Beruflich Dokumente
Kultur Dokumente
FORM APPROVED
Division of Health Service Regulation
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING: ______________________
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
recommendations;
(7) quality assurance and quality improvement
activities, including:
(A) composition and activities of a quality
assurance and quality improvement committee;
(B) written quality assurance and quality
improvement plan;
(C) methods for monitoring and evaluating the
quality and appropriateness of client care,
including delineation of client outcomes and
utilization of services;
(D) professional or clinical supervision, including
a requirement that staff who are not qualified
professionals and provide direct client services
shall be supervised by a qualified professional in
that area of service;
(E) strategies for improving client care;
(F) review of staff qualifications and a
determination made to grant
treatment/habilitation privileges:
(G) review of all fatalities of active clients who
were being served in area-operated or contracted
residential programs at the time of death;
(H) adoption of standards that assure operational
and programmatic performance meeting
applicable standards of practice. For this
purpose, "applicable standards of practice"
means a level of competence established with
reference to the prevailing and accepted
methods, and the degree of knowledge, skill and
care exercised by other practitioners in the field;
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
DC #1.
-The MD would have to make the decision for
and a treatment team meeting would have
to have been held.
-A ) was
not discussed with DC #1.
-DC #1's case was never brought before the
treatment team. The Medical Director was never
consulted regarding drug
screens. There was never a discussion
regarding a higher level of care.
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
intervention.
-"They were really lacking there in that sense.
Counselors just had training on how to improve
with documentation ..."
-" ...For to be saying
not qualified (to make a
diagnosis). should have brought to
doctor, then a treatment team meeting with the
patient to try to figure out what to do. When not
telling anyone, how is anyone else going to know
...?"
-The PD stated the Medical Director (MD) was
not involved in DC #1's treatment after testing
for
-The MD should have been involved by the
second test. DC #1 tested for
months in a row.
-No one had mentioned DC #1's in the
or .
-"I wasn't very cognizant of that
until we reviewed
record after death ...some things we're limited
in what we do and what we treat, if someone is
telling you and you're a counselor and that's out
of your knowledge base, you need to immediately
get the nurse or doctor, could even call 911, must
document follow through. Those things did not
occur in that case ..."
-No were used when DC #1 tested
for
-" ...After the first should have been
right then, If it came back
counselor would say we need to meet with doctor
...The reality was as soon as first drug screen
for action should have been
taken and it wasn't ..."
- DC #1's case was not staffed by CSAC #1 for
or for a treatment team meeting.
-Stated the nurses should be looking at drug
screen and the counselors should be checking
Division of Health Service Regulation
STATE FORM 6899
4BC611 If continuation sheet 16 of 50
PRINTED: 10/16/2017
FORM APPROVED
Division of Health Service Regulation
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING: ______________________
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
R
MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
conditioning slats
-The ceilings had water stains
-On hallway B, near the dosing window, there
were black strips of tape holding the frayed carpet
down
-Numerous ends of the carpet were untapped
and loose in areas.
-The tile in the dosing room area had worn and
stained tiles
-The two dosing window ledges had worn and
missing paint
-On hallway C, the clients' bathroom had debris in
the light fixture cover
-The sink was dirty
-A three foot by two foot area on the floor was
brown and appeared to have rust on it
-The toilet was clogged with toilet tissue
-The drawer under the sink was off the track on
the right side
-There were numerous stains on the carpet
throughout the hallway
-Black tape held down places on the carpet that
were frayed
-The clients' group room had a strong odor of
mold/mildew
-There were several large black stains on the
carpet
-Numerous small holes on the walls
-The conference room table had white stains
covering it
-There were spider webs on the window blinds
-Pooled and dried coffee stains on the coffee
stand
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MHL065-117 B. WING _____________________________
09/29/2017
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1611 CASTLE HAYNE ROAD, UNIT D
NEW HANOVER TREATMENT CENTER
WILMINGTON, NC 28404
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)