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Home My WebLink AboutAgenda - 09-02-2008- 10fORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 2, 2008 Action Agenda Item No. ~~-~ SUBJECT: Nursing Home Community Advisory Committee-New Appointment DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Under Separate Cover INFORMATION CONTACT: Membership Roster Clerk's Office, 245-2130 Letter of Recommendation Application(s)/Resume(s) of Person(s) Recommended Interest List Application(s)/Resume(s) of Person(s) on the Interest List PURPOSE: To consider making one new appointment to the Nursing Home Community Advisory Committee. BACKGROUND: The Clerk's office has received a recommendation from the Nursing Home Community Advisory Committee for Tiffany Washington. If appointed she will be serving aone- yeartraining term, which will end on 6/24/2009. FINANCIAL IMPACT: None. RECOMMENDATION(S): Consider making one new appointment to the Nursing Home Community Advisory Committee. Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Mating Times: 3:30 p.m. Every other Lt Monday starting with Jars. Terms: 2 Contact Person: Vibeka Talley OTR/L Meeting place; Seymour Center Positions: 12 Length: 3 years Contact Phone: 919-968-2087 Description: All appointments are made by the Board of Commiaaioners. Thin comnrittx helps to maintain the intent of the Residents' Bill of Rights. promotes community involvement and provides public education on long-tam care issues. The regional ombudsman with Triangle J Council of Oovamnenta provides apecializad training and support. Mr. Arthur $t. John Day Phone: 919-968-3003 gex; Male First Appointed: 01848005 1 Ev~ing Phone: 919-968-3003 Race: Caucasian Current Appointment: 06/138006 101 Hayworth IMve FAX: Township: Chapel Hi11 Bxpitation: 01/308009 Chapel Hill NC 27317 B-snail: at1299®belleouth.net . Resid/Spec Req: At-Large Number of Teens: 1 Special Repr: At-Lugs Mr. Ed Flowers Day Phone: 919.403-1963 Sex; Male First Appointed: 03!068008 2 Beating Phone: 919-967-3693 Race; Caucwien Current Appointrnettt: 03/068008 1011'ariuide Circle FAX: 919.403-8965 Township: Chapel Hill Bxpiration: 03/318009 Chapel Hill NC 275 t 6 B-mail: adflowas(a3mindspring.wm Resid/Spec Req: At-larga Nttmbec of Terms: Special Repr: At-Largo Mrs. Patricia Revels Day Phone: (919) 241-407 Sex; Female First Appointed: 03/068008 3 Evening Phone: Same Race: Caucasian Current Appointment: 03/068008 329 West King Street FAX: N/A 'Township; Hillsborough Bxpiration: 03/318009 Hillsborough NC 27278 B-mail: preve1s001®ne.rr.com . Resid/Spec Req: At-Large Number of Tetras: Special Rcpr: At-LaBe Ms. Shawn Karnash Day Phone: 919-479-3661 Sex: Female First Appointed: 06/128007 Evening Phone: came Race: Caucasian Current Appointment: Oti/128007 4 5513 Quail Hollow Drive FAX: Township: Little River Bxpiration: 06/308003 Hillsborough NC 27278 B-mail: sharon.kamash®duka.edu Resid/Spec Req: At-Large Number of Terms: 0 .Special Repr. At-Large Mr. Mario C. Battigelli Day Phone:. 919-942-3736 Sex; Male First Appointed: 04/038001 Evening Phone: Race: Caucasian Current Appointment: 06/'078005 S 1307 Wildwood !hive FAX: Township: Chapel Hiil Bxpiradon: 06/308008 Chapel Hill NC 27314 B-mail: MAt3IBAT®AOLCOM Resid/Spec Req: At-largo Nutnber of Terms: 2 Special Rept: Nursing Home Administration Monday~June 09.2008 Page 1 Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Times: 5:30 p.m. Every other 1st Monday starring with Jan. Terms: 2 Contact Person: Vibeke Talley. OTR/L Meeting Place: Seymour Center Positions: 12 Length: 3 years Contact Phone: 919-968-2087 Description: All appointments are made by the Board of Commissioners. This committee helps to maintain the intact of the Residents' Bill of Rights. promote community involvement and provides public education on long-tam care issues. The regional ombudsman with Triangle 1 Council of Oovemments provide specialized training and support. Ms. Susan Taylor Day Phone: 919-2S6-loss sex: Female Firac Appointed: ognln~7 Bveahtg Phone: 919-357-6639 Race: Caucasian Cttrrent Appointment: 0881/2007 6 2103 Baycourt Trail FAX: Township: Hillsborough Bxpiration: 09/308008 Hilbborough NC 27278 E-mail: ataylor20@ac.rrcom Resid/Spec Req: At-Large Number of Teima: Special Repr: Nursing Home Administration ~,~.YMS. Slit: Waters -... .~.- ..-- ._ - _-_~ Day Phone: 919-643-2040 ~ Sex: Female First Appointed: 09818004 Bvening Phone: 919-643-2040 Race: Caucasian Current Appointment: 11/1S/2003 7 608 Red Fox Trail FAX: Township: Hillsborough Bxpiration: 09/30/2008 Hillsborough NC 27278 B-mail: ronwatas®earthlink.net Resid/Spec Req: At-Large Number of Tem'ts: 1 Special Repr: At-Large - VACANT ~~ _ Day Phone: Sex: First Appointed: Bvening Phone: Race: Cutratt Appointctuttt: 8 FAX: Township: Bxpiradon: 06/308009 E-mail: Reaid/Spec Req: At-Large Number of Temps: Special Repr. At-Large ____-^MS. Mary Ann Peter Day Phone: 919-732-6073 Sex: Female First Appointed: o6ro38003 Chalr Bvening Phone: 919-732-6073 Race: Caucasian Current Appointtmttt: OWt28007 9 1.18 W. Tryon Street FAX: Township: Hillsborough Bxpinatlon: 06/308009 Hillsborough NC 27278 E-mail: marYannpeta~rthlink.net Resid/Spec Req: At-Large Number of Tern7s: 2 Special Repr: At-Large Ms. Patricia Koch Day Phone: 942-6637 Sex; Female First Appointed: 06/198006 Evening Phone: same Race: Caucasian Cutent Appointment: 06/128007 to 1540 Ferrell Rd FAX: Township: Chapel Hill Expiration: 06/308009 Chapel Hilt NC 27517 E-mail: plcoch@mindapring.com Resid/Spec Req: At-large Number of Terms: 1 Special Repr: At-Large Monday, June 09, 2008 Page 2 W Board and Commission Members And Vacant Positions Nursing Home Community Advisory Committee Meeting Tittles: 5:30 p.m. Every other tat Monday slatting with Jan. Terms: 2 Contact Person: Vibeke Talley, OTR/L Mceting Place: SSW' C~~' Positions: 12 Length: 3 years Contact Phone: 9t9-968-2087 Description: All appointmet-b aro made by the Board of Commissiottera. This committee helps to maintain the intent of the Residents' Bill of Rights, promote wmmunity involvement and provides public education on long-tam cars issues. The regional ott~tdstrnin with Triangle J Councii of Governments provides apecialits:d training and support. 11 12 Ms. Anne Winfield Day Phone: 919-419-9139 Sex: Female First Appointed: 1a17noo6 Evening Phone: Race: Caucasian Cttttatt Appointtttent: 12/03n007 6712 Pauline Dtive FAX: Township: Chapel Hiii Bxpitation: 12/31n010 Chapel Hilt NC 27514 B-mail: abvyinfield®mindspring.com Resid/Spec Req: At-Large Number of Terms: 1 Special Repr: Nursing Home Administration ~. C~.ol j~~~ Day Phone: 919/644/8414 Sax; Female First Appointed: lat7noo6 Evening Phone: same Race: Caucasian Cttrrent Appointment: 12/t13n007 1028 Lakeview Dr. FAX: same Township: Cedar Grove Bxpiration: 12/31n010 Cedar (trove NC 27231 B-mail: donhiaman®aol.com Resid/Spec Req: At-Large Number of Tetras: 1 Special Repr. Nursing Home Administration Monday, June 09, 2008 Page 3 --Original Message----- From: Mary Ana Peter [mailto:maryannpeter~earthlink.net] Sent: Monday, June 09, 2008 8:52 AM To: Donna Baker Cc: Jill Passmore Subject: Tiffa~ Washington nomination for nursing home committee To: Orange County Board of County Commissioners Barry Jacobs, Chairman From: Mary Ana Peter Chair, Orange County Nursing Home Community Advisory Committee Re: Nom nation for OCD'03CAC June 9, 2008 We are pleased to recommend Tiffany Washington for membership on the committee. Ms Washington is a PhD student in the UNC-Chapel Hill School of Social Work and is a resident of Orange County. She hae attended a committee meeting and has submitted her application stating her interest. We would be very fortunate to have someone with her qualifications and interest in long term care as a member of this committee. We hope that you will appoint her at the next opportunity. Thank you most sincerely for your support of this committee. 1 .• ~~ .; 0 ~~ G Page 1 of 2 Tiffany Washington Volunteer Application Orange County Advisory Boards and Commissions Name: Ms. Tiffany Washington Name Called: Home Address: 515 Hinton James Drive #138 (mail: PO Box 746) Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Chapel Hill NC 27514 (33639-8144 twashing a~email.unc.edu UNC Chapel Hill - DHRE Community Manager Chapel Hill Does not apply Female African American 5/29/1978 Boards/Commissions applied for: Nursing Home Community Advisory Committee Adult Care Home Community Advisory Committee Advisory Board on Aging Work Experience: 02-05 Medical Social Worker Northside Dialysis .Center Winton Salem 03-05 Medical Social Worker Amedisys Home Health Winston Salem 05-07 Patient Services Coordinator, Southeastern Kidney Council Raleigh 05-07 Medical Social Worker, Genova Home Health, Raleigh, NC Volunteer Experience: National Kidney Foundation UNC Kidney Center March of Dimes Buckle up America American Red Cross Education: 1996-2000 UNC Chapel Hill - BA 2000.2002 UNC Greensboro/NCA8~TSU - Master of Social Work 2007-present UNC Chapel Hill -PhD in Social Work Other Comments: I have 2 years experience investigating complaints and grievances of dialysis and transplant patients 'in North Carolina, South Carolina, and Georgia. My research area is n Page 2 of 2 Tiffany Washington health and aging. I enjoy volunteer work and community service. STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Committee, Adult Care Home Community Advisory Committee and Advisory Board on Aging on 5/5/2008. ADDRESS VERIFICATION: 515 Hinton James Drive #138 is in Chapel Hill township UNC~ jurisdiction. This application was current on: 5/5/200811:12:32 PM Date Printed: 6/92008 O Applicant Interest Listing by Board Name and by Applicant Name Nursin Some Commun' Adviso Committee ~~ Person. ~' a3' n' Coact Phone: Mr. Blake Bt7rklln 117 Crsd St Clmpd liiD NC 27516 Slv'lls: Habitat far Hurtsnity SIo7k: Sociobgy Major Dgy Phone: 919-812394 Evening Phone: 919-812394 FAX: E-mat7: burldin®ernail.unc.cdu Also Saves Oa Also Saves On: Ms. Jeanette Clark 221 Rencha St Apt 3 Hillsbonwgh NC 27278 Sla'lls: Nursing Home Expaience• Day Phone: 919-620-8662 Evening Phone: 732-7856 FAX; 6208662 E-mail: Also Saves On: Vlbeke Talley, OTR/I. 919-968-2087 ~; .Male Race: C,arcasiur Township: Chapel H71 Date Applied: 02/032008 Sex: Female Race: Afiian Americm Township: H'llsborough Date Applied: 02232005 MS. Peggy Cohn Day Phone; 919-489-6624 gam: Femab t0 Baysarater Phce Evening Phone: same Race: Ca°cas'a" Chapel Bill NC 27517 FAX: To~P~ ~1e~ H'T E_~; peggycolml(ajeartblinl~net Date Applied: 10/1OJ2005 S1~71s: Geriatric Cars Also Saves Oa: Adult Care home Corrmamity Advisory Canunittce Also Saves On: Advisory Board ~ AgQrg MS. ELIZABETH CRONER 1605 N. GREENBOROIJGH ROAD CARRBORO NC 27510 S1n'llc: Retired Day Phone: 919.933.862 Evening Phone: FAX: E-mat7: Also Saves On: ~; Female Race: ASican American Township: Chapel Hill Date Applied: 11/05/2005 Mr Ed F10Wers Day Phone: 919-357-9256 $~: Mete 2813 BeclaetPs Ridge Drive Evening Phone: 919-357-9256 Race: ~+~~ Hillsborough NC 27278 FAX: Township: Iiillsborough E-mail: ED FLAWERS~YAHOO.COM Date Applied: 11/182007 Sln71c: Ciu7drar's Issues Also Serves On: S1v71s: Nuclear physicist Also Server On: Monday, hme 09, 2008 • Page 1 of 2 1 Applicant Interest Listing by BoardxamoandhyApplicaatxame Nursin Some Commun' g ~ Adviso Committee ~'~p`~' ~ Contact Phone: viheke Talley, oTR/I, 919-968-2087 Ms. Jane Powell ~' ~~ 9107 sex: Far'~e 656 Craige Dam Evening F'hon~ 919-9144924 gee; African Amman iINC Chapd liiU FAX: Township: Chapd Hr11 Chapd Hill NC 27514 E-marl: )'7.~.eau Date Applied: 09/308004 Slv'Ils: Caslria Also Serves On: Slalla: eomnamity Service Vohmtca Also Saves On: Slnlls: Customs Service Also Saves On: MS. Tammy ThaCkei Day Phone: 638-4387 Spt; Female 517 N. Hill Street Evening Phone: Race: Afrian Amman Hillsborough NC 27278 FAX: Township: Hrllsborough E-mail: S~~Y@Y~.~ Date Applied: 0?J148006 Slaps: CatiSed Nurser Aide Also Saves On: Ms. Tiffany Washington Day phone: (33639-8144 515 Iimtar lames Drive #138 (marl: PO Box 746) Evening Phone: Chapel Hill NC 27514 FAX: E-mail: twashing(n~rmrl.unc.edu Sln'lls: social works Also serves thr: Sex: Fsrmle gam; Aft'ian Amman Township: Chapel ihll Date Applied: 05/058008 Monday. )une 09, 2008 Page 2 of 2 i~ Page 1 of 1 Blake Burklin Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Mr. Blake Burklin 117 Creel St Chapel Hill NC 27516 919-812394 919-812-4394 burklin(d3email.unc.edu Johnny T Shirt Township of Residence: Chapel Hill Zone of Residence: Chapel Hill Twnsp Sex: Male Ethnic Background: Caucasian Date of Birth: 11/15/1983 Boards/Commissions applied for: Orange County Planning Board Nursing Home Community Advisory Committee Work Experience• Hams Teeter Triangle Sportsplex Johnny T Shirt Volunteer Experience: UNC Hospital Habitat for Humanity Education: B.A. in Sociology from the University of North Carolina at Chapel Hill Other Comments: As an undergraduate sociology major I was able to design and implement IRB approved social research on stigmatized populations confidentially. I believe as a life long resident of the Chapel HiIV New Hope area, that I will have some insight the Board might find valuable. STAFF COMMENTS: Originally applied for Orange County Planning Board & Nursing Home Community Advisory Committee on 2/3/2008. ADDRESS VERIFICATION: 117 Creel St, Chapel Hill, is Chapel Hill township in CHPL jurisdiction. This application was current on: 2/3/200810:5329 PM Dabs Printed: 6x9/2008 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 Boards/Commissions applied for: Nursing 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 certfied 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: 6/9/2008 i~ Page 1 of 1 Peggy Cohn 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. Peggy Cohn Peggy 10 Bayswater Place Chapel Hill NC 27517 91989-6624 same peggycohn1 a~earthlink.net retired Geriatric Care Manager Chapel Hill C.H. City Limits Female Caucasian 8/28/1938 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: Community Health Nursing educator UNC and Penn State University Director of Family Ties, Geriatric Care Management, State College PA Volunteer Experience: Nursing Home visitation Non profit Boards in PA Education: BA, Wellesley BSN, Columbia University MPH, UNC PhD, Penn State University College of Health and Human Developmenet Other Comments: STAFF COMMENTS: Originally applied for Adult Care Home Community Advisory Committee and NHCAC and Adv. Board on Aging 10/10/2005. ADDRESS VERIFICATION: Mailing address listed above. Residence is 233 McCauley Street in Chapel Hill city limits. This application was curn3nt on: 10/10/200511:3421 AM Date Printed: 6/9/2008 (3 Page 1 of 1 ELIZABETH CRONER 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. ELIZABETH CRONER 1605 N. GREENBOROUGH ROAD CARRBORO NC 27510 919.933.862 RETIRED Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Ethnic Background: Date of Birth: Female African American 5/14/1934 Boards/Commissions applied for: Advisory Board on Aging Nursing Home Community Advisory Committee Work Experience: RETIRED FROM STATE OF OHIO, CLEVELAND DEVELOPMENTAL CENTER; STAFF SUPV. Volunteer Experience: CURRENTLY ASSISTING ABUNDANT LIFE. CHURCH PANTRY Education: HIGH SCHOOL; CONTINUED EDUCATION; Other Comments: STAFF COMMENTS: Originally applied for Adv. Board on Aging, Nursing Home CAC, and Board of Soaai Services 11/8/2005. ADDRESS VERIFICATION: 1605 N. Greensboro St is in Carrboro City Limits in Orange County in the Chapel Hill Township. This application was current on: 11/5/20051128:47 AM Date Printsd: 6/9/2008 IH Page 1 of 2 Ed Flowers Volunteer Application _ _ Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone: (Days Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Mr Ed Flowers 281.3 Beckett's Ridge Drive Hillsborough NC 27278 919-357-9256 919-357-9256 ED FLOWERS(a~YAHOO.COM Duke University Hospital Senior Nuclear Medicine Technologist Hillsborough Male Caucasian 2/10/1944 Boards/Commissions applied for: Nursing Home Community Advisory Committee Work Experience: 1965 -1970 Nuclear Medicine Technologist NC Baptist Hospital 1970 -1976 Chief Nuclear Medicine Technologist Duke Medical Center 1976 -1991 Technical Administrator -Nuclear Medicine -Duke Medical Center 1991 - prestnt Senior Nuclear Medicine Technologist Volunteer Experience: Dufiam Congregations in Action Yokefellows -Durham County - Alamance/Orange Counties Dufiam Nursery School Advisary Committee Blowing Rock Conference Center Board of Directors -Treasurer Education: High School -Southwest Forsyth College -Mars Hill Radiologic Technology -North Carolina Baptist Hospital Nuclear Medicine Technology -North Carolina Baptist Hospital Other Comments: Extensive experience with regulatory agencies (e.g., JCAHO, N.C.Radiation Safety, OSHA, Nuclear Regulatory Commission) STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Community Advisory Committee on 11/18/2007. ADDRESS VERIFICATION: 2813 Beckett's Ridge Drive, is Hillsborough Township. 15 Page 1 of 1 Jane Powell 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: Ms. Jane Powell 656 Craige Dorm UNC Chapel Hill Chapel Hill NC 27514 910-474-9083 919-914-4924 japo(c~email.unc.edu Wynnsong 15 Theatre Cashier Chapel Hill Zone of Residence: Chapel Hill Township within C.H. city limits Sex: Ethnic Background: Date of Birth: Female African American 10/18/1983 Boards/Commissions applied for: Nursing Home Community Advisory Committee 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 Force. 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: 6/9/2008 ~W Page 1 of 1 Tammy Thacker 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. Tammy Thacker 517 N. Hill Street Hillsborough NC 27278 638-4387 gr8tpay@yahoo.com Aryzen Health and Wellness President and CAN II Township of Residence: Hillsborough Zone of Residence: Hillsborough Town Limits Sex: Female Ethnic Background: African American Date of Birth: 5/31/1968 Boards/Commissions~appiied for: Nursing Home Community Advisory Committee Work Experience: I have been in Health Care for over 15 years and I have a good knowledge base about the elderly. I understand people need and what it takes to live in a safe environment. Volunteer Experience: I have volunteered in the classrooms of my children. Education: Certfied CNA I and II. Certified EKG technician and Certfied Medication Technician. Other Comments: STAFF COMMENTS: Originally applied for Adult Care Home and Nursing Home Care Advisory Boards and Advisory Board on Aging 2/14/2006. ADDRESS VERIFICATION: 51 T Hill Street is in the Town of Hillsborough in Orange County. This application was current on: 2H4/2006 Date Printed: 6/'9/2008