HomeMy WebLinkAboutSignature 2019-01-17
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: 01/17/2019
Report has been
provided as a summary
of a fourth quarter visit,
delayed from the 2018
visiting period.
Time spent in facility: 1 hour Arrival time: 5:00 am X pm
Name of person exit interview was held with: Interview was held: X in Person Phone
Admin. SIC (Supervisor in Charge) Other Staff Rep. Carissa Campbell, MSW
Committee Members Present: Karen Macklin, Stephanie Boswell, Stephanie Miller
Report Completed by: Stephanie Miller
Number of Residents who received personal visits from committee members: 9 residents
Resident Rights Information is clearly visable: Yes Ombudsman Contact Info is correct and clearly posted: Yes
The most recent survey was readily accessible: Yes
(Required for Nursing Homes Only)
Staffing information clearly posted: Yes
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? 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? N/A
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? N/A Overall, residents who spoke with CAC members
seemed moderately satisfied with the living
conditions. None had strong complaints nor
strong praise for the facility.
9. Did you notice unpleasant odors in commonly used areas? No
10. Did you see items that could cause harm or be hazardous? Yes A closet on the 200 hall marked with a biohazard
sign was unlocked.
11. Did residents feel their living areas were too noisy? N/A
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* *One resident indicated that he was unhappy
with the staff response time, while others
interviewed said staff responded in an adequate
amount of time to their requests. While we were
visiting, we observed a resident used the call bell.
Staff responded quickly and courteously.
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?
N/A* One resident mentioned that staff provide the
schedule of activities regularly and encourage
residents to attend.
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
As noted in the September 2018 CAC report, the
DON had mentioned that “several families
[were] in the process of organizing a family
council.” The current status of the family council
remains unknown.
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?
-Status of family council
-Door to bio-hazard closet not locked
-Complaints about quality of food
Yes During the first quarter visit of 2019, CAC
members will inquire about the status of the
family council.
Exit interview was conducted with the facility
social worker, who indicated she would
communicate concerns to the administrator.
CAC members emphasized during the interview
that the same biohazard closet had not been
locked during the current and several previous
visits.
Several residents mentioned that the food was
not well seasoned, which was also communicated
during the exit interview.
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.