Inspection Report
Annual Inspection
Deficiencies: 2
Jun 22, 2022
Visit Reason
The Adult Care Licensure Section conducted an annual survey from 06/21/22 through 06/22/22 to assess compliance with regulations related to medication administration and infection prevention and control.
Findings
The facility failed to administer medications as ordered for one resident, specifically failing to give an additional dose of Lasix for weight gain as prescribed. Additionally, the facility did not ensure daily temperature screening of residents during the COVID-19 pandemic, contrary to CDC and state guidance.
Deficiencies (2)
| Description |
|---|
| Failed to administer medications as ordered for 1 of 5 sampled residents, including a medication to help reduce fluid overload (Lasix). |
| Failed to ensure implementation of infection prevention and control program related to daily screening for fever, signs, and symptoms of COVID-19 for 43 residents. |
Report Facts
Residents affected: 1
Residents protected: 43
Medication tablets available: 15
Dates of survey: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Medication Aide | Responsible for obtaining and documenting resident weights and medication administration; failed to document refusal and notify Health and Wellness Director. | |
| Health and Wellness Director | Responsible for overseeing weight documentation and medication administration; interviewed regarding medication and infection control deficiencies. | |
| Primary Care Provider | Resident #4's PCP aware of weight gain and lack of additional Lasix administration. | |
| Administrator | Expected medication aides to administer medications as ordered and was unaware that daily resident temperature checks were required. | |
| Resident Care Coordinator | Provided information about temperature screening practices. |
Inspection Report
Census: 76
Capacity: 76
Deficiencies: 8
Oct 10, 2019
Visit Reason
This was a Construction Section Biennial Survey conducted to assess compliance with the 1996 and applicable portions of the 2005 Rules for Licensing of Adult Care Homes and the 1996 North Carolina State Building Code.
Findings
Multiple deficiencies were identified including missing handrails in corridors, corridor obstructions reducing clear width, fire safety doors not closing and latching properly, improper storage near fire sprinkler heads, malfunctioning GFCI receptacles, compromised fire-rated ceilings, improperly fitted sprinkler escutcheons, and a ceiling fan with blades sagging below the required height.
Deficiencies (8)
| Description |
|---|
| No handrail provided for 16 feet on one side of the corridor in two separate areas of the 200 Hall. |
| Corridor was not maintained free of obstructions; chairs and carts stored near room 402 reduced clear width to about 3.33 feet. |
| Many corridor doors prevented from closing quickly and latching to resist fire and smoke passage, including smoke barrier doors in Special Care and doors to laundry, TV lounge, dining room, service corridor, and resident rooms. |
| Improper storage too close to fire sprinkler heads in maintenance room, pantry, and Biohazard room, potentially negating sprinkler effectiveness. |
| GFCI type receptacles at back door and exit from 200 Hall would not trip when tested, presenting shock or electrocution risk. |
| One-hour fire rated ceiling compromised by holes and penetrations around a large flue in the main electrical room. |
| One-hour fire rated ceilings compromised by improperly fitting sprinkler escutcheons in closet off room 212 and room 402. |
| Ceiling fan on screened porch off breakroom had blades sagging to only 6 feet 2 inches above the floor. |
Report Facts
Residents served: 76
Handrail missing length: 16
Clear corridor width: 3.33
Gap between double doors: 0.3125
Gap between double doors: 0.5
Storage clearance below sprinkler: 18
Storage clearance observed: 1
Storage clearance observed: 3
Ceiling fan blade height: 6.17
Inspection Report
Capacity: 76
Deficiencies: 9
Sep 20, 2017
Visit Reason
The report documents a Construction Section Biennial Survey conducted to assess compliance with physical plant and building code requirements for an adult care home licensed to serve 76 residents.
Findings
Multiple deficiencies were identified related to building safety and maintenance, including lack of sprinkler protection in certain areas, absence of hand grips in showers, unclean mechanical systems, unsafe emergency equipment, fire safety issues, and electrical system failures.
Deficiencies (9)
| Description |
|---|
| Building failed to have all required areas protected with sprinklers, specifically Bedroom 111 Window Closet lacked automatic fire sprinkler protection. |
| Facility failed to provide hand grips in showers accessible to residents, specifically the spa shower lacked a hand grip. |
| Building mechanical systems not kept clean and in good repair; ventilation grilles near dining had excessive dust/lint. |
| Building's emergency equipment not maintained in safe and operating condition, including storage within 18 inches of fire sprinkler heads and non-illuminating exit signs. |
| Fire sprinkler escutcheon plates did not cover holes in fire-resistance-rated ceilings, allowing spread of smoke and heat in multiple locations. |
| Attic access door would not close and latch properly, leaving a gap not firestopped. |
| Open-ended sleeve with cable bundle and open joint in fire-resistance-rated ceiling assembly not firestopped. |
| Corridor doors not maintained in safe and operating condition; dead bolt lockset on Med Room door and door wedge preventing automatic latching. |
| Electrical system failure: GFCI receptacle did not trip when tested. |
Report Facts
Licensed capacity: 76
Residents in SCU: 24
Inspection Report
Annual Inspection
Deficiencies: 1
Dec 2, 2015
Visit Reason
The Adult Care Licensure Section conducted an annual survey on 12/2/15 and 12/3/15 with an exit conference via telephone on 12/4/15.
Findings
The facility failed to assure that the resident's physician certified the care plan by signing and dating it within 15 days of assessment completion for 1 of 5 sampled residents (#2). The Personal Service Plans (PSPs) dated 04/24/15 and 09/16/15 lacked physician signatures, and the Health and Wellness Director was responsible for obtaining these signatures but was unable to locate them.
Deficiencies (1)
| Description |
|---|
| Facility failed to assure the resident's physician certified the care plan by signing and dating within 15 days of assessment completion for 1 of 5 sampled residents (#2). |
Report Facts
Sampled residents: 5
Resident admission date: Mar 18, 2015
PSP completion dates: Apr 24, 2015
PSP completion dates: Sep 16, 2015
Oxygen flow rate: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Health and Wellness Director | Responsible for completion of PSP and obtaining physician's signature; interviewed regarding missing signatures | |
| Administrator | Interviewed and unaware of missing physician signatures on PSPs |
Inspection Report
Capacity: 76
Deficiencies: 4
Oct 8, 2015
Visit Reason
This is a Biennial Construction Survey conducted to assess compliance with the 1996 and applicable 2005 Rules for Licensing of Adult Care Homes and the 1996 North Carolina State Building Code.
Findings
The facility was found to have multiple deficiencies including obstructed corridors, fire protection equipment not maintained properly, unprotected penetrations compromising fire resistance, and doors that did not close and latch properly.
Deficiencies (4)
| Description |
|---|
| Corridors were obstructed, including exit vestibules used for storage and office space, and incorrect exit signage directing traffic improperly. |
| Building fire protection equipment was not maintained, including dirty smoke detector tubes, sprinkler heads covered by insulation, and stored items within 18 inches of sprinkler heads. |
| Building components lacked proper fire-resistance rating maintenance, with unprotected penetrations by pipes and holes in ceilings and walls, and dropped sprinkler escutcheon revealing attic openings. |
| Facility components were not operable due to doors that did not close completely and latch, specifically an exit door near room 309. |
Report Facts
Total licensed capacity: 76
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