Deficiencies per Year
20
15
10
5
0
Moderate
Unclassified
NC DHSR Star Rating History
| Date | Rating | Score | Merits | Demerits | Type |
|---|---|---|---|---|---|
| Oct 28, 2025 | 91.5 | 0.5 | 9 | Annual Inspection | |
| Feb 26, 2024 | 99.5 | 3.5 | 4 | Annual Inspection | |
| Aug 17, 2022 | 93.5 | 3.5 | 10 | Annual Inspection | |
| Mar 3, 2020 | 105.5 | 5.5 | 0 | Annual Inspection | |
| Jan 7, 2019 | 101.5 | 5.5 | 4 | Annual Inspection | |
| May 5, 2017 | 98.75 | 3.75 | 0 | Follow-Up Inspection | |
| Mar 28, 2017 | 95 | 4.5 | 9.5 | Annual Inspection | |
| Sep 24, 2015 | 92.5 | 0 | 10 | Complaint Investigation | |
| May 23, 2014 | 102.5 | 4.5 | 2 | Annual Inspection | |
| May 16, 2013 | 104.5 | 4.5 | 0 | Annual Inspection | |
| Jun 12, 2012 | 95.5 | 5 | 0 | Follow-Up Inspection | |
| Mar 23, 2012 | 90.5 | 2.5 | 11 | Follow-Up Inspection | |
| Jan 20, 2012 | 99 | 4.5 | 5.5 | Annual Inspection | |
| Jul 14, 2010 | 97 | 7 | 0 | Annual Inspection | |
| Sep 1, 2009 | 96.25 | 3.75 | 0 | Follow-Up Inspection | |
| Jun 23, 2009 | 92.5 | 4.5 | 12 | Annual Inspection |
Inspection Report
Annual Inspection
Deficiencies: 3
Aug 27, 2025
Visit Reason
The Adult Care Licensure Section conducted an annual and follow-up survey from August 26, 2025 to August 27, 2025 to assess compliance with health care and medication administration regulations.
Findings
The facility failed to ensure proper referral and follow-up with the Primary Care Provider (PCP) regarding medication crushing orders for Resident #2, resulting in medications being administered whole despite orders to crush. Additionally, medication administration records were inaccurate, and medications were not administered as ordered, placing Resident #2 at increased risk of choking and aspiration pneumonia.
Severity Breakdown
Type B Violation: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure referral and follow-up to meet routine healthcare needs related to notifying PCP about medications that could not be crushed for Resident #2. | Type B Violation |
| Failed to administer medications as ordered during medication pass for Resident #2; medications were administered whole instead of crushed. | Type B Violation |
| Medication administration records (MAR) were inaccurate for Resident #2 related to medications administered during the medication pass. | Type B Violation |
Report Facts
Medication administration opportunities documented: 26
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 30
Medication administration opportunities documented: 26
Medication administration opportunities documented: 50
Medication administration opportunities documented: 62
Medication administration opportunities documented: 50
Medication administration opportunities documented: 73
Medication administration opportunities documented: 93
Medication administration opportunities documented: 76
Medication administration opportunities documented: 26
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 51
Medication administration opportunities documented: 62
Medication administration opportunities documented: 50
Medication administration opportunities documented: 26
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 11
Medication administration opportunities documented: 31
Medication administration opportunities documented: 26
Medication administration opportunities documented: 50
Medication administration opportunities documented: 50
Medication administration opportunities documented: 50
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Medication administration opportunities documented: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Medication Aide | Administered medications during medication pass; interviewed about medication crushing | |
| Health and Wellness Director (previous) | Entered incorrect eMAR entry 'may crush medications unless contraindicated' and failed to follow up with PCP | |
| Health and Wellness Director (current) | Interviewed about medication cart audits and eMAR review responsibilities | |
| Administrator | Interviewed about medication cart audits and eMAR review responsibilities | |
| Pharmacist | Interviewed about medication orders and pharmacy communications | |
| Primary Care Provider (previous) | Provided orders and communication regarding medication crushing and speech therapy | |
| Speech Therapist | Evaluated Resident #2 and recommended medication crushing |
Inspection Report
Follow-Up
Deficiencies: 2
Jan 14, 2025
Visit Reason
This is a Construction Section Biennial Follow Up Survey conducted to verify correction of previously identified deficiencies.
Findings
Deficiencies remain uncorrected related to building maintenance and electrical safety. Several fire exit hardware devices were missing end caps, and multiple ground-fault circuit-interrupter (GFCI) electrical power receptacles did not have electrical power, preventing testing for ground fault.
Deficiencies (2)
| Description |
|---|
| Building components broken exposing sharp edges; fire exit hardware devices missing end caps in Admin Hall, 100 Hall, and 200 Hall smoke barriers. |
| Electrical system not maintained in safe operating condition; multiple GFCI electrical power receptacles lacked electrical power preventing ground fault testing. |
Inspection Report
Annual Inspection
Deficiencies: 4
Jan 24, 2024
Visit Reason
The Adult Care Licensure Section conducted an annual survey and follow-up survey on 01/23/24 through 01/24/24 to assess compliance with medication administration and related regulatory requirements.
Findings
The facility failed to administer medications as ordered to 2 of 5 sampled residents, including medications for hypothyroidism, wheezing, and dementia. Additionally, medication administration records were found to be inaccurate, with documentation errors regarding medication administration and omissions.
Deficiencies (4)
| Description |
|---|
| Failure to administer levothyroxine as ordered to Resident #5, with multiple documented missed doses due to awaiting medication from pharmacy. |
| Failure to administer ipratropium/albuterol nebulizer treatments to Resident #5 due to lack of nebulizer machine and inaccurate documentation of administration. |
| Failure to discontinue rivastigmine transdermal patch from medication cart after order discontinuation for Resident #3, resulting in administration of discontinued medication. |
| Inaccurate medication administration records for Resident #5, including documentation of medications as administered when they were not given. |
Report Facts
Sampled residents: 5
Residents with medication administration issues: 2
Levothyroxine tablets dispensed: 30
Ipratropium/albuterol vials dispensed: 10
Rivastigmine patches dispensed: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Health and Wellness Director | Health and Wellness Director | Responsible for medication cart audits, medication order discontinuations, and notification of missed doses |
| Administrator | Administrator | Oversight of medication administration processes and staff training |
| Medication Aide | Medication Aide | Responsible for medication administration and ordering, involved in documentation and interviews |
| Resident #5's Primary Care Provider | Primary Care Provider | Ordered medications and expected notification of missed doses |
| Resident #3's Primary Care Provider | Primary Care Provider | Provided orders and confirmed no harm from medication overlap |
Inspection Report
Annual Inspection
Deficiencies: 5
Jul 13, 2022
Visit Reason
The Adult Care Licensure Section and the Iredell County Department of Social Services conducted an annual survey of Summit Place of Mooresville on 07/12/22 - 07/13/22 to assess compliance with health care and medication administration regulations.
Findings
The facility was found deficient in multiple areas including failure to notify the Primary Care Provider of resident refusals, failure to administer medications as ordered for sampled residents, failure to ensure medications prepared in advance were properly identified and protected, failure to administer medications within the prescribed timeframes, and inaccuracies in the electronic Treatment Administration Record documentation related to compression stockings.
Deficiencies (5)
| Description |
|---|
| Failed to notify the Primary Care Provider for 1 of 2 sampled residents related to refusal of compression stockings. |
| Failed to administer medications as ordered for 2 of 7 sampled residents with orders for vitamin supplement, stomach acid medication, and blood pressure medication. |
| Failed to ensure medications prepared for administration in advance were identified by name and strength up to the point of administration and protected from contamination and spillage for 1 of 7 residents. |
| Failed to ensure medications and treatments were administered within one hour before or after the prescribed or scheduled times for 2 of 5 sampled residents, resulting in late or untimely administration of medications and compression stockings. |
| Failed to ensure accuracy of the electronic Treatment Administration Record for 2 of 5 sampled residents related to compression stockings administration, including documentation errors and use of incorrect initials. |
Report Facts
Medication administration times: 30
Medication administration times: 31
Medication administration times: 10
Medication administration times: 7
Medication administration times: 12
Medication administration times: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Medication Aide | Mentioned in relation to refusal of compression stockings and medication administration errors | |
| Wellness Director | Interviewed regarding medication administration policies and issues | |
| Physician Assistant | Contracted PA interviewed regarding medication orders and refusals | |
| Special Care Coordinator | Interviewed regarding medication availability and administration | |
| Administrator | Interviewed regarding knowledge of medication administration and documentation issues | |
| Director of Nursing | Interviewed regarding staffing and medication administration concerns | |
| Third shift Medication Aide | Mentioned in relation to compression stockings administration and documentation |
Inspection Report
Follow-Up
Deficiencies: 8
Jan 3, 2019
Visit Reason
Biennial Follow Up Construction Survey conducted to verify compliance with physical plant and safety code requirements.
Findings
Multiple deficiencies were identified including non-functional emergency release switches on special locking doors, fire alarm system issues, unsecured oxygen cylinders, non-operational emergency lighting and exit signs on backup power, obstructed fire sprinkler heads, corridor doors not latching properly, doors requiring excessive force to open, and failure of exhaust ventilation systems in multiple areas.
Deficiencies (8)
| Description |
|---|
| Special locking system emergency release switches incapable of releasing electromagnetic locks on exit doors near Bedroom 212, 216, 228 and SCU Living Room. |
| Fire alarm system hold open devices reenergize in silence mode allowing smoke compartment doors to be held open during an alarm. |
| Portable medical oxygen cylinders in Bedroom 112 not physically secured, posing hazard if they fall. |
| Emergency lights and exit signs in multiple locations (Women, Men, Front Living Room, corridors, SCU Med Room, Fire Wall Back side) did not illuminate on backup power during testing. |
| Fire sprinkler heads obstructed by stored items within 18 inches below sprinkler head near Bedroom 120. |
| Corridor and smoke tight doors not maintained in safe operating condition; some doors held open by wedges or did not latch properly (Kitchen to Dining, Bedrooms 106, 200, 208, 215). |
| Doors required more than 15 pounds of force to open, exceeding North Carolina State Building Code limits (Bedroom 215). |
| Exhaust ventilation systems failed to operate in multiple areas including Women, Men, Staff Toilet Room, Kitchen Mop Closet, AL Nursing Office Bathroom, Bedroom 110 Bathroom, and Bedroom 228 Bathroom. |
Report Facts
Force to open door: 15
Date of survey: Jan 3, 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ed | Conducted the Biennial Follow Up Construction Survey. | |
| Maintenance Director | Interviewed regarding failure to meet code requirements for special locking doors. |
Inspection Report
Capacity: 60
Deficiencies: 17
Oct 3, 2018
Visit Reason
This is a Construction Section Biennial Survey conducted to assess compliance with physical plant, fire safety, electrical, mechanical, and plumbing requirements applicable to an adult care home licensed as a Home for the Aged.
Findings
Multiple deficiencies were cited related to physical plant and safety code compliance, including malfunctioning special locking door components, fire alarm and emergency lighting failures, housekeeping hazards, electrical safety issues, fire safety door and sprinkler problems, and non-functioning exhaust ventilation systems.
Deficiencies (17)
| Description |
|---|
| Special locking system emergency release switches failed to release electromagnetic locks on exit doors, preventing free egress. |
| Fire alarm system hold open devices reenergized during silence mode, allowing smoke compartment doors to remain open. |
| Building ceilings stained from past leaks (e.g., Bedroom 228). |
| Portable medical oxygen cylinders not physically secured in bedrooms 110 and 112, posing projectile hazard. |
| HVAC return grille falling out of ceiling in dining area. |
| Loose hand grip (grab bar) on tub in SCU Spa. |
| Electrical outlets in wet locations lacked ground fault circuit interrupters; GFCI receptacle failed to trip at employee side entrance. |
| Emergency lights and exit signs failed to illuminate on backup power at multiple locations including women's and men's restrooms, front living room, corridors, SCU med room, and fire wall back side. |
| HVAC duct mounted smoke detector sample tubes dirty, potentially impairing smoke detection. |
| Fire-resistance-rated ceiling assembly deteriorated due to leaks; patches improperly installed; exit sign base did not cover ceiling penetration. |
| Fire rated doors in firewall did not latch properly, preventing containment of smoke/fire. |
| Fire sprinkler heads obstructed by stored items below sprinkler heads in AL nurse office closet and storage across from Bedroom 120. |
| Corridor and smoke tight doors propped open with objects preventing proper closing and latching; some doors did not latch into frames. |
| Corridor doors in Bedrooms 215 and 229 required more than 15 pounds of force to open, exceeding code limits. |
| Fire sprinkler missing escutcheon plate near Bedroom 105, exposing opening allowing smoke and heat spread. |
| Electrical hazards from refrigerators plugged into power taps and multiple plug adaptors without overcurrent protection in various locations. |
| Exhaust ventilation systems failed to operate in multiple bathrooms, mop closet, nursing office, and other areas. |
Report Facts
Total licensed bed capacity: 60
Number of portable oxygen cylinders unsecured: 4
Number of emergency lights and exit signs failing backup illumination: 9
Number of doors requiring excessive opening force: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ed Miller | Construction Section Surveyor | Conducted the Construction Section Biennial Survey on October 3, 2018. |
| Maintenance Director | Interviewed regarding special locking door system deficiencies. |
Inspection Report
Annual Inspection
Deficiencies: 2
Jul 12, 2018
Visit Reason
The Adult Care Licensure Section conducted an Annual survey on July 10-12, 2018 to assess compliance with health care and medication storage regulations.
Findings
The facility failed to implement treatments as ordered for Resident #3, including wound dressing changes and lotion application. Additionally, the facility failed to ensure medications were stored securely for Resident #5 who self-administers medication.
Deficiencies (2)
| Description |
|---|
| Failed to implement treatments as ordered by a licensed prescribing practitioner for Resident #3, including dressing changes every other day and lotion application twice daily. |
| Failed to ensure that Resident #5's medications were stored in a safe and secure manner; medications were not kept in a locked box in the resident's room. |
Report Facts
Deficiency count: 2
Medication bottle volume: 250
Medication dosage: 10
Medication dosage volume: 0.2
Inspection Report
Follow-Up
Census: 53
Deficiencies: 1
Apr 21, 2017
Visit Reason
The Adult Care Licensure Section conducted a follow-up survey to verify correction of previous deficiencies related to door closures in resident rooms.
Findings
The facility failed to assure that 6 of 53 occupied resident room doors closed properly with less than a 1/8 inch gap around the doors to comply with fire code. Multiple observations revealed doors with approximately 1/4 inch gaps or malfunctioning latches preventing proper closure.
Deficiencies (1)
| Description |
|---|
| Facility failed to assure 6 of 53 occupied resident room doors closed properly with less than a 1/8 inch gap around the doors to comply with fire code. |
Report Facts
Occupied resident rooms: 53
Doors with improper closure: 6
Inspection Report
Follow-Up
Deficiencies: 5
Jan 24, 2017
Visit Reason
The visit was a Biennial Follow Up Construction Survey to verify correction of previously cited deficiencies related to building fire safety and equipment maintenance.
Findings
The survey found that several fire safety deficiencies from the prior survey had not been satisfactorily corrected, including open-ended sleeves with unsealed cable bundles, doors that did not latch properly, and rotting exterior exit doors. One deficiency related to a door wedge was corrected before the survey departed.
Deficiencies (5)
| Description |
|---|
| Building fire safety was not maintained in a safe condition; open-ended sleeve with unsealed cable bundles penetrating fire-resistance-rated ceiling. |
| Private Dining corridor door did not latch into its frame when closed. |
| Exterior exit door near Beauty Shop fits tightly into frame requiring extra force to open. |
| Exterior exit door near Beauty Shop was rotting. |
| Bedroom 229 corridor door did not latch into its frame when closed. |
Inspection Report
Capacity: 60
Deficiencies: 12
Nov 29, 2016
Visit Reason
This document is a Construction Section Biennial Survey conducted to assess compliance with physical plant requirements, building codes, and safety regulations for an adult care home facility.
Findings
Multiple deficiencies were cited including unlabeled and malfunctioning emergency release switches, lack of current sanitation and fire safety inspection reports, excessive dust accumulation, unsafe storage of medical oxygen cylinders, fire safety hazards such as unsealed cable penetrations and obstructed fire suppression equipment, electrical safety issues, emergency lighting failures, door latch problems, and inadequate exhaust ventilation.
Deficiencies (12)
| Description |
|---|
| Emergency release switches for the Special Locking system had no identifying labels and did not function as on/off switches as required. |
| Facility failed to maintain current annual sanitation and fire safety inspection reports, including missing kitchen sanitation report and outdated fire marshal inspection. |
| HVAC return and ventilation grilles had excessive accumulation of dust and lint. |
| Portable medical oxygen cylinders were stored standing up and not secured, posing a hazard. |
| Fire safety was compromised by open-ended sleeves with unsealed cable bundles penetrating fire-resistance-rated ceilings. |
| Commercial kitchen hood fire suppression system manual actuator was obstructed. |
| Fire sprinkler heads were obstructed with debris, delaying fire response. |
| Electrical panel had open slots exposing energized components; improper use of power taps and extension cords. |
| Emergency lighting did not illuminate on backup power. |
| Multiple corridor and exit doors failed to latch properly or were held open, preventing rapid closure and latching. |
| Exterior exit door was rotting and difficult to open. |
| Ventilation system failed to exhaust odors properly due to central unit malfunction. |
Report Facts
Total licensed bed capacity: 60
Date of last annual Fire Marshal Inspection: Mar 6, 2014
Date of last Annual Fire Alarm System Inspection: Jul 21, 2016
Date of last Annual Sprinkler System Inspection: Jul 20, 2016
Number of portable oxygen cylinders improperly stored: 3
Inspection Report
Complaint Investigation
Deficiencies: 6
Sep 1, 2015
Visit Reason
The Adult Care Licensure Section and the Iredell County Department of Social Services conducted a complaint investigation initiated by the Iredell County Department of Social Services on August 19, 2015, regarding discharge procedures for Resident #1.
Findings
The facility failed to justify the reason for discharge of Resident #1, failed to provide proper notice of discharge to the resident and POAs on the same date as the notice was written, discharged the resident before the appeal decision, and failed to rescind the discharge notice despite no physician-documented level of care change. The Hearing Officer reversed the discharge notice on August 24, 2015. Resident #1 was prevented from returning to her room which contained her personal belongings.
Complaint Details
Complaint investigation initiated by Iredell County Department of Social Services on August 19, 2015, regarding discharge of Resident #1 from Summit Place of Mooresville.
Deficiencies (6)
| Description |
|---|
| Failed to assure the reason for discharge of Resident #1 was justified. |
| Failed to provide the POAs and resident with a Notice of Discharge and Hearing request via hand delivery to the resident and hand delivery or certified mail for the POA on the same date as the Notice of Discharge was written. |
| Discharged the resident before the final decision resulting from the appeal had been rendered. |
| Failed to rescind a discharge notice for Resident #1 when there was no physician-documented level of care change. |
| Failed to assure the rights of Resident #1 were maintained and exercised without hindrance related to discharge. |
| Failed to treat Resident #1 with respect, consideration, dignity, and full recognition of individuality and right to privacy related to discharge. |
Report Facts
Discharge notice date: Aug 7, 2015
Hearing date: Aug 18, 2015
Hearing decision date: Aug 24, 2015
Resident admission date: Jan 13, 2011
Refund amount: 3107.99
Payment amount: 4057
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