Inspection Reports for Somerset Court of Cherryville

The complaint investigation was initiated by Gaston County Department of Social Services on October 6, 2025. Based on observations, interviews, and record reviews, Resident #1 was not interviewable.

The facility failed to provide a safe environment free of hazards due to a loose grab bar in the shower enclosure used by two residents in rooms 121 and 122. Observations and interviews confirmed the grab bar was loose despite a recent repair attempt using caulk, which was ineffective.

The complaint investigation found that the facility did not provide a written discharge notice or appeal rights to Resident #1, who was discharged to a hospital and later not readmitted due to unmet medical needs. The failure resulted in the resident staying unnecessarily in the hospital for two additional weeks and was deemed serious neglect.

The facility failed to ensure proper notices of discharge and appeal rights were provided to a resident whose medical needs could not be met, resulting in a Type A1 violation for serious neglect. The resident was discharged without proper documentation and experienced an unnecessary extended hospital stay.

The complaint investigation was substantiated as the facility did not refund Resident #6 within the required 14 days after discharge. The refund was paid 30 days after the discharge date.

The facility failed to ensure that one of six sampled residents (Resident #6) received a refund within 14 days after discharge. The refund was paid 30 days after discharge, which did not meet the regulatory requirement.

The facility failed to administer medications as ordered for Resident #5, including anticonvulsant, antipsychotic, sedative, and eye drop medications, with multiple missed doses documented due to waiting on prescriptions or medication not being available. Resident #1 had an order for a topical ointment that was discontinued but remained on the medication administration record, and the facility failed to ensure physician notification for medication refusal related to fish oil supplement. Additionally, one medication aide (Staff C) had not passed the required written medication aide exam within 60 days of completing the clinical skills validation.

Deficiencies were found including walls not kept in good repair with a rough/sharp edge on a windowsill, and fire safety equipment not maintained in a safe and operating condition, including gaps in fire-resistant ceilings and unresolved sprinkler system deficiencies.

Multiple deficiencies were cited including walls not kept in good repair, hazards such as door hardware installed backwards, fire safety equipment not maintained in safe and operating condition with issues like leaking sprinkler pipes, gaps in fire-resistant ceilings, and improper storage obstructing fire safety. Additionally, exhaust ventilation was not maintained in required areas.

The facility failed to assure therapeutic diets were served as ordered by the resident's physician for 2 of 3 sampled residents. Specifically, residents on mechanical soft and all ground diets were served incorrect food items during breakfast, such as bacon instead of ground sausage, contrary to physician orders and therapeutic diet menus.

Multiple deficiencies were cited including lack of proper wrist type lever handles on medication preparation sinks, failure to maintain cleanliness and repair of walls, floors, and furniture, presence of chronic unpleasant odors, unsafe plumbing equipment, improper storage of medical oxygen cylinders, lack of fire sprinkler protection in some areas, malfunctioning emergency exit signs, deteriorated fire-resistance-rated assemblies, unsafe electrical systems, and doors not closing properly to contain smoke and fire.

The visit included a complaint investigation as well as the annual survey. The complaint involved medication administration practices.

The facility failed to assure medications were administered in accordance with infection control measures for 2 of 5 residents observed during medication passes. Specific issues included the Medication Aide not wearing gloves when administering eye drops and eyelid scrubs, and giving a resident a pill that had been dropped on the floor.