Inspection Report
Plan of Correction
Deficiencies: 0
Jul 1, 2024
Visit Reason
The document is a Plan of Correction submitted in response to a Biennial Construction Survey to address previously cited deficiencies.
Findings
All previously cited deficiencies from the Biennial Construction Survey have been corrected as noted in the acceptable Plan of Corrections received on June 21, 2024. Therefore, no further action is required.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jonathan Gamsey | Reported on the Plan of Corrections for the Biennial Construction Survey. |
Inspection Report
Biennial Survey
Census: 3
Capacity: 3
Deficiencies: 2
May 8, 2024
Visit Reason
DHSR Construction Section conducted a Biennial Survey to ensure compliance with the 2005 Rules 10A NCAC 13G for Family Care Homes and applicable portions of the 2012 North Carolina Building Code - Residential - Section R103.
Findings
Two deficiencies were cited: a reversed locking mechanism on bedroom #2 door that could potentially lock a resident in the room, which was fixed at the time of the survey; and an old monitored smoke alarm that was not compliant and required repair or removal.
Deficiencies (2)
| Description |
|---|
| Bedroom #2 had a reversed locking mechanism on the door that could potentially lock a resident in the room. |
| An old monitored smoke alarm was present in the facility and was not compliant with the rule. |
Report Facts
Number of residents: 3
Inspection Report
Original Licensing
Deficiencies: 3
May 22, 2019
Visit Reason
The Adult Care Licensure Section conducted an initial survey of the facility on May 22, 2019.
Findings
The facility failed to comply with tuberculosis testing requirements for 2 of 3 residents, did not complete Resident Registers within 72 hours of admission for all sampled residents, and failed to ensure quarterly Licensed Health Professional Support (LHPS) evaluations for all sampled residents with specific care needs.
Deficiencies (3)
| Description |
|---|
| Failure to assure 2 of 3 residents were tested upon admission for tuberculosis disease in compliance with control measures. |
| Failure to ensure Resident Registers were completed for 3 of 3 sampled residents within seventy-two hours of admission. |
| Failure to assure quarterly Licensed Health Professional Support evaluations were completed for 3 of 3 sampled residents for specified care tasks. |
Report Facts
Residents sampled: 3
Residents with TB testing deficiency: 2
Residents with Resident Register deficiency: 3
Residents with LHPS quarterly evaluation deficiency: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Interviewed regarding TB testing, Resident Register completion, and LHPS evaluations; responsible for ensuring compliance | |
| Hospice aide | Interviewed about use of hoyer lift and feeding assistance for Resident #2 |
Inspection Report
Census: 3
Deficiencies: 6
Feb 26, 2019
Visit Reason
DHSR Construction Section conducted a Biennial Survey to ensure compliance with the 2005 Rules 10A NCAC 13G for Family Care Homes and applicable portions of the 2012 North Carolina Building Code - Residential - Section R103.
Findings
Multiple deficiencies were cited including lack of current fire and sanitation inspection reports, absence of handrails on ramps, use of scatter rugs, improper location of heat detector in attic, difficult access to electrical panel due to storage, and water temperature exceeding allowed maximum in a resident bathroom.
Deficiencies (6)
| Description |
|---|
| On-site staff was unable to provide a current Fire and Sanitation Inspection Report. |
| No handrails installed for the two ramps of the home. |
| Scatter rugs were being utilized at the front entrance and garage door of the home. |
| Heat detector for the home was located at the bottom of the attic, not compliant with the rule. |
| Electrical panel was difficult to access due to the amount of storage in front of it. |
| Water temperature in the Bathroom of Bedroom #3 reached 122 degrees Fahrenheit, exceeding the maximum allowed of 116 degrees. |
Report Facts
Number of residents: 3
Water temperature: 122
Inspection Report
Original Licensing
Census: 1
Deficiencies: 5
Nov 9, 2016
Visit Reason
The Adult Care Licensure Section and Wake County Department of Social Services conducted an initial survey of Cary Family Care on November 9, 2016.
Findings
The facility failed to ensure that one staff member (Staff B) had required tuberculosis testing, a current Health Care Personnel Registry check, and a criminal background check. Additionally, one resident was not documented as having a tuberculosis test upon admission, and quarterly pharmaceutical medication reviews were not completed timely.
Severity Breakdown
Type B Violation: 3
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 1 staff (Staff B) had been tested for Tuberculosis disease in compliance with TB control measures. | Type B Violation |
| Failed to assure 1 of 1 staff (Staff B) had no substantiated findings on the North Carolina Health Care Personnel Registry. | Type B Violation |
| Failed to assure 1 of 1 staff (Staff B) had a criminal background check in accordance with G.S 131D-40. | Type B Violation |
| Failed to assure 1 of 1 resident was tested upon admission for tuberculosis disease in compliance with control measures. | — |
| Failed to assure quarterly pharmaceutical medication reviews were completed quarterly for 1 of 1 resident sampled. | — |
Report Facts
Staff sampled: 1
Resident sampled: 1
Pharmacy review missing quarter: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Attendant | Named in findings related to tuberculosis testing, Health Care Personnel Registry check, and criminal background check deficiencies. |
| Administrator/Owner | Interviewed multiple times regarding staff qualifications, tuberculosis testing, and facility compliance. |
Loading inspection reports...
