HomeMy WebLinkAboutSignature 2017-07-18
Community Advisory Committee
Quarterly/Annual Visitation Report
County: Orange Facility Type:
Family Care Home
Adult Care Home
X Nursing Home
Facility Name: Signature
Census – current/licensed: 75/108
Visit date and day of the
week:
July 18, 2017 (Tuesday)
Time spent in facility:
1 hours 30 minutes
Arrival time: 11AM
Name of person(s) with whom exit interview was held:
Lee Cole and the new Director of Nursing
Interview was held: in person
Committee members present:
Jacqulyn (Jackie) Podger, Karen Macklin, Vibeke Talley
Number of residents who received personal visits from committee members:
12
Report completed by: Jackie Podger
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
survey posted): 6/12/2017- 6/14/2017
Staffing information clearly posted? Yes
Resident Profile Yes
No
N/A
Comments/Other Observations (please
number comments)
1. Do the residents appear neat, clean and odor free? Yes
2.Did residents say they receive assistance with personal care
activities? (i.e. brushing their teeth, combing their hair, inserting
dentures or cleaning their eyeglasses)
Yes
3. Did you see or hear residents being encouraged participate in
their care by staff members? N/A
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? Yes
6. Did you observe restraints in use? No
7. If so, did you ask staff about the facility’s restraint policies?
Note: Do not ask about confidential information without consent. N/A
Resident Living Accommodations Yes No
N/A
Comments/Other Observations (please
number comments)
8. Did residents describe their living environment as
homelike?
Yes
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?
N/A
12. Does the facility accommodate smokers? Note: By
regulation smoking is only permitted outside.
N/A
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: Signature 7/ 18/2017
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?
Yes
15b Two activities preceded our arrival at
11AM. Afternoon activities were scheduled.
17: In a resident’s room a cup of cranberry
juice labeled 7/17/2017 was sitting next to
today’s juice cup labeled 7/18/2017. This was
discussed at exit interview.
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?
N/A*
16. Do residents have the opportunity to purchase personal
items of their choice using their monthly needs funds?
N/A
16a.Can residents access their monthly needs funds at
their convenience?
N/A
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 and
Family Council?
Yes
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?
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?
Exit interview was held with the Administrator and new
Director of Nursing. Issue above (17) was mentioned with
resident preferring not to be named. The Administrator and
DON were informed that residents were positive and often
complimentary during individual interviews. Family
members were also positive. Committee members noted
positive atmosphere and positive staff attitudes. The
committee found that the call bells checked were in good
working order and that staff were attentive to residents and
their needs.