Danby House

Facility Information

License Number: HAL-034-093
Site Address: 3150 Burke Mill Road
Winston-Salem, NC 27103-6431
County:Forsyth
Capacity: 100 Beds

Statement of Deficiencies

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 TypeDocument TypeInspection DatePagesIDR Pending
Other No Deficiencies Cited 9/29/2020 No
ACLS Follow-up Statement of Deficiency with Plan of Correction 4/16/2020 20 No
ACLS Follow-up Statement of Deficiency 4/16/2020 19 No
ACLS Complaint Statement of Deficiency with Plan of Correction 1/17/2020 60 No
ACLS Complaint Statement of Deficiency 1/17/2020 60 No
ACLS Complaint and Follow-up Statement of Deficiency 11/15/2019 339 No
ACLS Annual and Complaint Statement of Deficiency with Plan of Correction 7/26/2019 82 No
ACLS Annual and Complaint Statement of Deficiency 7/26/2019 82 No
ACLS Annual No Deficiencies Cited 8/23/2017 No
ACLS Annual and Complaint No Deficiencies Cited 3/3/2016 No
ACLS Annual Statement of Deficiency with Plan of Correction 10/29/2015 10 No
ACLS Annual Statement of Deficiency 10/29/2015 10 No
Constr Biennial Follow-up No Deficiencies Cited 10/3/2019 0 No
Constr Biennial Follow-up Statement of Deficiency 9/12/2019 2 No
Constr Biennial Statement of Deficiency with Plan of Correction 7/18/2019 11 No
Constr Biennial Statement of Deficiency 7/18/2019 11 No
Constr Biennial Follow-up No Deficiencies Cited 8/21/2017 0 No
Constr Biennial Follow-up Statement of Deficiency with Plan of Correction 7/13/2017 3 No
Constr Biennial Follow-up Statement of Deficiency 7/13/2017 1 No
Constr Biennial Statement of Deficiency with Plan of Correction 6/2/2017 10 No
Constr Biennial Statement of Deficiency 6/2/2017 10 No
Constr Biennial Follow-up No Deficiencies Cited 9/25/2015 0 No
Constr Biennial Follow-up Statement of Deficiency 7/29/2015 2 No
Constr Biennial Follow-up Statement of Deficiency with Plan of Correction 7/29/2015 2 No
Constr Biennial Follow-up Statement of Deficiency with Plan of Correction 6/25/2015 2 No
Constr Biennial Statement of Deficiency 6/18/2015 2 No
Constr Biennial Statement of Deficiency 4/9/2015 7 No
Constr Biennial Statement of Deficiency with Plan of Correction 4/9/2015 7 No

Star Rating

Star Ratings are based on the results of DHSR inspections and some inspections by the County Department of Social Services (DSS).

StarsScoreIssue DateMeritsDemeritsInspection Type 
(ZERO STARS) (0) 27 5/29/2020 10 0 Follow-up View Worksheet
(ZERO STARS) (0) 17 3/5/2020 0 15.5 Complaint View Worksheet
(ZERO STARS) (0) 32.5 3/5/2020 5 47 Follow-up View Worksheet
One Star (1) 74.5 10/15/2019 0 25.5 Annual View Worksheet
Four Stars (4) 102.5 10/20/2017 2.5 0 Annual View Worksheet
Three Stars (3) 100.25 3/8/2016 1.25 0 Follow-up View Worksheet
Three Stars (3) 99 11/24/2015 2.5 3.5 Annual View Worksheet
Four Stars (4) 104.5 6/26/2013 4.5 0 Annual View Worksheet
Three Stars (3) 102.25 9/12/2012 1.25 0 Follow-up View Worksheet
Three Stars (3) 101 6/7/2012 4.5 3.5 Annual View Worksheet
Three Stars (3) 93.5 4/25/2011 10 0 Follow-up View Worksheet
Two Stars (2) 83.5 2/28/2011 2.5 19 Annual View Worksheet
Three Stars (3) 102.5 10/26/2009 4.5 2 Annual View Worksheet

Penalties

Penalties imposed during the last 36 months are listed.

Penalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
10/1/2020 $14,000.00 A1 10A NCAC 13F .0901 (b)† †Personal Care and Supervision;†G.S. 131D-21(4)† †Declaration of Residents' Rights Facility failed to provide supervision according to residents' assessed needs and current symptoms for 5 of 9 sampled residents (#1, #4, #10, #11 and #13) including a resident who eloped from the Special Care Unit (SCU) without staff's knowledge, resulting in a fractured hip (#13), a confused resident who consumed an unknown substance (#11), two residents who displayed agitation and aggressive behaviors and physically abused other residents (#4 and #10), and a resident with altercations and falls (#1). Appealed 10/30/2020
10/1/2020 $3,500.00 A1 G.S. 131D-25† †Declaration of Residents' Rights;†G.S. 131D-21(4)† †Declaration of Residents' Rights Administrator failed to assure the management, operations, and policies of Facility were implemented and rules were maintained for personal and other staffing, Special Care Unit staff, personal care and supervision, health care, resident rights, medication administration, reporting of accidents and incidents, settlement of cost of care, Ach infection prevention requirements and Ach medication aides; training and competency. Appealed 10/30/2020
10/1/2020 $1,000.00 A2 10A NCAC 13F .0909† †Residents' Rights;†G.S. 131D-21(4)† †Declaration of Residents' Rights Facility failed to assure residents' rights for 10 of 15 residents (Residents #1, #2 #11, #12, #14, #15, #16, #17, #18, and #20) regarding staff yelling at a resident (#12), a staff (Staff G, personal care aide (PCA)) hitting a resident (#1), a resident being forced to sit in the hallway all day due to not having portable oxygen (#2) and residents receiving injuries and bruises after being hit by other residents (#11, #14, #15, #16, #17, #18, and #20). Appealed 10/30/2020
10/1/2020 $4,000.00 A1 10A NCAC 13F .0901 (b)† †Personal Care and Supervision;†G.S. 131D-21(4)† †Declaration of Residents' Rights Facility failed to provide supervision according to residents' assessed needs and current symptoms for 5 of 9 sampled residents (#1, #4, #10, #11 and #13) including a resident who eloped from the Special Care Unit (SCU) without staff's knowledge, resulting in a fractured hip (#13), a confused resident who consumed an unknown substance (#11), two residents who displayed agitation and aggressive behaviors and physically abused other residents (#4 and #10), and a resident with altercations and falls (#1). Appealed 10/30/2020
10/1/2020 $2,000.00 A1 10A NCAC 13F .0909† †Residents' Rights;†G.S. 131D-21(4)† †Declaration of Residents' Rights Facility failed to assure 3 of 6 sampled residents (Residents #8, #9 and #10) in the Special Care Unit (SCU) were free of physical abuse and neglect by three staff (Staff A, Staff B, and Staff C) encouraging the residents to fight each other, resulting in one resident being strangled with her face turning red (Resident #8) while staff recorded and shared the video through social media; a staff (Staff A) pushed a resident into a room, turned off the light and yelled to the resident to go to sleep, and then closed the door leaving the resident in the dark room (Resident #8); and a resident being left on the floor while staff recorded a second video and shared the video through social media (Resident #10). [Refer to Tag 338, 10A NCAC 13F .0909 of Residents' Rights (Type A1 Violation). Appealed 10/30/2020