards? Yes
10c. Were rooms containing hazardous materials locked? Yes
11. Did residents feel their living areas were kept at a reasonable
noise level?
Yes
12. Does the facility accommodate smokers?
Note: By regulation smoking is only permitted outside of the
Building
No
13. Were residents able to reach their call bells with ease? Yes
14. Did staff answer call bells in a timely & courteous manner? Yes
14a If no, did you share this with the administrative staff? N/A
*** N/A equals not applicable, not asked, not observed
Facility / Date:
Resident Services Yes
No
N/A
Comments/Other Observations (please
number comments)
15. Were residents asked their preferences or opinions
about the activities planned for them at the facility?
No* 15. Discussed with Activity Director during
exit interview.
16 and 16a. The facility does not admit residents on
Medicaid but if a resident is admitted as private pay
and later has to go on Medicaid the resident will be
allowed to remain in facility.
15a. Was a current activity calendar posted in the facility? Yes
15b. Were activities scheduled to occur at the time of
your
visit actually occurring?
Yes
16. Do residents have the opportunity to purchase personal
items of their choice using their monthly needs funds?
Yes*
16a.Can residents access their monthly needs funds at
their
convenience?
Yes*
17. Are residents asked their preferences about meal &
snack choices?
Yes
17a. Are they given a choice about where they prefer to dine? Yes
17b. Did residents express positive opinions regarding
their
dining experience?
Yes
17c. Is fresh ice water available and provided to residents? Yes
18. Do residents have privacy in making and receiving
phone calls?
Yes
19. Is there evidence of community involvement from other
Civic, volunteer or religious groups?
Yes
20. Does the facility have a functioning: Resident’s
Council?
Family
Council?
Yes
No
Areas of Concern Exit Summary
Are there resident issues or topics that need follow-up or
review at a later time or during the next visit?
No
Discuss items from “Areas of Concern” Section as well as
any changes observed during the visit. Give summary of
visit with Administrator or SIC. Does the facility have
needs that the committee or community could help address?
The Activity Director stated that the Resident’s Council has
input on activities and she gets feedback from residents fol-
lowing activities.
1/2015