Ultimate Family Care Home

The facility failed to ensure health care follow-up for a resident related to a referral appointment with a pulmonologist. Specifically, there was no documentation that the resident attended the referred appointment between October 2021 and June 2022. Interviews confirmed the resident missed a scheduled appointment in November 2021.

The facility failed to ensure that each resident's bedroom was equipped with a chest of drawers or a built-in dresser. An observation revealed a resident's clothing was being stored in plastic bins in a closet instead of a required dresser. Staff and administration were unaware of the missing furniture due to inadequate monitoring of furnishings.

The facility failed to ensure the implementation of the Infection Prevention and Control Program (IPCP) and related guidance during a communicable disease outbreak or emerging infectious disease threat. The facility must follow specific directives issued by the NCDHHS or local health department during such events.

The facility failed to ensure that audible sounding devices were activated on exit doors for residents identified as intermittently disoriented or wanderers. Specifically, the kitchen door, the laundry room exit door, and the front exit door lacked functioning alarms to alert staff when opened. This failure occurred despite documentation showing that residents #1 and #3 were assessed as intermittently disoriented.

The facility failed to ensure that exit doors were equipped with audible sounding devices to alert staff when opened. This was observed on three different exit doors, including the kitchen door and the door near the laundry room, for residents documented as being intermittently disoriented.

The facility failed to maintain clean and well-repaired walls, floors, and furnishings. Specific issues included a missing floorboard in a hallway, damaged bathroom doors, and significant accumulations of dust and debris on baseboards, blinds, and televisions across multiple resident rooms and bathrooms.