Inspection Reports for Clemmons Village I- Memory Care

The Adult Care Licensure Section conducted an annual and follow-up survey on August 5-6, 2025.

The facility failed to administer medications as ordered by a licensed practitioner for 1 of 5 sampled residents, specifically Resident #5 whose levothyroxine dosage was not adjusted according to the current physician's order.

This is a Construction Section Biennial Survey conducted to assess compliance with the 1996 Rules for the Licensing of Adult Care Homes and applicable building codes.

Several deficiencies were cited including failure to maintain the building free of hazards, unsafe and inoperable building equipment such as smoke-tight corridor doors and emergency equipment, and a non-operational exhaust fan in the medication room.

The Adult Care Licensure Section conducted a complaint investigation and a COVID-19 focused infection control survey with on-site visits on 12/15/20 and 12/17/20, a desk review from 12/16/20 through 12/18/20, and a telephone exit on 12/18/20.

The facility failed to ensure that 2 of 3 sampled staff who administered medications had documentation of completion of a Medication Clinical Skills Competency Validation prior to administering medications at the current facility. Both Staff A and Staff B had competency validations from sister facilities but did not complete new validations upon transfer to the current facility.

Complaint investigation conducted with substantiation of failure to ensure medication clinical skills competency validation for staff transferring from sister facilities.

This is a Biennial Follow Up Construction Survey conducted to verify correction of previously cited deficiencies related to building mechanical systems, fire safety, and physical plant conditions.

Multiple deficiencies were found including excessive dust accumulation in ventilation systems, failure to document fire safety rehearsals adequately, emergency equipment not maintained in safe operating condition, fire safety issues with penetrations and sprinkler pipe sealing, unsafe electrical system use with power taps for medical equipment, and failure of exhaust ventilation in a bathroom.

This document is a Construction Section Biennial Survey conducted to assess compliance with physical plant and safety regulations for an adult care home.

Multiple deficiencies were cited related to physical plant and safety including lack of exit signs, corridor obstructions, unsafe outside premises, unclean mechanical systems, inadequate fire safety rehearsals, malfunctioning emergency equipment, fire safety issues, electrical hazards, obstructed fire sprinkler heads, and non-functioning exhaust ventilation.

The Adult Care Licensure Section conducted an annual survey on September 14-15, 2017 to assess compliance with regulatory requirements for the facility.

The facility failed to have a matching therapeutic diet menu for one resident ordered a low concentrated sweets (LCS) diet, and failed to ensure the Medication Administration Skills Validation was completed for one sampled staff member.

This is a biennial construction section survey to assess compliance with the 1996 Rules for the Licensing of Adult Care Homes and applicable building codes for a Home for the Aged licensed to serve 60 residents.

The facility was found to have deficiencies including improper storage too close to a fire sprinkler head, lack of description in fire safety rehearsal records, and a corridor door that would not latch properly to resist fire and smoke.

The Adult Care Licensure Section conducted an annual survey and follow-up survey on August 19-20, 2015 to assess compliance with regulations.

The facility was found deficient in multiple areas including failure to provide adequate supervision for a resident with frequent falls, failure to implement physician orders for blood pressure monitoring, failure to provide feeding assistance in a manner that maintains resident dignity, and failure to administer medications as prescribed.