HomeMy WebLinkAboutSignature 2018-09-11
Community Advisory Committee Quarterly/Annual Visitation Report
County: Orange Facility Type:
Family Care Home Nursing Home X
Adult Care Home Combination Home
Facility Name/Address: Signature Healthcare of Chapel Hill
1602 E Franklin St, Chapel Hill, NC 27514
Visit Date: 09/11/2018 Time spent in facility: 1 hr 10 min Arrival time: 4:30pm
Name of person exit interview was held with: Onjaleka White-Franks, DON Interview was held: in Person X
Committee Members Present: Stephanie Boswell, Vibeke Talley
Report Completed by: Vibeke Talley
Number of Residents who received personal visits from committee members: 5
Resident Rights Information is clearly visible: Yes X No Ombudsman Contact Info is correct and clearly posted: Yes X No
The most recent survey was readily accessible: Yes X No
(Required for Nursing Homes Only)
Staffing information clearly posted: Yes X 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? NA
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? NA
6. Did you observe restraints in use? No
7. If so, did you ask staff about the facility’s restraint policies?
Resident Living Accommodations Yes/No/NA Comments/Other Observations
8. Did residents describe their living environment as homelike? NA
9. Did you notice unpleasant odors in commonly used areas? No
10. Did you see items that could cause harm or be hazardous? Yes* 10: One door to a bio-hazard trash storage room
was left unlocked.
11. Did residents feel their living areas were too noisy? No
12. Does the facility accommodate smokers?
Where? Outside only Inside only Both Inside/Outside
Yes.
Outside
only
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
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
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
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
No*
20. DON reported that several families are in the
process of organizing a family council
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?
- Door to bio-hazard closet not locked
Discuss items from “Areas of Concern” Section
as well as any changes observed during the visit
- DON made aware of unlocked door to bio-
hazard closet. Informed her that it had been an
issue at visit in June.
- One resident stated that she had expected to
receive physical therapy to improve her mobility
and according to her she did not receive
physical therapy for mobility. This was brought
to the attention of the DON.
- Discussed the facility’s readiness for an
approaching hurricane. The DON stated that
the generators were ready and fueled, there
was extra medicines and food, staffing had
been increased and as resident census was
low the facility was able to offer staff to stay at
facility during the storm. So DON felt the facility
was prepared for the hurricane.
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.