Inspection Reports for Kerner Ridge
250 Hopkins Rd, Kernersville, NC 27284, United States, NC, 27284
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Inspection Report
Annual Inspection
Deficiencies: 2
Aug 27, 2025
Visit Reason
The Adult Care Licensure Section conducted an annual and a follow-up survey from 08/26/2025 through 08/27/2025 to assess compliance with regulatory requirements.
Findings
The facility failed to serve therapeutic diets as ordered for Resident #6, who was on a finger food diet but was served inappropriate foods and utensils. Additionally, the facility failed to administer Novolog insulin as ordered for Resident #1, with multiple documented instances of insulin doses not given according to sliding scale insulin parameters.
Deficiencies (2)
| Description |
|---|
| Failed to serve therapeutic diets as ordered for Resident #6 on a finger food diet, including serving incorrect foods and allowing use of utensils contrary to diet orders. |
| Failed to administer Novolog insulin as ordered for Resident #1, with multiple instances of insulin doses not given according to sliding scale insulin parameters. |
Report Facts
Instances of Novolog insulin not administered as ordered: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident Care Director | Resident Care Director (RCD) | Assisted Resident #6 with meals and provided a fork despite diet orders; unaware of diet noncompliance. |
| Dietary Manager | Dietary Manager (DM) | Responsible for preparing residents' meals and serving diets as ordered; acknowledged errors in meal preparation for Resident #6. |
| Resident Care Coordinator | Resident Care Coordinator (RCC) | Responsible for reviewing eMAR audits; unaware of medication errors for Resident #1. |
| Administrator | Administrator | Unaware of diet and medication administration errors until shortly before the survey; responsible for oversight. |
Inspection Report
Census: 66
Capacity: 66
Deficiencies: 12
Nov 6, 2024
Visit Reason
The report documents a Construction Section Biennial Survey conducted to assess compliance with physical plant, fire safety, sanitation, and building codes applicable to the facility.
Findings
Multiple deficiencies were cited including failure to comply with emergency release key training, fire alarm system requirements, lack of current fire safety inspection reports, unsafe and unclean physical environment conditions, and non-operational exhaust ventilation systems.
Deficiencies (12)
| Description |
|---|
| Only one SCU staff member carried the emergency override switch key and was not trained on its use. |
| Fire alarm system doors did not remain unlocked until manual reset as required by NFPA 72. |
| Facility did not have all current fire and building safety inspection reports available; latest fire sprinkler inspection dated October 9, 2023. |
| Outside premises not maintained in a clean and safe condition; planter box corner braces dry rotted with exposed nails. |
| Ceilings and floors not kept clean; dust accumulation on exhaust fans and debris on floors in multiple rooms. |
| Furnishings not kept clean and in good repair; broken cabinet hinge and loose gate hinges in SCU areas. |
| Fire safety systems not maintained safe; unsealed cable penetrations in ceilings and dropped sprinkler escutcheon ring. |
| Electrical equipment not maintained safe; porch light twisted and bulb missing at D Hall exit. |
| Plumbing piping not maintained with required 2" air gap; icemaker drain lines too low above floor drain. |
| Fire safety equipment not maintained in operating condition; sprinkler head at kitchen hood loaded with dust. |
| Unapproved device (wedge) holding open Soiled Linen door, impeding fire safety door closure. |
| Exhaust ventilation not maintained in specified spaces; fans not working in A Hall and Service Hall. |
Report Facts
Residents: 66
Licensed capacity: 66
Date of last fire sprinkler inspection: Oct 9, 2023
Inspection Report
Annual Inspection
Deficiencies: 1
May 16, 2024
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey from 05/15/24 to 05/16/24 to assess compliance with medication administration regulations.
Findings
The facility failed to ensure the electronic Medication Administration Records (eMARs) were accurate for 1 of 5 sampled residents regarding sliding scale insulin (SSI) Novolog. Specifically, there was no documentation of the amount of Novolog insulin administered for Resident #2 across multiple months due to the eMAR system lacking a space to record this information.
Deficiencies (1)
| Description |
|---|
| Failure to document the amount of Novolog insulin administered for Resident #2 for 92 of 92 opportunities in March 2024, 90 of 90 opportunities in April 2024, and 43 of 43 opportunities in May 2024 due to eMAR system limitations. |
Report Facts
Opportunities for Novolog documentation: 92
Opportunities for Novolog documentation: 90
Opportunities for Novolog documentation: 43
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Clinical Services | Director of Clinical Services | Interviewed regarding auditing eMARs and awareness of documentation issues |
| Special Care Resident Coordinator | Special Care Resident Coordinator | Interviewed regarding auditing eMARs and communication about documentation issues |
| Administrator | Administrator | Interviewed regarding oversight and education related to SSI documentation |
Inspection Report
Annual Inspection
Deficiencies: 4
Oct 27, 2022
Visit Reason
The Adult Care Licensure Section conducted an annual survey of Kerner Ridge Assisted Living on October 25-27, 2022 to assess compliance with applicable regulations.
Findings
The facility failed to provide adequate supervision for Resident #2 with a history of falls, as no increased supervision was documented after multiple falls. Additionally, the facility failed to ensure referral and follow-up for Resident #4's neurology consult ordered in May 2022. The facility also failed to clarify and properly administer medication orders for Resident #5, specifically regarding scheduled and as needed doses of amlodipine based on systolic blood pressure parameters.
Deficiencies (4)
| Description |
|---|
| Failed to provide supervision according to Resident #2's needs after multiple falls, with no documentation of increased safety checks or interventions. |
| Failed to ensure referral and follow-up for Resident #4's neurology consult ordered in May 2022. |
| Failed to clarify medication orders for Resident #5 regarding scheduled and as needed doses of amlodipine with parameters for systolic blood pressure. |
| Failed to administer amlodipine as ordered for Resident #5, with multiple documented occasions where blood pressure met parameters for administration but medication was not given. |
Report Facts
Fall incidents: 6
Missed medication administrations: 25
Medication tablets: 8
Medication tablets: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident Care Coordinator | Resident Care Coordinator (RCC) | Responsible for reviewing incident reports, determining interventions, and overseeing referrals and medication clarifications. |
| Resident Care Director | Resident Care Director (RCD) | Responsible for reviewing incident reports, determining interventions, and overseeing referrals and medication clarifications. |
| Medication Aide | Medication Aide (MA) | Documented incident reports, administered medications, and reported vital signs and concerns to RCC. |
| Administrator | Facility Administrator | Oversaw facility operations and expected clinical staff to ensure compliance with medication administration and referrals. |
| Interim Director | Interim Director at Resident #2's hospice provider's office | Provided information about hospice services and equipment for Resident #2. |
Inspection Report
Census: 66
Deficiencies: 8
Jul 13, 2017
Visit Reason
This is a Construction Section Biennial Survey conducted to assess compliance with physical plant, fire safety, and building maintenance regulations for an adult care home licensed since 1999.
Findings
The survey identified multiple deficiencies including improper storage of portable medical oxygen cylinders, failure to conduct required fire safety rehearsals on each shift quarterly, malfunctioning emergency lights and fire alarm system, corridor doors not closing and latching properly, and security issues with the sprinkler room door.
Deficiencies (8)
| Description |
|---|
| Portable medical oxygen cylinders were stored in no container or rack in room D-04, posing a hazard if cylinders fall and become projectiles. |
| Fire drill rehearsals were not conducted regularly with at least one per shift each quarter; missing rehearsals in multiple quarters and shifts. |
| Some fire drill rehearsal records did not include the time or shift when the rehearsal was done. |
| Battery powered emergency lights would not work when tested in corridor near room A-07 and mechanical room off the small dining room. |
| Fire alarm system 'Silence' feature did not work; system was difficult to reset; no access door for duct mounted smoke detector in mechanical room off D Hall. |
| Corridor doors prevented from closing quickly and latching properly, including smoke barrier doors near A-01 and C-08, double doors to TV room and Library, and propped or wedged open doors to bedroom B-07 and Sunroom. |
| One ceiling fire damper was closed above the air handling unit in the mechanical room off D Hall, limiting ventilation. |
| Outside door to sprinkler room was difficult to close and latch and was found unlatched/unlocked during the survey. |
Report Facts
Residents served: 66
Special Care Unit residents: 14
Inspection Report
Annual Inspection
Deficiencies: 1
Sep 14, 2016
Visit Reason
The Adult Care Licensure Section and the Forsyth County Department of Social Services conducted an annual survey of Kerner Ridge Assisted Living on 9/08/16 through 9/13/16.
Findings
The facility failed to attend to personal care needs for 1 of 5 sampled residents (Resident #5) in the Memory Care Unit who required assistance with compression stocking application and removal, resulting in leg wounds and sepsis. The resident developed wounds and infections due to prolonged and improper use of compression stockings, leading to hospitalization and eventual death.
Severity Breakdown
Type B Violation: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to attend to personal care needs for Resident #5, including improper application and removal of compression stockings resulting in leg wounds and sepsis. | Type B Violation |
Report Facts
Dates of survey: 4
Resident sample size: 5
Wound measurement: 5.2
Compression stocking application time: 16
Date of death: Jul 8, 2016
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Memory Care Unit Director (MCUD) | Interviewed regarding care and compression stocking removal | |
| Skilled Nurse | Provided wound care and education on compression stocking use | |
| Physician Assistant | Provided medical evaluation and progress notes on Resident #5 | |
| Executive Director | Interviewed about awareness of Resident #5's condition and care | |
| Personal Care Aides (PCAs) and Medication Aides (MAs) | Interviewed regarding daily care and observations of Resident #5 | |
| Emergency Department Physician | Provided medical assessment of Resident #5 upon hospital admission |
Inspection Report
Follow-Up
Deficiencies: 4
Sep 25, 2015
Visit Reason
Follow-Up Construction Survey to verify correction of deficiencies cited during the Biennial Construction Survey.
Findings
The building was found not to be maintained in a safe and operating condition due to breaches in fire-resistance-rated construction, including improperly sealed penetrations in the smoke barrier walls in the attic near various rooms.
Deficiencies (4)
| Description |
|---|
| Smoke Barrier Wall in the Attic near the SCU has two PVC pipe penetrations sealed with orange foam not approved for fire-resistance-rated construction. |
| Smoke Barrier Wall in the Attic near Bedroom A01 has a metal sleeve penetration not secured to the wall and cables inside not properly sealed. |
| Smoke Barrier Wall in the Attic near Bedroom A02 has three PVC conduits penetrating the wall that are not firestopped sealed. |
| Smoke Barrier Wall in the Attic near Bedroom B01 has an iron fire sprinkler pipe penetration with a cracked and displaced firestop seal, not properly sealed. |
Inspection Report
Plan of Correction
Census: 66
Deficiencies: 14
Jul 16, 2015
Visit Reason
Biennial Construction Survey conducted to assess compliance with physical plant requirements, building safety, fire safety, housekeeping, and ventilation standards for an adult care home.
Findings
Multiple physical plant deficiencies were identified including non-compliance with special locking arrangements on exit doors, lack of current sanitation and fire safety inspection reports, unclean and disrepair conditions in resident rooms, breaches in fire-resistance-rated construction, inadequate fire sprinkler protection, malfunctioning emergency lighting, impaired fire sprinkler escutcheon plates, corridor doors not containing smoke properly, improper storage of medical oxygen cylinders, lack of inspection and maintenance of commercial kitchen hood fire extinguishing system, and insufficient exhaust ventilation in several areas.
Deficiencies (14)
| Description |
|---|
| Exit doors for the Special Care Unit have magnetic locks with emergency release switches requiring keys not possessed by all staff. |
| Facility failed to provide the required annual sanitation and fire safety inspection reports. |
| Unclean conditions and equipment in disrepair including dried-up commode allowing sewer gases and loose commode connections. |
| Breaches through fire-resistance-rated construction including unapproved sealing materials and unsecured penetrations. |
| New construction eliminated fire sprinkler protection in some areas. |
| Emergency lighting units did not work on backup power in multiple locations. |
| Fire and smoke resistance of hazardous area doors compromised by doors not closing/latching properly and gaps between door leaves. |
| Automatic roll-down fire door between Kitchen and SCU Dining not inspected as required. |
| Fire sprinkler escutcheon plates impaired or missing coverage exposing openings. |
| Corridor doors held open by devices preventing rapid closing and latching. |
| Portable medical oxygen cylinder stored unsecured in Med Room. |
| Commercial kitchen hood fire extinguishing system lacked required monthly inspection records since March 2015. |
| Corridor doors had holes compromising smoke containment. |
| Exhaust ventilation system failed to remove required air volume in multiple toilet rooms, housekeeping, and bathroom areas. |
Report Facts
Residents served: 66
Special Care Unit residents: 14
Date of last annual Fire Marshal Inspection: Mar 18, 2014
Date of commercial kitchen hood semi-annual maintenance: 201503
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