HomeMy WebLinkAboutSignature 2018-03-15
Community Advisory Committee Quarterly/Annual Visitation Report
County: Orange Facility Type:
Family Care Home X Nursing Home
Adult Care Home Combination Home
Facility Name/Address:
Signature HealthCARE of Chapel Hill
1602 E Franklin St, Chapel Hill, NC 27514
Visit Date: 03 /15 /2018 Time spent in facility: 1 hr 40 min Arrival time: 10:00 X am pm
Name of person exit interview was held with: Interview was held: X in Person Phone
X Admin, Jacqueline Miller SIC (Supervisor in Charge) X Director of Nursing, Onjie Whitt
Committee Members Present: Vibeke Talley, Molly Stein, Karen Macklin, Jacqulyn
Podger
Report Completed by: Jacqulyn Podger
Number of Residents who received personal visits from committee members: 6
Resident Rights Information is clearly visable. X Yes No Ombudsman Contact Info is correct and clearly posted: X Yes No
The most recent survey was readily accessible: X Yes No
(Required for Nursing Homes Only)
Staffing information clearly posted: X Yes No
Resident Profile Yes/No/NA Comments/Other Observations
1. Do the residents appear neat, clean and odor free? Yes
2. Did residents say they receive assistance with personal care
activities? Ex. brushing their teeth, combing their hair, inserting
dentures or cleaning their eyeglasses?
Yes
3. Did you see or hear residents being encouraged to participate 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? Yes
6. Did you observe restraints in use? No
7. If so, did you ask staff about the facility’s restraint policies? N/A
Resident Living Accommodations Yes/No/NA Comments/Other Observations
8. Did residents describe their living environment as homelike? Yes
9. Did you notice unpleasant odors in commonly used areas? No
10. Did you see items that could cause harm or be hazardous? No
11. Did residents feel their living areas were too noisy? No
12. Does the facility accommodate smokers?
Where? X Outside only Inside only Both Inside/Outside
Yes
13. Were residents able to reach their call bells with ease? Yes
14. Did staff answer call bells in a timely & courteous manner?
If no, did you share this with the administrative staff?
Yes
Yes
One resident commented that he had to wait too
long for assistance with toileting.
Resident Services Yes/No/NA Comments/Other Observations
15. Were residents asked their preferences or opinions about the
activities planned for them at the facility?
Yes Resident outings are quite popular. The next
scheduled trip will be to Washington, D.C.
16. Do residents have the opportunity to purchase personal items of
their choice using their monthly needs funds?
Can residents access their monthly needs funds at their
convenience?
Yes
Yes
17. Are residents asked their preferences about meal/snack choices?
Are they given a choice about where they prefer to dine?
Yes
Yes
One resident complained the food was not good.
Another resident indicated the water tasted like
chlorine. (Note: resident is used to and likes well
water.)
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 Resident’s Council?
Family Council?
Yes
Yes
Areas of Concern Yes/No/NA 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.
Last state survey was December 20,
2017. Findings from survey were not
discussed with the administrator.
The citing involved following the care
plan and proper bathing techniques. The
new administrator indicated she was
attending to training the staff.
Signature has completed Phase I of the
transformation to the Eden Model. The
tree graphic that displays the phases
has temporarily been removed due to
painting. Corporate is due to return to
replace the graphic. The activity
calendar has also been removed from
display and residents are given a copy
of the week’s activities.
This Document is PUBLIC RECORD. Do not identify any Resident(s) by name or inference on this form.
Top Copy is for the Regional Ombudsman’s Record. Bottom Copy is for the CAC’s Records.