The document discusses options for improving Centre Crest Nursing Home as a county-operated facility. It proposes constructing an outpatient therapy entrance, renovating resident rooms, redesigning the cafeteria, and expanding employee parking. It also recommends increasing staffing levels through a nurse aide training program and partnering with Complete Healthcare Resources to improve nursing services and marketing. The investments aim to increase occupancy and revenue while decreasing the county's contribution over time by stabilizing operations and improving resident and staff satisfaction at the facility.
This document discusses a hotel search and booking platform that allows customers to find and book rooms directly through major hotel chains like Hilton, Hyatt, and Marriott. It provides an easy way for users to search by location, dates, price, and ratings, then view availability and prices in a table. The platform aims to increase booking volumes and occupancy rates for these hotel groups by offering a simple user experience and redirecting customers to individual hotel sites to complete reservations.
Council will face a $92 million funding shortfall over the next 10 years due to rising costs and slower revenue growth. It is consulting the community on two options to address this - a 7.25% annual rates increase for seven years to maintain current services, or an 8.95% increase to enhance some services. Feedback is sought on preferred services and willingness to pay more rates through an online survey closing October 4. The preferred option will be developed and released for further input before a rate increase application is submitted.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/.
View a full recap of this webinar at http://www.macpas.com/pennsylvania-2014-budget-and-corporate-tax-update
This webinar was hosted by Jason Skrinak (Tax Principal) and Michael Eby (Tax Manager) from McKonly & Asbury. The presentation included a detailed discussion of the 2014 Pennsylvania Budget where we reviewed key tax implications and compared the changes to the corporate tax reform initiated from last year’s budget. We also discussed recent corporate tax changes in Pennsylvania including Business Privilege Tax, Pennsylvania Department of Revenue modernization, revisions of Pennsylvania’s Board of Finance and Revenue, among other topics. Finally, we highlighted potential corporate tax issues that are being debated by the Pennsylvania legislature.
The document provides information for a City Council study session on a proposed minimum wage and paid sick leave ordinance in Emeryville, California. It includes: an overview of existing wage policies; background on the draft ordinance; a summary of public comments; recommendations from an Economic Development Advisory Committee; additional analysis of issues like small business definitions, tipped employees, and medical benefit credits; potential exemptions or phased implementation; and details on paid sick leave requirements. The draft ordinance would set the initial minimum wage rate at the current living wage rate of $14.42 per hour effective July 1, 2015.
Craig T. Brown has over 30 years of experience leading organizations in healthcare, education, and social services. He has served as Executive Director, CEO, President, and Director for various organizations. He specializes in strategic planning, relationship management, negotiations, change management, and business development. Brown has a proven track record of initiating partnerships, acquiring funding, directing organizational change, and establishing new programs and facilities. He holds an MBA and B.A. and is a certified healthcare executive.
This document discusses a hotel search and booking platform that allows customers to find and book rooms directly through major hotel chains like Hilton, Hyatt, and Marriott. It provides an easy way for users to search by location, dates, price, and ratings, then view availability and prices in a table. The platform aims to increase booking volumes and occupancy rates for these hotel groups by offering a simple user experience and redirecting customers to individual hotel sites to complete reservations.
Council will face a $92 million funding shortfall over the next 10 years due to rising costs and slower revenue growth. It is consulting the community on two options to address this - a 7.25% annual rates increase for seven years to maintain current services, or an 8.95% increase to enhance some services. Feedback is sought on preferred services and willingness to pay more rates through an online survey closing October 4. The preferred option will be developed and released for further input before a rate increase application is submitted.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/.
View a full recap of this webinar at http://www.macpas.com/pennsylvania-2014-budget-and-corporate-tax-update
This webinar was hosted by Jason Skrinak (Tax Principal) and Michael Eby (Tax Manager) from McKonly & Asbury. The presentation included a detailed discussion of the 2014 Pennsylvania Budget where we reviewed key tax implications and compared the changes to the corporate tax reform initiated from last year’s budget. We also discussed recent corporate tax changes in Pennsylvania including Business Privilege Tax, Pennsylvania Department of Revenue modernization, revisions of Pennsylvania’s Board of Finance and Revenue, among other topics. Finally, we highlighted potential corporate tax issues that are being debated by the Pennsylvania legislature.
The document provides information for a City Council study session on a proposed minimum wage and paid sick leave ordinance in Emeryville, California. It includes: an overview of existing wage policies; background on the draft ordinance; a summary of public comments; recommendations from an Economic Development Advisory Committee; additional analysis of issues like small business definitions, tipped employees, and medical benefit credits; potential exemptions or phased implementation; and details on paid sick leave requirements. The draft ordinance would set the initial minimum wage rate at the current living wage rate of $14.42 per hour effective July 1, 2015.
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Funding our future community information session nov 2013maitlandyoursay
Council is facing a $92 million funding shortfall over the next 10 years due to rising costs and stagnant revenue growth. A 7-year special rate variation is proposed to address this by gradually increasing rates higher than the rate peg. This would allow services to be delivered as programmed and some to be enhanced. The proposal shifts more of the rate burden from businesses and farms to residents. It is estimated to increase average residential rates by $115-179 per year. Alternatives and next steps are outlined for community feedback before Council decides whether to apply to IPART.
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The document discusses Canada's economic outlook for 2017, focusing on key areas like employment, exports, government spending, and business investment. It notes that while government spending can support the economy, overspending risks future tax increases or spending cuts. Job growth is skewed toward part-time roles, while business investment and exports face challenges like infrastructure gaps and lack of trade agreements. Risks to the economic outlook include high household debt, new carbon taxes, and uncertainty around US policy changes.
This document is a resume for Philip Bryant Scott, outlining his experience leading senior living organizations. It details that he was President of Carlton Senior Living from 2006-2015, during which time he oversaw significant growth in revenue, profit, and the development of new service models. Prior to that he held Vice President roles at other senior living companies, where he helped start up new communities and implement systems to improve operations and financial performance.
The Council of the District of Columbia held an administrative meeting on January 13, 2015 to discuss the city's financial update. Key points include:
- Revenues are projected to increase more slowly than previously estimated, with a $25.5M shortfall in FY2014 and budget pressures of $83.3M in FY2015 and $245.6M in FY2016.
- The spending freeze instituted by the former mayor remains in effect and is under review by the new mayor.
- Tax reforms went into effect to improve the economic situation, and performance budget oversight dates were outlined.
2014 Real Estate & Economic Outlook Seminar CBIZ, Inc.
This document provides summaries of various economic development initiatives and incentives in Missouri and Kansas. It discusses Missouri programs like Missouri Works job creation incentives, innovation campuses partnerships between tech companies and universities, and the state's building of entrepreneurial capacity. For Kansas, it outlines incentives such as the Promoting Employment Across Kansas program, the High Performance Incentive Program, and the Job Creation Fund. It also summarizes tax credits at both the state and federal level that can incentivize activities like historic rehabilitation, brownfield redevelopment, and affordable housing development.
Example of a Foster Care Business Plan for an Independent Fostering AgencyThe Pathway Group
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The document discusses affordable and senior housing. It defines affordable housing as housing costs not exceeding 30% of total household income. It then outlines barriers to affordable housing such as low household incomes, lack of equity, and high housing costs. The document discusses best practices communities can adopt including updating regulations, utilizing smart growth, public funding programs, and public-private partnerships. It provides examples of affordable housing projects including senior apartments, multi-family developments, and urban redevelopment projects.
The document provides an overview of municipal budgeting. It defines a budget as a municipality's financial plan and explains why budgets are important for accountability, planning, evaluation, and information. It describes the key components of a budget, including proposed expenses and revenues. The document also discusses different types of budgets like line-item, program, lump sum, and multi-year budgets. Finally, it outlines statutory budget requirements for Wyoming municipalities and budget best practices.
The document provides an overview of municipal budgeting. It defines a budget as a municipality's financial plan and explains why budgets are important for accountability, planning, evaluation, and information. It describes the key components of a budget, including proposed expenses and revenues. The document also discusses different types of budgets like line-item, program, lump sum, and multi-year budgets. Finally, it outlines statutory budget requirements for Wyoming municipalities and budget best practices.
The document provides information about an upcoming budget presentation by Evelyn Dufford and Catherine Kuhn for the Washington State Chapter of the Community Associations Institute, covering topics such as accounting basics, the budget process, budget development, and budget considerations for community associations. The presentation will include a general presentation divided into several sections followed by a question and answer period. Attendees will receive materials including articles and contact information.
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Despite greater flexibility to raise income, councils still have to make savings and ensure their budgets are spent as efficiently as possible.
In many councils the spotlight is on Council Tax to raise income and the Council Tax Reduction Scheme (CTRS) to make savings.
Council Tax Schemes have been locally designed since April 2013. While many still reflect the nationally administered Council Tax Benefit, we're starting to see greater innovation locally.
The driver of this innovation is the backdrop of the cumulative impact of past and future welfare reforms, the introduction of Universal Credit and ever tighter budgets.
CTRS schemes are intended to keep the most vulnerable citizens safe from poverty. Knowing who those people are is a huge challenge.
We've modelled options for future CTRS schemes in detail for various councils. The impact assessments are used to make informed policy decisions by officers and members.
View this webinar to learn how:
1. We accurately model the cost of CTRS schemes today
2. We accurately model the cost of CTRS schemes in the future, including under Universal Credit
3. We accurately model, compare and evaluate CTRS options under consideration
4. We provide evidenced based recommendations on which CTRS scheme best supports the strategy e. g. best fit for anti-poverty strategy while operating within financial constraints
5. What CTRS schemes we have created for North Hertfordshire, Leeds City and Newcastle City Councils
Universal Credit is the UK's new working-age benefit system that aims to simplify the previous complex system of benefits and tax credits. It consolidates 6 benefits into one monthly payment administered through an online system. The goals are to make work pay, reduce poverty and fraud, and incentivize people into employment. However, its rollout has been problematic, with many claimants experiencing difficulties accessing payments and hardship. Evaluations show improvements in employment for some but significant issues remain regarding delivery and the system has not proven its value for money. There is ongoing debate around whether Universal Credit is achieving its original aims and meeting the needs of the 21st century job market.
How landlords can prepare for managed migration workshopPolicy in Practice
Policy in Practice has teamed up with Bill Irvine, UC Advice & Advocacy, to help housing associations learn how to prepare for managed migration to Universal Credit. This workshop featured the following speakers and topics:
Background to Universal Credit managed migration by Zoe Charlesworth, Policy in Practice
The view from the frontline by Nadine Burns and Michelle Birley, The Guinness Group
Key challenges to smooth delivery of managed migration by Bill Irvine, Universal Credit Advice
Transitional Protection by Louise Murphy, Policy and Data Analyst, Policy in Practice
Best practice advice for preparing tenants by Bill Irvine, Universal Credit Advice
How Royal Borough of Greenwich is preparing for managed migration by Corin Hammersley, Royal Borough of Greenwich
Develop your own proactive action plan for managed migration
For more information please visit www.policyinpractice.co.uk, call 0330 088 9242 or email hello@policyinpractice.co.uk
Staff presented this material to the Anna City Council on the many challenges and concerns for FY19/20, to get feedback and consensus to prepare the annual budget. Later in the year the actual budget will be presented for review, approval and implementation.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
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This document is a resume for Philip Bryant Scott, outlining his experience leading senior living organizations. It details that he was President of Carlton Senior Living from 2006-2015, during which time he oversaw significant growth in revenue, profit, and the development of new service models. Prior to that he held Vice President roles at other senior living companies, where he helped start up new communities and implement systems to improve operations and financial performance.
The Council of the District of Columbia held an administrative meeting on January 13, 2015 to discuss the city's financial update. Key points include:
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Despite greater flexibility to raise income, councils still have to make savings and ensure their budgets are spent as efficiently as possible.
In many councils the spotlight is on Council Tax to raise income and the Council Tax Reduction Scheme (CTRS) to make savings.
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View this webinar to learn how:
1. We accurately model the cost of CTRS schemes today
2. We accurately model the cost of CTRS schemes in the future, including under Universal Credit
3. We accurately model, compare and evaluate CTRS options under consideration
4. We provide evidenced based recommendations on which CTRS scheme best supports the strategy e. g. best fit for anti-poverty strategy while operating within financial constraints
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2. Observations
• We have not exhausted all options.
• We didn’t get into this position overnight and we
won’t get out of it overnight.
• Multi-faceted approach
– Outpatient Rehabilitation
– Long-Overdue Capital Investments
– CNA Training Program/Reduction Outside Agency Staff
– Ongoing contract with Complete Healthcare Resources
• A county home has not converted to a nonprofit in
over 20 years.
• A county can operate a nursing home well.
3. What do we need to do?
• Continue with a respectful dialogue
• Make sure Centre Crest is not privatized
• Improve the care of the residents and the
morale of the staff
• Stabilize the County’s contribution to Centre
Crest
• Decide whether we will do this as a county-
operated facility or as a nonprofit organization
5. Setting the Record Straight
In 2004, Commissioners Dershem and Exarchos
DID NOT want to privatize or make Centre Crest
a nonprofit. The day after they were elected
they toured Centre Crest and began working
immediately to improve it as a county-owned
and county-operated home. Throughout their
first term in 2004-2007 they contributed
$2,800,000 in General Fund revenue to Centre
Crest.
6. “Our View”
November 6, 2003 - Centre Daily Times
“We commend [Commissioner Steve]
Dershem for hitting the ground running.
He visited the Centre Crest nursing
home Wednesday to begin talking with
officials there with an eye toward
improvements once he officially takes
office in January.”
7. “County in Familiar Centre Crest Discussions”
August 12, 2005 – Centre Daily Times
“Board of Commissioners Chairman
Chris Exarchos said the county has been proactive in
addressing the many concerns of the nursing home's
employees.
“He said that when he and fellow Republican
Commissioner Steve Dershem took office, they visited
the nursing home during each shift to see what
workers were up against.
“Wages were examined,” he said, “and several posts
had salaries significantly boosted to make them
competitive with local providers.”
8. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
9. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
10. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
11. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
12. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
13. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
14. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
15. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times
16. “Oks Tentative Budget – Reserve Funds to
Cover Costs at Centre Crest, Other Deficits”
November 15, 2006 – Centre Daily Times
“The Centre County Board of Commissioners
approved an $83.7 million tentative 2007 budget
Tuesday that has no tax increase but taps into
reserves to cover a $2.2 million deficit. The major
source of the deficit is Centre Crest nursing home,
which accounts for $1.5 million of the projected
shortfall. Chairman Chris Exarchos said the county is
working on strategies to cover costs at Centre Crest .
The cost of operating the nursing home, $17.4
million this year, is projected to be $18.4 million in
2007.
17. “…[Commissioner] Exarchos noted it will be the sixth
consecutive year without a tax increase but said that
can't continue indefinitely. ‘At some point, there has to
be a tax increase,’ Exarchos said. In fact, 2007 might be
the last year property owners don't see county taxes
climb. The 2007 budget will cut the county's fund
balance from $7.5 million to $5.3 million. Exarchos said
the county needs to have a $3.5 million to $4 million
reserve to cover expenses that will be reimbursed.
Commissioners are also looking into contracting a
company to run Centre Crest 's pharmacy as a cost-
saving strategy.”
“Oks Tentative Budget – Reserve Funds to
Cover Costs at Centre Crest, Other Deficits”
November 15, 2006 – Centre Daily Times
18. Paying for the Investments
• $5 Million Bond in 2013
– 10 year payback
– ~$700,000 in interest
• 2/10 mill increase in Debt Service millage
– 1 mill = ~$3,100,000
– 2/10 mill = ~$620,000
20. How would we pay for a new building?
• Complete Healthcare Resources’ Proforma
estimated a new building would cost
$27,700,000.
• County would have the debt service available to
pay for the new building beginning in 2021.
– 6 Years of $1,300,000 payments = $7,800,000
– 10 Years of $2,500,000 payments = $25,000,000
– TOTAL = $37,800,000
• NOTE: The above number is not an estimate of a new
building cost.
21. The Tax Facts
• 2002-2009 Budgets had no tax increase
• 2010 Budget contained a tax Increase
– 6.54 mills 8.04 mills (6.85 General & 1.19 Debt)
• 2011 Budget contacted a tax Decrease
– 8.04 mills 7.79 mills (6.60 General & 1.19 Debt)
• 1 mill = $3,100,000
22. The Tax Facts
• How much more in revenue was received in…
– 2010 v 2009 … $4,650,000
– 2011 v 2009 … $3,875,000
– 2012 v 2009 … $3,875,000
– 2013 v 2009 … $3,875,000
• From January 1, 2010 to December 31, 2013,
there will have been $16,275,000 of new
revenue to Centre County government from the
2010 tax increase.
23. Tax Facts
• $5 Million Bond for Capital Improvements
–Outpatient Rehabilitation
–Much-needed Improvements
• Resident Rooms
• Cafeteria
• Employee Parking
• Community Rooms
24. Outpatient Therapy
• On September 17, 2007, Centre Crest received
letter granting the county a waiver to perform
outpatient therapy.
• Due to PA Department of Health regulations,
we were unable to do outpatient therapy
without constructing another entrance.
• Our current therapy provider, Apex, does
outpatient therapy at other nursing facilities
25. Current Centre Crest Therapy Profit
2012
Physical Therapy + $672,810
Occupational Therapy + $470,835
Speech Therapy + $393,560
Total Therapy + $1,537,205
26.
27.
28.
29.
30.
31. Costs
• Paving, Excavating, Lighting, Hand-rails,
Awning, New Outside Door, New Inside Door
• Work w/ Apex to contribute to the project
• Revenue increase: $250,000 to $400,000/year
32. Resident Rooms
• Our Resident Rooms are out-of-date. Some of
the equipment, furniture, and decorations
have been in the facility since the 1970s.
– We need to paint the rooms a new color, new
floors, new furniture, new curtains, new
decorations and fixtures, new doors (or at least
new bump-guards), new signage
33.
34.
35.
36. Other capital improvements
• Decorations and furniture inside the building
– Photos and pictures around the building
– Resident room signage, cork boards, lighting, glove
holders, “Notices” by CareTracker machine
• Outside the building
– New welcome sign
– New garden areas
– Expand employee parking area
• Raze the house and pave
37. Broken Windows Theory
• The theory states that maintaining and
monitoring urban environments in a well-
ordered condition may stop further vandalism
and escalation into more serious crime.
• Applied to nursing homes: a clean, well-kept
environment will encourage better care.
• A nursing home that doesn’t continually invest
in the facility will lead to a decline census,
decline in staff morale and decline in resident
care.
55. Investments We Need
• Construct Outpatient Therapy
Entrance
• Renovate Resident Rooms
• Redesign Cafeteria
• Expand Employee Parking Lot
• Not to Exceed $5,000,000
56. Improvements in Operations
• Increase Census
• Nurse Aide Training Program
• Decrease Utilization of Outside
Nursing Agency Staff
• Bring Complete Healthcare
Resources on as a partner to help
us in nursing and marketing
57. Census Increase
• In 2012, the average census was 214 residents
Net Patient Revenue (Census = 220) + $463,163.10
Nursing - $230,300.40
Pharmacy - $21,286.80
Rehab - $38,281.20
Laundry - $13,183.80
Dietary - $54,640.50
Therapeutic Rec - $13,402.80
Net Income + $92,067.60
58. Nurse Aide Training
• Centre Crest competes with other companies
for nursing staff:
– Mount Nittany, HealthSouth, Hearthside,
Brookline, Hospice Agencies, Nursing Agencies,
Doctor offices, etc.
• Currently the bulk of our CNAs come from CPI
classes, however that’s not enough. (Penn
State-UP graduates LPNs and RNs.)
59. Current Staffing (census = 214)
Shift CNAs/
shift
Ratio PRD
7a-3p 20 1:11
3.333p-11p 17.5 1:12
11p-7a 9 1:24
62. What would this cost?
• We need to hire additional staff:
– 16 more CNAs
– xx more LPNs
• Based on the data in 2013 Budget, annual cost
of 0.01 PRD = $22,678
• Difference of 0.20 PRD between Current and
Ideal Staffing
• Estimated cost: ($22,678 x 20) = $453,560
63. Nurse Staffing
• Create an in-house Nurse Aide Training
Program
• Starting a Nurse Aide Training Program
• Partnership between Penn State and
Pennsylvania Department of Education:
Teaching the Educator
65. Complete Healthcare Resources
• Change Complete Healthcare Resources’ focus
from transitioning Centre Crest to improving the
facility under county-operation
– Nursing
• Improve the nurse to patient ratio
• Enhance staff appreciation program
• Work with RNACs to enhance MDS reporting
– Admissions/Marketing
• Implement marketing strategies that CHR has done at
their other homes here at Centre Crest.
66. 2014 County Contribution
2012 County Contribution - $1,000,000
CHR contract - $100,000
Increase in Nursing Staff - $454,000
Hire Retention Specialist - $50,000
Outpatient Rehab + $300,000
Decrease in Agency Staff + $300,000
Increase in Occupancy + $92,000
TOTAL - $912,000
67.
68.
69.
70.
71.
72.
73.
74.
75. Centre Crest Auxiliary
• Secured a $5,000 grant to purchase 21 new
wheelchairs.
• Purchased tables, benches and umbrellas for
the Stanton Court Garden
• Completed Kline Way garden
• Provision of beauty shop supplies; this allows
the service to be provided to residents at no
cost
76. Centre Crest Auxiliary
• Provide the opportunity for residents to
"shop" for their family at Christmastime so
each resident has gifts to give to their family
members at no cost to the residents.
• Purchase birthday and Christmas gifts for
residents without families.
• Provide holiday treat gift bags for each
resident.
77. Centre Crest Auxiliary
• Purchase hair curlers for residents that cannot
get to the beauty parlor.
• Purchase shampoo caps for bedfast residents.
• Provide welcome bags to all new residents.
• Sponsor annual butterfly releases in the
garden areas.
• Purchased commercial blender for the Centre
Crest kitchen.
78. Centre Crest Auxiliary
• Assist with welcome social for new residents
and their families.
• Purchase outdoor Christmas decorations.
• Provide free postage stamps and greeting
cards for residents.
• Sponsor two entertainments monthly for the
residents' enjoyment.
• Sponsor employee appreciation events.
79. Centre Crest Auxiliary
• Provided sun setter canopies.
• Purchased a digital scale for resident use.
• Purchased a resident lift.
• Formed Comfort and Love Volunteer Group to
accompany residents through the end of life
stages as well as support to their families
during their time of loss.
80. Centre Crest Auxiliary
• Refurbished the first floor living room with
new flooring, furniture, electric fireplace,
drapes, and large screen TV.
• Manages the Centre Crest Auxiliary Gift Shop.
82. Moving Forward: Short-Term
• Direct staff to put together a plan for:
– Painting the hallways
– Purchasing new resident signs, “notice” boards,
hallway decorations (picture frames)
• Work with Auxiliary to get Bellefonte photos
83. Moving Forward: Long-Term
• Continue to work together with my fellow
commissioners to improve Centre Crest.
Answer any questions on my major
recommendations.
• Re-Examine the Complete Healthcare
Resources proforma based on my proposals
and send them a list of questions and
clarifications.