HomeMy WebLinkAboutAgenda - 06-07-2005-9d7ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 7, 2005
Action Agenda -l
Item No. 9- d -
SUBJECT: Nursing Home Community Advisory Committee- One New Appointment
DEPARTMENT: Board of Commissioners
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Cover
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 one new appointment to the Nursing Nome Community Advisory
Committee.
BACKGROUND: Several members of the Nursing Home Community Advisory Committee will
be rolling off the board on 06/30/2005, The Board is recommending Dawn Pickett to fill a
vacant position.. If appointed, Ms. Pickett will be serving aone-year training term ending
6/30/2006.
Position Number S ecial Re resentation
8 At-Lar e
I 1 Nursing Home Adminstration
12 Nursing Home Administration
FINANCIAL IMPACT: None,
RECOMMENDATION(S): Consider making one new appointment to the Nursing Home Community
Advisory Committee, as the Board may desire,
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Monica Evans- Pickettrecommendation4-29-05.doc Page '
Mary Ann Peter
118 W. Tryon Street
Hillsborough, NC 27278
Apri129,Z005
The Honorable Moses Cazey, Chair
Orange County
Boazd of County Commissioners
P.O. Boa 8181
Hillsborough, NC 27278
Dear Chair Carey
Subject: Committee Appointment
The Orange County Nursing Home Community Advisory Committee reviewed all
applicants for the Cotrunittee and recommends Dawn Pickett, a resident of Chapel Hill,
NC.
She has attended two meetings to familiarize herself with the work of the committee. We
think she is well qualified for membership.
Her application is attached.
Sincerely,
Mazy Ann Peter, RIV, PhD
Chair
Orange County Nursing Home Community Advisory Committee
Page 1 of 1
Dawn C. Pickett
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. Dawn C. Pickett
107 Jones Street
Chapel Hill NC 27514
919-929-8965
919-929-8965
pickettdawn@hotmail,com
Township of Residence: Chapel Hill
Zone of Residence: At-Large or C,H, city limits
Sex:
Ethnic Background:
Date of Birth:
Female
Caucasian
11 /2/ 1945
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Volunteer Experience:
Education:
Other Comments:
On 10/23/03, she updated her application with staff at CFE; she is still interested in CFE
but primarily in NHCAC, 11!25/02 renewed her app: for Nursing Home Community Adv.
Committee, 1st choice; CFE, 2nd choice, Applied 2/19/02 for Nursing Hame Community
Advisory Committee; Adult Care Home Community Advisory Committee; Commission for
the Environment, WORK EXPERIENCE: Medical Review of N.C.., Senior Assoc; OVP
Projects. VOLUNTEER EXPERIENCE: Wake County Nursing Home Advisory
Committee; N,C. Health Access Coalition (see attached letter). EDUCATIONAL
EXPERIENCE: B.A, Industrial Relations, tJNC-Chapel Hilh addrs.ver.mpqust.ncp. 107
Jones Street is in C.H. city limits.
This application was current on: 10/23/2003 Date Printed: 5/23/2005
7
Applicant Interest Listing by Board Name and by Applicant Name
Contact Person: Kate Barrett, L.CSW/Eldercare
Nursing Horne CorrznzunityAdvisory Committee Contact Phone: 919-968-2085
MS, JeanetteClaTk Day Phone: 979-620-6662 Se%: Female
221 Rencher St Apt 3 Evening Phone: 732-7856 Race: African American
Hillsborough NC 27278 FAX: 6208662 Township: Hillsborough
E-mail: Date Applied: 02/23/2005
Skills: Nursing Home Experience Atso Serves On:
Mr, Jonghoon Lee
11 I Howell St. Apt B
Chapel Hill NC 27514
Skills: Habitat for Humanity
Day Phone: 919-360-742?
Evening Phone:
FAX:
E-mail: j1ee5@email unc edu
Also Serves On:
Sex: Male
Race: Asian American
Township: Chapel Hitt
Date Applied: 12/27/2003
Ms. Dawn C, Pickett
107 tones Street
Chapel Mill NC 27514
Skills: Advisory Board Experience
Ms. Tan'e Powell
656 Craige Dorm
tINC Chapel Hill
Chapel Hitt NC ?7514
Skills: Cashier
Skills: Community Service Volunteer
Skills: Customer Service
Day Phone: 919-929-8965
Evening Phone: 919-929-8965
FAX:
E-mall: pickettdawn@hotmail com
Also Serves On:
Day Phone: 910-474-9083
Evening Phone: 919-914-0924
FAX:
E-mail: japo@emait unc edu
Also Serves On:
Also Serves On:
Also Serves On:
Sex: Female
Race: Caucasian
Township: Chapel Bill
Date Applied: 10/23/?003
Sex: Female
Race: African American
Township: Chapel Hitl
Date Applied: 09/30/2004
Monday, May 23, 2005 Page 1 of t
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
6208662
Central Family Care
Supervisor in Charge
Hillsborough
Hillsborough ETJ
Female
African American
7/8/1955
BoardslCommissions 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
Qther Comments:
STAFF COMMENTS: Originally applied far 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
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
Does not apply
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 Minor
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.
This application was current on: 12/27/2003 2:27:55 PM Date Printed: 5/23!2005
Page 1 of 1
Jane Powell j~
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone:(Dayi
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence
Zone of Residence:
Sex:
Ethnic Background
Date of Birth:
Ms. Jane Powell
656 Craige Dorm
UNC Chapel Hill
Chapel Hill NC 27514
910-474-9083
919-914-4924
japo@email.unc.edu
Wynnsong 15 Theatre
Cashier
Chapel Hill
Chapel Hill Township within C.H. city limits
Female
African American
10/18/1983
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Affordable Housing Advisory Board
Work Experience:
Ocean Beach Club; waitress and secretary, Dairy Queen: cashier, Wynnsong 15: cashier
Volunteer Experience:
Volunteer with Public Service Scholars, Volunteer at Dobbins Hill apartments on
Mondays, Volunteer at UNC Hospital on Mondys. DO other volunteering when needed.
Education:
High School-Lumberton Senior High School, attending UNC Chapel, BS Nursing
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home Community Advisory
Committee, Affordable Housing Advisory Board, and Animal Shelter Operations Task
Farce. ADDRESS VERIFICATION: 656 Craige Dorm is on the campus of UNC-Chapel
Hill and is located off of Manning Drive in Orange County, in the Chapel Hill Township in
the City Limits.
This application was current on: 9/30/2004 Date Printed: 5/23/2005