Inspection Reports for Memory Care of the Triad
413 North Main Street Kernersville, NC 27284, Kernersville, NC, 27284
Back to Facility ProfileDeficiencies (last 6 years)
Deficiencies (over 6 years)
9.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
77% worse than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
100% occupied
Based on a July 2019 inspection.
Census over time
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Jul 6, 2023
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey on 07/05/23 through 07/06/23 to assess compliance with regulations related to nutrition, food service, and medication administration.
Findings
The facility failed to serve therapeutic diets as ordered for 2 of 5 sampled residents, specifically for pureed and mechanical soft diets. Additionally, the facility failed to ensure electronic medication administration records (eMAR) were accurate for one resident regarding documentation of weekly blood pressure checks.
Deficiencies (2)
Failed to serve therapeutic diets as ordered for 2 of 5 sampled residents (#2 and #6) who had orders for a pureed diet and a mechanical soft diet.
Failed to ensure electronic medication administration records (eMAR) were accurate for 1 of 5 residents (Resident #2) related to documenting the resident's weights ordered weekly.
Report Facts
Residents sampled: 5
Residents with diet order issues: 2
Blood pressure documentation dates: 5
Blood pressure documentation dates: 4
Blood pressure documentation dates: 1
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Oct 7, 2021
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey on October 7 and 8, 2021 to assess compliance with regulations related to nutrition, medication administration, special care unit staff training, and infection prevention and control.
Findings
The facility failed to have matching therapeutic diet menus for residents with physician-ordered diets, failed to maintain an accurate therapeutic diet listing, failed to administer insulin as ordered regarding timing, failed to ensure special care unit staff completed required training hours, and failed to properly screen visitors for COVID-19 symptoms and temperature upon entry.
Deficiencies (5)
Failed to have matching therapeutic menus for 11 residents with orders for therapeutic diets.
Failed to maintain an accurate and current listing of residents with physician ordered therapeutic diets for 1 of 4 sampled residents.
Failed to administer medications as ordered by a licensed physician for 1 of 3 sampled residents related to timing of insulin administration.
Failed to ensure 1 of 2 sampled special care unit staff completed 20 hours of training within first six months of employment.
Failed to ensure visitor screening for COVID-19 symptoms and temperature checks upon entry to the facility.
Report Facts
Residents with therapeutic diet orders: 11
Sampled residents with therapeutic diet listing issue: 1
Sampled residents with medication administration issue: 1
Sampled staff with incomplete training: 1
Temperature for COVID-19 screening: 100
Inspection Report
Follow-Up
Deficiencies: 2
Date: Sep 17, 2019
Visit Reason
This was a Biennial Follow Up Construction Survey to verify correction of previously identified deficiencies.
Findings
Some deficiencies were not corrected. Specifically, hand grips were not provided adjacent to the commode in Bath #2/South Hall, and one side of the double doors on the North Hall side of the Living Room did not latch properly during the emergency test.
Deficiencies (2)
No hand grips provided adjacent to the commode located at Bath #2/South Hall.
One side of the double doors on the North Hall side of the Living Room did not latch to the frame during the emergency test.
Inspection Report
Census: 42
Capacity: 42
Deficiencies: 7
Date: Jul 31, 2019
Visit Reason
The inspection was a Biennial Construction Section Survey to assess compliance with building codes and licensing requirements for an adult care home licensed for 42 Special Care residents.
Findings
Multiple deficiencies were cited including failure to meet building code requirements for special locking systems, lack of hand grips at commodes, damaged ceiling panels due to water migration, unsafe and non-operating building equipment, and non-functional exhaust ventilation fans in bathrooms.
Deficiencies (7)
Emergency release switches at exit doors did not deactivate magnetically locked doors when tested, though doors did deactivate with fire alarm simulation.
No hand grips provided adjacent to the commode located at Bath #2/South Hall.
Lay-in ceiling panels damaged due to water migration above refrigeration units in the kitchen.
Double doors on the North Hall side of the Living Room did not latch fully during emergency test.
Exterior exit door on the short Hall in the North Hall has panic hardware not secured to the door.
Gas supply lines behind gas dryer appliances in the Main Laundry are not secured to walls or ceiling.
Mechanical exhaust ventilation fans are not operational in Bathrooms #1 and #2/South Hall.
Report Facts
Licensed capacity: 42
Residents served on 08/01/1986: 59
Inspection Report
Complaint Investigation
Capacity: 42
Deficiencies: 2
Date: Jan 25, 2019
Visit Reason
The inspection was conducted in response to a complaint alleging that the facility had no heat for two weeks and there were roaches in the kitchen.
Complaint Details
The roach complaint was substantiated based on observations and interviews. The complaint about no heat was mentioned but not substantiated in the findings.
Findings
The complaint regarding roaches in the kitchen was substantiated with observations of dead and live roaches in the kitchen and pantry areas. Additionally, deficiencies were found related to the facility's failure to meet building code requirements for special locking arrangements on exit doors.
Deficiencies (2)
Facility failed to meet Code requirements for special locking arrangements on exit doors; emergency override switches require metal keys and are not on/off switches as required.
Facility failed to provide effective control of roaches in the kitchen and pantry, with several dead roaches and one live roach observed, and perimeter floors needing sweeping.
Report Facts
Licensed capacity: 42
Inspection Report
Follow-Up
Deficiencies: 1
Date: Oct 4, 2018
Visit Reason
The Adult Care Licensure Section conducted a follow-up survey on October 4 and 5, 2018 to verify correction of previous deficiencies related to housekeeping and furnishings.
Findings
The facility failed to maintain cleanliness and good repair of walls, ceilings, floors, vents, fans, and bathroom tiles. Observations revealed dirt, dust, black substances, rust stains, and debris in multiple areas including dining room, hallways, common sitting area, and bathrooms. Interviews indicated unclear responsibilities for cleaning certain areas and insufficient cleaning schedules.
Deficiencies (1)
Facility failed to assure corners of floors, walls, ceiling air vents, ceiling fan, and wall tile in common bathroom and shower were kept clean and in good repair.
Report Facts
Survey dates: 2
Cleaning staff work days: 2
Cleaning staff tenure: 4
Cleaning staff hire duration: 2
Cleaning schedule time: 6
Filter last changed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Food Service Director | Interviewed regarding cleaning responsibilities in dining room | |
| Maintenance worker | Interviewed about filter changes and vent cleaning | |
| Custodian | Interviewed about cleaning duties and schedule | |
| Housekeeper | Interviewed about cleaning routines and responsibilities | |
| Administrator | Interviewed about staffing and cleaning efforts |
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Jul 6, 2018
Visit Reason
The Adult Care Licensure Section conducted a complaint investigation initiated by the Forsyth County Department of Social Services on 06/21/18, focusing on supervision and medication administration at the facility.
Complaint Details
Complaint investigation was initiated by the Forsyth County Department of Social Services on 06/21/18 due to concerns about supervision and medication administration.
Findings
The facility failed to provide adequate supervision for 3 of 5 sampled residents who were disoriented and semi-ambulatory, resulting in repeated falls with injuries including a broken elbow, subdural hematoma, and broken wrist. The facility also failed to administer medications as prescribed, including crushing medications that should not be crushed, improper dosing, and failure to administer medications as ordered. Additionally, medication administration records were inaccurate and incomplete, and one medication aide administered medications without completing required qualifications.
Deficiencies (4)
Failed to provide supervision for 3 of 5 sampled residents who were disoriented and semi-ambulatory resulting in repeated falls with injuries including a broken elbow, subdural hematoma, and broken wrist.
Failed to administer medications as prescribed including crushing medications that should not be crushed, improper dosing, and failure to administer medications as ordered.
Medication administration records (MAR and eMAR) were inaccurate and incomplete for a resident regarding morphine sulfate oral solution and lorazepam oral solution.
Medication aide failed to complete required written medication administration exam prior to administering medications from January 2018 to March 2018.
Report Facts
Medication pass error rate: 16
Number of residents on fall risk list: 4
Number of falls for Resident #1: 10
Number of falls for Resident #5: 7
Number of morphine sulfate 5 mg/0.25 ml prefilled syringes delivered: 20
Number of lorazepam 0.5/0.25 ml prefilled syringes delivered: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Personal Care Aide | Administered medications from January 2018 to March 2018 without completing the written medication administration exam until 04/17/18. |
Inspection Report
Annual Inspection
Deficiencies: 6
Date: May 16, 2018
Visit Reason
The Adult Care Licensure and the Stokes County Department of Social Services conducted an annual survey on 05/15/18-05/18/18 with an exit conference via telephone on 05/22/18.
Findings
The facility failed to ensure the environmental storage room containing hazardous materials was locked and inaccessible to residents, failed to maintain cleanliness and good repair of floors, walls, and furnishings, failed to ensure tuberculosis testing for staff, failed to notify physicians of critical resident conditions, and failed to administer medications as ordered, placing residents at substantial risk of harm.
Deficiencies (6)
Environmental storage room containing hazardous materials was unlocked and accessible to residents.
Floors, walls, handrails, baseboards, ceiling air vents, windows, doors, and common bathrooms were not kept clean and in good repair.
Facility failed to ensure tuberculosis testing was completed upon employment for one staff member.
Facility failed to notify physician for residents with critical conditions including high blood sugar, TED hose not applied, and resident threatening suicide with no antipsychotic medication available.
Facility failed to administer medications as ordered for multiple residents including discontinued medications, incorrect dosages, and missing topical treatments.
Facility failed to ensure residents were free from neglect related to health care and medication administration.
Report Facts
Missed doses of Haldol 1mg (0.5ml): 22
Missed doses of Haldol 1mg: 4
FSBS readings >= 400: 5
FSBS readings >= 400: 54
FSBS readings >= 400: 12
Days TED hose not applied: 12
Melatonin tablets remaining: 3
Melatonin 3mg tablets remaining: 24
Inspection Report
Follow-Up
Deficiencies: 1
Date: Nov 7, 2017
Visit Reason
This was a biennial follow-up construction survey conducted to verify correction of previously identified deficiencies related to building equipment and fire safety.
Findings
The facility failed to correct deficiencies related to fire protection in electrical ceiling penetrations through fire rated wall assemblies. Specifically, unrated foam was used to seal holes in electrical and HVAC piping penetrations in the Main Mechanical Room.
Deficiencies (1)
Failure to provide fire protection in all electrical ceiling penetrations through fire rated wall assemblies; use of unrated foam to seal holes.
Inspection Report
Follow-Up
Deficiencies: 5
Date: Aug 25, 2017
Visit Reason
This is a biennial follow-up construction survey conducted to verify correction of previously cited deficiencies related to building code compliance and physical plant requirements.
Findings
The facility was found deficient in meeting building code requirements for special locking arrangements, bathroom hand grips, mechanical ventilation in bathrooms, safe maintenance of building equipment including oxygen cylinder storage, and fire protection in electrical ceiling penetrations.
Deficiencies (5)
Facility does not meet Building Code requirements for Special Locking Arrangements; not all evacuation staff carried release switch keys; no wiring diagram for locking system; no centrally controlled emergency release switch.
Hand grips in bathrooms are not maintained in a safe condition, specifically missing on the toilet sidewall in Room #1 Bathroom.
Bathrooms lack mechanical ventilation where odors are generated, specifically in Front Hall Housekeeping Closet and Shower Room #2.
Improper storage of oxygen cylinders; one oxygen bottle in Room 15 not in rack.
Lack of fire protection in electrical ceiling penetrations through fire rated wall assemblies in the Main Mechanical Room.
Report Facts
Staff responsible for evacuation carrying release switch keys: 5
Staff responsible for evacuation not carrying release switch keys: 2
Oxygen bottles not stored in rack: 1
Inspection Report
Capacity: 42
Deficiencies: 8
Date: Jul 13, 2017
Visit Reason
This is a Construction Section Biennial Survey conducted to assess compliance with building codes and physical plant requirements for the facility licensed as a Home for the Aged serving 42 Special Care residents.
Findings
Multiple deficiencies were cited including non-compliance with building code requirements for special locking arrangements, lack of current sanitation and fire safety inspection reports, missing hand grips in bathrooms, inadequate mechanical ventilation in certain areas, unsafe storage of oxygen cylinders, lack of fire protection in electrical ceiling penetrations, and plumbing issues such as missing floor drain covers and loose toilet seats.
Deficiencies (8)
Facility does not meet Building Code requirements for Special Locking Arrangements; emergency release keys not carried by all staff; no wiring diagram provided; no centrally controlled emergency release switch.
Facility failed to maintain current sanitation and fire safety inspection reports on site.
Hand grips not maintained in a safe condition at toilets in Back Hall Shower Room, Room #1 Bathroom, and Shower Room #2.
Bathrooms not mechanically ventilated properly; mechanical exhaust fans not exhausting interior air in Front Hall Housekeeping Closet and Shower Room #2.
Improper storage of oxygen cylinders; 4 oxygen bottles in Room 15 not in racks.
Lack of fire protection in electrical ceiling penetrations through fire rated wall assemblies in Main Mechanical Room.
Plumbing drainage not maintained safely; missing protective floor drain cover in roll-in shower in Back Hall Shower Room.
Loose toilet seats in Back Hall Shower Room and Room 1.
Report Facts
Licensed capacity: 42
Oxygen bottles not in racks: 4
Inspection Report
Capacity: 42
Deficiencies: 11
Date: Jul 21, 2015
Visit Reason
This report is of a biennial construction survey conducted to assess compliance with building codes and licensing rules for Memory Care of the Triad, a facility licensed for 42 Special Care residents.
Findings
Multiple deficiencies were noted including failure to maintain fire resistance rated walls, unsafe egress due to slip hazards, loose floor covers creating tripping hazards, non-operable fire protection equipment, unknown location of emergency switches, malfunctioning magnetic locking equipment, doors that do not close properly, unsafe storage of oxygen bottles, electrical wiring issues, lack of exhaust fans, and unprotected penetrations in fire-rated walls.
Deficiencies (11)
The 1-hour fire resistance rated corridor wall was penetrated by a return air transfer opening sealed inadequately.
Egress paths had hazards including algae and water on concrete pads creating slip hazards.
Loose floor cover over a floor chase creating a tripping hazard.
Fire extinguishers and fire protection equipment were not maintained operable; monthly checks on the Ansul system were not performed.
Staff did not know the location of emergency switches; magnetic locking equipment was not operable, including a non-working emergency release switch on an exterior maglocked gate.
Fire rated doors did not close completely to contain smoke and fire when activated by the fire alarm system.
Oxygen bottles were stored in a beverage crate that could not prevent tipping.
Doors in resident rooms (Room 16 and Room 1A) would not close and latch properly.
Electrical wiring included wire junctions above drop ceilings not contained in mounted junction boxes.
Mechanical exhaust system was not operating; no exhaust fans in Laundry Room and front bathroom on right corridor.
Multiple unprotected penetrations in fire-rated walls above drop ceilings in left wing, right wing, and Dining Room/Boiler Room wall.
Report Facts
Licensed capacity: 42
Inspection Report
Annual Inspection
Census: 41
Deficiencies: 1
Date: Jul 15, 2015
Visit Reason
The Adult Care Licensure Section conducted an annual survey of the facility on July 15, 2015.
Findings
The facility failed to complete quarterly assessments for all residents in the Special Care Unit (SCU), as evidenced by missing quarterly assessments for 5 sampled residents. Interviews with staff revealed a lack of awareness of the quarterly assessment requirement.
Deficiencies (1)
Failure to assure a quarterly assessment was completed for 5 of 5 sampled residents in the Special Care Unit.
Report Facts
Residents in Special Care Unit: 41
Sampled residents without quarterly assessment: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Memory Care Manager | Memory Care Manager (MCM) | Interviewed regarding lack of quarterly assessments and unawareness of requirement. |
| Licensed Health Professional Support Nurse | LHPS Nurse | Interviewed; unaware that quarterly assessments were required for all SCU residents. |
| Nurse Practitioner | Facility Nurse Practitioner | Interviewed; completed standardized mental exams on admission but unaware of quarterly assessment requirement. |
| Administrator | Administrator | Interviewed; unaware of quarterly assessment requirement and acknowledged none were completed for 41 SCU residents. |
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