Inspection Reports for Southfork
1345 Jonestown Road Winston-Salem, NC 27103, Winston-Salem, NC, 27103
Back to Facility ProfileDeficiencies (last 7 years)
Deficiencies (over 7 years)
7.9 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
52% worse than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
60% occupied
Based on a August 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 47
Capacity: 78
Deficiencies: 7
Date: Aug 1, 2025
Visit Reason
The Adult Care Licensure Section conducted an annual survey from 07/30/25 to 08/01/25 to assess compliance with adult care home regulations.
Findings
The facility was found deficient in housekeeping and furnishings, staffing levels, nutrition and food service, resident rights, and medication administration. Specific issues included unclean kitchen floors, inadequate staffing hours in the Assisted Living unit, uncovered ice scoop, failure to serve water at every meal, failure to treat residents with dignity and respect, and failure to administer and document medications accurately.
Deficiencies (7)
Facility failed to ensure the floors were kept clean in the kitchen with brown and black grease buildup observed.
Facility failed to meet minimum required aide hours to meet the needs of residents in the Assisted Living unit for 7 of 9 sampled shifts.
Facility failed to ensure residents' ice supply was protected from contamination; ice scoop was uncovered on top of the ice machine.
Facility failed to ensure water was served at each meal for 31 of 37 assisted living residents, in addition to other beverages.
Facility failed to ensure 3 of 5 sampled residents were treated with respect, consideration, and dignity; residents experienced delayed call bell responses and inadequate assistance.
Facility failed to administer medications as ordered for 1 of 5 sampled residents including an antidepressant (sertraline).
Facility failed to ensure medication administration records were accurate for 1 of 5 sampled residents including inaccurate documentation of a fast-acting insulin.
Report Facts
Facility capacity: 78
Census: 47
Aide hours shortage: 2
Aide hours shortage: 1
Aide hours shortage: 6.5
Aide hours shortage: 3
Aide hours shortage: 1.5
Aide hours shortage: 9.5
Aide hours shortage: 11.5
Residents present at lunch: 37
Residents present at breakfast: 35
Sertraline doses not administered: 6
Sertraline tablets remaining: 3
Insulin aspart doses held but documented administered: 12
Insulin aspart doses held but documented administered: 10
Insulin aspart doses held but documented administered: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Manager | Mentioned in relation to kitchen cleaning and ice scoop issues. | |
| Regional Vice President of Operations | Interviewed multiple times regarding facility expectations and staffing. | |
| Resident Care Coordinator | Interviewed regarding staffing and medication administration. | |
| Special Care Unit Coordinator | Interviewed regarding staffing and resident care. | |
| Medication Aide | Interviewed regarding medication administration and staffing. | |
| Personal Care Aide | Interviewed regarding resident care and staffing. | |
| Resident #4's primary care provider | Psychiatric provider | Interviewed regarding medication administration for Resident #4. |
Inspection Report
Follow-Up
Deficiencies: 1
Date: Jun 13, 2024
Visit Reason
The visit was a Biennial Follow Up Construction Survey conducted to assess the facility's compliance with physical plant and fire safety equipment maintenance requirements.
Findings
The facility's fire safety equipment was found not to be maintained in operating condition, specifically a bent deflector on a sprinkler head outside Room D124, which could impair fire suppression capability. A second sprinkler company has been hired to evaluate needed repairs.
Deficiencies (1)
The deflector on the sprinkler head outside of Room D124 is bent which may deter the ability of the head to suppress a fire.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ed Miller | Conducted the Biennial Follow Up Construction Survey | |
| Maintenance Director | Interviewed regarding fire safety equipment condition |
Inspection Report
Follow-Up
Deficiencies: 1
Date: Nov 7, 2023
Visit Reason
The visit was a Construction Section Biennial Follow Up Survey conducted to assess compliance with physical plant and fire safety regulations.
Findings
The facility's fire safety equipment was found not to be maintained in operating condition, specifically a bent deflector on the sprinkler head outside Room D125 that may impair fire suppression capability.
Deficiencies (1)
The deflector on the sprinkler head outside of Room D125 is bent which may deter the ability of the head to suppress a fire.
Inspection Report
Capacity: 78
Deficiencies: 11
Date: Jul 19, 2023
Visit Reason
The facility was surveyed for conformance with the applicable portions of the current 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and the 1996 Edition of the North Carolina Building Code(s), Institutional Occupancy and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure.
Findings
Multiple deficiencies were cited including failure to meet physical plant requirements such as automatic door closers on smoke barrier walls, emergency release switches for electromagnetic locks, lack of current fire and building safety inspection reports, improper storage in bathrooms, malfunctioning wanderer alarms, unsafe outside premises, poor housekeeping and furnishings, hazards related to oxygen bottle storage, missing fire rehearsal records, failure to maintain fire safety equipment and electrical equipment in safe operating condition, and inadequate exhaust ventilation.
Deficiencies (11)
Door in smoke barrier wall does not automatically close due to removed door closer.
Emergency release switch for electromagnetic lock was inaccessible due to screwed shut cover.
Facility did not have current fire and building safety inspection reports available for review.
Bathroom was being utilized for storage with approximately 30 cardboard boxes and cleaning equipment.
Exit doors accessible by residents known to be disoriented or wanderers were not equipped with functioning sounding devices.
Outside premises not maintained in a clean and safe condition with water damage and trip/fall hazards.
Furnishings and ceilings not kept in good repair, including holes in doors and peeling ceiling finish.
Oxygen bottles improperly stored without restraint, creating hazards; sliding bolt latches on bathroom doors prevent emergency access.
Facility lacked records of quarterly fire rehearsals on each shift for multiple quarters.
Fire safety systems not maintained in safe condition with holes in fire resistant ceilings, malfunctioning doors, blocked or held open fire doors, bent sprinkler deflectors, and electrical hazards.
Exhaust ventilation not maintained in specified spaces; exhaust fans on D Hall not working.
Report Facts
Total licensed capacity: 78
Special Care Unit beds: 20
Number of cardboard boxes stored in bathroom: 30
Width of crack in concrete sidewalk: 1
Diameter of hole in ceiling: 2
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Dec 21, 2022
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey from 12/20/22 to 12/21/22 to assess compliance with health care and medication administration regulations.
Findings
The facility failed to ensure implementation of physician orders for one resident related to blood pressure checks, weight checks, and a laboratory test. Additionally, the facility failed to administer an anti-anxiety medication as ordered for another resident due to delayed medication refills.
Deficiencies (2)
Failed to ensure implementation of orders for blood pressure checks, weight checks, and a laboratory test for Resident #1.
Failed to administer alprazolam medication as ordered for Resident #5 due to delayed medication refills.
Report Facts
Sampled residents: 5
Medication doses missed: 5
Medication remaining: 58
Medication cards: 2
Medication tablet strength: 0.25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Resident Care Coordinator | RCC | Responsible for ensuring physician orders were processed and placed on eMAR; missed orders for Resident #1 |
| Lead Supervisor | LS | Responsible for ensuring physician orders were processed and placed on eMAR; missed orders for Resident #1 |
| Assistant Executive Director | AED | Interviewed regarding responsibilities and expectations for order implementation and medication administration |
| Medication Aide | MA | Multiple medication aides interviewed regarding documentation and medication administration for Residents #1 and #5 |
| Memory Care Coordinator | MCC | Conducted medication cart audits; missed refill of Resident #5's alprazolam |
| Psychiatric Care Provider | PCP | Prescribed and managed Resident #5's alprazolam order; aware of missed doses |
| Personal Care Aide | PCA | Interviewed about Resident #5's anxiety symptoms |
Inspection Report
Capacity: 78
Deficiencies: 11
Date: Nov 21, 2019
Visit Reason
The facility was surveyed for conformance with the applicable portions of the current 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and the 1996 Edition of the North Carolina Building Code(s), Institutional Occupancy and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure. This was a Construction Section Biennial Survey.
Findings
Multiple deficiencies were cited including failure to meet code requirements for emergency release switch keys, lack of current fire safety inspection reports, inadequate bathroom facilities on the assisted living side, insufficient wanderer alarm volumes, poor housekeeping and maintenance issues such as dust accumulation and unsecured oxygen bottles, and fire safety system failures including holes in fire-resistant ceilings, sprinkler system leaks, propped open fire doors, and obstructions below sprinkler heads.
Deficiencies (11)
Facility does not meet code requirements for emergency release switch keys; staff did not carry keys for the SCU Courtyard gate override switch.
Facility did not have current fire safety inspection reports maintained.
Bathroom on the assisted living side lacks a roll-in shower and bathtub accessible on at least two sides; the community bath is out of service due to a broken tub.
Not all override switch alarms were of sufficient volume to be heard by staff; some alarms did not work.
Ceilings and equipment were not kept clean and in good repair; radiation dampers had heavy dust accumulation.
Facility was not maintained free from hazards; unsecured oxygen bottles were found on the floor.
Failure to maintain building's fire safety systems in a safe condition; holes or gaps in fire-resistant ceilings and walls could allow fire and smoke to spread.
Fire safety equipment not maintained in operating condition; sprinkler system leak detected.
Unapproved devices used to keep fire doors open, impeding quick closure and potentially limiting smoke/fire containment.
Resident room doors had gaps and holes that could allow smoke passage.
Failure to maintain 18" clearance below sprinkler heads; obstructions such as boxes and adult diaper packages stored to the ceiling.
Report Facts
Total licensed capacity: 78
Inspection Report
Annual Inspection
Census: 20
Deficiencies: 3
Date: Oct 3, 2019
Visit Reason
The Adult Care Licensure Section conducted an annual survey from 10/02/19 to 10/03/19 to assess compliance with health care, nutrition, and staff training regulations in the facility.
Findings
The facility failed to assure physician notification for abnormal fingerstick blood sugar readings for one resident, failed to serve 8 ounces of milk twice daily to residents in the Special Care Unit, and failed to ensure one staff member completed required special care unit training within six months of hire.
Deficiencies (3)
Failed to assure physician notification for 1 of 5 sampled residents regarding fingerstick blood sugar readings outside of parameters.
Failed to assure 8 ounces of milk was served twice daily to residents in the Special Care Unit.
Failed to assure 1 of 3 sampled staff in the Special Care Unit completed 20 hours of training within the first six months of hire.
Report Facts
Residents present at meal service: 20
Fingerstick blood sugar readings above 300: 14
Hours of special care unit orientation completed: 6
Inspection Report
Follow-Up
Deficiencies: 2
Date: Nov 22, 2017
Visit Reason
The visit was a biennial follow-up construction survey to verify correction of previously identified deficiencies.
Findings
Some deficiencies were not corrected, including corridor doors not latching properly and gaps around fire sprinkler escutcheon plates that were not firestopped, compromising fire safety.
Deficiencies (2)
Corridor door in Bedroom D-127 did not latch into its doorframe when closed.
Gap around the fire sprinkler escutcheon plate in the Main Dining Janitor Closet was not firestopped as the fire sprinkler penetrates the fire-resistance-rated ceiling assembly.
Inspection Report
Capacity: 78
Deficiencies: 9
Date: Sep 13, 2017
Visit Reason
The facility was surveyed for conformance with the applicable portions of the current 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and the 1996 Edition of the North Carolina Building Code(s), Institutional Occupancy and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure. This was a Construction Section Biennial Survey.
Findings
Multiple deficiencies were cited including failure to maintain current annual fire alarm inspection reports, lack of hand grips in tubs accessible to residents, corridors obstructed by equipment, poor housekeeping with dust accumulation and odors due to non-functioning exhaust ventilation, inadequate fire safety rehearsals, building equipment not maintained in safe operating condition including emergency lights and fire extinguishers, corridor doors held open improperly, gaps in fire-resistance-rated ceiling assemblies, and electrical system issues such as loose receptacles and blocked electrical panels.
Deficiencies (9)
Facility failed to maintain current annual fire alarm system inspection report.
Tubs accessible to residents lacked hand grips (grab bars).
Corridors were obstructed by equipment such as chairs and carts, impeding egress.
Walls and building mechanical systems were not kept clean and in good repair; excessive dust/lint accumulation and odors due to non-functioning exhaust ventilation systems.
Fire drill rehearsals were not performed regularly on all shifts quarterly and documentation was incomplete.
Emergency lighting and exit signs did not illuminate on backup power; fire extinguisher inspections were not documented monthly; some fire extinguishers missing annual maintenance tags.
Corridor doors were held open with wedges or chairs or did not latch properly, compromising fire safety.
Gaps and holes in fire-resistance-rated ceiling assemblies were not properly firestopped.
Electrical system issues including loose GFCI receptacle and blocked electrical panels limiting emergency access.
Report Facts
Licensed capacity: 78
Special Care Unit beds: 20
Inspection Report
Capacity: 78
Deficiencies: 8
Date: Jul 15, 2015
Visit Reason
The facility was surveyed for conformance with the applicable portions of the current 2005 Rules for Licensing of Adult Care Homes of Seven or More Beds and the 1996 Edition of the North Carolina Building Code(s), Institutional Occupancy and the 1996 Rules for Licensing of Adult Care Homes of Seven or More Beds in effect at the time of initial licensure.
Findings
Physical plant deficiencies were noted including issues with special locking arrangements on doors, lack of current sanitation and fire safety inspection reports, housekeeping and furnishings not maintained in good repair, HVAC and ventilation hazards, fire safety equipment not properly maintained, and inadequate exhaust ventilation in several areas.
Deficiencies (8)
Facility failed to meet Code requirements for doors equipped with Special Locking Arrangements; emergency release switches require a metal key and staff were unaware of gate's emergency release switch location; no emergency light coverage at SCU courtyard gate's keyed emergency release switch.
Facility failed to provide current sanitation and fire safety inspection reports as required.
Facility failed to keep walls, ceilings, floors, and floor coverings clean and in good repair; spider webs present in 12% of bedroom closets.
Facility failed to provide necessary equipment to ensure clean potable water supply; shampoo sink hose not equipped with vacuum breaker to prevent backsiphonage.
Facility failed to maintain HVAC/ventilation grilles and dampers free of hazards; excessive accumulation of dust/lint noted.
Facility failed to maintain automatic roll-down fire door between kitchen and dining; emergency lighting did not work properly in multiple locations; breaches in fire-resistance-rated construction invalidated integrity; inadequate supply of spare fire sprinkler heads.
Fire sprinkler escutcheon plates were impaired, exposing openings through ceiling; corridor doors did not latch properly to resist smoke passage; portable medical oxygen cylinders not properly secured.
Facility failed to maintain exhaust ventilation where odors are generated; exhaust ventilation not working in multiple specified locations.
Report Facts
Licensed beds: 78
Special Care Unit beds: 20
Percentage of bedroom closets with spider webs: 12
Spare fire sprinkler heads: 3
Portable medical oxygen cylinders unsecured in Bedroom D-131: 5
Portable medical oxygen cylinders unsecured in Bedroom B-113: 3
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