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Community Advisory Committee Quarterly/Annual Visitation Report County Facility Type - I:J Family Care Home Facility Name Cabarrus ~dull Care Home I:J Nursing Home Concord Retirement Center o Combination Home VisltDale 11/5/2004 Time Spenlin Facility 1 hr 45 min ArrlvalTime Name of Person Exillnterview was held with Erica Jones Interview was held SICr_.".,,) 1:J0ther Staff Rep Committee Members Present: Gail Hall, Melzie Hartsell, Karen Pens en Number of Residents who received arsonal visits from committee members: 10 Resident Rights Infonnation is cleMy visible. Yes I:J No Ombudsman contact infonnalion is correct and cleartyposted. esl:JNo The most recent survey was readily accessible.I:JYes I:J No Staffing infonnalion is posted. Yes I:J No Required for Nursin Homes Only) Resident Living Accommodations Comments & Other Observations 1. Do the residents appear neat, clean and odor free? 181 Yes and 181 No 2. Did residents say they receive assistance with personal care activities, Ex. brushing their teeth, combing their hair, inserting dentures or cleaning their.yeg/asses? I:J Yes I:J No (did not inquire) 3. Did you see or hear residents being encouraged to participate in their care by staff members? Yes 181 No 4. Were residents interacling w/ staff. other residents & visitors? ~ Yes I:J~ 5. Did staff respond to or interact with residents who had difficulty communicating or making their needs known verbally? 181 Yes 0 No 6. Did you observe restraints in use? DYes ~ No 7.lf so. did you ask staff about the facility's restraint poliCies? I:JYesl:J~ 8. Did residents describe their living environment as homelike? DYes 181 No 9. Did you not~e unpleasant odors in commonly used areas? I:JYes IifNo 10. Did you see items that could cause hann or be hazardous? 181 Yes No 11. Did residenfs feel their living areas were too noisy? I:JYes 181 No 12. Does the facility accommodate smokers? 181 Yes I:J No 12a. Where? 181 Outside only I:J Inside only I:J Both Inside & Outside. 13. Were residenfs able to reach their call bells with ease? I:JYes I:J No NIA 14. Did staff answer call bells in a timely & courteous manne(? I:JYes I:J No 14a. If no. did you share this with the administrative staff? 0 Yes 0 No 15. Were residents asked their preferences or opinions about the activities planned for them at the faCility? DYes Q9 No 16. Do residents have the opportunity to purchase personal items of their choice using their monthly needs funds? 181 Yes I:J No 16a. Can residents access their monthly needs funds at their convenience? 181 Yes I:J No 17. Are residents asked their preferences about meal & snack choices? I:JYes 181 No 17a. Are they given a choice about where they prefer to dine? 181 Yes I:J No 18. Do residents have privacy in making and receiving phone calls? I:JYes ~ No -iJ portable phone by staff station -no privacy for calfs 19. Is there evidence of community involvement from other civic, volunteer or religious groups? I:JYes 181 No 20. Does the facility have a Residen!"s Council? I:JYes 181 No Family Council? I:JYes 181 No One resident emptied his own commode in the toilet then proceeded to rinse it in the hand washing sink in a hallway bathroom. Several residents disheveled looking-hair not combed, mismatched clothing, etc. 4. Some residents in hallways watching CAC members walk around; many just in their rooms-no activities available dunng CAC visit. 6. A lot of wheelchairs in use-more than usually observed. Sign taped to each bedroom door: "No Food or Dnnks In Bedrooms. Sheet over window in bathroom across from #3; towel rack broken; wooden post holding up sink. Bathroom door in #3 has been repaired and sink in back BR has been fixed. Sink in #9 new and works Wall by beds in backroom on the nght is caked with "sor.,eth;ng- (fced, fecal mattei)? 10, See additional comments below 13. No call bells Dirty laundry uncovered; Chemical closed unlocked; Room #9---:overhead lights not working-does not appear to be enough light for staff to attend to residents (i.e. clean them) or clearty see at night; No bedside reading lights for all residents; Resident stated that his urinalsare not emptied atnighl; Same resident stated he didn't have Rx mads-facility neglected to take him to M.D. to reorder Rx; that he went to the ER to get Rx.; Light bulbs missing/inoperable in ceiling lights. Staff noted that light bulbs, tissues, pine sol, soap, sanitizers, movies are locked in the "Activity Closet" and p.m.lweekend staff do not have any keys to this closet and therefore cannolaccess personal supplies or even movies (WhiCh was listed as an activity the evening of this visit); Hot lamp in back room on top of dresser may be a safety issue if someone laced an clothin over it. Are there resident issues or topics that need fOllow-up or review at a later time or during the next visit? Discuss items from "Areas of Concern" Section as well as any changes observed dunng the visit. . .....Continuing concerns about bedridden, paralyzed resident with a long list of complaints: didn't get his spending money this month on lime. not gotten out of bed. not bathed regularty, not assisted wi personal care, etc. CAC believes this resident is too dependenf to be in assisted Iiving-doesn't even have a call bell to request help. Although resident admitted to CAC that he lied to us about some things, we don't believe he lies about everything. . + our other comments above on the right Conversation with SIC detailing our observations; several other staff pulled up chairs while we were talking; residents kind of standing nearby (no pnvate place to talk). No one took notes so not sure if our concerns were ever shared with the owner. CAC believes this facilitv needs continuous/freauent monitorina bv reaulatorv aaencies and Rea. Ombudsman. DHHS DAAS.02212004 G--~ This Document is a PUBLIC RECORD. Do not identify any Resident(s) by name or inference on this form. ~ is for the Regional Ombudsman's Record. Bottom CODV is for the CAC's Records.