Inspection Reports for Country Time Inn
602 Brevard Road Kings Mountain, NC 28086, Kings Mountain, NC, 28086
Back to Facility ProfileDeficiencies (last 6 years)
Deficiencies (over 6 years)
3.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
37% better than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Mar 5, 2025
Visit Reason
The Adult Care Licensure Section and the Gaston County Department of Social Services conducted an annual survey and complaint investigation on 03/04/2025 through 03/05/2025.
Complaint Details
The visit included a complaint investigation as stated in the initial comments section.
Findings
The facility failed to ensure referral and follow-up for routine healthcare needs, proper implementation of physician orders, clarification of medication orders, and administration of medications as ordered for sampled residents. Additionally, the facility failed to update Special Care Unit resident profiles on a quarterly basis for two sampled residents.
Deficiencies (5)
Failed to ensure referral and follow-up to meet routine healthcare needs for Resident #4 related to notifying the Primary Care Provider of finger stick blood sugars less than 80 and greater than 450.
Failed to ensure physician orders were implemented for Resident #4 related to insulin lispro medication to treat elevated blood sugars.
Failed to clarify medication orders for Resident #4 regarding an order for depressive disorder medication sertraline.
Failed to ensure medications were administered as ordered for Resident #6 related to insulin lispro medication to lower blood sugar.
Failed to ensure Special Care Unit resident profiles were updated quarterly for Residents #2 and #4.
Report Facts
Sampled residents: 6
Finger stick blood sugar (FSBS) readings: 9
Insulin lispro units: 10
Medication administration times: 3
SCU resident profiles: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Medication Aide | Interviewed regarding notification procedures and medication administration. | |
| Special Care Unit Coordinator (SCC) | Interviewed regarding expectations for PCP notification, auditing FSBS readings, and SCU resident profiles. | |
| Administrator | Interviewed regarding oversight of medication orders, notification procedures, and SCU resident profiles. | |
| Resident Care Coordinator (RCC) | Interviewed regarding sending physician orders to pharmacy and clarifying medication orders. | |
| Pharmacist | Interviewed regarding medication orders and pharmacy processes. | |
| Regional Nurse | Interviewed regarding medication availability and emergency procedures. |
Inspection Report
Capacity: 59
Deficiencies: 1
Date: Dec 13, 2023
Visit Reason
The facility was surveyed for conformance with applicable licensing rules and building codes as part of a Construction Section Biennial Survey.
Findings
Deficiencies were cited related to the facility not following rules for construction projects, specifically the installation of a new generator without a submitted project through the Division of Health Service Regulation (DHSR).
Deficiencies (1)
Facility is installing a new generator without a record of a project submitted through DHSR.
Report Facts
Licensed beds: 59
Special Care Unit beds: 26
Addition beds: 33
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ryan Meyer | Surveyor who conducted the Construction Section Biennial Survey |
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Jan 30, 2019
Visit Reason
The Adult Care Licensure Section conducted an annual survey on January 29-30, 2019 to assess compliance with health care regulations.
Findings
The facility failed to assure referral and follow-up for 2 of 5 sampled residents regarding physician notification and appointment scheduling. Resident #2 missed a cardiac rehabilitation appointment and the facility did not reschedule it, and Resident #1 did not have an orthopedic referral appointment set up following a fall.
Deficiencies (2)
Failure to assure referral and follow-up for Resident #2 related to a missed cardiac rehabilitation appointment after hospital discharge.
Failure to set up an orthopedic referral appointment for Resident #1 following a fall.
Report Facts
Sampled residents: 5
Residents with referral failures: 2
Appointment date: Jan 29, 2019
Referral date: Jan 2, 2019
Inspection Report
Capacity: 59
Deficiencies: 3
Date: Feb 8, 2018
Visit Reason
This facility was surveyed for conformance with the applicable portions of the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds, and applicable portions of the North Carolina Building Codes and Minimum Standards and Regulations for Homes for the Aged in effect at time of initial licensure.
Findings
Deficiencies were cited related to physical plant requirements including the absence of an emergency on/off release switch at a magnetically locked exit door, non-functioning emergency lighting in the Special Care Unit courtyard, and a water supply line leak at the water heater in the mechanical room.
Deficiencies (3)
No emergency on/off release switch within 3 feet of magnetically locked exit door #6 as required by NC State Building Code.
Emergency lighting in the Special Care Unit courtyard does not illuminate when tested in emergency mode.
Water supply line leak at the top of the water heater adjacent to the circulator pump in the mechanical room.
Report Facts
Licensed beds: 59
Special Care Unit beds: 26
Inspection Report
Capacity: 59
Deficiencies: 7
Date: Mar 23, 2016
Visit Reason
This is a Biennial Construction Survey conducted to assess the facility's conformance with applicable licensing rules and building codes for an adult care home licensed for 59 beds with a 26 bed Special Care Unit.
Findings
The facility was found deficient in housekeeping and furnishings, including lack of ventilation causing odors, scratched interior doors, unmaintained HVAC grilles with grease buildup, and moldy ceramic tiles in shower areas. Additionally, building equipment was not maintained safely, with exit doors malfunctioning, fire protection equipment in the HVAC system not maintained, and missing fire detection in required areas such as the SCU/Dining Hall closet.
Deficiencies (7)
Facility failed to provide ventilation where odors are generated, affecting residents and staff.
Interior doors are scratched and have unsuitable finishes in multiple areas including Administrator's Office and Resident Room doors.
HVAC supply and return air grilles not maintained; excessive grease buildup in kitchen.
Ceramic tile in roll-in showers is moldy where shower tile walls meet shower floor in Spa Rooms.
Exit doors not maintained in safe operating condition; specific doors drag or have panic bars removed restricting safe exit.
Fire protection equipment in HVAC system not maintained; excessive particulate buildup in sampling tubes and ductwork.
Fire detection not provided in all required spaces; specifically missing in SCU/Dining Hall closet.
Report Facts
Licensed beds: 59
Special Care Unit beds: 26
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Nov 3, 2015
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey on November 3 and 4, 2015 to assess compliance with adult care home regulations.
Findings
The facility failed to maintain walls, doors, carpets, and tiled floors in clean and good repair throughout the facility, with multiple areas of staining, discoloration, and damage observed in resident rooms, bathrooms, hallways, and common areas. Additionally, three resident chairs were found to be unclean and in poor repair.
Deficiencies (2)
Facility failed to maintain walls, doors, carpet, and tiled floors clean and in good repair throughout the facility, including scraped doors, stained walls, and heavily soiled carpets and floors.
Facility failed to maintain 3 resident chairs clean and in good repair, with stains and worn fabric noted.
Report Facts
Facility score: 96
Demerits deducted: 2
Area measurements: 4
Area measurements: 4
Area measurements: 4
Area measurements: 7
Area measurements: 4
Area measurements: 3
Area measurements: 5
Area measurements: 5
Area measurements: 7
Area measurements: 6
Area measurements: 4
Area measurements: 6
Area measurements: 4
Area measurements: 2
Area measurements: 6
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