Inspection Reports for
Cypress Manor
503 West Buncombe Street Roper, NC 27970, Roper, NC, 27970
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
16
12
8
4
0
Inspection Report
Follow-Up
Deficiencies: 0
Date: Jun 23, 2025
Visit Reason
Follow Up Construction Survey by Documentation to verify correction of previously cited deficiencies.
Findings
All previously cited deficiencies have been corrected based on documentation received, and no further action is required at this time.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Suzanna Fay | Reported the Follow Up Construction Survey. |
Inspection Report
Capacity: 40
Deficiencies: 12
Date: May 29, 2025
Visit Reason
This report documents a Construction Section Biennial Survey conducted to assess conformance with the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and applicable portions of the 1996 North Carolina Building Code and licensing rules in effect at the time of initial licensure.
Findings
Multiple deficiencies were cited including lack of wrist type lever handles on the medication preparation sink, walls and furniture not kept in good repair, inadequate bedroom towel bars, failure to maintain fire safety systems and equipment, electrical hazards, plumbing issues, insufficient exhaust ventilation, and failure to maintain emergency lighting and fire safety doors.
Deficiencies (12)
Med Prep area sink was not equipped with wrist type lever handles to prevent contamination after hand washing.
Walls were not kept in good repair, including a 2" diameter indention in the corridor wall below the emergency light.
Furniture was not kept in good repair, including drawers off tracks and cabinet doors not closing in Med Prep Room and Nurses Station.
Each bedroom or adjoining bathroom did not have a towel bar for each resident; some towel bars were broken or damaged.
Failure to maintain building's fire safety systems in a safe condition, including holes or gaps at penetrations through fire resistant ceilings or walls.
Failure to maintain fire safety equipment in safe operating condition; doors in smoke compartments did not completely close and latch.
Electrical equipment not maintained safely; GFCI outlets malfunctioning or tripped, posing shock hazards.
Plumbing equipment not maintained safely; toilet in 204 Bath not secure to floor.
Fire safety equipment such as kitchen hood suppression system not inspected timely (last inspection August 2024).
Mechanical equipment not maintained safely; exterior dryer exhaust cap damaged allowing pest entry.
Electrical emergency/safety lighting equipment not maintained; emergency light in Business Office did not illuminate on test.
Failure to maintain exhaust ventilation in specified spaces; janitor's closet exhaust fan not pulling enough air.
Report Facts
Total licensed capacity: 40
Hole diameter: 2
Last inspection date: 2024
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Jul 27, 2022
Visit Reason
The Adult Care Licensure Section and the Washington County Department of Social Services conducted an Annual survey, follow up survey and complaint investigation on 07/27/22-07/28/22. The complaint investigation was initiated by the Washington County Department of Social Services on 07/19/22.
Complaint Details
Complaint investigation was initiated by the Washington County Department of Social Services on 07/19/22 and was part of the survey conducted on 07/27-07/28/22.
Findings
The facility failed to clarify medication orders for 1 of 11 residents during medication pass, resulting in medication administration errors including diabetic medication errors and timing errors for psychotropic medication. The electronic medication administration records (eMAR) were also found inaccurate for 2 of 8 sampled residents.
Deficiencies (3)
Failed to clarify medication orders for 1 of 11 residents during medication pass for a medication used to treat high blood glucose levels dependent upon parameters.
Failed to administer medications as ordered for 2 of 8 sampled residents including errors in diabetic medications and a medication used to prevent extrapyramidal symptoms caused by psychotropic medications.
Failed to ensure electronic medication administration records (eMAR) were accurate for 2 of 8 sampled residents including errors in diabetic medications and a medication used to prevent extrapyramidal effects.
Report Facts
Medication administration error rate: 6
Resident count observed for medication pass: 11
Sampled residents for medication administration: 8
Inspection Report
Annual Inspection
Deficiencies: 1
Date: Mar 6, 2020
Visit Reason
The Adult Care Licensure Section conducted an annual survey and follow-up survey on 03/05/2020 and 03/06/2020 to assess compliance with nutrition and food service regulations.
Findings
The facility failed to assure that foods being stored, prepared, and served to residents were protected from contamination related to dating and labeling of stored food and keeping food storage containers free of contamination. Multiple observations revealed unlabeled and undated food items and improper storage practices.
Deficiencies (1)
Facility failed to assure foods being stored, prepared, and served were protected from contamination related to dating and labeling stored food and keeping food storage containers free of contamination.
Report Facts
Packets of gelatin: 45
Inspection Report
Capacity: 40
Deficiencies: 6
Date: Jul 11, 2019
Visit Reason
This facility was surveyed for conformance with the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and applicable portions of the 1996 Edition of the North Carolina Building Code, Institutional Occupancy, and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure.
Findings
Deficiencies were cited related to housekeeping and furnishings, including floor coverings not kept clean and in good repair, and building equipment not maintained in a safe and operating condition, including fire safety issues, HVAC problems, and missing dryer vent dampers.
Deficiencies (6)
Floor tiles adjacent to the toilet for Room 102 have excessive staining and are dirty.
There is a through wall hole in the Lobby under the clock into the Dining Hall that would allow the passage of smoke and/or fire.
Doors at Room 205 and Soiled Linen Room do not latch, allowing passage of smoke and/or fire.
Kitchen return-air grille and filter have excessive grease build-up.
Ceiling diffuser in the front Administrator's Office has peeling paint/rust due to condensation.
Back-draft dampers for the 4" dryer vent are missing, allowing vermin to enter the facility.
Inspection Report
Capacity: 40
Deficiencies: 12
Date: Jun 29, 2017
Visit Reason
The facility was surveyed for conformance with the 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and applicable portions of the 1996 Edition of the North Carolina Building Code, Institutional Occupancy, and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure.
Findings
The survey identified multiple deficiencies related to physical plant conditions including unsafe outside premises, housekeeping issues with odors and repairs needed, hazards such as obstructed electrical panels and unsecured oxygen tanks, and failures in maintaining fire safety and life safety equipment in operating condition. Specific issues included gaps in fire resistant ceilings, damaged ceilings from sprinkler leaks, malfunctioning emergency lighting, and compromised fire doors.
Deficiencies (12)
Outside grounds were not maintained in a safe condition; side exits lacked working light bulbs and unstable grease trap covers posed fall hazards.
Facility was not maintained free of unpleasant odors; strong urine smell in Room 102.
Doors within wall openings not maintained in good repair; living room door drags on frame.
Bathroom fixtures not maintained in good repair; sink in 200 Hall left bath not secure.
Floors not maintained in good repair; broken floor tiles in Room 208.
Facility not maintained free from hazards; electrical panel access obstructed by laundry barrels and unsecured oxygen bottles present.
Failure to maintain fire safety systems due to penetrations and gaps in fire resistant rated ceilings; damage from sprinkler leaks and missing escutcheons.
Failure to maintain life safety equipment in operating condition; emergency lights failed to illuminate on battery power.
Smoke detector in Room 106 chirping due to low battery.
Fire doors did not completely close and latch; hall bathroom doors and cross-corridor doors sticking.
Electrical equipment not maintained in a safe condition; missing screw on electrical outlet cover plate in Room 208 bath.
Fire alarm panel indicated trouble at smoke detector by Room 102 where sprinkler pipe leak occurred.
Report Facts
Total licensed capacity: 40
Inspection Report
Annual Inspection
Census: 12
Deficiencies: 1
Date: Feb 7, 2017
Visit Reason
The Adult Care Licensure Section conducted an annual survey, follow-up survey, and a complaint investigation on 1/31/17-2/3/17 and 2/6/17-2/7/17.
Complaint Details
Complaint investigation was part of the visit conducted between 1/31/17-2/3/17 and 2/6/17-2/7/17.
Findings
The facility failed to assure medications were administered as ordered for 5 of 12 residents observed during medication passes, including errors with short-acting insulin, long-acting insulin, and a digestive enzyme. The medication error rate was 17%, with 5 errors out of 28 opportunities during medication passes on 2/1/17 and 2/2/17.
Deficiencies (1)
Failed to assure medications were administered as ordered for 5 of 12 residents observed during medication passes, including errors with short-acting insulin, long-acting insulin, and a digestive enzyme.
Report Facts
Medication error rate: 17
Residents observed during medication pass: 12
Medication errors: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Medication Aide | Administered insulin and medications; interviewed multiple times regarding medication administration errors. | |
| Assistant Manager | Interviewed regarding medication administration policies and corrective actions including contacting physicians and pharmacists. | |
| Manager | Interviewed about monitoring insulin orders and ensuring medications are administered within 30 minutes of meals. | |
| Administrator | Interviewed about medication administration policies and ensuring insulin is administered just prior to meals. |
Inspection Report
Follow-Up
Deficiencies: 1
Date: Dec 10, 2015
Visit Reason
This is a follow-up construction survey conducted to verify correction of previously cited deficiencies related to building equipment and fire safety.
Findings
The fire alarm panel was found to be displaying a persistent 'TROUBLE' signal despite transmitting alarms to the monitoring company and sounding within the facility, indicating the deficiency has not been corrected.
Deficiencies (1)
Fire alarm panel not maintained in a safe operating condition, displaying a persistent 'TROUBLE' signal.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Greg Cates | Conducted the follow-up construction survey |
Inspection Report
Follow-Up
Deficiencies: 3
Date: Sep 15, 2015
Visit Reason
This is a follow-up construction survey conducted to verify correction of previously cited deficiencies related to bathroom hand grips and building equipment safety.
Findings
The facility has replaced grab bars and tiles in bathrooms, but the floor tile remains slippery without non-slip applications. Some fire sprinkler heads remain obstructed due to recessed ceiling panels, and the fire alarm panel displays a persistent 'TROUBLE' signal despite testing.
Deficiencies (3)
Commodores, tubs, and showers are not equipped with stable hand grips, affecting resident safety.
Some fire sprinkler heads are obstructed due to recessed ceiling panels, compromising fire safety.
Fire alarm panel is displaying a persistent 'TROUBLE' signal despite testing and resetting.
Inspection Report
Follow-Up
Deficiencies: 2
Date: Jul 8, 2015
Visit Reason
This is a follow-up construction survey conducted to verify correction of previously cited deficiencies related to bathroom hand grips and building equipment safety.
Findings
The facility had not corrected all previously cited deficiencies. The bathroom renovations were ongoing with removal and replacement of tile and grab bars. Most fire sprinkler heads were no longer obstructed, but vinyl ceiling panels were warped and loosened, posing a risk of falling, and one sprinkler head might still be obstructed.
Deficiencies (2)
Facility failed to ensure commodes, tubs, and showers are equipped with stable hand grips, affecting resident safety.
Building was not maintained in a safe and operating condition due to obstructed fire sprinkler heads and warped ceiling panels.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Greg Cates | Conducted the follow-up construction survey | |
| Billy Bryant | Conducted the follow-up construction survey |
Inspection Report
Annual Inspection
Deficiencies: 4
Date: May 20, 2015
Visit Reason
The Adult Care Licensure Section conducted an annual survey of Cypress Manor on 5/20/15 - 5/21/15 to assess compliance with state regulations for adult care homes.
Findings
The facility failed to maintain hot water temperatures within the required range at multiple fixtures, had staff qualification deficiencies including missing Health Care Personnel Registry checks and criminal background checks for some staff, and the kitchen was found to be unclean with multiple sanitation and maintenance issues.
Deficiencies (4)
Failed to assure hot water temperatures were maintained between 100°F and 116°F at multiple sinks and tubs in resident and community bathrooms.
Failed to assure 1 of 5 facility staff sampled had no substantiated findings listed on the North Carolina Health Care Personnel Registry before hire.
Failed to assure 2 of 5 sampled staff had a statewide criminal background check in accordance with state law.
Failed to assure the kitchen, including reach-in cooler, freezer, dry storage shelves, ice machine, can opener, stove hood, floors, and walls, were clean and maintained.
Report Facts
Hot water fixtures out of temperature range: 10
Staff sampled: 5
Staff without HCPR check: 1
Staff without criminal background check: 2
Date of survey: May 20, 2015
Inspection Report
Capacity: 40
Deficiencies: 15
Date: Mar 12, 2015
Visit Reason
This report is of a Biennial Construction Survey conducted on March 12, 2015, to assess compliance with the 1996 and applicable portions of the 2005 Rules for Licensing of Adult Care Homes and the 1991 North Carolina State Building Code for a Home for the Aged serving 40 residents.
Findings
Multiple deficiencies were noted related to physical plant safety and maintenance, including unstable hand grips in bathrooms, loose handrails in corridors, HVAC and ventilation issues, fire sprinkler system leaks and obstructions, fire alarm and emergency lighting malfunctions, fire door and smoke barrier deficiencies, electrical safety hazards, and inadequate exhaust ventilation in certain areas.
Deficiencies (15)
Loose hand grips at commodes, tubs, and showers affecting resident safety.
Unstable handrails in corridors not supporting required load.
HVAC/ventilation grilles and dampers not maintained, with excessive dust and lint accumulation.
Loose commode connections and a commode that would not flush solids.
Fire sprinkler system pipes leaking and fire sprinkler protection bypassed.
Dirty smoke detector sample tubes in HVAC ducts.
Fire alarm horn/strobe dangling from wall and HVAC duct obstructing heat detector.
Exit signs not working on backup power.
Fire sprinkler heads obstructed by stored items and lint.
Breaches in fire-resistance-rated construction including gaps, holes, and missing radiation dampers.
Emergency lighting not working on backup power.
Fire rated doors in firewall not latching properly.
Corridor doors not resisting smoke passage due to poor fit, lack of latching, holes in door leaves, and damaged hardware.
Electrical power system unsafe with broken switches, receptacles, and improper adapters.
Lack of ventilation or non-functioning exhaust fans in resident laundry and staff toilet.
Report Facts
Licensed capacity: 40
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