Deficiencies (last 4 years)
Deficiencies (over 4 years)
4.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
8% better than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Routine
Deficiencies: 4
Date: Apr 16, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to medication self-administration, residents' rights including advanced directives, infection prevention and control, and wound care practices at Autumn Care of Statesville.
Findings
The facility failed to assess a resident's ability to self-administer medications and improperly left medications at a resident's bedside without an order. The facility also failed to maintain accurate code status documentation for a resident. Additionally, the facility did not properly clean and disinfect a glucometer between uses and failed to use enhanced barrier precautions during wound care for a resident with a chronic wound.
Deficiencies (4)
Failed to assess a resident's ability to self-administer medications and left medications at bedside without an order.
Failed to ensure accurate code status documentation for a resident, resulting in discrepancies between medical record and code status notebook.
Failed to clean and disinfect an individually assigned glucometer prior to use and after use as per manufacturer's recommendations.
Failed to provide enhanced barrier precautions (gown) during wound care for a resident with a chronic wound.
Report Facts
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nurse #4 | Passed medications to Resident #76 and left medication cup at bedside without self-administration order | |
| Nurse #5 | Assigned nurse to Resident #76 who reported no self-administration order and medication should not have been left at bedside | |
| Nurse #2 | Observed failing to clean and disinfect glucometer prior to and after use on Resident #13 | |
| Nurse #1 | Interviewed regarding code status procedures and acknowledged missing DNR form for Resident #10 | |
| Director of Nursing | Provided information on medication self-administration policies, glucometer cleaning retraining, and wound care precautions | |
| Administrator | Interviewed about medication self-administration policies, code status discrepancies, and infection control policies | |
| Assistant Director of Nursing | Staff Development Coordinator and Infection Preventionist | Provided information on glucometer cleaning training and enhanced barrier precautions for wound care |
| Social Worker | Responsible for auditing advanced directives and code status; acknowledged Resident #10 was missing from audit | |
| Wound Care Nurse | Failed to wear gown during wound care for Resident #39 despite enhanced barrier precautions requirement | |
| Wound Care Physician Assistant | Failed to wear gown during wound care for Resident #39 and acknowledged sign for enhanced barrier precautions was missing | |
| Unit Manager | Explained glucometer cleaning and disinfecting procedures |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Feb 8, 2024
Visit Reason
The inspection was conducted based on complaints regarding respiratory care and infection control practices at Autumn Care of Statesville.
Complaint Details
The complaint investigation revealed failures in respiratory care for Resident #92 and infection control practices including PPE use, with repeat deficiencies noted from prior surveys.
Findings
The facility failed to administer oxygen at the prescribed rate for one resident and failed to implement proper infection prevention and control procedures, including improper use of personal protective equipment by staff. The Quality Assessment and Assurance committee also failed to sustain effective quality improvement programs.
Deficiencies (3)
Failed to administer oxygen at the prescribed rate for Resident #92.
Failed to implement policy for Personal Protective Equipment when Nurse Aide #1 did not perform hand hygiene or don PPE before entering Resident #1's room on transmission-based precautions.
Failed to maintain implemented procedures and monitor interventions for Infection Control and Respiratory Care, showing inability to sustain an effective QA program.
Report Facts
Oxygen liters prescribed: 3
Oxygen liters observed: 4
Pulse oximeter reading: 95
Weight loss: 40
Number of residents reviewed for respiratory care: 2
Number of residents reviewed for infection control: 3
Number of Nurse Aides failing to wear eye protection: 3
Number of nurses failing to don eye protection: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nurse #1 | Interviewed regarding oxygen administration and PPE responsibilities | |
| Director of Nursing | Director of Nursing (DON) | Interviewed about oxygen tubing changes, infection preventionist role, and QA committee |
| Nurse Practitioner | Nurse Practitioner (NP) | Interviewed about Resident #92's condition and oxygen therapy |
| Administrator | Administrator | Interviewed about QA committee and infection control training |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Aug 31, 2023
Visit Reason
The inspection was conducted as an annual survey of the nursing home facility to assess compliance with health and safety regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Routine
Deficiencies: 12
Date: Aug 25, 2022
Visit Reason
The inspection was conducted to evaluate compliance with regulatory requirements related to resident care, safety, medication administration, and facility operations.
Findings
The facility was found deficient in multiple areas including failure to notify responsible parties of resident falls, untimely completion of quarterly assessments, medication errors including wrong medication administration and missed doses, failure to provide scheduled bathing assistance, failure to apply ordered splints, inadequate supervision and call light maintenance leading to resident falls, improper pain management with incorrect medication dosages, failure to provide routine dental care, unsafe storage of oxygen tanks, and poor kitchen sanitation with expired food items.
Deficiencies (12)
Failed to notify responsible party of resident fall (Resident #66).
Failed to complete quarterly Minimum Data Set (MDS) assessment within regulatory timeframes (Resident #69).
Failed to ensure correct medications were administered and failed to administer ordered anti-anxiety medication (Residents #153 and #403).
Failed to provide bathing assistance to dependent residents as scheduled (Residents #1, #81, #82).
Failed to apply left-hand splint as ordered (Resident #91).
Failed to have working call bell and failed to use correct mechanical lift resulting in resident falls (Residents #66 and #156).
Failed to secure oxygen tank stored upright in resident room (Resident #16).
Failed to manage resident's pain with correct dosage of narcotic medication (Resident #38).
Failed to obtain routine dental services for resident reporting dental issues (Resident #81).
Failed to discard expired food items and maintain clean kitchen environment.
Failed to ensure medication administration record accurately reflected medications provided (Resident #45).
Failed to ensure call light was functioning in resident bathroom and bathing area (Resident #156).
Report Facts
Deficiencies cited: 12
Medication administration errors: 14
Medication administration errors: 10
Expired food items: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nurse #1 | Nurse | Involved in medication administration and bathing deficiencies; interviewed regarding medication and bathing documentation. |
| Nurse #9 | Nurse | Administered wrong medications to Resident #153; re-educated on medication administration. |
| Nurse Practitioner #1 | Nurse Practitioner | Assessed Resident #66 after fall; involved in medication management for Resident #38. |
| Nurse Practitioner #2 | Nurse Practitioner | Primary care provider for Resident #38; involved in pain management and medication order errors. |
| Director of Nursing | Director of Nursing | Involved in oversight of medication errors, bathing, and pain management issues. |
| Nurse Aide #21 | Nurse Aide | Transferred Resident #66 using incorrect lift resulting in fall. |
| Nurse Aide #17 | Nurse Aide | Found Resident #156 on floor; reported call light not working. |
| Nurse Aide #18 | Nurse Aide | Cared for Resident #156 during transfer to hospital after fall and nosebleed. |
| Maintenance Director | Maintenance Director | Responsible for call light maintenance; no work order found for Resident #156's call light. |
| Dietary Manager | Dietary Manager | Interviewed regarding kitchen sanitation and expired food items. |
| Facility Transporter #1 | Facility Transporter | Made dental appointment for Resident #81; appointment cancelled due to stretcher issue. |
Viewing
Loading inspection reports...
