HomeMy WebLinkAboutAgenda - 06-07-2005-5b1ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 7, 2005
Action Agend
Item No. 5
SUBJECT: Adult Care Home Community Advisory Committee- Reappointments
DEPARTMENT: Board of Commissioners
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Gover
Membership Roster
Letter of Recommendation
Application(s)/Resume(s) of Person(s) Being
Recommended
Interest List
Application(s)/Resume(s) of Person(s) on the
Interest List
INFORMATION CONTACT:
Clerk's Office, ext. 2130, 2125, 2126, 2129
TELEPHONE NUMBERS:
Hillsborough 245-2130
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To consider making reappointments to the Adult Care Home Community Advisory
Committee.
BACKGROUND: The terms of Ann Chamberlin and Laurin Eastham will expire on 06/30/2005.
The Adult Care Home Community Advisory Committee is recommending Ms. Chamberlin and
Ms. Easthom for reappointment, If reappointed, both will be serving first full terms ending
6/30/2008,
FINANCIAL IMPACT: None.
RECOMMENDATION(S): Consider making reappointments to the Adult Care Home Community
Advisory Committee, as the Board may desire.
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Monica Evans -Fwd: Orange Adult Care Home CAC business Page
S
From: <JMPASSMORE@aol,com>
To: <mevans@co orange.nc us>
Date: 4/26/2005 10:28:27 AM
Subject: Fwd: Orange Adult Care Home CAC business
Hi, Monica,
In regards to the Orange Adult Care Home Community Advisory Committee
1 I already forwarded you info on Ann Chamberlin, that she wishes to be
reappointed. Please see forwarded message, (I wanted to assure that I
submitted all the OACCAC business at one time to make it simpler for you.)
2. Laurin Easthom also wishes to be reappointed. However, she has only
attended one business meeting in the past year.. She has attended over 75% of
her facility visits. I know it is the Commissioners call whether or not to
reappoint, of course. The Committee chair, Charron Andrews wrote this:
"The Orange County Adult Care Home Advisory Committee would like
Laurin Eastholm to be reappointed for another two year appointment. Ms.
Eastholm
has served on the committee for the last year. Although she has not been
able to attend
our bimonthly afternoon meetings because of scheduling conflicts, she has
made
quarterly visits to her assigned adult care home and followed up with
required reports to the committee and subcommittees. Laurin would like to
continue serving older residents of Orange County by continuing her
appointment to this committee."
Let me know if you have any questions. Jmpassmore@aol.com_
(mailto:jmpassmore@aotcom) or 423.1444
Thank you!
Jill
Jill V. Passmore
Region J Lead LTC Ombudsman
Triangle J Area Agency on Aging
Triangle J Council of Governments
PO Box 12276
RTP, NC 27709
Voicemail: 558.9401
Cell: 423,1444
CC: <cfandrew@email.unc.edu>, <Ideloye@hotmaiLcom>, <kleith@co orange..nas.us>
Page 1 of 1
Ann Chamberlin ~N
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Ann Chamberlin
2329 Falls Dr,
Chapel Hill NC 27514
919-383-8105
919-383-8105
acandcm@earthlink..net
La Salle Health Care
Physical Therapist
Chapel Hill
Chapel Hill Twnsp
Female
Undesignated
11 /6/ 1957
Boards/Commissions applied for:
Work Experience:
La Salle Healthcare Durham, 10/03-present; Durham Reg. Hosp. 10/03 - 12/02; UNC
School of Medicine, Project Mgr, Research; 10/96 - 8/00; School of Nursing, UNC 8/95 -
9/96 ,Project Mgr,; tJNC Sch, Of Medicine, 4(92- 4/95; 12/86 - 12/91 Program
Coordinator, Western Man Hospital, Westfield, MT.
Volunteer Experience:
New Hope Elem. Sch. Reader, 1995-1997, 2002-2003. IFC Community Shelter, 8/96 -
5/97.
Education:
2002 MPT UNC Sch, Of Medicine, Div, Of Physical Therapy; 1984 UNC Sch. Of Public
Health, Dept. of Health, Behavior and Health Education, 1979, B,A, Psychology, SONY
@Binghamton,
Other Comments:
STAFF NOTES: Originally applied 1/5/2004 for CFW, HSAC and HRC, ADDRESS
VERIFICATION: On 6/17/04 an address change was received for 4909 Walnut Grove
Church Road, Hurdle Mills, NC 27514,
2704 Millcreek Road, Mebane is in Cheeks Township( current 1/5/2004).
This application was current on: 12/19/2003 Date Printed: 5/23/2005
Page 1 of 1
Laurin Easthom
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Laurin Easthom
305 Rowe Road
Chapel Hill NC 27516
919-942-0001
919-773-3002
919-773-8824
laurindds@earthlink.net
Medicaid Dental Center
Dentist
Chapel Hill
Female
Boards/Commissions applied for:
Work Experience:
Currently I am a dentist (part-time) treating underprivileged children (medicaid) in
Raleigh, I have also been a general dentist treating adults/elderly. I also (before a
dentist) was a case manager in rehabilitation aiding injured workers find adequate
employment,
Volunteer Experience:
In college, I volunteered at nursing homes assisting /entertaining residents. I was a
hospital volunteer in physical therapy far a year in my master's program at USC,
Education:
B.A, History (1986), Davidson College; M.Ed, (1988) (Master of Education) Counseling at
lJniv. So. Carolina, D,D,S, & NC Chapel Hill in 1998.
Other Comments:
Original Application submitted on 10129/03 for Adult Care Home Community Advisory
Committee. I have had friends/family in nursing homes (still do), I deeply care about this
population -they have given their long lives to society and have weathered many a storm
and have so much to tell - we owe them our greatest respect in the world, They deserve
the best and demand our greatest respect and empathy, I want to help them. Address
Verification: 305 Rowe Road is in CH ET~J current 10/30/03,
This appiicatlon was current on: 10/29/2003 9:49:44 PM Date Printed: 5/23/2005
D
Applicant Interest Listing by Board Name and by Applicant Name
Contact Person: Katherine Leith
Adult Care Honze Community Advisory Committee Contact Phone: 919-968-2082
Rev Gwendolyn G. Tordan Day Phone: 643-2207 Sex: Female
2314 Miller Rd Evening Phone: Race: African American
Hillsborough NC 27278 FAX: Township: Eno
E-mail: Date Applied: 04/12/2005
Skills: Also Serves On:
Skills: Minority Community Also Serves On:
Skills: Political Volumeer Also Serves On:
MS. JeBllette CIffiIC Day Phone: 919-620-8662 Sex: Female
221 Rencher St Apt 3 Evening Phone: 732-7656 Race: African American
Fillsborough NC 27278 FAX: 6208662 Township: Hillsborough
E-mail: Date Applied: 02/23/2005
Skills: Nursing home Experience Also Serves On:
MS CflpT12132TI7S Day Phone: 919-732-7483 Sex: Female
327 Forrest Street Evening Phone: 919-923-6378 Race: African American
Hillsbourgh NC 27278 FAX: Township: Hillsborough
E-mail: Roro~Randbabyl7@aolcom Date Applied: 09/09/2004
Skills: Fast Food Service Also Serves On:
MS .1O112Ill13 .~e11Sen Day Phone: 225.1925 Sex; Female
2201 Baycourt trail Evening Phone: 245-1637 Race: Caucasian
Hillsborough NC 27278 FAX: Township: Iillsborough
E-mail: jlensenj@mindspring com Date Applied: 11/09/2003
Skills: Medical Technologist Also Serves On:
Mr. .1O17ghOOn L08 Day Phone: 919-360-1422 Sex; Male
t 11 Howell St Apl B Evening Phone: Race: Asian American
Chapel Hill NC 27514 FAX: Township: Chapel Hill
E-mail: jtee5@email.unc edu Date Applied: 12/27/2003
Skins: Habitat for Humanity Also Serves On:
Monday, May 23, 2005 Page t of 2
Applicant Interest Listing
by Board Name and by Applicant Name
Contact Person:
Adult Care Ho»ie ComnauiaityAdvismy Contrnittee Contact Phone: I:atherine Leith
919-968-2082
MS. Jlldlfll M1tCllell Day Phone: (919)933-8381 Sex: Female
3620 Dairyland Road Evening Phone: 919-933-1851 Race: Caucasian
Hillsborough NC 27278 FAX: 919-933-6623 Township: Bingham
E-mail: jmitche1158@earthlink.net Date Applied: 11/15/2003
Skills: Community Service Volunteer Also Serves On:
Skills: EMi Also Serves On:
Skills: Receptionist Also Serves On:
Ms. Rupa Slmkla
601 Jones Ferry RD A-5
Carrboro NC 27510
Skins: Coach
Skills: Sales
Skills: Special Olympics - N C
Day Phone: 962-2143
Evening Phone: 270- 3707
FAX:
E-mail: shukla@emailunc edu
Also Serves On:
Also Serves On:
Also Serves On:
Sea: Female
Race: Asian American
Township: Chapel Bill
Date Applied: 09/28/2004
Monday, May 23, 2005 Page 2 of 2
~o
Page 1 of 2
Gwendolyn G, Jordan
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence
Zone of Residence:
Sex:
Ethnic Background
Date of Birth:
Rev. Gwendolyn G, Jordan
2314 Miller Rd
Hillsborough NC 27278
643-2207
retired
Eno
Eno Twnsp
Female
African American
9/25/1948
Boards/Commissions applied for:
Board of Sociai Services
Advisory Board on Aging
Adult Care Home Community Advisory Committee
Historic Preservation Commission
Human Services Advisory Commission
Commission for Women
Work Experience:
Worked as an income Maintence Specialist for 25 years in New Jersey, Middlesex
County Welfare, Board of Social Services, Medicaid, Food Stamps, Work First.
Licensed Minister-Associate Minister of Jones Grove Missionary Baptist Church
Hillsborough
Volunteer Experience:
NAACP, Democratic Party, Worked the polls Election Day 11/2004. African American
Democratic Caucus,
Education:
Middlesex County College Credits, New Jersey State/County Training on Welfare- Work
first programs, Master's Degree in Religious Education ,
Other Comments:
STAFF COMMENTS: Originally applied for Board of Social Services, Advisory Board on
Aging, Adult Care Home Community Adv, Committee, HSAC, Commission for Women,
Historic Preservation. ADDRESS VERIFICATION: 2314 Miller Rd is in the Eno township
Page 2 of 2
Gwendolyn G. Jordan ' I
in Orange County,
This application was current on: 4/12/2005 Date Printed: 5/2 312 0 0 5
Page 1 of 1
Jeanette Clark ~,~~
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background
Date of Birth:
Ms. Jeanette Clark
221 Rencher St Apt 3
Hillsborough NC 27278
919-620-8662
732-7856
62Q8662
Central Family Care
Supervisor in Charge
Hillsborough
Hillsborough ETJ
Female
African American
7/8/1955
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Adult Care Home Community Advisory Committee
Joint Orange Chatham Community Action Agency
Work Experience:
I have been in the medical experience for about 12 yrs. I am a certified nurse assistant,
and a certified medical technician. I have nursing home and adult care home
experience. I supervise a group home now for mental residents
Volunteer Experience:
I have no volunteer experience but I have done outreach before and I have a certificate
for a class I took as an outreach worker.
Education:
GED
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home CAC and Adult Care Home
Community Advisory Committee and JOCCA. ADDRESS VERIFICATION: 211 Rencher
St is in Orange County in Hillsborough Township in Hillsborough ETJ.
This application was current on: 2/23/2005 Date Printed: 5/23/2005
Page 1 of 1
Capria Harris
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Ms Capria Harris
327 Forrest Street
Hillsbourgh NG 27278
919-732-7483
919-923-6318
Rorograndbabyl7@aol,com
Township of Residence: Hillsborough
Zone of Residence: Hillsborough Tawn Limits
Sex:
Ethnic Background
Date of Birth:
Female
African American
8/31/1986
Boards(Commissions applied for:
Adult Care Home Community Advisory Committee
Hillsborough Planning Board
Board of Social Services
Human Relations Commission
Work Experience:
I have worked at the Holiday Inn, the KFC and Hardees.
~3
Volunteer Experience:
I have volunteerd at the Center for Volunteer Caregiving and at the Sportsplex and Tom
Thumb Daycare Center in Salemburg When I was attending school I also volunteerd at
two Nursing Homes in 5alemburg.l also have 150 hours in community service from
school.
Education:
I attended Tarheel Challenge in Salemburg where I received my GED, June,11,2004
Other Comments:
I grew up here then I went to school in Salemburg, I am back home now looking for a job
or a place to volunteer, I hope that you will give me a call and let me voluteer for you or
offer me a job thank you, STAFF COMMENTS: Originally applied for Adult Care Home
Ocmmunity Advisory Committee, Hillsborough Planning Board and Board of Social
Services, ADDRESS VERIFICATION: 327 Forrest Street is in Hillsborough City Limits,
This application was current on: 9(9/2004 3:25:52 PM Date Printed: 5/23/2005
Page 1 of 1
Johanna Jensen
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Ms Johanna Jensen
2201 Baycourt Trail
Hillsborough NC 27278
225-1925
245-1637
jjensenj@mindspring.com
Medical Technologist
Township of Residence: Hillsborough
Zone of Residence: -
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 9/19/1963
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Duke University Hospital, Medical Technologist, 5/1990- present
Volunteer Experience:
Education:
BS in Medical Technology, Medical College of Virginia
I~.(
Other Comments:
STAFF NOTES: 10!03 Original app!. For CFW; ACHCAC. ADDRESS VERIFICATION:
2201 Baycourt Trail, Hillsborough is in Beckett's Ridge Subd, in Hillsborough City Limits,
In Hillsborough Township, MOAD/ncg .
This application was current on: 11/9/2003 Date Printed: 5/23/2005
Page 1 of 1
Jonghoon Lee
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Mr. Jonghoon Lee
111 Howell St. Apt B
Chapel Hill NC 27514
919-360-1422
jlee5@email.unc.edu
Chapel Hill
C.H. City Limits
Male
Asian American
7/28/1977
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Board of Health
Nursing Home Community Advisory Committee
Work Experience:
Hardee's Restaurant
UNC-CH Libraries
Pantry
Dental Research Center
Volunteer Experience:
Dental Research Center
Orange County Habitat for Humanity
Education:
Sanderson High School-Raleigh, NC
UNC-CH; Chemistry Major, Math Minar
Other Comments:
STAFF COMMENTS: Original) applied for Adult Care Home Comm. Adv. Committee;
Board of Health; and Nursing Home Comm. Adv. Committee. ADDRESS
VERIFICATION: 111 Howell St Apt B is in the Chapel Hill township in the Chapel Hill
City Limits.
>'j
This application was current on: 12/27/2003 2:27:55 PM Date Printed: 5/23/2005
Page 1 of 1
Judith Mitchell
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Ms, Judith Mitchell
3620 Dairyland Road
Hillsborough NC 27278
(919)933-8381
919-933-1851
919-933-6623
jmitchell58@earthlink,net
Retired
Township of Residence: Bingham
Zone of Residence:
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 6/20/1940
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Currently (11/03) I am working for Home Health Solution. Was retired from as
receptionist for Carrboro Peds. And Internal Medicine. Prior to that I worked as UNC
Student Health as a receptionist in Women's Health.
~~
Volunteer Experience:
Department of Social Service; Orange County Fire Department -EMT -First Responder,
Education:
High School; Few courses at Community College, 18 credit hours; Adult Education
Courses.
Other Comments:
STAFF NOTES: Renewed app. 11/15/03 forA.C.H.CAC. Applied 1/16/2001 for Adult
Care Home Community Advisory Committee. OTHER COMMENTS: Very interested
in helping the adult mentally alert but physcially challenged live on their own, There is
nothing for them in this county, I also beleive that Senior Citizens should have better care
both physically and mentally. There are a lot of lonely seniors in just this county alone.
You may check with Ghris Nutter or Heather Barrow far references. Or with any of the
Doctors at Carrboro Peds. And Internal Medicine,
This application was current on: 11/15/2003 Date Printed: 5/23/2005
Page 1 of 2
Rupa Shukla
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background
Date of Birth:
Ms, Rupa Shukla
601 Jones Ferry RD A-5
Carrboro NC 27510
962-2143
270- 3707
shukla@email.unaedu
UNC- CH Lineberger Comprehensive Cancer Cent
Research Technician/ Lab Manager
Chapel Hill
Carrboro City Limits
Female
Asian American
4/11/1981
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Carrboro Planning Board
Southern orange Senior Center (New) -Design Co
Work Experience:
University of North Carolina at Chapel Hill-- Lineberger Cancer Center
Ann Taylor Loft, Sales Associate
Volunteer Experience:
Orange County Special Olympics-- Swim Coach
Trinity Adult Day Care Center (Tullahoma, TN)
Relay- for- Life
Education:
BA History and BA Chemistry from UNG- Chapel Hill
~~
Other Comments:
I have helped out in my mother's adult day care center for the past 10 years, The center
specialized in Alzheimer's care, but also allows patrons with other physical ailments to
participate, The Trinity Adult Care Center is a great place for caregivers to comfortably
leave their loved ones while they are at work. The center provides meals, physical
exercises, as well as games that strengthen the participants' minds-- working on their
recall skills and helping to sharpen their minds, The knowledge I have gained through
this experience would definitely help me to serve on either the Adult Care Home
Community Adivsory Committeee or the Southern Orange Senior Center Design
Page 2 of 2 Rupa Shukla ~~
Committee! Thanks! STAFF COMMENTS: Originally applied for Adult Care Home
Community Advisory Committee, Carrboro Planning Board and Southern Orange Senior
Center Desaign Committee. ADDRESS VERIFICATION: 601 Janes Ferry Rd is in
Chapel Hill Township, in the Carrboro City Limits.
This application was current on: 9/26/2004 10:11:58 AM Date Printed: 5/23/2005