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HomeMy WebLinkAboutSignature 2023-05-18 Community Advisory Committee Quarterly/Annual Visitation Report County: Orange Facility Type: Facility Name/Address: Signature Healthcare, 1602 E Franklin ❑ Family Care Home X Nursing Home St, Chapel Hill, NC 27514 ❑ Adult Care Home ❑ Combination Home Visit Date: May 18,2023 Time spent in facility 1.5 hrs Arrival time: 10 am Name of person exit interview was held with: Interview was held: X in Person ❑Admin. SIC(Supervisor in Charge) Other Staff Rep:X(Name& Title) Ebony Harrison, Director of Nursing Committee Members Present: Jackie Podger, Shade Little Report Completed by: Jackie Podger Number of Residents who received personal visits from committee members: 10 Resident Rights Information is clearly visible: Yes Ombudsman Contact Info is correct and clearly posted:Yes The most recent survey was readily accessible: Yes Staffing information clearly posted: Yes (Required for Nursing Homes Only) 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 F----------- 3. Did you see or hear residents being encouraged to NA participate in their care by staff members? 4. Were residents interacting with staff, other residents & Yes visitors? 5. Did staff respond to or interact with residents who had difficulty communicating or making their needs known Yes verbally? 6. Did you observe restraints in use? No 7. If so, did you ask staff about the facility's restraint policies? Resident Living Accommodations Yes/No/ Comments/Other Observations NA 8. Did residents describe their living environment as Yes homelike? 9. Did you notice unpleasant odors in commonly used areas? No 10. Did you see items that could cause harm or be hazardous? Yes Shower Door on the Blue Corridor was unlocked. The door appeared not to latch properly. 11. Did residents feel their living areas were too noisy? NA 12. Does the facility accommodate smokers? Yes Where?X Outside only X Inside only; Both Inside/Outside 13. Were residents able to reach their call bells with ease? Yes 14. Did staff answer call bells in a timely&courteous manner? Yes If no, did you share this with the administrative staff? ' i i Observations NA 15. Were residents asked their preferences or opinions about Yes the activities planned for them at the facility? 16. Do residents have the opportunity to purchase personal Yes items of their choice using their monthly needs funds? Can residents access their monthly needs funds at their convenience? 17. Are residents asked their preferences about meal/snack Yes choices? Are they given a choice about where they prefer to dine? Yes 18. Do residents have privacy in making and receiving phone Yes calls? 19. Is there evidence of community involvement from other Yes civic,volunteer or religious groups? 20. Does the facility have a Resident's Council? Yes Family Council? No Are there resident issues or topics that need follow-up or review at Yes Check Shower Door lock on Blue a later time or during the next visit? Corridor 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.