Inspection Report
Capacity: 65
Deficiencies: 3
Mar 11, 2025
Visit Reason
The facility was surveyed as a Construction Section Biennial Survey to assess conformance with applicable state regulations and building codes.
Findings
Deficiencies were cited related to the lack of current sanitation and fire safety inspection reports, floors not maintained in good repair creating hazards, and fire safety equipment not maintained in a safe operating condition.
Deficiencies (3)
| Description |
|---|
| Facility failed to maintain current sanitation and fire and building safety inspection reports available for review. |
| Floors not maintained smooth and in good repair; flooring separated from slab creating cleaning obstacle and tripping hazard in Pink Laundry Room. |
| Failure to maintain fire safety equipment in safe operating condition; doors in smoke compartment do not completely close and latch, risking smoke or fire spread. |
Report Facts
Licensed bed capacity: 65
Inspection Report
Follow-Up
Deficiencies: 2
May 23, 2023
Visit Reason
Biennial Follow Up Construction Survey conducted to verify correction of previous deficiencies and identify any new deficiencies.
Findings
The facility was found to have deficiencies including lack of proper signage on delayed egress doors and failure to maintain exhaust ventilation in specified areas, specifically non-working fans on the Green Hall.
Deficiencies (2)
| Description |
|---|
| Delayed egress doors lacked required signage located above and within 12 inches of the release device reading 'PUSH UNTIL ALARM SOUNDS. DOOR CAN BE OPENED IN 15 SECONDS.' The Yellow Hall exit door was not labeled with the proper signage. |
| Facility did not maintain exhaust ventilation in specified spaces, causing humidity buildup and odor issues. Fans on the Green Hall were not working. |
Inspection Report
Capacity: 65
Deficiencies: 7
Oct 9, 2019
Visit Reason
The facility was surveyed for conformance with the 1996 Minimum Standards and Regulations for Homes for the Aged, the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds, and the 1996 (1999 Rev) Edition of the North Carolina State Building Code(s)-Institutional Occupancy.
Findings
Multiple deficiencies were cited including failure to maintain the facility free of obstructions and hazards in exit vestibules, failure to maintain fire safety components such as missing sprinkler heads and damaged sheetrock, unsecured plumbing fixtures, and a non-operational kitchen exhaust fan.
Deficiencies (7)
| Description |
|---|
| Facility failed to be kept uncluttered, orderly and free of all obstructions and hazards; exit vestibules partially blocked by household items and kitchen exit blocked by a fan. |
| Facility failed to maintain fire safety components in a safe and operating condition; missing sprinkler head at Porte Cochere ceiling at Main Entry. |
| Hole to the attic adjacent to the sprinkler head in Mechanical Room/Yellow Hall. |
| Severely damaged sheetrock due to chemical migration in Mechanical Room/Yellow Hall. |
| 3"x4" hole at exterior wall adjacent to exit door in Exit Vestibule/Pink Hall. |
| Toilet not secured to the floor in Spa/Pink Hall. |
| Mechanical exhaust system not maintained in good repair; Kitchen/Mop Sink Closet exhaust fan not operational. |
Report Facts
Total licensed capacity: 65
Inspection Report
Capacity: 65
Deficiencies: 13
Aug 30, 2017
Visit Reason
The facility was surveyed for conformance with the 1996 Minimum Standards and Regulations for Homes for the Aged, the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds, and the 1996 (1999 Rev) Edition of the North Carolina State Building Code(s)-Institutional Occupancy as part of a Construction Section Biennial Survey.
Findings
Multiple deficiencies were identified including non-compliance with delayed egress exit door requirements, corridor obstructions, unsafe housekeeping practices such as improper storage of oxygen cylinders, missing inspection tags on fire extinguishers, improper storage near fire sprinkler heads, use of extension cords instead of permanent wiring, blocked electrical panels, inadequate fire safety door closures and sealing, compromised fire-rated walls and ceilings, lack of exhaust ventilation in the housekeeping closet, and incomplete fire safety rehearsal records.
Deficiencies (13)
| Description |
|---|
| Delayed Egress exit gate failed to open with less than 15 pounds of force and signage was improperly mounted. |
| Corridors were obstructed by two love seats reducing clear width to about 40 inches. |
| Portable medical oxygen cylinders were stored unsecured in room 28. |
| Shower wand hose in Beauty Salon lacked a proper vacuum breaker. |
| No inspection tag on fire extinguisher near room 29. |
| No documentation of monthly inspections on range hood fire suppression system. |
| Improper storage within 6 inches of fire sprinkler head in clock room. |
| Extension cord used in place of permanent wiring in Activity office. |
| Storage obstructed electrical panels in multiple locations. |
| Many corridor doors failed to close and latch properly to resist fire and smoke passage. |
| One-hour fire rated walls and ceilings were compromised by holes and unsealed penetrations in multiple rooms. |
| No exhaust ventilation provided in housekeeping closet with mop sink. |
| Fire safety rehearsal records lacked sufficient description and did not always include time or shift. |
Report Facts
Total licensed bed capacity: 65
Force applied to delayed egress exit gate: 100
Corridor clear width: 40
Storage clearance from fire sprinkler head: 6
Required clearance below sprinkler head: 18
Required clear working space in front of electrical panels: 30
Required clear working space depth: 36
Inspection Report
Capacity: 65
Deficiencies: 6
Oct 1, 2015
Visit Reason
The facility was surveyed for conformance with the 1996 Minimum Standards and Regulations for Homes for the Aged, the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds, and the 1996 (1999 Rev) Edition of the North Carolina State Building Code(s)-Institutional Occupancy during a Biennial Construction Survey.
Findings
Multiple deficiencies were cited related to building equipment and safety, including dropped sprinkler head escutcheons, unsafe interior doors, unserviced HVAC air grilles with particulate buildup, missing required signage on magnetically locked exit doors, and a broken activation wall pull switch on the fire suppression system.
Deficiencies (6)
| Description |
|---|
| Facility fire protection equipment was not maintained in a safe manner, risking incomplete sprinkler coverage upon activation. |
| Dropped sprinkler head escutcheons found in the Educational Director's Office and Kitchen's wash sink closet. |
| Interior doors not maintained safely; Laundry Room entry door has a large split preventing closure, and entry doors for Rooms 4 & 29 drag on the floor. |
| HVAC supply and return air grilles not maintained or serviced; return-air grilles have excessive particulate buildup in Resident Rooms and Small Dining Room. |
| Facility fire protection equipment and safety signage not maintained; 15 second delay/magnetically locked exit doors lack required signage. |
| Ansul fire suppression system activation wall pull switch is broken. |
Report Facts
Total licensed capacity: 65
Number of magnetically locked exit doors missing signage: 15
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