HomeMy WebLinkAboutSignature 2019-06-25Community Advisory Committee Quarterly/Annual Visitation Report
County: Orange Co Facility Type:
Family Care Home Nursing Home
Adult Care Home
Facility Name/Address: Signature Nursing Home
1602 E. Franklin St.
Chapel Hill, N 27514
Visit Date: 6/25/2019 Time spent in facility: 1 hr 5 min Arrival time: 1 : 30 am pm
Name of person exit interview was held with: Interview was held: in Person Phone
Admin. SIC (Supervisor in Charge) Other Staff Rep. Carissa Campbell, MSW
Committee Members Present: Bill Morgan, Stephanie Boswell
Report Completed by: Bill Morgan
Number of Residents who received personal visits from committee members: 6
Resident Rights Information is clearly visable: Yes No Ombudsman Contact Info is correct and clearly posted:
Yes No
The most recent survey was readily accessible: Yes No
(Required for Nursing Homes Only)
Staffing information clearly posted: Yes No
Resident Profile Yes/No/NA Comments/Other
Observations
1. Do the residents appear neat, clean and odor free? Yes 1. Most residents were up and
dressed when we visited
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*
2. Most residents were up and
dressed, and clean when we visited.
Most residents indicated they
received care they needed.
One resident indicated that they had
a negative experience with one of
the staff hired in the facility. The
resident indicated that the staff
member did was abrupt and curt.
The resident indicated that they felt
comfortable in addressing their
concerns with the administration but
had not done so. The resident also
indicated that the majority of staff
who provide care do so in a
professionally.
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
9. Did you notice unpleasant odors in commonly used areas? No Facility looked and smelled clean
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? 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 call times
were slow on occasion but were
usually quick. Other residents felt
the response times were adequate,
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 Residents indicated that there were
a variety of activities offered, and
were encouraged to participate
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*
17* Residents reported being
content with the food, and although
they can select what option they
want prior to the food being
delivered. One resident indicated
that the food service staff informed
her she cannot request a different
meal once the food is delivered in
the future. (she asked for the other
option after she realized she did not
like the meal she originally ordered)
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
we met with a resident who
indicated that they participated
regular in resident’s counsel. A
family member we talked to
indicated they had received info on
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?
N/a Discuss items from “Areas of
Concern” Section as well as any
changes observed during the visit
1. A resident reported that they
were told they were not allow to
change food choice once meals
were delivered,
2. The negative experience with a
CNA reported to us by a resident.
This Document is PUBLIC RECORD. Do not identify any Resident(s) by name or inference on this form.