| License Number: | FCL-092-290 |
| Site Address: |
5818 Poole Road Raleigh, NC 27610 |
| County: | Wake |
| Capacity: | 6 Beds |
Statements of Deficiencies (form used by the state to document inspections) are posted for adult care facilities with survey dates beginning November 1, 2014 and deficiencies or violations were identified.
Note: A Yes under the column, IDR Pending, indicates the facility has requested Informal Dispute Resolution (IDR), a process that gives a facility the opportunity to dispute all or some of the findings of a state inspection. If the Statement of Deficiency is changed as a result of IDR, the web page will be updated.
| Inspection Type | Document Type | Inspection Date | Pages | IDR Pending |
|---|---|---|---|---|
| ACLS Annual and Follow-up | Statement of Deficiency | 10/8/2024 | 5 | No |
| DSS Complaint Investigation | Corrective Action Report with Plan of Correction | 5/14/2024 | 9 | No |
| DSS Complaint Investigation | Corrective Action Report | 5/14/2024 | 9 | No |
| DSS Complaint Investigation | Corrective Action Report with Plan of Correction | 4/12/2024 | 7 | No |
| DSS Complaint Investigation | Corrective Action Report | 4/12/2024 | 6 | No |
| ACLS Annual and Follow-up | Statement of Deficiency with Plan of Correction | 7/6/2023 | 4 | No |
| ACLS Initial | Statement of Deficiency with Plan of Correction | 6/13/2021 | 4 | No |
| Other | Statement of Deficiency | 5/13/2021 | 5 | No |
| ACLS Complaint | Statement of Deficiency | 5/13/2021 | 5 | No |
| ACLS Annual | No Deficiencies Cited | 7/20/2016 | No | |
| Constr Complaint Follow-up | Statement of Deficiency | 11/7/2018 | 2 | No |
| Constr Biennial Follow-up | Statement of Deficiency | 11/7/2018 | 3 | No |
| Constr Biennial Follow-up | Statement of Deficiency with Plan of Correction | 11/1/2018 | 4 | No |
| Constr Biennial Follow-up | Statement of Deficiency with Plan of Correction | 7/13/2018 | 3 | No |
| Constr Biennial Follow-up | Statement of Deficiency | 7/13/2018 | 3 | No |
| Constr Complaint | Statement of Deficiency with Plan of Correction | 3/14/2018 | 2 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 3/14/2018 | 3 | No |
| Constr Complaint | Statement of Deficiency | 3/14/2018 | 2 | No |
| Constr Biennial | Statement of Deficiency | 3/14/2018 | 3 | No |
| Constr Biennial Follow-up | No Deficiencies Cited | 10/23/2015 | 0 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 7/2/2015 | 8 | No |
| Constr Biennial | Statement of Deficiency | 7/2/2015 | 8 | No |
Star Ratings are based on the results of DHSR inspections and some inspections by the County Department of Social Services (DSS).
| Stars | Score | Issue Date | Merits | Demerits | Inspection Type | ||
|---|---|---|---|---|---|---|---|
|
(3) | 96 | 11/21/2024 | 0 | 4 | Annual | View Worksheet |
|
(2) | 80.5 | 8/14/2024 | 2.5 | 0 | County Monitoring Visit | View Worksheet |
|
(1) | 78 | 5/20/2024 | 0 | 10 | County Monitoring Visit | View Worksheet |
|
|
(2) | 88 | 4/23/2024 | 0 | 10 | County Monitoring Visit | View Worksheet |
|
|
(3) | 98 | 8/15/2023 | 0 | 2 | Annual | View Worksheet |
|
|
(3) | 91 | 11/15/2022 | 2.5 | 0 | County Monitoring Visit | View Worksheet |
|
|
(2) | 88.5 | 11/15/2022 | 0 | 10 | County Monitoring Visit | View Worksheet |
|
|
(3) | 98.5 | 8/6/2021 | 2.5 | 4 | Annual | View Worksheet |
|
(4) | 100 | 8/9/2016 | 0 | 0 | Annual | View Worksheet |
|
|
(3) | 100 | 2/11/2014 | 0 | 0 | Annual | View Worksheet |
|
|
(3) | 91 | 8/16/2012 | 1 | 10 | Annual | View Worksheet |
|
|
(4) | 100 | 11/18/2010 | 0 | 0 | Annual | View Worksheet |
|
|
(3) | 102.5 | 8/26/2009 | 2.5 | 0 | Annual | View Worksheet |
Penalties imposed during the last 36 months are listed.
| Facility | Facility License | Inspection Date & Nature of Validation | Rules Areas Cited | Level Cited | Penalty Amount | Date Penalty Imposed | Current Status |
|---|---|---|---|---|---|---|---|
| Destiny Family Care Home #4 | FCL-092-290 | 6/22/2022 | 10A NCAC 13G .0906 (f)(1)-(4) Other Resident Services G.S. 131D-21(2) Declaration of Resident's Rights | A1 | $1,000.00 | 2/15/2023 | Paid in Full |
| Destiny Family Care Home #4 | FCL-092-290 | 4/12/2024 | 10A NCAC 13G .0901(b) Personal Care and Supervision | A1 | $2,000.00 | 6/12/2024 | Appealed |
| Destiny Family Care Home #4 | FCL-092-290 | 5/14/2024 | 10A NCAC 13G .0901(b) Personal Care and Supervision | UA1 | $12,500.00 | 1/10/2025 |