Inspection Reports for The Haven in the Village at Carolina Place
13150 Dorman Road Pineville, NC 28134, Pineville, NC, 28134
Back to Facility ProfileInspection Report Summary
The most recent inspection on October 31, 2024, found deficiencies related to missing signatures and dates on the Resident Register for all sampled residents. Earlier inspections showed a pattern of issues primarily involving physical plant and fire safety code compliance, medication administration, and timely care plan documentation. Prior reports cited problems with emergency release switches, fire safety equipment, medication management, and care plan signatures. Complaint investigations were unsubstantiated except for the most recent one, which was addressed during the survey. The facility’s record shows ongoing challenges with documentation and physical plant maintenance, with some improvement in medication and care plan compliance noted in recent years.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
10.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
98% worse than North Carolina average
North Carolina average: 5.2 deficiencies/yearDeficiencies per year
16
12
8
4
0
Inspection Report
Annual Inspection
Deficiencies: 1
Date: Oct 31, 2024
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted an annual and follow-up survey and complaint investigation on 10/30/24-10/31/24. The complaint investigation was initiated on 09/24/24 by the Mecklenburg County Department of Social Services.
Complaint Details
Complaint investigation was initiated on 09/24/24 by the Mecklenburg County Department of Social Services and was part of the survey conducted on 10/30/24-10/31/24.
Findings
The facility failed to ensure the Resident Register was signed and dated by the Administrator and the resident or responsible party for 3 of 3 sampled residents (#1, #2, and #3). Specifically, admission dates, Power of Attorney signatures and dates, and Administrator signatures and dates were missing on the Resident Registers.
Deficiencies (1)
Failed to ensure the Resident Register was signed and dated by the Administrator and the resident or responsible party for 3 of 3 sampled residents.
Inspection Report
Follow-Up
Deficiencies: 9
Date: Aug 2, 2023
Visit Reason
The report documents a Biennial Follow Up Construction Survey conducted to verify correction of previously cited deficiencies related to physical plant and safety code compliance.
Findings
The facility was found to have multiple deficiencies including failure to meet code requirements for emergency release switches on locked doors, lack of wanderer alarms on exit doors in the Special Care Unit, use of throw rugs in resident bathrooms, missing records of quarterly fire safety rehearsals, multiple fire safety equipment issues such as missing or dropped sprinkler escutcheon rings, non-illuminated exit signs, improperly installed kitchen fire suppression equipment, burst sprinkler head not replaced, and non-functioning exhaust ventilation fans in specified areas.
Deficiencies (9)
Facility does not meet code requirements for emergency release switches on locked doors; switch requires special tool and staff unaware of override.
Exits accessible by residents in Special Care Unit lack sounding devices activated when doors are opened.
Resident bathroom had throw rugs without backing, creating slip hazard.
Facility lacked records of quarterly fire safety rehearsals on each shift.
Multiple sprinkler heads missing escutcheon rings or have dropped, leaving holes in fire-resistant ceilings.
Exit signs in community room and near SCU entrance were not illuminated or did not illuminate on test.
Kitchen fire suppression system nozzles improperly aimed due to equipment installation behind stove.
Sprinkler head under Charlotte porch burst and has not been replaced; line capped and tagged for repair.
Exhaust ventilation fans in guest toilets, kitchen housekeeping, and Wilmington Room 407 were not working.
Inspection Report
Follow-Up
Deficiencies: 1
Date: Jun 6, 2023
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted a follow-up survey on 06/06/23 to verify correction of previous deficiencies.
Findings
The facility failed to ensure that 2 of 3 sampled residents (#2 and #3) had care plans signed by the Primary Care Provider within 15 days of completion. Both care plans were completed earlier but signed on the day of the survey. Interviews revealed that the Director and Assistant Director of Resident Care were new to their roles and had not audited records to ensure timely signatures.
Deficiencies (1)
Failed to ensure 2 of 3 sampled residents (#2 and #3) had care plans signed within 15 days of completion.
Report Facts
Residents sampled: 3
Residents with deficient care plans: 2
Inspection Report
Annual Inspection
Census: 20
Deficiencies: 4
Date: Mar 16, 2023
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted an annual and a follow-up survey from March 15, 2023 to March 16, 2023.
Findings
The facility failed to ensure physician's orders were implemented and medications administered as ordered for sampled residents, and failed to maintain medications under locked security or direct supervision in the Special Care Unit. Additionally, care plans for sampled residents were not signed within 15 days of completion.
Deficiencies (4)
Failed to ensure physician's orders were implemented for medication sertraline for Resident #2.
Failed to ensure medication trazodone was administered as ordered for Resident #1.
Failed to ensure medications were maintained under locked security or direct supervision in the Special Care Unit for Residents #1 and #2.
Failed to ensure care plans for Residents #1, #2, and #3 were signed within 15 days of completion.
Report Facts
Special Care Unit census: 20
Medication quantity: 30
Medication quantity: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Assistant Resident Care Director | Assistant Resident Care Director (ARCD) | Responsible for faxing orders, auditing medication cart and MAR, aware of medication availability issues. |
| Resident Care Director | Resident Care Director (RCD) | Responsible for medication cart audits, faxing care plans, and following up on provider signatures. |
| Administrator | Administrator | Unaware of medication availability issues and medication storage in resident rooms. |
| Medication Aide | Medication Aide (MA) | Documented medication orders but did not fax orders to pharmacy. |
| Health and Wellness Director | Health and Wellness Director (HWD) | Responsible for faxing care plans for provider review and signature; new hire still in training. |
| Business Office Manager | Business Office Manager (BOM) | Responsible for completing care conferences and sending care plans to RCD. |
Inspection Report
Follow-Up
Deficiencies: 7
Date: Oct 1, 2019
Visit Reason
This is a biennial follow-up construction survey to verify correction of previously identified deficiencies related to physical plant and fire safety code compliance.
Findings
Several deficiencies were found not corrected, including staff unawareness of the central emergency release switch for special locking exit doors, incorrect labeling of the emergency release switch, lack of exit signs on required exit doors, unclear exterior evacuation paths with unsecured exit gates, and corridor doors that do not close and latch properly to resist fire and smoke.
Deficiencies (7)
Staff unaware of location, use, or existence of central emergency release switch for special locking exit doors.
Central emergency release switch on Special Care side labeled incorrectly as 'Fire'.
Building lacks required exit signs on all required exits or exit access doors, affecting egress directions.
Exterior evacuation paths not clearly defined or communicated; exit gates secured with padlocks and staff did not carry keys.
Many corridor doors prevented from closing quickly and latching, compromising fire and smoke resistance.
Closer disconnected on 3/4 hour fire door to laundry.
Two doors to activity closets disabled from latching with tape over the strike.
Inspection Report
Capacity: 60
Deficiencies: 14
Date: Aug 14, 2019
Visit Reason
The inspection was a Report of Construction Section Biennial Survey to ensure the facility meets the 1996 Rules for the Licensing of Adult Care Homes, applicable portions of the 2005 Licensing Rules, and the 1996 edition of the North Carolina State Building Code for Institutional Occupancy.
Findings
Multiple deficiencies were cited related to emergency release switches for magnetic locks, staff training on evacuation procedures, exit signage, housekeeping hazards, fire safety evacuation plans, building equipment maintenance including fire doors and fire-rated walls, and improper storage near fire sprinkler heads.
Deficiencies (14)
Most staff were unaware of the location or use of the required emergency release switch for the Special (magnetic) Locking at each exit door.
Facility failed to meet NC State Building Code requirements for Special Locking on exit doors; staff did not carry emergency release switch keys.
Staff unaware of the location or use of the required central emergency release switch for the Special Locking on all exit doors.
Central emergency release switch on the Special Care side was labeled incorrectly as 'Fire'.
Staff unaware of the location or use of the key to reset the central emergency release switch for the Special Locking.
Building did not provide all required exits or exit access doors with exit signs, affecting egress directions.
Waste trap for the hopper was dry, allowing noxious odors and possibly harmful bacteria to enter the facility.
Extension cord used in place of permanent wiring and run through a door from the Community room to a storage space.
Cord to a CD player was run through a door from the corridor to the Ice Cream Parlor; corrected during survey.
Exterior evacuation paths were not clearly defined or communicated; exit signs missing in courtyards; gates not easily visible and secured with padlocks without staff keys.
One required emergency release switch in Wilmington Community was broken, potentially delaying evacuation.
Many corridor doors prevented from closing quickly and latching, compromising fire and smoke resistance; several doors propped open or disabled from latching; some deficiencies corrected during survey.
Required one-hour fire rated walls and ceilings compromised by holes and penetrations not sealed with approved materials.
Improper storage too close to a fire sprinkler head, stacked within 5 inches of the ceiling, potentially negating fire sprinkler effectiveness.
Report Facts
Total licensed capacity: 60
Inspection Report
Annual Inspection
Deficiencies: 4
Date: Sep 5, 2018
Visit Reason
The Adult Care Licensure Section conducted an annual survey on 09/05/18 and 09/06/18 with an exit conference on 09/07/18.
Findings
The facility failed to notify the physician about the unavailability of an anti-seizure medication for Resident #3, failed to implement physician orders for daily blood pressure checks for Resident #1, and failed to assure accurate medication administration and documentation for Residents #1 and #2.
Deficiencies (4)
Failed to notify the physician for 1 of 5 sampled residents who did not have an anti-seizure medication available for administration (Resident #3).
Failed to implement physicians' orders for daily blood pressure checks for 1 of 5 sampled residents (Resident #1).
Failed to assure 2 of 5 residents were administered medications as ordered by the licensed prescribing practitioners, including mirtazapine for depression (Resident #1) and Humalog sliding scale insulin for control of high blood sugar (Resident #2).
Failed to assure the accuracy of the Medication Administration Record (MAR) for 1 of 5 sampled residents (Resident #2) related to documenting the administration of Novolog insulin.
Report Facts
Medication administration documentation errors: 14
Medication administration documentation omissions: 15
Medication administration occurrences: 3
Medication administration occurrences: 3
Inspection Report
Capacity: 60
Deficiencies: 3
Date: Aug 24, 2017
Visit Reason
The inspection was a Construction Section Biennial Survey to ensure the facility meets the 1996 Rules for Licensing of Adult Care Homes, applicable 2005 Licensing Rules, and the 1996 North Carolina State Building Code for Institutional Occupancy.
Findings
Deficiencies were cited related to physical plant requirements including lack of a central emergency release switch for magnetic locks, improper storage of gas cylinders creating hazards, and a kitchen door that does not close properly to prevent smoke or fire spread.
Deficiencies (3)
Facility has not provided measures indicated in the 1996 NC Building Code for Special Locking (magnetic locks) regarding emergency release; no central release switch at the Nurse Station within the locked unit.
Facility failed to store gas cylinders in an orderly manner to be free of hazards; helium gas cylinder found standing upright not secured by a chain or in a storage rack.
Facility has not maintained the building and all fire safety equipment in a safe condition; kitchen door adjacent to Service Hall is out of adjustment and does not close fully to prevent passage of smoke or fire.
Report Facts
Licensed capacity: 60
Inspection Report
Follow-Up
Deficiencies: 4
Date: Dec 11, 2015
Visit Reason
This report is of a Followup Survey conducted to verify correction of previously identified deficiencies at The Haven in the Village at Carolina Place.
Findings
The followup survey revealed that not all deficiencies were corrected. Observations included excessive dust accumulation on HVAC grilles, non-functioning exit signs on normal and backup power, missing fire sprinkler escutcheon plates exposing openings, and corridor doors that did not properly resist smoke passage due to improper fitting and latching.
Deficiencies (4)
Facility failed to maintain HVAC/ventilation grilles and associated dampers free of hazards due to excessive dust/lint accumulation.
Exit signs did not work on backup power or normal power, failing to relay directional information properly.
Fire sprinkler escutcheon plates were impaired or missing, exposing openings that could allow passage of smoke and heat.
Corridor doors did not resist passage of smoke due to door leafs not fitting into frames with acceptable gaps and failure of Nurse Station Dutch door to latch automatically.
Inspection Report
Capacity: 60
Deficiencies: 15
Date: Sep 24, 2015
Visit Reason
Biennial Construction Survey conducted to assess compliance with the 1996 Rules for Licensing of Adult Care Homes, applicable 2005 Licensing Rules, and the 1996 North Carolina State Building Code for a sixty bed special care unit facility.
Findings
Multiple physical plant deficiencies were identified including issues with special locking arrangements on doors, lack of current sanitation and fire safety inspection reports, obstructed corridors, furniture in disrepair, HVAC and ventilation hazards, unsafe building equipment and fire safety systems, impaired fire sprinkler escutcheon plates, breaches in fire-resistance-rated construction, non-compliant fire and smoke resistant doors, corridor doors held open improperly, improper storage of portable oxygen cylinders, and non-functioning exhaust ventilation.
Deficiencies (15)
Exit doors equipped with magnetic locks requiring keys for emergency release, but staff did not have keys to operate them.
Facility failed to maintain current annual sanitation and fire safety inspection reports.
Corridors obstructed by furniture and equipment blocking clear exit paths.
Furniture not kept clean and in good repair; built-in counter missing a drawer.
HVAC and ventilation grilles and dampers had excessive dust/lint accumulation posing fire hazard.
Egress from some areas required keys or special knowledge; exit signs not working or improperly marked.
Commercial kitchen hood fire extinguishing system lacked required inspections and monthly maintenance records.
Electrical power system unsafe with open panel slots, missing cover plates on refrigeration equipment and receptacles.
Fire sprinkler escutcheon plates were missing, dropped, or did not cover openings, compromising fire containment.
Breaches in fire-resistance-rated construction including unprotected cable penetrations and open attic access door.
Fire and smoke resistant doors in hazardous areas did not latch properly or were impaired by duct tape.
Corridor doors did not provide smoke tight seals due to gaps and missing astragals.
Corridor doors held open by devices that do not release with push or pull, preventing rapid closing and latching.
Portable medical oxygen cylinders improperly stored unsecured in beverage crates.
Exhaust ventilation system not functioning in multiple service and housekeeping areas.
Report Facts
Licensed capacity: 60
Date of survey: Sep 24, 2015
Occupant load: 49
Last fire alarm inspection date: Jul 8, 2015
Last kitchen hood maintenance: 201407
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