HomeMy WebLinkAboutCharles House Yorktown 2019-09-17Community Advisory Committee Quarterly/Annual Visitation Report
County: ORANGE Facility Type:
Family Care Home Nursing Home
Adult Care Home
Facility Name/Address: Charles House Yorktown
303 Yorktown Dr, Chapel Hill NC 27516
Census – current/licensed: 4/6
Visit Date: 9 /17 /2019 Time spent in facility: hr 50 min Arrival time: :40 am pm
Name of person exit interview was held with: Interview was held: in Person Phone
Admin. SIC (Supervisor in Charge) Other Staff Rep. Marla
Committee Members Present: Karen Green-McElveen , MaryLou Gelblum , Shade Little Report Completed by: Shade Little
Number of Residents who received personal visits from committee members:
Resident Rights Information is clearly visible: 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
Do the residents appear neat, clean and odor free? Yes 2 residents sleep in bed. The 103 year old
receives a hospice visit weekly.
1 loves Lucy and Carol Burnett watched TV but
also responded to both TV and staff and CACer.
1 received assurances from Marla on the progress
of her sandwich and the accompanying type of
drink.
Did residents say they receive assistance with personal care activities? Ex.
brushing their teeth, combing their hair, inserting dentures or cleaning
their eyeglasses?
No
Did you see or hear residents being encouraged to participate in their care
by staff members? No
Were residents interacting with staff, other residents & visitors? Yes
Did staff respond to or interact with residents who had difficulty
communicating or making their needs known verbally? Yes
Did you observe restraints in use? No
If so, did you ask staff about the facility’s restraint policies? NA Resident Living Accommodations Yes/No/NA Comments/Other Observations
1. Did residents describe their living environment as homelike? NA 1. WE observed the environment as homelike.
2. Urine scent in hallway
4. WE observed a very quiet house.
2. Did you notice unpleasant odors in commonly used areas? Yes
3. Did you see items that could cause harm or be hazardous? No
4. Did residents feel their living areas were too noisy? NA
5. Does the facility accommodate smokers?
Where? Outside only Inside only Both Inside/Outside
No
6. Were residents able to reach their call bells with ease? NA
7. Did staff answer call bells in a timely & courteous manner?
If no, did you share this with the administrative staff?
NA
Resident Services Yes/No/NA Comments/Other Observations
8. Were residents asked their preferences or opinions about the
activities planned for them at the facility?
No 9. Due to the level of dementia for these
residents, they do not manage their own finances.
11. Residents are unable to communicate on the
phone.
13. The residents cannot have a council due their
dementia.
10. One offered fruit, the other choice of sandwich
when she was wheeled to the room after a nap.
We observed an excellent activity calendar.
Most staff been there (Marla4 yrs, Tanya 11) for a
while, some movement of younger staff.
9. 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?
NA
NA
10. Are residents asked their preferences about meal/snack choices?
Are they given a choice about where they prefer to dine?
Yes
No
11. Do residents have privacy in making and receiving phone calls? NA
12. Is there evidence of community involvement from other civic,
volunteer or religious groups?
13. Does the facility have a Resident’s Council?
Family Council?
No
No 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?
The alarm on kitchen door is broken, part has been ordered.
Yes We told of the urine smell. It was attributed to the
resident who awoke from her nap and needed
changing. We did NOT go by her room to check.
Do that next time.
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.