Inspection Reports for Cleveland House
950 Hardin Drive Shelby, NC 28150, Shelby, NC, 28150
Back to Facility ProfileDeficiencies (last 6 years)
Deficiencies (over 6 years)
10 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
92% worse than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Capacity: 72
Deficiencies: 4
Date: Jul 9, 2025
Visit Reason
The inspection was a Construction Section Biennial Survey conducted to assess compliance with the 1991 Rules for Adult Care Homes, the 2005 Rules for Licensing Adult Care Homes of Seven or More Beds, and the 1991 North Carolina State Building Code.
Findings
Deficiencies were cited including failure to maintain current sanitation and fire safety inspection reports, failure to submit construction documents for renovation approval, and unsafe conditions related to electrical and fire safety equipment such as a non-alarming emergency release switch and doors that do not fit properly in their jambs.
Deficiencies (4)
Facility failed to maintain current sanitation and fire safety inspection reports available for review.
Facility performing renovation without submitting construction documents for review and approval.
Electrical equipment not maintained in a safe and operating condition; emergency release switch did not alarm when opened.
Fire safety equipment not maintained in a safe operating condition; doors do not completely close and latch, potentially exposing occupants to smoke or fire.
Report Facts
Total licensed capacity: 72
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Feb 5, 2025
Visit Reason
The Adult Care Licensure Section completed an annual and follow-up survey on February 4 through February 5, 2025 to assess compliance with adult care home regulations.
Findings
The facility failed to maintain walls, ceilings, and floors in good repair and cleanliness, with multiple bathrooms and resident rooms observed to be dirty or cluttered. Additionally, medication administration records were inaccurate for one resident related to wound care documentation, and medications were found unsecured in a resident room during the facility tour.
Deficiencies (3)
Walls, ceilings, and floors were not kept clean and in good repair; four shared bathrooms were not clean, one bathroom had a damaged wall, and two residents' rooms were cluttered.
Electronic medication administration records (eMAR) were inaccurate for one resident related to wound care documentation.
Medications were not maintained under locked security; a medication cup was found unsecured in a resident room.
Report Facts
Demerit deductions: 5.5
Number of residents sampled: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Facility housekeeper | Interviewed regarding cleaning tasks and schedule; acknowledged missed cleaning days. | |
| Administrator | Interviewed about housekeeping staffing, environmental repairs, and medication administration policies. | |
| Medication Aide (MA) | Interviewed regarding wound care documentation and medication administration practices. | |
| Home Health Clinical Supervisor | Interviewed about wound care services provided to Resident #3. | |
| Resident Care Coordinator (RCC) | Interviewed about auditing eMARs, medication administration, and wound care responsibilities. |
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Nov 16, 2022
Visit Reason
The Adult Care Licensure Section completed an annual and follow-up survey from 11/15/22 through 11/16/22 at Cleveland House.
Findings
The facility failed to ensure proper contact with a resident's physician for clarification of a medication order and failed to maintain accurate electronic medication administration records (eMAR) for two sampled residents related to medication documentation and order discrepancies.
Deficiencies (2)
Failed to ensure contact with a resident's physician for clarification of a treatment order for donepezil 10mg for Resident #4.
Failed to ensure the electronic medication administration records (eMAR) were accurate for Resident #5 related to documentation of an iron supplement (ferrous gluconate 324mg).
Report Facts
Sampled residents: 5
Donepezil tablets remaining: 7
Ferrous gluconate tablets remaining: 6
Inspection Report
Follow-Up
Deficiencies: 11
Date: Jan 31, 2020
Visit Reason
The Adult Care Licensure Section and the Cleveland County Department of Social Services conducted a follow-up survey and a complaint investigation from 01/28/20 to 01/31/20, initiated by complaints received on 12/11/19, 12/30/19, and 01/17/20.
Complaint Details
Complaint investigations were initiated by the Cleveland County Department of Social Services on 12/11/19, 12/30/19, and 01/17/20, leading to a follow-up survey from 01/28/20 to 01/31/20.
Findings
The facility failed to maintain adequate heating, ensure staff qualifications, provide personal care, administer medications as ordered, notify responsible parties of incidents, and implement infection control policies during a norovirus outbreak. Multiple residents experienced harm due to these failures, including untreated infections, missed medications, and neglect during quarantine.
Deficiencies (11)
Facility failed to maintain temperature at 75°F in resident rooms and dining area during winter design conditions.
Facility failed to ensure 1 of 5 staff had no substantiated findings on the North Carolina Health Care Personnel Registry upon hire.
Facility failed to provide personal care to 2 of 5 residents, resulting in untreated genital/buttock rash and dried, soiled incontinent brief adhered to skin.
Facility failed to ensure timely referral and follow-up for 2 of 7 residents related to untreated genital/buttock rash and psychotropic medication not administered for up to 28 days.
Facility failed to ensure medications were properly labeled for 2 of 5 residents related to multi-dose packaging lacking medication name, dosage, or frequency.
Facility failed to administer medications as ordered for 4 residents, including missed diuretics, antihistamine, vitamin D3, psychotropic medication, and 18 missed doses of magnesium chloride.
Facility failed to ensure accuracy of medication administration records for 2 residents related to documenting administration of unavailable psychotropic medication and missing blood sugar readings.
Facility failed to notify County Department of Social Services of incidents resulting in injury requiring emergency medical evaluation or hospitalization for 6 of 26 residents related to falls.
Facility failed to ensure residents were treated with respect and dignity related to denial of showers and personal care during norovirus outbreak, resulting in residents feeling dirty and unsanitary conditions.
Facility failed to implement infection control policy consistent with CDC guidelines to prevent transmission of bloodborne pathogens and norovirus, including proper use of glucometers and PPE, and maintaining supplies.
Facility failed to ensure overall management, operations, and policies were implemented and rules maintained for personal care, referral and follow-up, medication administration, infection prevention, staff requirements, and resident rights.
Report Facts
Medication error rate: 9.5
Residents affected by norovirus: 50
Staff affected by norovirus: 3
Missed doses: 18
Medication count: 196
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Medication Aide | Had two substantiated findings of neglect on North Carolina Health Care Personnel Registry upon hire. |
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Nov 25, 2019
Visit Reason
The Adult Care Licensure Section conducted a complaint investigation from November 21, 2019 to November 25, 2019 regarding supervision and care of residents related to falls and health care follow-up.
Complaint Details
Complaint investigation conducted due to concerns about resident supervision, health care follow-up, resident rights, and death reporting.
Findings
The facility failed to provide adequate supervision for 5 sampled residents related to falls, failed to assure timely referral and follow-up for acute health care needs for a resident with GI bleed and fractures, failed to treat residents with dignity and respect, and failed to notify local law enforcement of a resident's unexpected death.
Deficiencies (4)
Failed to provide supervision for 5 of 5 sampled residents related to falls.
Failed to assure referral and follow-up to meet acute health care needs for a resident with delayed treatment for GI bleed and fractures.
Failed to assure residents were treated with dignity and respect; Resident #4 felt alienated by staff and Resident #2 had items removed from his room without permission.
Failed to notify local law enforcement of a resident's unexpected death.
Report Facts
Falls: 4
Falls: 3
Vital sign checks missed: 3
Vital sign checks missed: 4
Vital sign checks missed: 5
Vital sign checks missed: 1
Vital sign checks missed: 2
Inspection Report
Capacity: 72
Deficiencies: 10
Date: Jun 5, 2019
Visit Reason
The report documents a Construction Section Biennial Survey conducted on June 5, 2019, to assess compliance with the 1991 Rules for Adult Care Homes and applicable building codes for a licensed 72-bed Home for the Aged facility.
Findings
Multiple deficiencies were cited including failure to maintain current annual fire and safety inspection reports, inadequate housekeeping and repair of plumbing fixtures, lack of regular fire safety rehearsals and incomplete documentation, unsafe and non-operating fire alarm and sprinkler systems, fire-resistance-rated barriers and doors not properly maintained, electrical hazards, and failure to maintain required exhaust ventilation systems.
Deficiencies (10)
Facility failed to maintain current annual fire alarm inspection report.
Broken handle on commode in women's restroom limiting use.
Fire safety rehearsals not performed regularly each shift quarterly and incomplete documentation of rehearsals.
Fire alarm system not maintained in safe and operating condition; HVAC smoke detector sampling tubes dirty.
Fire-resistance-rated smoke barrier penetrations not properly firestopped; openings and crushed walls in attic areas.
Fire rated doors held open preventing proper closure and smoke containment.
Electrical system unsafe; loose conduit connections and water stored in front of electrical panels limiting clearance.
Smoke tight corridor doors missing strike plates or with holes preventing smoke containment.
Fire sprinkler heads missing escutcheon plates or improperly installed allowing spread of smoke and heat.
Exhaust ventilation system not working in housekeeping and Hoper rooms.
Report Facts
Total licensed capacity: 72
Inspection date: Jun 5, 2019
Inspection Report
Follow-Up
Deficiencies: 2
Date: Jun 14, 2017
Visit Reason
The visit was a biennial follow-up construction survey conducted to assess compliance with physical plant regulations, specifically to verify correction of previously cited deficiencies.
Findings
The facility failed to maintain current annual sanitation and fire safety inspection reports as required. The annual Fire Sprinkler System Inspection performed on May 17, 2017, identified 12 deficiencies that require correction.
Deficiencies (2)
Failure to maintain current annual sanitation and fire safety inspection reports.
Twelve deficiencies identified in the annual Fire Sprinkler System Inspection, Testing, and Maintenance Report.
Report Facts
Deficiencies identified: 12
Inspection Report
Life Safety
Capacity: 72
Deficiencies: 8
Date: Apr 20, 2017
Visit Reason
The inspection was a Construction Section Biennial survey conducted to ensure compliance with the 1991 Rules for Adult Care Homes, applicable portions of the 2005 Rules for Licensing Adult Care Homes of Seven or More Beds, and the 1991 North Carolina State Building Code.
Findings
The facility was found deficient in maintaining current sanitation and fire safety inspection reports, proper handling and storage of portable medical oxygen cylinders, conducting and documenting fire safety rehearsals, providing ground fault circuit protection for electrical outlets in wet locations, maintaining fire-rated walls and ceilings, ensuring corridor doors close and latch properly, and maintaining exhaust ventilation systems in working condition.
Deficiencies (8)
Facility did not have current annual Fire Marshal building safety inspection report (last dated 2-25-2016).
Facility did not have current annual sprinkler system inspection report (last dated 2-10-2016).
Portable medical oxygen cylinders were stored improperly without containers, creating a hazard.
Fire safety rehearsals on each shift were not adequately documented with descriptions of what the rehearsals involved.
Electrical outlets in wet locations lacked ground fault circuit protection, including two receptacles near the med room sink and one in housekeeping on Maple Court.
One-hour fire rated walls and ceilings were compromised by unsealed penetrations and missing or improperly mounted sprinkler escutcheons in multiple locations.
Corridor doors did not close and latch properly, including double doors to the dining room, kitchen to dining room door, door to room 19, and the RCC office door was propped open.
Exhaust ventilation systems were not functioning in multiple areas including med room storage near lobby, bathrooms off rooms 25, 34, library, and the beauty parlor.
Report Facts
Total licensed capacity: 72
Date of last Fire Marshal inspection: Feb 25, 2016
Date of last sprinkler system inspection: Feb 10, 2016
Number of portable oxygen cylinders improperly stored: 3
Number of electrical outlets without ground fault protection: 3
Number of locations with compromised fire rated ceilings/walls: 7
Number of corridor doors not latching properly: 4
Number of exhaust ventilation failures: 5
Inspection Report
Follow-Up
Deficiencies: 2
Date: Jul 8, 2015
Visit Reason
Follow-up survey conducted to verify correction of previously identified deficiencies related to building safety and equipment maintenance.
Findings
Not all deficiencies were corrected. The building was found not to be maintained in a safe manner due to missing radiation dampers in supply ducts and exhaust fans lacking proper fire resistance protection.
Deficiencies (2)
Building was not maintained in a safe manner by not maintaining the fire-resistance rating of building components, specifically missing radiation dampers in the high/low make up air ducts in the laundry area.
Building exhaust ventilation was not maintained in accordance with regulations; specifically, the Kitchen Mop Closet had no exhaust fan initially, and although an exhaust fan was later installed, it lacked a radiation damper or indication of maintaining one-hour fire resistance of the ceiling.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dennis Harrell | Conducted the follow-up survey on 7-8-2015. | |
| Bob Getchell | Referenced in deficiency related to building fire-resistance rating. |
Inspection Report
Follow-Up
Deficiencies: 3
Date: Apr 28, 2015
Visit Reason
Follow-up survey conducted to verify correction of previously identified deficiencies related to physical plant and safety compliance at Cleveland House.
Findings
Not all deficiencies were corrected; issues remain with fire sprinkler equipment maintenance, untested backflow preventer, lack of radiation dampers in HVAC ducts, and missing exhaust fan in the kitchen mop closet.
Deficiencies (3)
Building fire sprinkler equipment was not maintained in a safe manner, including untested backflow preventer.
Building was not maintained in a safe manner by not maintaining the fire-resistance rating of building components, including missing radiation dampers in HVAC ducts.
Building exhaust ventilation was not maintained; kitchen mop closet exhaust fan not installed.
Inspection Report
Capacity: 72
Deficiencies: 11
Date: Feb 19, 2015
Visit Reason
This report is of a Biennial Construction Survey conducted to assess compliance with the 1991 and applicable 2005 Rules for Licensing of Adult Care Homes and the 1991 North Carolina State Building Code.
Findings
Multiple deficiencies were noted related to fire safety, building maintenance, electrical hazards, plumbing, and ventilation. Issues included unprotected penetrations in smoke barrier walls, missing or damaged sprinkler heads, malfunctioning emergency lighting, unsecured oxygen bottles, improper plumbing installations, and non-functioning exhaust fans.
Deficiencies (11)
Building fire sprinkler equipment was not maintained safely; sprinkler heads removed leaving holes in ceilings in multiple rooms.
Unprotected openings and penetrations in attic smoke barrier walls and other areas compromising fire-resistance rating.
Dirty sample tubes for HVAC duct mounted smoke detectors and storage of items within 18 inches of sprinkler head in room 15.
Emergency lights not working in corridor near room 25.
Handrail in Sycamore Spa loose from wall, creating fall hazard.
Electrical fixtures hanging by wires; bathroom heater hanging from ceiling and inadequate knockout in kitchen electrical panel.
Oxygen bottles unsecured in room 27.
Ice machine drain line lacks required 2-inch air gap between discharge pipe and floor level.
Door to Activity Room Storage has two holes near door handle.
Plumbing cross connections present; spray hose in room 12 bathroom lacks vacuum breaker.
Building exhaust ventilation not maintained; exhaust fans not moving air in multiple rooms including rooms 6, 25, 27, Beauty Shop, and Kitchen Mop Closet.
Report Facts
Total licensed capacity: 72
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