Inspection Reports for The Haven & The Laurels in the Village at Carolina Place
13180 Dorman Rd, Pineville, NC 28134, United States, NC, 28134
Back to Facility ProfileDeficiencies per Year
20
15
10
5
0
Moderate
Unclassified
NC DHSR Star Rating History
| Date | Rating | Score | Merits | Demerits | Type |
|---|---|---|---|---|---|
| Apr 15, 2024 | 103.5 | 3.5 | 0 | Annual Inspection | |
| Jul 22, 2022 | 102.5 | 2.5 | 0 | Annual Inspection | |
| Apr 28, 2021 | 99.5 | 0 | 0 | Complaint Investigation | |
| May 6, 2019 | 99.5 | 5.5 | 6 | Annual Inspection | |
| Dec 8, 2017 | 94 | 0 | 6 | Annual Inspection | |
| Apr 7, 2015 | 102.5 | 2.5 | 0 | Follow-Up Inspection | |
| Dec 19, 2014 | 100 | 5.5 | 5.5 | Annual Inspection | |
| Aug 6, 2014 | 93.5 | 2.5 | 10 | Monitoring Visit | |
| Sep 18, 2012 | 101 | 1 | 0 | Annual Inspection | |
| Nov 1, 2010 | 103.5 | 5.5 | 2 | Annual Inspection | |
| May 19, 2009 | 103.5 | 5.5 | 2 | Annual Inspection |
Inspection Report
Follow-Up
Deficiencies: 0
Feb 13, 2024
Visit Reason
Report of Construction Section Follow Up Biennial Survey conducted on February 13, 2024.
Findings
Corrections have been made. No further action is needed.
Inspection Report
Capacity: 104
Deficiencies: 10
Dec 11, 2019
Visit Reason
This is a Construction Section Biennial Survey conducted to ensure the facility meets the 1996 Homes for the Aged and Disabled Minimum Standards and Regulations, applicable portions of the 2005 Rules for Adult Care Homes of Seven or More Beds, and the 1996 Edition of the North Carolina State Building Code.
Findings
Multiple deficiencies were cited related to physical plant maintenance including ceilings in disrepair due to moisture, unsecured oxygen cylinders, fire safety components such as fire rated doors not closing properly, plumbing fixtures not secured, and renovation-related hazards.
Deficiencies (10)
| Description |
|---|
| Ceilings not maintained in a clean and good repair condition; kitchen ceiling tiles dirty and damaged due to moisture/water migration. |
| Storage room attic access removed allowing passage of fire and/or smoke. |
| Electrical conduit/wiring ceiling penetrations not fire protected in Laundry Room and Activity Storage Room on second level. |
| Oxygen cylinders improperly stored and unsecured in multiple rooms, posing risk of rupture. |
| Fire rated cross corridor doors did not close fully to prevent passage of fire and/or smoke in multiple hallways. |
| Laundry room door hinge loose preventing door closure. |
| Large holes in corridor walls due to renovation of care stations on both levels. |
| Laundry door delaminating at hinge preventing closure. |
| Kitchenette entry door lacks hardware to latch or stay closed. |
| Toilets not secured to floors in hall baths on first and second levels. |
Report Facts
Licensed bed capacity: 104
Inspection Report
Annual Inspection
Deficiencies: 3
Feb 20, 2019
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted an annual and follow-up survey on 02/19/19-02/20/19.
Findings
The facility failed to assure medications were administered as ordered for 2 of 5 sampled residents, and medication administration records were not accurate and complete for 2 of 5 sampled residents. Additionally, the facility failed to ensure 3 of 3 sampled residents permitted to self-administer medications met requirements including having a physician's order and assessment of competency.
Deficiencies (3)
| Description |
|---|
| Failed to assure medications were administered as ordered by a licensed prescribing practitioner for 2 of 5 sampled residents related to Lantus and Senna laxative. |
| Failed to assure medication administration records (MARs) were accurate and complete for 2 of 5 sampled residents. |
| Failed to assure 3 of 3 sampled residents permitted to self-administer medications met requirements including having a physician's order and assessment of competency. |
Report Facts
Missed Lantus doses: 5
Missed Senna doses: 26
Nystatin powder administration opportunities: 93
Nystatin powder administration opportunities: 90
Nystatin powder administration opportunities: 55
Eye drop administration missing documentation: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident Services Director | Resident Services Director (RSD) | Supervised LPN staff and expected medication administration and physician contact as ordered. |
| Administrator | Administrator | Expected medications to be administered as ordered and physician to be contacted if orders were unclear. |
| Licensed Practical Nurse | LPN | Responsible for blood glucose checks, medication administration, and MAR accuracy; did not administer Lantus when blood glucose was below 100 without physician order. |
| Medication Aide | Medication Aide (MA) | Administered medications as listed on MAR; unaware of need to document reasons for omitted medications. |
| Primary Care Physician | Physician | Did not order or know about residents self-administering nystatin powder; expected oversight if self-administration allowed. |
Inspection Report
Follow-Up
Deficiencies: 1
Dec 18, 2017
Visit Reason
Biennial Follow Up Construction Survey conducted to verify correction of previously identified deficiencies.
Findings
Some deficiencies related to electrical outlets in wet locations were not corrected. Specifically, ground fault circuit interrupter receptacles were not installed adjacent to kitchen sinks in multiple rooms on the first and second floors.
Deficiencies (1)
| Description |
|---|
| Facility has not provided ground fault protection adjacent to wet areas; Ground Fault Circuit Interrupter receptacles missing adjacent to kitchen sinks in multiple rooms. |
Report Facts
Deficiency findings dates: 2
Number of rooms without GFCI receptacles: 11
Inspection Report
Capacity: 104
Deficiencies: 3
Nov 1, 2017
Visit Reason
This is a Construction Section Biennial Survey to ensure the facility meets applicable building codes and adult care home regulations.
Findings
Deficiencies were cited related to the lack of ground fault circuit interrupter outlets adjacent to wet areas and failure to maintain electrical and fire safety equipment in a safe and operating condition, including unsecured electrical junction box and interior doors that failed to latch.
Deficiencies (3)
| Description |
|---|
| Facility has not provided ground fault protection adjacent to wet areas; no Ground Fault Circuit Interrupter receptacles located adjacent to kitchen sinks in multiple rooms. |
| Failed to maintain electrical equipment in a safe condition; ceiling mounted electrical junction box without cover plate in Sprinkler Riser Room. |
| Failed to maintain fire safety components; interior doors failed to latch allowing passage of smoke and/or fire in 'A' Hall Restroom on Second Floor and Break Room on First Floor. |
Report Facts
Licensed bed capacity: 104
Inspection Report
Annual Inspection
Deficiencies: 3
Sep 27, 2017
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted an annual survey on 09/26/17 and 09/27/17 to assess compliance with state regulations for the facility.
Findings
The facility failed to implement physician orders for finger stick blood sugars (FSBS) for one resident and failed to ensure adequate and appropriate care for another resident, including timely response to call pendants and proper incontinent care. Additionally, staff on the third shift were found sleeping during their shift, neglecting resident care duties.
Deficiencies (3)
| Description |
|---|
| Failed to assure orders for finger stick blood sugars (FSBS) were implemented as ordered for 1 of 5 sampled residents (Resident #5). |
| Failed to ensure 1 of 5 sampled residents (Resident #2) received care and services which were adequate, appropriate, and in compliance with relevant laws and regulations, including inadequate response to call pendants and incontinent care. |
| Third shift staff were found sleeping during their shift, failing to provide required care and timely response to residents. |
Report Facts
Sampled residents: 5
FSBS checks: 4
Hemoglobin A1c: 12
Shift staff count: 5
Third shift staff break duration: 45
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) | LPNs responsible for receiving and transcribing physician orders and administering FSBS for Resident #5 | |
| Resident Services Director (RSD) | Oversaw patient care staff and provided interviews regarding FSBS orders and resident care | |
| Medication Aide/Supervisor (MA/S) | Supervisor on third shift responsible for medication administration and staff oversight | |
| Administrator | Facility Administrator interviewed regarding staff responsibilities and FSBS order transcription | |
| Personal Care Aide (PCA) | Third shift PCA observed sleeping during shift and first shift PCA reporting concerns |
Inspection Report
Follow-Up
Deficiencies: 2
Feb 25, 2016
Visit Reason
Follow-up survey conducted to verify correction of previously identified deficiencies.
Findings
Some deficiencies related to building equipment and fire safety were not corrected. Specifically, corridor smoke barrier doors were found not closing or latching properly, posing a fire safety risk.
Deficiencies (2)
| Description |
|---|
| Corridor smoke barrier door near room C201 was dragging the floor and would not automatically close. |
| Smoke barrier door near room D201 would not latch when closed. |
Inspection Report
Capacity: 104
Deficiencies: 17
Nov 5, 2015
Visit Reason
Biennial Construction Survey conducted to assess compliance with the 1996 Homes for the Aged and Disabled Minimum Standards and Regulations, the 2005 Rules for Adult Care Homes of Seven or More Beds, and the 1996 Edition of the North Carolina State Building Code.
Findings
The facility was found deficient in multiple areas including fire safety, physical plant maintenance, housekeeping, and building equipment. Key issues included improper combustible storage, lack of current fire safety inspections, obstructed exits, malfunctioning exit signs, compromised fire-rated walls and doors, improperly stored oxygen cylinders, non-functioning GFCI receptacles, and inadequate exhaust ventilation.
Deficiencies (17)
| Description |
|---|
| Storage room larger than 100 sq. feet used for combustible storage with only an unrated door separating it from corridor. |
| No supporting documentation indicating correction of fire extinguisher service and fire door deficiencies noted in Fire Marshal inspection dated 7-22-2015. |
| Two exits from Rehab obstructed with chairs and equipment. |
| Exit signs directing exiting in wrong directions near rooms A201 and D201. |
| Waste trap dry in soiled utility room allowing noxious odors and bacteria. |
| Vacuum breakers removed from mop sinks in D up laundry and near hair salon. |
| Records of fire drill rehearsals lacked description of what the rehearsals involved. |
| Sprinkler inspection report dated 1-28-2015 listed deficiencies with OS&Y tamper switches not activating on valve closure. |
| Many corridor doors prevented from closing and latching properly, including smoke barrier doors and storage room doors. |
| One-hour fire rated walls and ceilings compromised by holes and unsealed penetrations in multiple locations. |
| Exit signs in Rehab not illuminated. |
| Improper storage of portable medical oxygen cylinders in multiple rooms; one deficiency corrected onsite. |
| GFCI receptacles in Clinic did not trip when tested. |
| Component covers missing on panic hardware latches exposing sharp edges. |
| Electrical panels obstructed by furniture in main electrical room. |
| Ice machine drain line laying directly on floor, risking contamination. |
| Facility failed to maintain required exhaust ventilation in laundry areas. |
Report Facts
Total licensed capacity: 104
Fire Marshal inspection date: Jul 22, 2015
Sprinkler inspection date: Jan 28, 2015
Number of portable oxygen cylinders improperly stored: 11
Number of GFCI receptacles not tripping: 2
Inspection Report
Annual Inspection
Deficiencies: 3
Nov 20, 2014
Visit Reason
The Adult Care Licensure Section and the Mecklenburg County Department of Social Services conducted an annual survey on November 19-20, 2014.
Findings
The facility failed to ensure 5 of 7 sampled staff had no substantiated findings on the North Carolina Health Care Personnel Registry and failed to administer the required second step tuberculosis skin test to 3 of 7 sampled residents in compliance with state regulations.
Severity Breakdown
Type B Violation: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility failed to ensure 5 of 7 sampled staff had no substantiated findings on the North Carolina Health Care Personnel Registry due to missing documentation of HCPR checks for nonclinical staff. | Type B Violation |
| Facility failed to assure 3 of 7 sampled residents were administered the second step tuberculosis skin test in compliance with control measures. | — |
| Facility failed to ensure residents received care and services which were adequate, appropriate, and in compliance with relevant laws regarding HCPR checks for new employees. | — |
Report Facts
Sampled staff with missing HCPR checks: 5
Sampled residents missing second step TB test: 3
Sample size for staff: 7
Sample size for residents: 7
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