Division of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION. Roger McCoy conducted the compliance investigation.

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5 Division of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING: PRINTED: 07/31/2017 FORM APPROVED (X3) DATE SURVEY COMPLETED B. WING /04/2017 NAME OF PROVIDER OR SUPPLIER WAKE COUNTY DETENTION CENTER (X4) ID SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) STREET ADDRESS, CITY, STATE, ZIP CODE 3301 HAMMOND ROAD RALEIGH, NC ID PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE J A NCAC 14J Initial Comments J 000 Roger McCoy conducted the compliance investigation. This compliance investigation was conducted as per 10A NCAC 14J JAILS, LOCAL CONFINEMENT FACILITIES Rules. This building was approved for use on January 1, 2012, under North Carolina State Building Code (NCSBC) 2009 Edition with an occupancy classification of Group I-3. The jail design capacity is 976 male beds and 96 female beds with a total design capacity of 1072 beds. The investigation began at 8:40AM and ended at 11:10AM. A Report of Inmate Death was received by the Construction Section on March 27, This compliance investigation was conducted in the death of inmate Jose Humberto Lara-Pineda which occurred on March 24, The report indicated the inmate was found in distress at 5:56PM on March 21, The report futher indicated the inmate died at 4:55AM on March 24, 2017, at the hospital, and the manner of death was suicide. 10A NCAC 14J.0601 (c) Supervision (c) Officers shall directly observe, at least four times per hour, inmates who display the following behavior: (1) physically hitting or trying to hit an officer; or (2) being verbally abusive; or (3) stating he will do harm to himself; or (4) intoxicated, as determined by a score of.15 on a breathalyzer or displaying slurred speech or smelling of alcohol or inability to control body movement; or (5) displaying erratic behavior such as Division of Health Service Regulation LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 D8XY11 If continuation sheet 1 of 3

6 Division of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING: PRINTED: 07/31/2017 FORM APPROVED (X3) DATE SURVEY COMPLETED B. WING /04/2017 NAME OF PROVIDER OR SUPPLIER WAKE COUNTY DETENTION CENTER (X4) ID SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) STREET ADDRESS, CITY, STATE, ZIP CODE 3301 HAMMOND ROAD RALEIGH, NC ID PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Continued From page 1 screaming, crying, laughing uncontrollably, or refusing to talk at all. In addition to displayed behavior, a previous record of a suicide attempt or a previous record of mental illness shall warrant observation at least four times per hour. History Note: Authority G.S. 153A-221; Eff. October 1, 1990; Amended Eff. June 1, This Rule is not met as evidenced by: Based on staff interviews and records review on the morning of April 4, 2017, supervision rounds of four times per hour on an irregular basis were not conducted as required by this Rule. Findings include: Interview of the Health Care Administrator indicated the jail nurse completed the medical screening form on March 21, 2017, at 11:33AM and placed the inmate on psychiatric special watch until evaluated by a psychiatrist. Interview of the jail administrator indicated the following: the inmate was incarcerated on March 21, 2017, at 6:42AM; the inmate was placed in cell S0038 in the Arrest/Receiving area; and the inmate was placed on psychiatric special watch by the nurse at 11:33AM. Division of Health Service Regulation STATE FORM 6899 D8XY11 If continuation sheet 2 of 3

7 Division of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING: PRINTED: 07/31/2017 FORM APPROVED (X3) DATE SURVEY COMPLETED B. WING /04/2017 NAME OF PROVIDER OR SUPPLIER WAKE COUNTY DETENTION CENTER (X4) ID SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) STREET ADDRESS, CITY, STATE, ZIP CODE 3301 HAMMOND ROAD RALEIGH, NC ID PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Continued From page 2 Records review of the documented supervision rounds for this inmate on March 21, 2017, indicated the following: the facility did not begin four times per hour direct observation on the inmate until 1:00PM; and this reflected an 87 minutes lapse before four times per hour direct observation began. The record further indicated the following: during the 4:00PM hour only three supervision rounds were documented; and during the 12:00PM and 5:00PM hours, there were NO documented supervision rounds. Division of Health Service Regulation STATE FORM 6899 D8XY11 If continuation sheet 3 of 3