Deficiencies per Year
8
6
4
2
0
Unclassified
NC DHSR Star Rating History
| Date | Rating | Score | Merits | Demerits | Type |
|---|---|---|---|---|---|
| Oct 3, 2024 | 105.5 | 5.5 | 0 | Annual Inspection | |
| Jun 6, 2023 | 103.5 | 3.5 | 0 | Annual Inspection | |
| Sep 10, 2021 | 95 | 5 | 10 | Annual Inspection | |
| Dec 14, 2018 | 100.5 | 2.5 | 2 | Annual Inspection | |
| Nov 10, 2016 | 100 | 0 | 0 | Annual Inspection |
Inspection Report
Annual Inspection
Deficiencies: 5
Jun 24, 2021
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey of the facility on June 24, 2021.
Findings
The facility was found deficient in multiple areas including failure to maintain a hazard-free environment due to unsecured oxygen cylinders, failure to maintain hot water temperatures within the required range, incomplete tuberculosis testing for a resident, lack of matching therapeutic diet menus for residents with physician-ordered diets, and failure to store medications securely under locked conditions.
Deficiencies (5)
| Description |
|---|
| Facility failed to maintain a hazard-free environment related to four unsecured oxygen cylinders in a resident room. |
| Facility failed to ensure hot water temperatures were maintained at a minimum of 100 degrees F to a maximum of 116 degrees F for 3 of 4 fixtures at two sinks and one shower in two residents' bathrooms. |
| Facility failed to ensure 1 of 3 sampled residents had completed tuberculosis testing upon admission in compliance with control measures. |
| Facility failed to have matching therapeutic diet menus for food service guidance for 1 of 3 sampled residents with physician order for a regular mechanical soft diet. |
| Facility failed to ensure residents' medications were maintained in a safe manner under locked security, including creams, powders, and Miralax bottles left unsecured. |
Report Facts
Oxygen cylinders unsecured: 4
Water temperature readings: 129.2
Residents sampled: 3
Miralax bottles: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Responsible for ensuring oxygen cylinders were stored securely, water temperatures maintained, tuberculosis testing completed, diet orders communicated, and medication storage compliance. | |
| Supervisor-in-Charge | Aware of unsecured oxygen cylinders, water temperature issues, and medication storage deficiencies; assisted staff with meal preparation and reported issues to Administrator. | |
| Medication Aide | Provided information on oxygen delivery, tuberculosis testing scheduling, diet preparation, and medication storage practices. | |
| Personal Care Aide | Interviewed regarding oxygen cylinder storage, water temperature observations, and diet preparation. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Aug 1, 2018
Visit Reason
The Adult Care Licensure conducted an annual survey of the facility on August 1, 2018, to assess compliance with state regulations and building code requirements.
Findings
The facility failed to meet North Carolina State Building Code requirements for non-ambulatory residents, as one of five residents was physically and/or cognitively impaired and unable to evacuate independently. The facility was licensed for six ambulatory residents, with ongoing installation and inspection of the sprinkler system for non-ambulatory licensing.
Deficiencies (1)
| Description |
|---|
| Facility failed to assure the building met the North Carolina State Building Code requirements for non-ambulatory residents, evidenced by one resident unable to evacuate independently. |
Report Facts
Licensed capacity: 6
Resident census: 6
Date of admission: Jun 30, 2018
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