Listing of Facilities with Penalties

This is the list of facilities, by county names, that have been found in violation of one or more rules in the last 36 months.

County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation

Alamance County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lane St. Retirement Home HAL-001-149 12/13/2018 $110,250.00 Unabated A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure supervision was provided for 1 resident with a history of smoking in the facility. Referred to Controller's Office 04/09/2019
Bountiful Blessings FCH FCL-001-146 8/24/2020 $500.00 A2 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure hot water temperatures were maintained at a minimum of 100 degrees Fahrenheit (F) to a maximum of 116 degrees F for 6 of 6 fixtures.
Bountiful Blessings FCH FCL-001-146 8/24/2020 $3,000.00 A2 10A NCAC 13G .0601( c)(2)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure there was a supervisor-in-charge in Facility or within 500 feet of facility.

Alexander County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $2,000.00 A1 10A NCAC 13F .0601(a) Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(2) Declaration of Residents' Rights The Administrator failed to assure the management and overall operations of the facility were in substantial compliance by failing to meet and monitor rules related to housekeeping. Appealed 10/21/2019
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $20,000.00 A1 10A NCAC 13F .0902(a) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for residents who required acute and routine health care needs. Appealed 10/21/2019
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $4,000.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Appealed 10/21/2019

Anson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Meadowview Terrace of Wadesboro HAL-004-003 9/14/2020 $2,000.00 A2 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights 4. Based on observations, interviews and record reviews, the Administrator failed to assure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with rules and statutes governing adult care homes as related to health care, medication administration and nutrition and food services.
Meadowview Terrace of Wadesboro HAL-004-003 9/14/2020 $2,000.00 A2 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with the facility's policies for 3 of 6 residents (#6, #7, #8) observed during the medication passes including errors with insulins (#8), an oral antifungal for infection (#6), and a lubricant eye drop (#7); and for 4 of 6 residents sampled (#1, #2, #3, #6) for record review including errors with insulin (#6), a blood pressure medication (#1), medications for anxiety and depression (#2); and multiple medication errors including medications for sleep/depression, high blood pressure, and diabetes for Resident #3.

Ashe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashe Assisted Living and Memory Care HAL-005-013 9/24/2019 $1,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify law enforcement immediately of an incident in which residents were abused by a staff person. Paid in Full $1,000.00 10/10/2019

Avery County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cranberry House HAL-006-007 8/23/2018 $500.00 A2 G.S. 131D-21(4)   Declaration of Resident's Rights; G.S. 131D-21(2)  Facility failed to assure that 5 residents were treated with respect and were free from physical and verbal abuse from a stafF . Paid in Full $500.00 4/5/2019

Bertie County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
A Sharpe Haven FCL-008-038 1/31/2019 $2,000.00 A1 10A NCAC 13G .0902(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify the mental health provider for 1 resident who exhibited increasingly threatening and aggressive behaviors and who refused psychotropic medications for at least five days. Paid in Full $2,000.00 12/20/2019
A Sharpe Haven FCL-008-038 1/31/2019 $55,500.00 Unabated B 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to protect 6 residents by allowing a staff member who was terminated for alleged abuse of residents to have access to residents; and 1 resident to threaten, intimidate and physically assault at least 4 residents. Paid in Full $55,500.00 12/20/2019

Bladen County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
West Bladen Assisted Living HAL-009-025 1/25/2019 $8,000.00 A1 10A NCAC 13F .0901(b)   Personal Care and Supervision, 10A NCAC 13F .1501(a)  ; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to supervise by not addressing the current symptoms and needs for residents who had dementia. Settlement Fulfilled 02/03/2020 Settlement Agreement 08/23/2019 Appealed 02/15/2019 $1,000.00 2/3/2020
Oak Grove Family Care Home FCH-009-028 7/15/2019 $1,500.00 A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications prepared for administration in advance were kept in a sealed container that identified the name and strength. Paid in Full $1,500.00 9/9/2019
Oak Grove Family Care Home FCH-009-028 7/15/2019 $2,625.00 A1 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Residents' Rights; Facility failed to assure residents were not left alone in the facility at any time. Paid in Full $2,625.00 9/9/2019
Oak Grove Family Care Home FCH-009-028 7/15/2019 $2,000.00 A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral and follow up for acute and routine health care needs. Paid in Full $2,000.00 9/9/2019

Brunswick County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Shallotte Assisted Living HAL-010-008 12/13/2018 $4,000.00 A2 10A NCAC 13F .1105(b)   Refund of Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that 3 residents' personal funds were dispensed to the appropriate recipient within 30 day after the residents' death. Paid in Full $4,000.00 11/4/2019
Shallotte Assisted Living HAL-010-008 12/13/2018 $4,000.00 A2 10A NCAC 13F .1105(a)  Refund of Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 4 residents' personal funds returned to them or responsible party within 14 days of residents leaving facility. Paid in Full $4,000.00 11/4/2019
Shallotte Assisted Living HAL-010-008 8/5/2019 $9,000.00 A1 10A NCAC 13F .0305(h)(3) Physical Environment; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure fire exits were easily operable with a single hand motion, with the intentional obstruction of fire exit doors Referred to Controller's Office 11/04/2019
Leland House HAL-010-007 12/9/2019 $5,250.00 A2 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights "The facility failed to respond immediately with care and interventions in accordance with their fall policy and policy for accidents. " Appealed 01/08/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $34,000.00 Unabated B 10A NCAC 13F .1104(b)   Accounting for Resident's Personal Funds; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 7 of 7 sampled residents who had four specialty referrals (#2), redness and weeping legs and thick, long toenails. Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $14,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to report an allegation of misappropriation of a resident's personal money to the North Carolina Health Care Personnel Registry (HCPR) within 24 hours for 1 of 1 sampled resident (#12) and failed to ensure allegations of drug diversion were reported to HCPR within 24 hours and 5-day follow-up reporting was completed. Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $12,000.00 A1 10A NCAC 13F .1008 (a)   Controlled Substances ; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure readily retrievable records that accurately reconciled the receipt, disposition, and administration of controlled substances for 4 of 5 residents . Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 G.S. 131D-21(5) Assisted Living Residence; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management, total operations, and policies and procedures of Facility were implemented to maintain each residents' right to be free of serious neglect and exploitation as evidenced by the failure to maintain substantial compliance with the rules and statutes governing adult care homes as related to health care. Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 7 of 7 sampled residents who had four specialty referrals (#2), redness and weeping legs and thick, long toenails. Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered and in accordance with facility's policies for 2 of 3 residents observed. Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral for the acute healthcare needs for 1 of 5 sampled residents. Appealed 09/18/2020
Leland House HAL-010-007 10/1/2020 $6,900.00 Unabated B 10A NCAC 13G .0406 Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure staff were tested for tuberculosis disease in accordance with control measures established by the Commission of Public Health
Leland House HAL-010-007 10/1/2020 $14,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure the acute and chronic health care needs were met for 5 of 8 sampled residents (#1, #3, #4, #13, and #15) related to notification of the health care providers for a change in status.
Leland House HAL-010-007 10/1/2020 $14,000.00 A1 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure safe policies and procedures were established and maintained for medication administration; failed to assure medications were administered as ordered for 2 of 6 residents (#9, #10), observed during the medication passes, including errors with insulins (#9, #10), an antiarrhythmic (#9), an oral antidiabetic and bulk fiber (#10); and for 4 of 7 residents sampled for record reviews (#1, #3, #4, #15) including delays in starting and missed doses of antibiotics (#4, #15), a delay is administration of an antifungal (#3) a delay in starting an antidepressant (#3), errors with rapid and long acting insulins (#3), and a medication used to treat hypothyroidism (#1).
Leland House HAL-010-007 10/1/2020 $4,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to assure the overall management of Facility's operations and policies/procedures in order to maintain each residents' rights and substantial compliance with the rules and statutes regarding medication administration, health care, and training on cardio-pulmonary resuscitation.

Buncombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Richmond Hill Rest Home #5 HAL-011-188 9/13/2018 $1,000.00 A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 1 resident accordance to the resident's assessed needs and current symptoms. Paid in Full $1,000.00 9/25/2018
White Fawn Family Care Home (Closed) FCL-011-297 9/12/2018 $2,000.00 A2 10A NCAC 13G .0906(f)(4)   Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to immediately notify the appropriate law enforcement and County DSS when the whereabouts of a resident were unknown and there were reasons to be concerned about resident's safety. Referred to Controller's Office Office 04/09/2019
Fairview Family Care Home #4 FCL-011-025 12/13/2018 $3,500.00 A1 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the referral and follow up. Paid in Full $3,500.00 3/3/2020
White Fawn Family Care Home (Pty 1) (Closed) FCL-011-297 12/13/2018 $3,600.00 Unabated B 10A NCAC 13G .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practioner for 3 residents. Referred to Controller's Office 04/09/2019
Woodland Terrace Family Care Home #4 FCL-011-342 2/26/2019 $5,100.00 Unabated B 10A NCAC 13G .1004(a)   Medication Administration, 10A NCAC 13G .0601(a)   Management and other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered for residents related to delay in reordering medications. Management failed to maintain compliance in the rule areas regarding, activities program, accurate accounting of 3 controlled medications, medication administration, pre-pouring medications, 3-5 day supply. Referred to Controller's Office 08/20/2019
Woodland Terrace FCH #6 FCL-011-351 3/18/2019 $2,000.00 A2 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(1)   Declaration of Residents' Rights Facility failed to assure residents were treated with respect and dignity related to Staff speaking to residents in a disrespectful manner and yelling at residents. Referred to Controller's Office 08/20/2019
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 $1,000.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered to 2 residents. Referred to Controller's Office 09/03/2019
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 $1,000.00 A2 10A NCAC 13G .0601(a)   Management and Other Staff G.S. 131D-21(2)   Declaration of Residents' Rights Facility Co-Administrators failed to be responsible for the total operation of the facility by failing to meet and maintain all applicable rules and regulations related to Housekeeping and Furnishings, Health Care, Activities, Resident Rights, Medication Administration and Pharmaceutical Care. Referred to Controller's Office 09/03/2019
Chunn's Cove Assisted Living HAL-011-262 6/4/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure residents who requested medical transportation to the hospital related to breathing difficulty. Appealed 07-08-2019
Chunn's Cove Assisted Living HAL-011-262 6/4/2019 $20,000.00 A1 10A NCAC 13F .0904(e )(4) Nutrition and Food Service; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure therapeutic diets were served as ordered. Appealed 07-08-2019
Chase Samaritan HAL-011-133 9/24/2019 $20,000.00 A1 10A NCAC F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow-up. Paid in Full $20,000.00 12/17/2019
Chunn's Cove Assisted Living HAL-011-262 9/24/2019 $8,100.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications related to pain treatment as ordered. Settlement Agreement 05/27/2020 Appealed 10/14/2019
Becky's Rest Home #1 HAL-011-002 8/7/2020 $2,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure 3 of 4 residents were free from physical and verbal abuse by a personal care aide.
Chunn's Cove Assisted Living HAL-011-262 8/7/2020 $16,400.00 Unabated B 10A NCAC 13 F .0901(c ) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to document the administration of medication immediately following the administration by the staff who had administered the medications. Settlement Fulfilled 03/20/2021 Settlement Agreement 12/10/2020 Appealed 09/10/2020 $1,000.00 3/20/2021

Burke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Burke Long Term Care HAL-012-042 9/24/2019 $11,850.00 Unabated B G.S. 131D-4.4 (A) (b) ACH Infection Prevention Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the federal Centers for Disease Control and Prevention guidelines to assure proper infection control procedures for the use of glucometers. Appealed 09/26/2019

Cabarrus County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Concord House HAL-013-038 1/24/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G. S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as prescribed by a licensed practitioner. Referred to Controller's Office 05/17/2019
Concord House HAL-013-038 1/24/2019 $12,000.00 A2 10A NCAC 13F .1004(j)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure accurate documentation on the Medication Administration Record. Referred to Controller's Office 05/17/2019
Concord House HAL-013-038 2/19/2019 $16,000.00 A1 10A NCAC 13F .0601(a)   Management of Facilities with a Capacity of Census of Seven to Thirty Residents; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure the facility had a functional air conditioner or at least one fan per resident in the bedrooms, living areas and dining area when the temperature was above 85 (F). Referred to Controller's Office 05/17/2019
Concord House HAL-013-038 2/19/2019 $14,000.00 A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to administer medications as prescribed by a licensed prescribing practitioner for residents. Referred to Controller's Office 05/17/2019
Concord House HAL-013-038 2/19/2019 $7,000.00 A2 10A NCAC 13F .1104(f)   Accounting for Resident's Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure accurate documentation on the Medication Administration Record. Referred to Controller's Office 05/17/2019
The Living Center of Concord HAL-013-044 2/26/2019 $1,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 2 staff had no substantiated findings on the North Carolina Health Care Personnel Registry (HCPR). Settlement Fulfilled 02/06/2020 Settlement Agreement 09/04/2019 Appealed 03/04/2019 $1,000.00 2/6/2020
Concord House HAL-013-038 4/4/2019 $35,200.00 Unabated B 10A NCAC F .0311(a)   Other Requirements; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure all plumbing equipment were maintained in a safe and operating condition. Referred to Controller's Office 08/08/2019
Concord House HAL-013-038 4/4/2019 $35,200.00 Unabated B 10A NCAC F .0306(a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure the home was maintained clean and free of all obstructions and hazards. Referred to Controller's Office 08/08/2019
The Living Center of Concord HAL-013-044 7/1/2019 $4,000.00 A2 10A NCAC 13F .1004(a)(1)(2) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Settlement Agreement 03/24/2020 Appealed 07/18/2019
Suburban Guardianship FCL-013-047 6/4/2019 $1,000.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Paid in Full $1,000.00 12/5/2019
Suburban Guardianship FCL-013-047 6/4/2019 $1,000.00 A2 10A NCAC 13G .1004(a)(1)(2) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure physician notification to meet routine and acute health care needs. Paid in Full $1,000.00 12/5/2019
The Country Home HAL-013-042 8/5/2019 $7,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to contact the primary care physician for the acute and routine health care needs Paid in Full $7,000.00 11/16/2019
Kannapolis Family Care Home FCL-013-046 9/24/2019 $800.00 Unabated B 10A NCAC G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the building was equipped and maintained for residents residing in the facility who had cognitive and physical impairments and were unable to evacuate independently. Paid in Full $800.00 11/20/2019

Carteret County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Shoreline Family Care Home FCL-016-020 6/17/2019 $750.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure that medication was administered as ordered. Paid in Full $750.00 6/25/2019
Carteret Landing HAL-016-022 10/1/2020 $7,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide adequate supervision in accordance to the resident's assessed needs and current symptoms to 1 of 8 residents sampled who was known to wander throughout the Memory Care Unit and exhibit verbal and physical aggression. Appealed 10/30/2020

Caswell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Caswell House HAL-017-054 1/31/2019 $2,000.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision. Settlement Agreement 01/10/2020 Appealed 03/08/2019
Caswell House HAL-017-054 1/31/2019 $2,000.00 A1 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure 8 residents who resided on the (SCU) were free from assault. Settlement Agreement 01/10/2020 Appealed 03/08/2019
Caswell House HAL-017-054 1/31/2019 $1,000.00 A2 10A NCAC 13F .1308   Cooperation with Case Managers; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure adequate staffing to meet the needs of residents on the Special Care unit. Settlement Agreement 01/10/2020 Appealed 03/08/2019
Caswell House HAL-017-054 7/15/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification and referrals. Settlement Agreement 01/10/2020 Appealed 08/14/2019
Caswell House HAL-017-054 7/15/2019 $4,000.00 A2 10A NCAC 13F . 0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents with diagnoses of dementia, a history of repeated falls resulting in fractures. Settlement Agreement 01/10/2020 Appealed 08/14/2019
Caswell House HAL-017-054 7/15/2019 $3,000.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to implement their follow-up process when a resident had been transferred to a medical center for a mental health evaluation. Settlement Agreement 01/10/2020 Appealed 08/14/2019
Caswell House HAL-017-054 7/15/2019 $5,250.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Administrator failed to assure the management, operations, and policies of the facility were implemented and rules were maintained. Settlement Agreement 01/10/2020 Appealed 08/14/2019
Poole's Rest Home HAL-017-006 8/5/2019 $4,000.00 A2 10A NCAC 13F .0909 Resident Rights; F .0601; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure residents were protected from bedbugs; Administrator failed to assure the management and overall operation of the facility by failing to meet and monitor rules related to resident rights, housekeeping and furnishings. Referred to Controller's Office 10/02/2019
Poole's Rest Home HAL-017-006 7/15/2019 $400.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure a medication was administered as ordered by a licensed prescribing practitioner. Referred to Controller's Office 10/02/2019
Poole's Rest Home HAL-017-006 7/15/2019 $400.00 Unabated B 10A NCAC 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff member had completed a course on Cardio-Pulmonary resuscitation (CPR) and choking management within the past 24 months Referred to Controller's Office 10/02/2019
Poole's Rest Home HAL-017-006 11/18/2019 $12,000.00 A2 10 A NCAC 13F .0601   Management of Facilities; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure the management and overall operation of the facility by failing to meet and monitor rules related to medication administration, health care and adult care home medication aide training. Referred to Controller's Office 04/07/2020
Poole's Rest Home HAL-017-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .0902(c)(3-4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure implementation of physician orders for 1 resident. Referred to Controller's Office 04/07/2020
Poole's Rest Home HAL-017-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility staff failed to administer medications as ordered for 2 residents. Referred to Controller's Office 04/07/2020
Poole's Rest Home HAL-017-006 11/18/2019 $25,800.00 Unabated B 10A NCAC 1310A NCAC 13F .0306(a)(4)   Housekeeping and Furnishings; G.S 131D-21(2)   Declaration of Residents' Rights  The facility failed to assure the North Carolina Division of Environmental Health sanitation score remained 85 or above at all times. Referred to Controller's Office 04/07/2020
Caswell House HAL-017-054 10/1/2020 $10,200.00 Unabated B 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Based on observations, record reviews and interviews, Facility failed to provide personal care assistance for nailcare for 2 of 7 sampled residents (#1, #7).
Caswell House HAL-017-054 10/1/2020 $10,200.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance to Facility's policy for 5 of 9 residents (#10, #6, #11, #9, #8) observed during the medication pass, including errors with a pancreatic enzyme replacement medication, insulin, an antiemetic, and an oral antidiabetic medication; and for 2 of 5 residents (#6, #4) sampled for record review including errors with a medication used to treat diabetes (#6), and eye drops and an antidepressant (#4).
Poole's Rest Home HAL-017-006 10/1/2020 $24,000.00 Unabated A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility staff failed to administer medications as ordered for 2 of 3 sampled residents (#1 and #2) related to medications used to treat chronic obstructive pulmonary disease (#1 and #2); not having an inhaler used in an emergency available for immediate relief of breathing difficulty (#1) and continued administration of a medication used to reduce the amount of acid in the stomach for 52 days after the physician's order to discontinue the medication (#2).
Poole's Rest Home HAL-017-006 10/1/2020 $24,000.00 Unabated A2 10A NCAC 13F .0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to assure the management and overall operation of the facility by failing to meet and monitor rules related to housekeeping and furnishings, staff qualifications, nutrition and food service, medication orders, medication administration, medication disposition, and infection prevention.
Poole's Rest Home HAL-017-006 10/1/2020 $24,000.00 Unabated A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights facility staff failed to administer medications as ordered for 2 of 3 sampled residents (#1 and #2) related to medications used to treat chronic obstructive pulmonary disease (#1 and #2); not having an inhaler used in an emergency available for immediate relief of breathing difficulty (#1) and continued administration of a medication used to reduce the amount of acid in the stomach for 52 days after the physician's order to discontinue the medication (#2).

Catawba County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Springs of Catawba Pty 1 HAL-018-032 9/12/2018 $10,000.00 A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered by prescribing physician. Settlement Fulfilled 12/04/2019 Settlement Agreement 05/03/2019 Appealed 10/12/2018 $3,500.00 12/4/2019
Springs of Catawba Pty 2 HAL-018-032 9/12/2018 $10,000.00 A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician concerning 3 residents related to elopement, bruising and swelling of a resident's forearm; and a resident needing a higher level of care. Settlement Fulfilled 12/04/2019 Settlement Agreement 05/03/2019 Appealed 10/12/2018 $3,500.00 12/4/2019
Heritage Care of Conover HAL-018-018 12/13/2018 $2,000.00 A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to refer and follow up with physician and durable medical equipment company to ensure the acute health care needs were met. Settlement Fulfilled 02/25/2020Settlement Agreement 09/04/2019 Appealed 01/02/2019
Heritage Care of Conover HAL-018-018 12/13/2018 $2,000.00 A2 10A NCAC 13F .0902(c)(3-4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement physician orders for 2 residents with physician orders for oxygen administration. Settlement Fulfilled 02/25/2020Settlement Agreement 09/04/2019 Appealed 01/02/2019

Chatham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Coventry House Of Siler City HAL-019-018 4/4/2019 $15,200.00 10A NCAC F .0306(a)(5)   Adult care homes shall: be maintained in an uncluttered, clean and orderly manner G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure the facility was maintained clean and free of all hazards. Referred to Controller's Office 08/08/2019
Liselotte Rest Home FCL-019-006 4/4/2019 $1,400.00 Unabated B 10A NCAC 13G .0302(b)   Design and Construction; G.S. 131D-21(2)   Declaration of Residents' Rights Failed to assure the building met the NC state building code requirements for non-ambulatory residents as evidenced. Referred to Controller's Office 08/08/2019
Liselotte Rest Home FCL-019-006 7/15/2019 $2,000.00 A2 10A NCAC 13G .0317(a) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the plumbing equipment was in a safe and operation condition resulting in the water testing positive for bacteria. Referred to Controller's Office 10/02/2019
Liselotte Rest Home FCL-019-006 7/15/2019 $3,500.00 A2 10A NCAC 13G .0601 Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to assure the management and total operation of the facility by failing to meet and monitor the rules and regulations for family care homes related to building service equipment and use of physical restraints and alternatives. Referred to Controller's Office 10/02/2019

Chowan County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Heavenly Merciful Home of Tyner FCL-021-005 9/24/2019 $6,400.00 Unabated B 10A NCAC F . 0601(a) Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to assure the overall management, operations, and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing family care homes as related to health care, other staff qualifications. Appealed 10/21/2019
Heavenly Merciful Home of Tyner FCL-021-005 9/24/2019 $6,400.00 Unabated B G.S. 131D-4.5B(b) ACH Medication Aides; Training and Competency Evaluation Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medication aide had successfully passed the state medication aide written exam within 60 days of hire and validation of their medication administration competency checklist. Appealed 10/21/2019
Heavenly Merciful Home of Tyner FCL-021-005 9/24/2019 $6,400.00 Unabated B 10A NCAC 13G .0507 Training in Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure at least one staff person on the premises at all times had completed a course on cardio-pulmonary resuscitation (CPR) and choking management within the last 24 months. Appealed 10/21/2019
Heavenly Merciful Home of Tyner FCL-021-005 9/24/2019 $6,400.00 Unabated B 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to perform criminal background checks on staff prior to hire. Appealed 10/21/2019

Cleveland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lean's 3 Family Care Home FCL-023-049 1/18/2019 $500.00 A2 10A NCAC 13G .0901(b)   Cooperation with Case Managers; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision to 1 resident who was assessed as disoriented and had a history of wandering. Paid in Full (03/20/2019)
Cleveland House HAL-023-045 10/1/2020 $7,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute health care needs for 1 of 5 sampled residents related to delayed treatment for a resident who had black tarry stools, dizziness and weakness and in regard to delayed treatment for two fractures of the right wrist after a fall, (Resident #1). Appealed 10/30/2020
Cleveland House HAL-023-045 10/1/2020 $5,250.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 5 of 5 sampled residents (Resident #1, #2, #3, #4, and #5) related to falls. Appealed 10/30/2020

Columbus County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lake Pointe AL (Pty 1) HAL-024-011 8/23/2018 $4,000.00 A1 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to assure that residents were free from neglect and mental abuse. Settlement Fulfilled 02/26/2019 Settlement Agreement 01/10/2019 Appealed 09/20/2018 $2,000.00 2/26/2019
Lake Pointe AL (Pty 2) HAL-024-011 8/23/2018 $4,000.00 A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the health care needs of 5 by failing to report an infection wound to health care provider; failing to follow-up with a referral to a cardiologist; failing to follow-up with a the health care provider as indicated by the ER referral after a resident was treated for wound care and for a resident treated for seizures; and by failing to notify health care provider for a resident's tooth pain. Settlement Fulfilled 02/26/2019 Settlement Agreement 01/10/2019 Appealed 09/20/2018 $4,000.00 2/26/2019
Lake Pointe AL (Pty 3) HAL-024-011 8/23/2018 $2,000.00 A2 10A NCAC 13F .0702(f)   Discharge of Residents; G.S. 131D-21(17)   Declaration of Residents' Rights; G.S. 131D-25  Facility failed to ensure a safe and orderly discharge for 1 resident. Settlement Fulfilled 02/26/2019 Settlement Agreement 01/10/2019 Appealed 09/20/2018 $4,000.00 2/26/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $16,000.00 A1 10A NCAC 13F .0604(1)(a)(b)(c)   Personal Care and Other Staffing; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure there was enough staff on duty to monitor and meet the needs of the residents according to facility census, for 8 of 8 Shifts sampled from 10/12/18-10/15/18. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .0901(a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide scheduled showers, incontinence care, bed linen changes, and assistance with transfers for 3 residents, resulting in one resident falling out of bed. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision resulting in resident leaving unsupervised. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $16,000.00 A2 10A NCAC 13F .0307(a)(b)(c)   Fire Alarm System; G.S. 131D-21(4)  Facility failed to assure the fire alarm system was able to transmit a signal automatically to the local emergency fire department dispatch center and failed to conduct mandatory fire watches. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $20,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that acute and routine health care needs were met. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $20,000.00 A2 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure policies implemented to maintain each residents' rights which resulted in significant noncompliance with rules and statutes. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 G.S. 131D-4.4A(b)   Adult care home infection prevention requirements; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to maintain infection control procedures consistent with the federal CDC guidelines for infection prevention. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 2/19/2019 $17,800.00 Unabated B 10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure floors in the hallways, activity room, dining room and 4 resident rooms were kept safe, free of hazards, and were in good repair. Appealed 11/25/2019
Lake Pointe Assisted Living HAL-024-011 2/19/2019 $7,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the health needs. Appealed 11/25/2019
Lake Pointe Assisted Living HAL-024-011 10/24/2019 $17,800.00 Unabated B 10A NCAC 13F .0306(a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure the floors in the hallways, activity room, the dining room and 4 resident rooms were kept safe and free of hazards. Appealed 11/25/2019
Lake Pointe Assisted Living HAL-024-011 10/24/2019 $7,000.00 A2 10A NCAC 1310A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure the health care needs of residents were met. Appealed 11/25/2019
Liberty Hill Family Care FCL-024-012 12/9/2019 $1,000.00 A2 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(4) The facility failed to provide supervision in accordance with the resident's need for 1 resident. Referred to Controller's Office 04/07/2020
Liberty Hill Family Care FCL-024-012 12/9/2019 $2,000.00 A2 10A NCAC 13G .0601(a) Personal Care & Supervision; G.S. 131D-21(4) The Administrator failed to assure the total operation of the facility to meet and maintain rules related to supervision, health care, residents' rights, medication administration, medication disposition, management and other staff and housekeeping and furnishings. Referred to Controller's Office 04/07/2020
Liberty Hill Family Care FCL-024-012 8/24/2020 $14,300.00 Unabated B 10A NCAC 13G .0315(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the front living room, back living room, dining room, kitchen, one resident bedroom, bathroom, and walkway areas in Facility were maintained in an uncluttered, clean and orderly manner, free of obstructions and hazards which consisted of broken glass.

Craven County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
New Bern House (name change to The Gardens of Trent) Pty 1 HAL-025-035 8/23/2018 $2,000.00 A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to obtain health care for 3 residents. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019
New Bern House (name change to The Gardens of Trent) Pty 2 HAL-025-035 8/23/2018 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights Facility failed to provide supervision for 1 resident known to be disoriented and known to remove Wanderguard and had wandered away from facility. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019
New Bern House (name change to The Gardens of Trent) Pty 3 HAL-025-035 8/23/2018 $5,000.00 A1 10A NCAC 13F .0909   Resident Rights, G.S. 131-21D(4)   Declaration of Residents' Rights Facility failed to protect 1 resident from neglect. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019
New Bern House (name change to The Gardens of Trent) Pty 4 HAL-025-035 8/23/2018 $2,000.00 A2 10A NCAC 13F .1004   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for 3 residents by prescribing practitioner. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019
Croatan Village HAL-025-037 1/24/2019 $4,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to assure the acute health care needs were met for 1 resident. Paid in Full $4,000.00 3/25/2019
Croatan Village HAL-025-037 1/18/2019 $4,000.00 A1 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision by not implementing interventions to address the current symptoms needs for 1 resident. Paid in Full $4,000.00 3/25/2019
Croatan Village HAL-025-037 8/5/2019 $7,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure the acute health care needs were met for sampled residents, related to failure to seen for medical evaluation. Paid in Full $7,000.00 10/7/2019
Good Shepherd Home for the Aged HAL-025-023 8/5/2019 $2,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(1) Declaration of Residents' Rights Facility failed to assure residents were treated with dignity and respect and received adequate care and services. Paid in Full $2,000.00 10/2/2019
Croatan Village HAL-025-037 12/9/2019 $750.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident. Paid in Full $750.00 2/10/2020

Cumberland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Harmony at Hope Mills HAL-026-065 8/7/2020 $7,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents (#2) resulting in the resident having multiple falls and sustaining injuries including multiple bruising over her entire body, a fracture to the right eye socket with optic nerve damage, and a laceration to the back of her head requiring sutures. Appealed 09/8/2020
Morning Star Special Care Unit HAL-026-066 8/7/2020 $1,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision to meet the needs of 1 of 5 sampled residents (Resident #2) who had three falls in less than 30 days. Paid in Full $1,000.00 8/25/2020
Morning Star Special Care Unit HAL-026-066 8/7/2020 $1,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for 2 of 5 residents (Resident #5 and Resident #1) related to wound care treatment orders and new skin breakdown. Paid in Full $1,000.00 8/25/2020
Morning Star Special Care Unit HAL-026-066 8/7/2020 $2,000.00 A2 10A NCAC 13 F .0902(b)Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered by a physician for 2 of 5 sampled residents (Resident #3) administered glipizide (an antidiabetic medication) without an order and Resident #5 not administered Flomax 0.4mg (used to improve urination flow in men) for 12 consecutive days. Paid in Full $2,000.00 8/25/2020

Dare County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor of the Outer Banks HAL-028-001 3/18/2019 $500.00 A2 10A NCAC 13F .0901(b)   Personal Care and Supervision G.S. 131D-21(2)   Declaration of Residents' Rights facility failed to provide supervision for 1 resident. Paid in Full $500.00 3/28/2019
Spring Arbor of the Outer Banks HAL-028-001 9/24/2019 $500.00 A2 10A NCAC 13F .0909 Residents Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure resident was protected. Paid in Full 500 9/30/2019
Spring Arbor of the Outer Banks HAL-028-001 9/24/2019 $500.00 Unabated A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide the necessary supervision to resident. Paid in Full 200 9/30/2019

Davidson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor of Thomasville HAL-029-004 11/18/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights "The facility failed to ensure medications were administered as ordered and in accordance with the facilities policies for two residents. " Paid in Full $2,000.00 1/14/2020
Brookstone Retirement Center HAL-029-001 8/24/2020 $3,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 7 sampled residents (#5 ) residing in the SCU, having repeated falls and requiring hip replacement surgery.
Grayson Creek of Welcome HAL-029-010 8/7/2020 $19,800.00 Unabated B 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered for 3 of 7 sampled residents (#1, #4, and #5) related to an antibiotic (#5), a diuretic (#1), and an anti-diabetic medication, anti-inflammatory medication, and anti-fungal medication (#4). Appealed 09/4/2020

Davie County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Heritage of Cedar Rock HAL-030-007 9/12/2018 $12,000.00 A2 G.S. 131-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Facility Administrator/Director failed to assure the total operations of the facility to meet and maintain rules and regulations related to housekeeping, staff training and qualifications, supervision, HCPR, incident and accident reporting, discharges, resident's rights, health care, nutrition and food services, activities and medication administration. Settlement Agreement 12/23/2019 Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 $7,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights Facility failed to provide supervision/ monitoring related to the safety for 1 resident. Settlement Agreement 12/23/2019 Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 $7,000.00 A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications and treatments were implemented for 1 resident. Settlement Agreement 12/23/2019 Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 $7,000.00 A2 10A NCAC 13F .0909   Resident Rights, G.S. 131D-21(2) & G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to protect 3 residents from mental, physical, and sexual abuse. Settlement Agreement 12/23/2019 Appealed 10/02/2018
The Heritage of Cedar Rock HAL-028-007 5/15/2019 $7,000.00 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision/monitoring related to safety for 1 resident. Settlement Agreement 10/23/2019 Appealed 05/17/2019
The Heritage of Cedar Rock HAL-030-007 7/15/2019 $12,000.00 A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Settlement Fulfilled 03/24/2020 Settlement Agreement 03/11/2020 Appealed 7/26/2019 $60,000.00 3/24/2020
The Heritage of Cedar Rock HAL-030-007 2/15/2021 $14000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to contact the health care and mental health providers and specialist health care providers for 7 of 11 sampled residents.
The Heritage of Cedar Rock HAL-030-007 2/15/2021 $14000.00 A1 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered by a licensed practicing practitioner for 6 of 6 sampled residents (#1, #2, #3, #4, #5 and #12) related to a topical antiseptic (#3), an anti-coagulant and a narcotic pain reliever (#4), a rapid acting insulin (#2, #3 and #12), a diuretic (#5), and a gastric acid reducer (#1).
The Heritage of Cedar Rock HAL-030-007 2/15/2021 $14000.00 A2 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 the facility were implemented and rules were maintained for ACH infection prevention requirements, medication administration, controlled substances, supervision, physical environment, personal care, housekeeping and furnishings, criminal background check, health care personnel registry check, nutrition and food services, residents' rights, health care personnel registry, incident and accident reports, activities, tuberculosis test, health care, ACH medication aides.

Duplin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wellington Park HAL-031-006 8/5/2019 $2,000.00 A1 10A NCAC 13F . 0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure physician notification for residents sampled with ankle wound. Paid in Full $2,000.00 8/30/2019
Autumn Village HAL-031-018 11/18/2019 $16,000.00 A2 10A NCAC 13F .0902(c)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to perform cardiopulmonary resuscitation for 1 resident that was found unresponsive with no pulse. Appealed 12/16/2019 Paid in Full $16,000.00 10/6/2020
Wellington Park HAL-031-006 11/18/2019 $3,500.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to ensure 1 resident was free from physical abuse. Appealed 11/26/2019
Moore Family Care Home #2 FCL-031-007 8/7/2020 $750.00 A2 10A NCAC 13 G .0909 Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure the 1 of 3 sampled residents was kept free from verbal and physical abuse by the Administrator. Paid in Full $750.00 8/25/2020
Moore Family Care Home #2 FCL-031-007 8/7/2020 $1,000.00 A2 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure that 1 of 3 residents was kept free verbal and physical abuse. Paid in Full $1,000.00 8/25/2020

Durham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Valley Living @ Oak Grove FCL-032-144 8/23/2018 $6,100.00 Unabated B 10A NCAC 13G .0206   Capacity; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to notify the DHSR of the evacuation capabilities of 4 residents that did not meet the facility's licensed ambulatory status as evident by residents requiring verbal prompting and the use of assistive device for ambulation. Paid in Full $1,000.00 12/11/2018
Spring Valley @ Beechwood FCL-032-133 12/13/2018 8000 A1 10A NCAC 13G .0312   Outside Entrance and Exits; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that exit alarms were of sufficient volume for staff to hear while on duty resulting in 1 resident diagnosis with dementia eloping and being seriously injured. Referred to Controller's Office 04/09/2019
Central Family Care Home - Clayton Road FCL-032-158 7/1/2019 $28,500.00 Unabated A2 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure sampled staff did not have substantiated findings on the Health Care Personnel Registry (HCPR) prior to employment. Referred to Controller's Office 09/18/2019

Edgecombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Kinillie Family Care Home FCL-033-015 1/24/2019 $500.00 A2 10A NCAC 13G .0901(b)   Cooperation with Case managers; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 4 sampled residents. Referred to Controller's Office 04/09/2019
Kinillie Family Care Home FCL-033-015 1/24/2019 $2,000.00 A1 10A NCAC 13G .0902(b)   Health Care, 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure management and overall operations by failing to implement rules and regulations related to management and other health care training. TB skin test for residents, medication administration, resident rights. and building service equipment Referred to Controller's Office 04/09/2019
Kinillie Family Care Home FCL-033-015 1/24/2019 $2,000.00 A1 10A NCAC 13G .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure 2 (#2 and were administered medications as ordered for Resident #3 who Was ordered anti-seizure medication: and Resident $2 was ordered an anti-psychotic mediation, Referred to Controller's Office 04/09/2019
Open Fields Assisted Living HAL-033-001 1/18/2019 $4,000.00 A2 10A NCAC 13F .0901(b) Cooperation with Case Managers; Facility failed to provide supervision for 1 of 7 residents. Resulting in a resident diagnosed with Alzheimer's, constantly disoriented and was known to wander, and eloped from the facility. Settlement Fulfilled 01/07/2019 Settlement Agreement 05/03/2019 Appealed 02/18/2019 $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $4,000.00 A1 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide bathing assistance for 1 resident. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $20,000.00 A1 10A NCAC 13F .0603   Management of Facilities with Capacity of 81 or More; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure the overall management, operations and policies and procedures of the facility were developed and implemented resulting in significant noncompliance with state rules and regulations related to each residents' right to be free of serious harm and neglect, supervision of residents, clarification of orders and testing for tuberculosis. Paid in Full $20,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $18,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide the necessary services to assure the protection of 2 residents. Paid in Full $18,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $4,000.00 A2 10A NCAC 13F .1002 (a)   Medication Orders; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to clarify orders for 1 resident. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $20,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure supervision was provided for 3 residents. Paid in Full $20,000.00 1/7/2019
Open Arms Family Services #2 FCL-033-011 4/4/2019 $1,000.00 A2 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; G.S. 131D-21 4 Declaration of Residents' Rights Facility failed to assure 1 of 3 sampled staff had no substantiated findings on their Health Care Personnel Registry (HCPR). Referred to Controller's Office 08/08/2019
Open Arms Family Services #2 FCL-033-011 4/4/2019 $500.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 2 Declaration of Residents' Rights Facility failed to assure medication was administered as ordered for 1 of 3 related to medication used to treat mood disorders. Referred to Controller's Office 08/08/2019
Heritage Care of Rocky Mount HAL-033-005 6/19/2019 $1,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Settlement Fulfilled 04/01/2020 Settlement Agreement 03/24/2020 Appeal 06/14/2019
A Child's Hope Family Health Care FCL-033-016 12/21/2018 $1,000.00 A1 10A NCAC 13G.0909 Resident Rights; G.S. 131D-21(2) Facility failed to assure resident's rights were maintained as related to residents not being treted with dignity and respect and right to privacy. Settlement Fulfilled 06/10/2020 Settlemnt Agreement 02/15/2019 9/26/1902 6/10/2020

Forsyth County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Carillon Assisted Living of Clemmons HAL-034-099 1/25/2019 $0.00 A2 10A NCAC 13F .0901(b) Cooperation with Case managers; G.S. 1315-21 (4) Declaration of Residents' Rights The facility failed to provide supervision for 2 residents who were disoriented and ambulatory. Resulting in repeated falls with injuries including a cervical vertebrae fracture and
Memory Care of the Triad HAL-034-068 1/31/2019 $3,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify the physician for 3 residents with order to contact the physician if blood sugar was over 400, TED hose not applied as ordered, and a resident threatening suicide who had no antipsychotic medication available for administration resulting in behavioral changes. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications for 6 residents including; a behavior medication, a antipsychotic medication, a sleep supplement, high blood pressure medication, cholesterol medication, two dementia medications, a rapid acting insulin and a long-acting insulin, an antipsychotic medication, an antidepressant, and vitamin supplement; a topical steroid cream, and a moisturizing cream. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $1,000.00 A2 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 3 residents who disoriented and semi-ambulatory resulting in repeated falls with injuries to include a broken elbow, subdural hematoma and broken wrist. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $1,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications for 2 residents observed during the medication pass with errors related to crushing medications that should not be crushed for vitamin B12, metoprolol ER, isosorbide ER, and improper dosing for sertraline liquid; and 3 residents related to furosemide, morphine sulfate 30 mg ER, morphine sulfate oral solution, and lorazepam oral solution, and atenolol Settlement Agreement 11/15/2019 Appealed 02/11/2019
Tranquility Care HAL-034-104 7/15/2019 $200.00 Unabated B G.S. 131D-4.5B(b) Rules adopted by Medical Care Commission; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure staff sampled who administered medications had employment verification or completed the 5-10-15 hour state approved medication administration training courses as required, or had a Medication Clinical Skills Competency checklist completed prior to administering medications. Paid in Full $200.00 8/29/2019
Salem Terrace HAL-034-098 11/18/2019 $7,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered and in accordance with the facility's policies. Paid in Full $7,000.00 1/21/2020
C.R.T. - Golden Lamb Rest Home HAL-034-019 12/9/2019 $2,000.00 Unabated B G.S. 131D-4.5B(b) Rules adopted by Medical Care Commission; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure 1 staff who administered medications, had completed the Medication Clinical Skills Competency Validation. Appealed 01/08/2020
The Bradford Village of Kernersville - West HAL-034-069 8/24/2020 $16,500.00 Unabated B 10A NCAC 13F .1004   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered by a prescribing practitioner for 2 of 5 sampled residents (#1 and #3) including a non-steroidal anti-inflammatory medication (#3) and a medication to treat gastric reflux (#1). Appealed 09/04/2020
Danby House HAL-034-093 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
Danby House HAL-034-093 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
Danby House HAL-034-093 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
Danby House HAL-034-093 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
Danby House HAL-034-093 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

Franklin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pinewood Manor Assisted Living FCL-035-030 10/10/2018 $2,000.00 A2 10A NCAC 13G .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide adequate supervision for 2 residents based on their assessed needs who had to administer their own medications; and for 1 resident assessed as totally dependent and intermittently disoriented related to Supervisor in Charge (SIC) becoming intoxicated while on duty. Settlement Fulfilled 02/04/2019 Settlement Agreement 01/03/2019 $500.00 2/4/2019
Pinewood Manor Assisted Living FCL-035-030 10/10/2018 $6,000.00 A1 10A NCAC 13G .0909 Resident Rights, 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131-21D (2) Declaration of Residents' Rights Facility failed to assure residents were free of neglect and mental abuse and failing to provide care and services for residents related to Supervisor in Charge (SIC) who instructed a resident to drive facility vehicle, pick up a member of the public, SIC purchasing and consuming alcohol and becoming intoxicated and disorderly while on duty requiring law enforcement to be called; Administrator failed to assure the overall management, operations and implementation of policies and procedures to maintain substantial compliance with rules and statues. Settlement Fulfilled 02/04/2019 Settlement Agreement 01/03/2019 $500.00 2/4/2019
Franklin Manor Assisted Living Center HAL-035-024 12/13/2018 $14,000.00 A1 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide adequate supervision for 5 residents in the Special Care Unit (SCU) with histories of frequent falls resulting in serious injuries including a femur fracture, subdural hematoma, and bruises and skin tears. Appealed 01/11/2019
Franklin Manor Assisted Living Center HAL-035-024 12/13/2018 $12,000.00 A2 10A NCAC 13F .0902 (b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure health care referral and follow up for 2 residents regarding medical evaluation of blood in urine and incontinence brief for 7 to 10 days, and for 1 resident regarding blood pressure refusals. Appealed 01/11/2019
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure residents were free of abuse as evidenced by allegations of Staff D verbally and physically abusing Resident #1 and Staff E exploiting Resident #11 by selling a narcotic medication for anxiety to the resident.
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with facility's policies for 4 of 8 residents (#3, #5, #13, #14,) observed during the medication passes including errors with insulin (#3, #14), an inhaler (#5), and a stool softener (#13); and for 3 of 6 residents sampled (#1, #3, #5) for record review including errors with an antipsychotic (#1), a Vitamin D supplement (#3), and an antidepressant (#5).
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 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 other requirements, health care, residents' rights, medication administration, controlled substances, nutrition and food service, health care personnel registry, and activities, all of which are the responsibility of the Administrator.
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $5,250.00 A2 G.S. 131D-21(5) Assisted Living Residence; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure Resident #1 was free of chemical restraints as related to the resident testing positive for a narcotic medication she had not been ordered to receive after the resident had an episode of agitation.

Gaston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rosewood Assisted Living pty#1 HAL-036-004 9/13/2018 $4,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 resident who was having suicidal thoughts in accordance with the resident's assessed needs and current symptoms. Settlement Fulfilled 12/13/2019 Settlement Agreement 05/10/2019 Appealed 10/04/2018 $500.00 12/13/2019
Rosewood Assisted Living pty#2 HAL-036-004 9/13/2018 $4,000.00 A2 10A NCAC 13F .0901 (a)   Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide personal care for 1 resident who required assistance with bathing and who was wearing the same soiled clothing for 10 days. Settlement Fulfilled 12/13/2019 Settlement Agreement 05/10/2019 Appealed 10/04/2018 $500.00 12/13/2019
Rosewood Assisted Living pty #3 HAL-036-004 9/13/2018 $7,000.00 A2 G.S. 131D-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Facility Administrator failed to assure the total operation of the facility met and maintained rules and regulations related to housekeeping and furnishings, personal care and supervision, health care, activities, reporting accidents and incidents and neglect. Settlement Fulfilled 12/13/2019 Settlement Agreement 05/10/2019 Appealed 10/04/2018 $500.00 12/13/2019
Wellington House HAL-036-031 11/18/2019 $4,000.00 A2 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights "The facility failed to respond immediately in the case of an incident involving a resident and in accordance with the facility's established policy and procedures. " Appealed 12/16/2019
Wellington House HAL-036-031 11/18/2019 $4,000.00 A2 10A NCAC 13F .1212 Reporting of Incidents and Accidents; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to immediately notify local law enforcement authorities for 1 resident after staff reported an allegation of sexual assault. Appealed 12/16/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A1 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to assure personal care for 1 resident who smelled of urine from a leaking Foley catheter. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to assure supervision was provided to 3 residents related to another resident's alcohol use and possession of drug paraphernalia. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to assure referral and follow up to the medical providers for 3 residents. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to assure residents' rights for 2 residents in regards to resident being fearful of threats to other residents. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 " 10a NCAC 13F .1006(b) Medication Storage; G.S. 131D-21(4) Declaration of Residents' Rights" The facility failed to assure medications were maintained in a safe manner under locked security or under direct supervision. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights The Administrator failed to assure the management, operations, and policies of the facility were implemented and rules were maintained. Appealed 12/19/2019

Granville County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Davis Family Care Home FCL-039-011 1/31/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(7)   Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure a staff member had a criminal background check in accordance with G.S. 114-19.10 and 131D-40 Settlement Fulfilled 03/13/2020 Settlement Agreement 06/28/2019 Appealed 02/22/2019 $500.00 3/13/2020
Dependable FCH - Pty 1 FCL-039-016 1/25/2019 $1,000.00 A2 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure the management and overall operations of the facility by not implementing rules and regulations. Referred to Controller's Office 05/17/2019
Dependable FCH - Pty 2 FCL-039-016 1/25/2019 $1,000.00 A2 10A NCAC 13G .0601(b)(1)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure a staff member was in the home at all times resulting in the residents were left alone. Referred to Controller's Office 05/17/2019
Harris Home FCL-039-002 8/7/2020 $8,700.00 Unabated B 10A NCAC 13G .0901(b) Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure supervision was provided for 1 of 2 sampled residents (#2) with a history of smoking in facility. Paid in Full $8,700.00 9/1/2020

Greene County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Edwards Group Home #6 FCL-040-003 12/9/2019 $1,500.00 A2 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2)   Declaration of Residents' Rights The facility failed to assure residents were free of exploitation. Paid in Full $1,500.00 2/3/2020

Guilford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
St Gales Manor HAL-041-023 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure as needed medication for shortness of breath was administered as ordered by the prescribing physician for sampled residents. Paid in Full $1,000.00 7/10/2019
St. Gales Estates HAL-041-023 7/1/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Paid in Full $4,000.00 8/8/2019
Brookdale Northwest Greensboro HAL-041-031 9/24/2019 $1,000.00 A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the hot water temperatures were maintained between 100 degrees Fahrenheit (F) to 116 degrees F Paid in Full $1,000.00 10/4/2019
Carriage House Senior Living Community HAL-041-065 9/24/2019 $1,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure health care referral and follow up for residents who had suicidal ideations. Paid in Full $1,000.00 11/8/2019
Carriage House Senior Living Community HAL-041-065 9/24/2019 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights "Facility failed to provide supervision for sampled residents who had a diagnosis of Alzheimer's disease who eloped on third shift and was found outside the facility. " Paid in Full $1,000.00 11/8/2019
Liggins Family Care Home Woodmere Center FCL-041-071 9/24/2019 $1,000.00 A2 G.S. 131D-21 (17) Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights "Facility failed to assure residents were provided a choice prior to being transferred from the licensed facility to the Administrator's private residence. " Paid in Full $1,000.00 12/2/2019
Liggins Family Care Home Woodmere Center FCL-041-071 9/24/2019 $1,000.00 A2 10A NCAC G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to assure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing family care homes. Paid in Full $1,000.00 12/2/2019
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $5,250.00 A1 GS 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to assure 4 staff had a criminal background check. Appealed 12/18/2019
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $3,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident who had a history of sexually inappropriate behavior toward other residents. Appealed 12/18/2019
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $5,250.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to assure 1 resident was free of verbal abuse and inappropriate sexual behaviors by another resident. Appealed 12/18/2019
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure medications were administered as ordered by a licensed practicing practitioner. Appealed 12/18/2019
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $3,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure allegations of verbal and physical abuse and neglect were reported to the Health Care Personnel Registry. Appealed 12/18/2019
Holden Heights HAL-041-080 11/18/2019 $2,000.00 A2 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to contact the physician for clarification to determine if the services of the facility met the individual's needs. Appealed 12/16/2019

Harnett County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Johnson Better Care Facility HAL-043-003 9/12/2018 $1,000.00 A2 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure residents were free from mental abuse by staff . Paid in Full $1,000.00 9/25/2018
Oak Hill Living Center HAL-043-015 12/12/2018 $11,000.00 A1 10A NCAC 13F .0901 (c)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide care and intervention according to facility's policies and procedures for 1 resident by not performing cardiopulmonary resuscitation (CPR) who was unresponsive and did not have a do not resuscitate (DNR) order. Paid in Full $11,000.00 2/12/2019
Absolute Care Assisted Living HAL-043-029 1/31/2019 $12,800.00 Unabated B 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for 2 residents which included medications for dementia and allergies , blood clots and heart conditions Settlement Agreement 11/15/2019 Appealed 02/28/2019
Absolute Care Assisted Living HAL-043-029 2/19/2019 $19,000.00 Unabated B 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to supervise 1 of 3 sampled residents who required assistance with ambulation and transfers and had a history of falls. Settlement Agreement 11/15/2019 Appealed 03/19/2019
Senter's Rest Home HAL-043-024 12/12/2018 $10,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to implement effective interventions as ordered by residents' primary care providers or in accordance with facility's fall management program for 3 residents identified by facility as high risk for falls and experienced multiple falls with injuries. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $500.00 A1 10A NCAC 13F .1308 (a)   Special Care Unit Staffing; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure adequate staffing to meet the needs of residents on 18 of 48 shifts resulting in staff not providing every two hour incontinence care and safety checks for residents. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $6,000.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure consistent responsibility for the operation, administration, management and supervision of the facility resulting in significant noncompliance with state rules and regulations related to personal care, supervision, health care, special care unit staffing, and reporting accidents and incidents. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $2,000.00 Unabated B 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide safety and incontinence care checks every two hours for 3 residents resulting in 1 resident's death being unnoticed by staff; 1 resident being hospitalized with sepsis and 1 resident sustaining skin breakdown. Paid in Full $2,000.00 2/8/2019
Absolute Care Assisted Living II HAL-043-031 6/17/2019 $4,000.00 A2 10A NCAC 13F .0504(a) Competency Validation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medication aides were competency validated to administer medication and feedings through a gastrostomy tube. Settlement Agreement 11/15/2019 Appealed 07/17/2019
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $9,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents who was a known as high elopement risk.
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $23,400.00 Unabated Type B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with facility's policies.
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $12,000.00 A2 10A NCAC 13F .0909   Resident Rights, G.S. 131-21(4)   Declaration of Residents' Rights Facility failed to assure residents were protected from abuse as evidenced by staff A who was observed slapping a resident
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $18,000.00 A2 10A NCAC 13F .0305(h)(4)   Physical Environment; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure all exit doors were equipped with a sounding device that was activated when the door was opened .
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $20,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 2 of 5 sampled residents known to wander , who eloped from the facility after staff failed to secure the doors of the facility on two separate occasions.
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $16,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to meet the acute health care needs of 1 of 5 sampled residents by not contacting emergency medical services immediately for a resident that was barely responsive and later died in the hospital
Green Leaf Care Center HAL-043-027 8/7/2020 $250.00 A2 10A NCAC 13 F .0901 Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 3 sampled residents' (#1) who had falls. Paid in Full $250.00 9/1/2020
Senter's Rest Home HAL-043-024 8/7/2020 $1,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were protected from abuse and neglect as evidence by staff who was observed grabbing, shaking and throwing a resident not the bed and slapping the hand of another resident. Appealed 09/04/2020

Henderson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Landings of Mills River HAL-045-127 8/7/2020 $3,500.00 A2 10A NCAC 13 F .0902( c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to implement a physician's order related to keeping a dementia resident inside facility for 1 of 5 residents (Resident #1) resulting with the resident being found outside for an undetermined amount of time and being sent to the hospital for dehydration and heat exhaustion. Appealed 09/04/2020

Hertford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pinewood Manor HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-25 Implementation; G.S. 131D-21(11)   Declaration of Residents' Rights Facility failed to assure residents had the right to voice complaints and be free of retaliation by Administrator and a staff by threats of discharge from facility and attempt to have 1 resident involuntarily committed; and failed to assure 1 hall was free of unpleasant and offensive odors that spread through the entire hall, front sitting and dining room areas. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(1)   Declaration of Residents' Rights Facility failed to assure residents were treated with respect and dignity as evidenced by the residents being subjected to disrespectfulness by the way Administrator, Resident Care Coordinator and other staff yelled and/or cursed at residents. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure 1 resident was free of physical abuse that resulted in both physical harm and emotional distress to resident. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor HAL-046-019 12/12/2018 $4,000.00 A1 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to investigate and report known allegations of abuse for 3 residents by 2 staff members to Health Care Personnel Registry (HCPR). Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $4,000.00 1/14/2020
Pinewood Manor HAL-046-019 12/12/2018 $7,600.00 Unabated B 10A NCAC 13F .0306 (a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to maintain areas that were uncluttered, clean and orderly manner, free of obstructions and hazards to doors, residents' rooms, bathrooms, showers, common living rooms, and dining areas. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,600.00 1/14/2020
Pinewood Manor Assisted Living HAL-046-019 4/4/2019 $18,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure residents were treated with respect and dignity and resided in an environment free of verbal, physical, mental and emotional abuse and threats of retaliation for communicating complaints. Referred to Controller's Office 08/08/2019
Pinewood Manor Assisted Living HAL-046-019 4/4/2019 $18,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' right which resulted in significant noncompliance with state rules and regulations related to health care and residents' rights Referred to Controller's Office 08/08/2019
Pinewood Manor Assisted Living HAL-046-019 6/28/2019 $18,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were treated with dignity and respect and received adequate care and services. Appealed 07/17/2019
Pinewood Manor Assisted Living HAL-046-019 6/28/2019 $18,000.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents received care and services which were adequate, appropriate and in compliance with relevant federal and state laws and rules and regulations related to health care and implementation of residents rights. Appealed 07/17/2019

Hoke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Crossings at Wayside HAL-047-011 12/12/2018 $4,000.00 A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed administer prescribed medications as ordered by licensed prescribing practitioner for 1 resident. Appealed 01/11/2019
The Crossings at Wayside HAL-047-011 12/12/2018 $14,000.00 A1 10A NCAC 13F .0902 (b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure referral for the acute health care needs for 1 resident who asked to be taken to local hospital for medical evaluation after complaining of severe pain. Appealed 01/11/2019
The Crossings at Wayside HAL-047-011 12/12/2018 $4,000.00 A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer prescription medications in accordance with orders prescribed by a licensed prescribing practitioner for 1 resident. Appealed 01/11/2019
Open Arms Retirement Center HAL-047-009 1/6/2019 $14,000.00 A2 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure bleaches. cleaners, and disinfectants were stored in a area and not accessible to residents. Settlement Agreement 04/02/2020 Appealed 02/01/2019
The Crossings at Wayside HAL-047-011 12/12/2018 $14,000.00 A1 10A NCAC 13F .0902 (b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure referral for the acute health care needs for 1 resident by not taking resident for a medical evaluation after complaining of severe pain and asking to be taken to hospital. Appealed 01/11/2019
The Crossings at Wayside HAL-047-011 7/1/2019 $10,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for residents sampled in accordance with the resident's assessed needs and current symptoms. Paid in Full $10,500.00 7/22/2019
Open Arms Retirement Center HAL-047-014 8/24/2020 $1,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 2 of 6 sampled residents (#5, #6) who had multiple falls that resulted in multiple injuries and visits to the local emergency department (ED).
The Crossings at Wayside HAL-047-011 8/24/2020 $250.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 residents in accordance with the resident's assessed needs and current symptoms.

Iredell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Olin Village HAL-049-016 12/12/2018 $7,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to meet the health care needs of 2 residents by failing to coordinate a urologist physician referral visit for a resident with a documented history of urinary infections, urinary retention with an indwelling faulty catheter; and by failing to coordinate a referral appointment for a resident with a history of dysphagia and gastro esophageal reflux disease. Paid in Full $7,000.00 1/2/2019
Aurora of Statesville HAL-049-028 6/7/2019 $12,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were administered medications as ordered by a licensed prescribing practitioner. Settlement Agreement 06-24-2019
Aurora of Statesville HAL-049-028 6/7/2019 $14,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for residents who resided in the Special Care Unit (SCU) Settlement Agreement 06-24-2019
Aurora of Statesville HAL-049-028 6/7/2019 $18,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to notify the physician residents related to one resident who had a fall and was not administered an anticonvulsant as ordered. Settlement Agreement 06-24-2019
Aurora of Statesville HAL-049-028 6/7/2019 $18,000.00 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 the facility were implemented and rules were maintained for supervision. Settlement Agreement 06-24-2019
Aurora of Statesville HAL-049-028 6/7/2019 $4,400.00 Unabated B 10A NCAC 13F .0406(a) Test for Tuberculosis; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure staff were tested for tuberculosis (TB) disease upon hire Settlement Agreement 06-24-2019
Aurora of Statesville HAL-049-028 6/7/2019 $4,400.00 Unabated B 10A NCAC 13F .0407(a) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff had no substantiated findings listed on the North Carolina Health Care Personnel Registry (HCPR) prior to hire. Settlement Agreement 06-24-2019

Johnston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Clayton House Pty 1 HAL-051-041 9/12/2018 $6,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights; Facility failed to provide supervision in accordance with each resident's assessed needs and current symptoms for 2 residents with multiple falls resulting in three ER visits for 1 resident with head injuries requiring staples and sutures and for 1 resident resulting in two ER visits for bruising and pain in the buttocks. Settlement Fulfilled 07/09/2019 Settlement Agreement 05/03/2019 Appealed 10/12/2018 $3,000.00 7/9/2019
Clayton House pty#2 HAL-051-041 9/12/2018 $4,000.00 A2 10A NCAC 13F .0902 (b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to meet the health care needs for 3 residents by failing to notify physician of multiple medication refusals for a resident, failing to obtain a new wheelchair for a resident with multiple falls with injuries, and failing to coordinate a mental health referral for a resident with symptoms of depression, anxiety and agitation. Settlement Fulfilled 07/09/2019 Settlement Agreement 05/03/2019 Appealed 10/12/2018 $3,000.00 7/9/2019
Country Wood #3 FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medication was administered as ordered for 4 residents. Referred to Controller's Office 04/09/2019
Country Wood #3 FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .0601 (a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility Administrator failed to assure the total operation of the facility to meet and maintain rules related to other staff qualifications, resident care plan, health care, resident's rights, medication administration, and adult care home medication aides training and competency evaluation requirements. Referred to Controller's Office 04/09/2019
Country Wood #3 FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .0902 (b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to meet the health care needs of 3 residents related to monthly antipsychotic injection that was not coordinated for administration or ordered from pharmacy in a timely manner resulting in a missed injection, and failing to assure residents went to scheduled visit with psychiatric provider. Referred to Controller's Office 04/09/2019
Gabriel Manor Assisted Living Center HAL-051-048 8/5/2019 $1,750.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure foods were free from contamination related to a wet pink, brown and black build-up substance in the large ice machine in the kitchen; a pink, tan and black build-up on the ice and water dispensing unit in the special care unit; Appealed 09/04/2019
Classic Care Homes #3 HAL-051-063 8/24/2020 $11,000.00 Unabated B 10A NCAC 13F .1004 (a)(2)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications for wound cleansing were maintained in a safe manner under locked security or under direct supervision of staff in charge of medication administration and were left unsecured on a counter in the hallway.
Sam's Family Care Homes FCL-051-067 8/24/2020 $6,000.00 A1 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to have sufficient staff on duty and awake at all times to meet the supervision needs for 2 of 4 sampled residents (Resident #1, #2).
Sam's Family Care Homes FCL-051-067 8/24/2020 $3,500.00 A1 10A NCAC 13G .0902(b)  Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure healthcare referral and follow up for 1 of 3 sampled residents (#1) who had symptoms of heart failure prior to a hospital admission.
Classic Care Homes #1 HAL-051-062 3/1/2021 $18000.00 Unabated B 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for 3 of 3 sampled residents (Residents #1, #2 and 3) which included including a medication used to treat major depressive disorder and neuropathic pain (#3); a medication used to treat gastroesophageal reflux disease (#2) and a medication used to treat depression and anxiety (#1).

Lee County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Leak's Family Care Home FCL-053-013 9/12/2018 $6,000.00 A1 10A NCAC 13G .0906 (f)(3)(4) Other Resident Services; G.S. 131D-21 Declaration of Residents' Rights Facility failed to notify law enforcement or the department of social services when the whereabouts of a resident was unknown. Referred to Controller's Office
Leak's Adult Family Care #3 FCL-053-019 8/7/2020 $2,000.00 A1 10A NCAC 13 G .0315(a)(5) Housekeeping and Furnishing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure Facility was kept clean, orderly and free of hazards as evidenced by a bed bug infestation for one year with live bed bugs on the blanket, sheet and mattress in resident room.

Lenoir County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Classic Care of Kinston FCL-054-069 8/5/2019 $1,000.00 A2 10A NCAC 13G . 0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician sampled residents related to scheduling follow up appointments for change in condition , post-hospital follow up medical appointments. Paid in Full $1,000.00 10/4/2019
Classic Care of Kinston FCL-054-069 8/5/2019 $1,000.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights; Administrator failed to assure the management and overall operations of the facility by failing to implement rules and regulations related to management and other staff, health care, and medication administration. Paid in Full $1,000.00 10/4/2019
Kinston Assisted Living HAL-054-062 8/5/2019 $4,000.00 A2 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the hot water temperatures were maintained at a minimum of 100 degrees Fahrenheit to a maximum of 116 degrees. Paid in Full $4,000.00 10/9/2019
Kinston Assisted Living HAL-054-062 8/12/2019 $3,500.00 A2 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide personal care assistance for resident. Paid in Full $3,500.00 10/28/2019
Kinston Assisted Living HAL-054-062 8/5/2019 $5,250.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide adequate supervision for residents. Paid in Full $5,250.00 10/9/2019
Kinston Assisted Living HAL-054-062 8/5/2019 $5,250.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for residents. Paid in Full $5,250.00 10/9/2019
Kinston Assisted Living HAL-054-062 8/5/2019 $3,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were free from resident to resident altercations resulting in physical injuries. Paid in Full $3,000.00 10/9/2019
Kinston Assisted Living HAL-054-062 8/5/2019 $5,250.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights Administrator, who was responsible for the total operation of the facility, failed to assure policies and procedures were implemented and in substantial compliance with the rules and statutes governing adult care homes as related to other requirements, personal care and supervision, health care, and residents' rights. Paid in Full $5,250.00 10/9/2019
Spring Arbor of Kinston HAL-054-066 6/17/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision resident with generalized weakness, who had five unwitnessed falls and six assisted falls during staff transfers. Paid 07/22/2019 $500.00 7/22/2019
Miller's Family Care Home FCL-054-066 11/13/2019 $375.00 A2 10A NCAC 13G .0909   Residents' Rights; G.S. 131D-21 (4)   Declaration of Residents' Rights The facility failed to assure that 1 residents was protected from physical abuse by a staff member.

Macon County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Franklin House HAL-056-006 9/27/2019 $3,500.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow up to meet the routine and acute health care needs for 1 of 8 (Resident #6) sampled residents related to the monitoring, assessment, and follow-up of a leg wound. Settlement Fulfilled 02/10/2020 Settlement Agreement 01/10/2020 Appealed 10/21/2019 $2,000.00 2/10/2020
Franklin House HAL-056-006 11/13/2020 $7,000.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights "Facility failed to assure health care referral and follow up for 1 of 4 sample residents related to critical laboratory results which resulted in hospitalization. "

Madison County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mintz Family Care Home #3 (Pty 1) FCL-057-003 9/12/2018 $8,200.00 Unabated B 10A NCAC 13G .0904 (a) (2)   Nutrition And Food Service; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to store and prepare food in a manner to protect from contamination in the kitchen and pantry.
Mintz Family Care Home #3 (Pty 2) FCL-057-003 9/12/2018 $8,200.00 Unabated B 10A NCAC 13G .0601 (a)   Management and Facilities; G.S. 131D-21(2)   Declaration of Residents' Rights Facility Administrator failed to assure rules and regulation were met and maintained relating to housekeeping and furnishings, building service equipment, outside premises, personal care training, background checks, HCPR check, TB Testing, nutrition and food service, medication administration, and pharmaceutical oversight.
Mintz Family Care Home #3 (Pty 3) FCL-057-003 9/12/2018 $6,000.00 A1 10A NCAC 13G .0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to assure 1 resident was free of exploitation by a staff who engaged in sexually inappropriate behavior with resident, and failed to assure the resident was free from verbal abuse by staff members as evident by staff cursing and making derogatory references about resident in the presence of resident.

Martin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Vintage Inn Retirement Village HAL-058-010 1/25/2019 $3,500.00 A1 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure residents were supervised for safety on the Special Care Unit. Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $333.00 2/6/2020
Vintage Inn Retirement Village HAL-058-010 1/25/2019 $3,500.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to meet healthcare needs timely residents with an eye injury of unknown origin, chest bruising and change in condition, red irritated stomach rash not responding to prescribed treatment, itchy rash on the chest, abdomen, back, and arms, and a diabetic resident with thick discolored long toenails Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $333.00 2/6/2020
Vintage Inn Retirement Village HAL-058-010 1/25/2019 $3,500.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure full time and consistent responsibility for the operation, administration, management and supervision of the facility which resulted in significant noncompliance with state rules and regulations related to personal care, supervision, health care, medication administration, residents' rights, health care personnel registry, housekeeping and furnishings and reporting incidents and accidents. Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $333.00 2/6/2020
Vintage Inn Retirement Village HAL-058-010 8/5/2019 $7,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect residents from falling off her bed sustaining injury, subsequently sent to the hospital, diagnosed with a fracture of the left shoulder, humerus and femur, and a right wrist sprain. Settlement Agreement 04/23/2020 Appealed 08/12/2019
Fields Foundation FCL-058-008 11/18/2019 $2,000.00 A2 0A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) "The facility failed to report an allegation of verbal and mental abuse toward a resident by one staff to the Health Care Personnel Registry within 24 hours. " Referred to Controller's Office 04/07/2020
Fields Foundation FCL-058-008 11/18/2019 $3,500.00 A2 10A NCAC 13G .0909   Residents' Rights; G.S. 131D-21 (4)   Declaration of Residents' Rights The facility failed to assure 1 resident was protected from verbal abuse and intimidation by another resident. Referred to Controller's Office 04/07/2020
Fields Foundation FCL-058-008 11/18/2019 $3,500.00 A1 10A NCAC 13G .0902 Health Care; G.S. 131D-21 (4)  Declaration of Residents' Rights The facility failed to notify the mental health provider for a resident who had combative behaviors and suicidal ideations. Referred to Controller's Office 04/07/2020
Vintage Inn Retirement Community HAL-058-010 3/1/2021 $5250.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 2 of 5 sampled residents (#2 and #3) according to the needs of the residents who demonstrated exit seeking (#3), left the Secure Care Unit (SCU) without knowledge of the staff and was found one half mile from the facility in need of emergency medical attention for dehydration and (#2) who exhibited aggressive behaviors toward other residents.
Vintage Inn Retirement Community HAL-058-010 3/1/2021 $10500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to contact the primary care provider (PCP) for 2 of 7 sampled residents related to a pressure ulcer on the resident's right hip (#9) and two pressure wounds on a resident's ankles (#11).

McDowell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cedarbrook Residential Center Pty 1 HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F .1004(a) Medication Administraton; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner for 4 residents. Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center Pty 2 HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights Facility failed to provide adequate supervision for 4 residents in accordance with the residents' assessed needs and current symptoms as evidenced by a resident who ingested hand sanitizer and mouthwash, a resident eating out of the trash, a resident frequently smoking inside building, and a resident escalating aggression of violent outburst and threats towards residents and stafF . Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center Pty 3 HAL-059-021 10/25/2018 $1,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility Administrator failed to assure the management, operations, and policies and procedures of the facility were implemented to maintain substantial compliance with rules relating to medication administration, residents assessments, supervision and personal care, staffing nutrition and food service, housekeeping and furnishings, and residents' rights. Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center Pty 4 HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to assure residents were not threatened by a staff who carried a utility knife at work; verbally threatened by a another staff, and that residents were not spoken to in a dismissive disrespectful manner by stafF . Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Lake James Lodge Assisted Living HAL-059-032 9/24/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure supervision of residents related to smoking. Paid in Full $2,000 10/2/2019
Lake James Lodge HAL-059-008 3/1/2021 $500.00 A2 10A NCAC 13F .1004   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure 1 of 5 sampled residents was administered medications according to physician's orders related to a resident having a narcotic pain patch applied without the old patch having been removed

Mecklenburg County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mint Hill Senior Living HAL-060-136 9/13/2018 $500.00 A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to follow-up with a durable medical equipment company to ensure portable oxygen was available for a resident with physician orders for oxygen. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018 $250.00 8/5/2019
Mint Hill Senior Living HAL-060-136 9/13/2018 $500.00 A1 10A NCAC 13F .0902(c) (3-4)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to implement physician orders for 2 residents with orders for oxygen administration and blood pressure checks. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018 $250.00 8/5/2019
Senior Retreat at Park Crossing FCL-060-152 9/12/2018 $500.00 A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to follow-up timely to meet the acute health care needs of a resident. Paid in Full $500.00 9/24/2018
Brookdale Charlotte East HAL-060-060 2/26/2019 $12,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the management, operations, and policies and procedures were implemented to maintain each residents' rights. Appealed 03/28/2019
Brookdale Charlotte East HAL-060-060 2/26/2019 $3,500.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for residents related to falls. Appealed 03/28/2019
Brookdale Charlotte East HAL-060-060 2/26/2019 $7,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure contact with resident's medical professional. Appealed 03/28/2019
Regency at Pineville HAL-060-139 2/19/2019 $4,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the management and overall operations of the facility by failing to meet and monitor rules governing adult care homes. Referred to Controller's Office 08/08/2019
Regency at Pineville HAL-060-139 2/19/2019 $4,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff provided supervision for 3 residents in SCU unit. Referred to Controller's Office 08/08/2019
Regency at Pineville HAL-060-139 2/19/2019 $4,000.00 A2 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(12)   Declaration of Residents' Rights Facility failed to notify resident's physician of changes, medications and failed to refer resident for treatment for an illness in a timely manner. Referred to Controller's Office 08/08/2019
Carillon Assisted Living of Huntersville HAL-060-142 8/5/2019 $12,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were free of neglect. Paid in Full $12,000.00 10/1/2019
Carillon Assisted Living of Mint Hill HAL-060-153 6/19/2019 $1,500.00 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 the resident's assessed needs, care plan, and current symptoms. Paid in Full $2,000.00 8/22/2019
Carillon Assisted Living of Huntersville HAL-060-142 6/17/2019 $7,000.00 A1 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to identify decubitus ulcers on a resident. Paid in Full $7,000.00 9/16/2019
Carillon Assisted Living of Huntersville HAL-060-142 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure residents medications were administered as ordered . Paid in Full $1,000.00 8/22/2019
East Towne Assisted Living HAL-060-149 6/4/2019 $6,000.00 A1 10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure implementation of orders for residents. Appealed 07/03/2019
East Towne Assisted Living HAL-060-149 6/4/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Appealed 07/03/2019
East Towne Assisted Living HAL-060-149 6/4/2019 $6,000.00 A1 10A NCAC 13F .0603(a) Management of Facilities with a Capacity or Census of 81 or more Residents; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to assure responsibility for the operation, administration, management and supervision of the facility. Appealed 07/03/2019
East Towne Assisted Living HAL-060-149 6/4/2019 $12,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral and follow up to residents. Appealed 07/03/2019
Legacy Heights Senior Living Community HAL-060-152 8/5/2019 $40,200.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered for residents including the observation of the medication pass. Paid 09-09-2019 $40,200.00
Legacy Heights Senior Living Community HAL-060-152 8/5/2019 $18,000.00 Unabated B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights facility failed to assure health care referral and follow up to meet the health care needs of residents. Paid 08-26-2019 $18,000.00 8/26/2019
Queen City Assisted Living HAL-060-126 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner for residents. Settlement Agreement 11/22/2019 Appealed 7/2/2019
Queen City Assisted Living HAL-060-126 6/17/2019 $2,000.00 A2 10A NCAC 13F . 0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute needs for residents. Settlement Agreement 11/22/2019 Appealed 7/2/2019
Summit Place of South Park HAL-060-116 8/5/2019 $9,000.00 A2 10A NCAC 13F .1002(a)(3) Medication Orders: G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to clarify orders for medications for residents with conflicting medication list. Paid in Full $9,000.00 8/21/2019
Sunrise on Providence HAL-060-057 7/1/2019 $500.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner. Paid in Full $500.00 7/18/2019
The Haven in Highland Creek HAL-060-108 6/4/2019 $2,000.00 A2 G.S. 131D-21(4) Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure residents were free from neglect, related to staff not seeking immediate medical evaluation and treatment. Paid in Full $2,000.00 6/18/2019
The Parc at Sharon Amity HAL-060-125 8/5/2019 $500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to notify resident's physician of refusals of medications. Paid 08-16-2019 $500.00 8/16/2019
East Towne HAL-060-149 9/24/2019 $21,200.00 Unabated B 10A NCAC 13F .0906 Other Resident Care And Services; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents were provided transportation to scheduled physician's appointments. Appealed 10/21/2019
East Towne HAL-060-149 9/24/2019 $15,900.00 Unabated B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were treated with respect and dignity regarding staff speaking to residents in a disrespectful manner. Appealed 10/21/2019
Elmcroft of Little Avenue HAL-060-156 9/24/2019 $250.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure multiple medications were administered to residents as ordered by the licensed prescribing practitioner. Paid in Full $250.00 10/14/2019
Summit Place of South Park HAL-060-116 10/23/2019 $7,000.00 A1 10A NCAC 13F .0901(c)  Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to respond immediately and provide intervention according to the facility's policies and procedures. Paid in Full $7,000.00 11/7/2019
Summit Place of South Park HAL-060-116 10/23/2019 $7,000.00 A1 10A NCAC 1310A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide adequate supervision for residents. Paid in Full $7,000.00 11/18/2019
The Parc at Sharon Amity HAL-060-125 11/13/2019 $500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights "The facility failed to assure physician notification for 2 residents as related to medication refusals. " Appealed 9/4/2019 $500.00 8/16/2019
East Towne HAL-060-149 11/18/2019 $128,250.00 Unabated A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to administer medications as ordered related to a resident not receiving her insulin. Appealed 12/5/2019
Regency at Pineville HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to notify the physician for 5 residents regarding medications not being available and not referring a resident for treatment for an illness in a timely manner. Referred to Controller's Office 04/28/2020
Regency at Pineville HAL-060-139 12/9/2019 $16,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights The Administrator failed to assure the management and overall operations of the facility by failing to meet and monitor rules related to personal care and supervision. Referred to Controller's Office 04/28/2020
Regency at Pineville HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to assure 4 residents were free of neglect and physical abuse. Referred to Controller's Office 04/28/2020
Regency at Pineville HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to administer medications as ordered for 5 residents. Referred to Controller's Office 04/28/2020
Regency at Pineville HAL-060-139 12/9/2019 $7,000.00 A2 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure staff provided personal care assistance for 6 residents. Referred to Controller's Office 04/28/2020
Charlotte Square HAL-060-087 8/24/2020 $2,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute healthcare needs for 2 of 7 sampled residents related to a resident who presented with lethargy, decreased appetite and a change in her ability to ambulate independently (Resident #2), and a second resident who had blood pressures that were not within normal limits (Resident #1).
East Towne Assisted Living HAL-060-149 8/24/2020 $15,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the acute and chronic health care needs were met for 1 of 6 sampled residents (Resident #7) related to primary care provider (PCP) notification of increase of a rash and itching, not receiving a topical steroid cream as ordered for psoriasis, and coordination of a return appointment to the dermatologist. Appealed 09/23/2020
Elmcroft of Little Ave. HAL-060-156 8/24/2020 $500.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 1 of 5 sampled residents who had a diagnosis of dementia and a know history of exit seeking behaviors and wandering. Paid in Full $500.00 9/15/2020
Parker Terrace HAL-060-054 8/7/2020 $3,500.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure 1 of 5 sampled residents received healthcare referral and follow-up related to seeking emergency evaluation when the resident's oxygen saturation levels began to fall.
The Crossings at Steele Creek FCL-078-077 8/24/2020 $3,500.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision in accordance with their current symptoms and assessed needs for 3 of 4 sampled residents with a history of falls (Resident #1, #3, and #4).
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13 F .0902( c)(4) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure physician notification for 4 of 7 sampled residents related to a missed appointment to the orthopedic practice after sustaining a fall requiring a total left hip replacement (Resident #1), symptoms of a urinary tract infection and abdominal pain (Resident #2), not notifying the physician of missed neurological appointments resulting in a delay in treatment and a four day hospitalization (Resident #5), and regarding a delayed urology consult (Resident #6). . Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights the Administrator failed to assure the management operations, and policies of Facility were implemented and rules were maintained for personal care, supervision, referral and follow-up. Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A2 F .0606 Facility failed to ensure 1 of 7 sampled residents (Resident #5) was provided transportation to scheduled physician's appointments related to missed Neurologist appointments, resulting in a delay of treatment and hospitalization for seizures. Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner 2 of 5 residents observed during a medication pass. Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure supervision was provided to 2 of 7 sampled residents related to a resident with a history of substance abuse, found to have knife, beer and marijuana in his room who returned to Facility on several occasions. Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (c)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond to incidents immediately and in accordance with Facility's established policy and procedures. Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $20,000.00 A1 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 4 of 7 sampled residents (Residents #2, #7, #6 and #1) related to a resident not receiving her insulin (Resident #2), a resident not receiving the evening dose of long acting insulin (Resident #7), a resident diagnosed with pneumonia not receiving nebulizer treatments as ordered (Resident #1), and a resident experiencing muscle spasm and not administered pain medication (Resident #6). Appealed 10/30/2020
East Towne Assisted Living HAL-060-149 10/1/2020 $146,000.00 Unabated A 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure physician notification for 4 of 7 sampled residents related to a missed appointment to the orthopedic practice after sustaining a fall requiring a total left hip replacement (Resident #1), symptoms of a urinary tract infection and abdominal pain (Resident #2), not notifying the physician of missed neurological appointments resulting in a delay in treatment and a four day hospitalization (Resident #5), and regarding a delayed urology consult (Resident #6). . Appealed 10/30/2020
The Parc at Sharon Amity HAL-060-125 10/1/2020 $9,000.00 A1 10A NCAC 13F .1004 (a)(1)(2)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner Appealed 10/30/2020
The Parc at Sharon Amity HAL-060-125 10/1/2020 $1,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Appealed 10/30/2020
The Parc at Sharon Amity HAL-060-125 10/1/2020 $5,250.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral and follow up for 2 of 6 sampled residents related to notifying the physician for blood sugar levels above the parameters set by the physician (Resident #6) and not notifying the physician of refusals of insulin and delayed mental health referral (Resident #1). Appealed 10/30/2020
The Parc at Sharon Amity HAL-060-125 10/1/2020 $5,250.00 A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 2 of 6 residents observed during the medication pass (Residents #6 and #7) , including a scheduled fast acting insulin dosage not administered before lunch (Resident #6) and a scheduled mood stabilizer administered as ordered (Resident #7), and for 3 of 5 residents sampled for review (Residents #1, #3 and #5) including errors with a fast acting insulin and oral medication used to treat Type 2 diabetes (Resident #3), failure to administer antipsychotic medication as ordered (Resident #1), and failure to have a medication ordered for nausea available for administration (Resident #5). . Appealed 10/30/2020

Moore County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Tara Plantation of Carthage HAL-063-011 12/9/2019 $4,000.00 A1 G.S. 131D-45   Examination and Screening for Controlled Substances The Administrator failed to assure the overall management and operations of the facility was maintained in substantial compliance with the rules and statutes for adult care homes. Appealed 1/8/2020
Tara Plantation of Carthage HAL-063-011 12/9/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer a controlled medication ordered for anxiety for 1 resident. Appealed 1/8/2020
Tara Plantation of Carthage HAL-063-011 12/9/2019 $4,000.00 A1 10A NCAC 13F .1004(I)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure Medication Aides observed 1 resident ingest her medication at the time of administration. Appealed 1/8/2020

Nash County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Somerset Court of Rocky Mount HAL-064-029 3/1/2021 $1000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to notify 2 of 3 sampled residents guardian when the resdent's relative removed the resident from facility and failed to contact law enforment when resident did not return to the facility within 24 hours.

New Hanover County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Castle Creek Memory Care (pty#1) HAL-065-034 8/23/2018 $6,000.00 A2 10A NCAC 13F .0305(h)(4)   Physical Environment; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the front entrance door alarms were maintained in operational conditions and activated with sounding device when opened resulting in 1 resident who exhibited wandering and exit seeking behaviors exiting facility unsupervised. Settlement Fulfilled 12/04/2019 Settlement Agreement 05/03/2019 Appealed 09/21/2018 $4,000.00 12/4/2019
Castle Creek Memory Care (pty#2) HAL-065-034 8/23/2018 $4,000.00 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for 3 residents in accordance to resident's assessed needs and current symptoms. Settlement Agreement 05/03/2019 Settlement Fullfilled 12/04/2019 $4,000.00 12/4/2019
Castle Creek Memory Care (pty#3) HAL-065-034 8/23/2018 $8,000.00 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care needs for 3 residents related to personal hygiene. Settlement Agreement 05/03/2019 Settlement Fullfilled 12/04/2019 $3,000.00 12/4/2019
Castle Creek Memory Care HAL-065-034 1/25/2019 $9,000.00 A2 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 resident resulting in the resident having multiple falls and sustaining multiple injuries. Appealed 02/22/2019
Brookdale Wilmington HAL-065-019 1/18/2019 $4,000.00 A2 10A NCAC 13F .0311(a)   Other Requirements; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to maintain the door alarm system in a safe and operating condition. Paid in full $4,000.00 3/4/2019
Spring Arbor of Wilmington HAL-065-014 8/5/2019 $8,000.00 A1 10A NCAC 13F .0703(d) Tuberculosis Test, Medical Examination and Immunizations; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to coordinate and assure the acute and routine health care needs were met for sampled residents. Settlement Agreement 11/15/2019 Appealed 08/22/2019
Brookdale Wilmington HAL-065-019 9/24/2019 $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 to resident who was identified as a high fall risk. Paid in Full $4,000.00 11/5/2019
Carolina Bay Health Care Center of Wilmington, LLC NH0649 11/13/2019 $20,000 A1 10A NCAC 13F .0901(c) The facility failed to check a resident every two hours according to his care plan and lower his bilateral assist bars at 1:43 AM on 10/01/19 after care was provided to 1 of 1 sampled residents (Resident #1) who had just experienced an episode of anxiety and attempted to get out of bed unassisted. Review of camera footage revealed no staff members had entered Resident #1's room between 1:43 AM and 6:42 AM on 10/01/19. The coroner's preliminary primary cause of death to be documented on the resident's death certificate was positional asphyxiation (the state or process of being deprived of oxygen, which can result in unconsciousness or death; suffocation due to the way in which the body was positioned). Paid $20,000 12/12/2019
Spring Arbor Assisted Living of Wilmington HAL-065-014 8/7/2020 $2,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow up with the licensed physicians for 3 of 6 residents (Resident #3, #9 and #5) related to documented falls ( Resident #3 and Resident #9), and Resident #5 with labs ordered by her Rheumatologist. Paid in Full $2,000.00 9/15/2020
Spring Arbor Assisted Living of Wilmington HAL-065-014 8/7/2020 $3,500.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure 2 of 5 residents (Resident #8 and #3) were treated with dignity and respect in regard to Resident #8 being monitored by a roommate's security camera without knowledge of being videotaped and Resident #3 being left unattended in her room waiting for staff to assist with her shower. Paid in Full $3,500.00 9/15/2020

Northampton County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rich Square Manor HAL-066-011 12/12/2018 2000 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect 11 residents from exploitation of their personal funds as evidence by residents' funds not being accounted for.
Hampton Manor HAL-066-012 6/4/2019 $1,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to respond to the residents need for medical attention. Settlement Agreement 12/02/2019 Appealed 07/02/2019
Rich Square Villa HAL-066-010 8/5/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure every resident's rights were maintained as related to failing to keep residents free from neglect. Settlement Fullfilled 03/05/2021 Settlement Agreement 12/23/2020 Appealed 09/04/2019 $1,000.00 3/5/2021
Rich Square Villa HAL-066-010 8/5/2019 $3,500.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure a resident who was unable to give consent was free from sexual abuse by another resident. Settlement Fullfilled 03/05/2021 Settlement Agreement 12/23/2020 Appealed 09/04/2019 $3,500.00 3/5/2021
Rich Square Manor HAL-066-011 12/12/2018 $2,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect 11 residents from exploitation of their personal funds as evidence by residents' funds not being accounted for. Settlement Fullfilled 03/05/2021 Settlement Agreement 12/23/2020 Appealed 09/04/201901/11/2019 $2,000.00 3/5/2021
Hampton Manor HAL-066-012 3/1/2021 $9000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that 4 of 5 sampled resdints were supervised resulting in aresident obtaining second degree burns while smoking in the facility while wearing oxygen tank.

Onslow County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Onslow House HAL-067-023 9/13/2018 $1,000.00 A1 10A NCAC 13F .0902 (b)   Health Care; G.S. 131D-21  Declaration of Residents' Right Facility failed to notify the primary care provider of changes for 2 residents. Settlement Fulfilled 08/05/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018
Onslow House HAL-067-023 12/12/2018 $11,000.00 A1 10A NCAC 13F .0901(c)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure staff responded immediately for 1 resident who was unresponsive requiring CPR. Settlement Agreement 10/31/2019 Appealed 01/11/2019
Lighthouse Village HAL-067-013 6/18/2019 $7,000.00 A1 10A NCAC 13F .0904(e)(4) Nutrition and Food Service; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide therapeutic diets as ordered for sampled residents. Appealed 6/24/2019
The Arc Community HAL-067-004 8/5/2019 $4,000.00 A2 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure that staff had no substantiated findings listed on the North Carolina Health Care Personnel Registry. Paid in Full $4,000.00 12/20/2019

Orange County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Livewell Assisted Living FCL-068-028 9/12/2018 $500.00 A2 10A NCAC 13G .0206 Capacity; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure residents' evacuation capabilities were in accordance with the evacuation capability listed on the home's license for residents living in facility. Paid in Full $500.00 11/14/2018
The Stratford HAL-068-025 6/4/2019 $2,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure immediate follow-up with the physician regarding residents being administered wrong medication. Settlement Fulfilled 06/09/2020 Settlement Agreement 01/10/2020 Appealed 07/02/2019 $1,000.00 6/9/2020

Pamlico County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Gardens of Pamlico HAL-069-002 1/8/2019 $500.00 A2 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(1)   Declaration of Residents' Rights Facility failed to respond to a resident's requests (#9) to be moved to another room due to verbal arguments with his roommate. Settlement Fulfilled 10/25/2019 Settlement Agreement 10/25/2019 Appealed 02/07/2019 $500.00 10/25/2019
The Gardens of Pamlico HAL-069-002 1/8/2019 $0.00 A2 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(1)   Declaration of Residents' Rights Facility failed to respond to a resident's requests (#9) to be moved to another room due to verbal arguments with his roommate. Settlement Fulfilled 10/25/2019 Settlement Agreement 10/25/2019 Appealed 02/07/2019

Pembroke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Dial's Family Care Home # 10 FCL-078-079 8/24/2020 $2,000.00 A1 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure the safety of residents as evidenced by staff failing to report feeling uncomfortable using Resident #2's mechanical lift device, failing to operate the mechanical lift device properly by failing to stabilize the lift when transferring residents and failing to have an ongoing monitoring process in place to assure the mechanical lifts were used correctly by staff and worked properly.

Pender County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashe Gardens HAL-071-015 9/12/2018 $8,000.00 A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs and current symptoms for 4 residents. Settlement Fulfilled 08/30/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018 $8,000.00 8/30/2019
Ashe Gardens (pty#2) HAL-071-015 9/12/2018 $42,500.00 A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure the health care needs for 2 residents were met by failure to assure resident received follow up visit with psychiatric provider; failure to notify license health care providers regarding behaviors; and failure to notify licensed health care providers for a resident's concerns with medication and missed speciality appointments. Settlement Fulfilled 08/30/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018 $20,000.00 8/30/2019
Ashe Gardens (pty#3) HAL-071-015 9/12/2018 $42,500.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Facility Administrator failed to assure the management, operations, and policies and procedures of the facility were implemented. Settlement Fulfilled 08/30/2019 Settlement Agreement 05/22/2019 Appealed 10/12/2018 $20,000.00 8/31/2019
Ashe Gardens HAL-071-015 12/9/2019 $10,500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to assure referral and follow up for acute and routine health care needs were met for 4 residents. Appealed 1/8/2020
Ashe Gardens HAL-071-015 12/9/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer medications as ordered and in accordance with the facility's policies for 3 residents. Appealed 1/8/2020
Ashe Gardens HAL-071-015 12/9/2019 $15,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The Executive Director failed to assure the total operation of the facility to meet and maintain rules related to personal care and supervision, health care, residents' rights, medication administration, controlled substances, and Health Care Personnel Registry. Appealed 1/8/2020
Ashe Gardens HAL-071-015 12/9/2019 $15,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to assure residents were protected from harm and injury from residents with aggressive behaviors. Appealed 1/8/2020
Ashe Gardens HAL-071-015 12/9/2019 $13,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 11 residents with assaultive, aggressive, sexually expressive and wandering behaviors. Appealed 1/8/2020
Ashe Gardens HAL-071-015 10/1/2020 $10,000.00 A1 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Executive Director (ED) failed to assure the management, operations, and policies of Facility were implemented and maintained for supervision, health care, medication orders, medication administration, special care unit staffing, adult care home medication aide training, and resident rights. Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $20,000.00 A1 10A NCAC 13F .0901  Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 6 of 12 sampled residents (#1, #2, #3, #7, #8, #19) in accordance with their current symptoms and assessed needs resulting in Residents (#1, #2, #3, #7, #8,) having multiple falls, being found on the floor, and sustaining multiple injuries to include fractures and facial and head injuries (#1, #2, #3, #7, and #8) and a resident (#19) having access to wipes when unsupervised causing an eye injury. Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $20,000.00 A1 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure safe policies and procedures were established and maintained for medication administration; failed to assure medications were administered as ordered for 2 of 5 residents (#5, #19) observed during the medication passes, including errors with medications to treat infection, hypertension, fluid and urinary retention, and two vitamin supplements. Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $10,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure health care referral and follow-up for 4 of 12 sampled residents (#4, #5, #14, #17) including failure to notify the primary care provider (PCP) of blood sugars greater than 400 (#5), failure to send a resident to the emergency department who fell and sustained a fractured hip (#14), failure to refer a resident to physical/occupational therapy (#4), and failure to notify the PCP of a resident (#17) with a draining, red, painful eye; bilateral lower extremity pitting edema; mycotic toenails; and an open wound to the outer right great toe. Appealed 10/30/2020

Perquimans County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lillian Brothers Family Care Home FCL-072-009 2/19/2019 $500.00 A2 10A NCAC 13G .0601   Management and Other Staff; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure residents were free of abuse and neglect. Paid in Full $500.00 4/2/2019
Merciful Heavenly Home of Woodville FCL-072-013 7/15/2019 $2,000.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(7) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up services for a resident. Referred to Controller's Office 10/02/2019
Merciful Heavenly Home of Woodville FCL-072-013 7/15/2019 $3,500.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights; Administrator failed to assure the overall management, operations, and policies and procedures of the facility. Referred to Controller's Office 10/02/2019

Person County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cambridge Hills Assisted Living HAL-073-003 8/5/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure all residents received care and services which were adequate, appropriate, and in compliance with relevant federal and state laws and regulations. Paid in Full $500.00 9/4/2019

Pitt County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Clemmie's Family Care Home (Closed) FCL-074-039 9/13/2018 $1,000.00 A2 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure that all bathroom fixtures hot water temperatures were maintained between 100 and 116 degrees Fahrenheit (F). Paid in Full $1,000.00 11/16/2018
Southern Living Assisted Care HAL-074-038 9/27/2019 $23,200.00 Unabated B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to schedule follow-up orthopedic care for resident. Appealed 10/28/2019
Southern Living Assisted Care HAL-074-038 12/9/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure referral and follow up for routine and acute health care needs for 4 residents. Appealed 12/19/2019
Southern Living Assisted Care HAL-074-038 12/9/2019 $4,000.00 A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4)  Declaration of Residents' Rights The facility failed to assure 4 residents were free of neglect and physical abuse. Appealed 12/19/2019

Randolph County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
All About Love Family Care Home FCL-076-035 1/18/2019 $500.00 A2 10A NCAC 13G .0906(f)(4)   Other Resident Services, 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to implement regulations related to rules governing adult care homes. Referred to Controller's Office 04/09/2019
All About Love Family Care Home FCL-076-035 1/18/2019 $15,300.00 Unabated B 10A NCAC 13G .0406(a)(5)   Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure a current sanitation report was available for review. Referred to Controller's Office 04/09/2019
North Pointe Assisted Living of Archdale HAL-076-032 7/1/2019 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision to residents who had a history of falls. Settlement Agreement 02/10/2020 Appealed 07/11/2019
North Pointe Assisted Living of Archdale HAL-076-032 7/1/2019 $750.00 A2 10A NCAC 13F .1501(a) Use of Physical Restraints and Alternatives; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physical restraints were used only after an assessment and care planning process had been completed through a team process and after alternatives had been tried and documented in the resident's record. Settlement Agreement 02/10/2020 Appealed 07/11/2019
Caregivers of Liberty II FCL-076-033 11/18/2019 $375.00 A2 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident who had forgetfulness, needed consistent reminders and had exited the facility without staff's knowledge. Paid in Full $375.00 1/10/2020

Robeson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
B & B Assisted Living #2 FCL-078-103 12/12/2018 $2,000.00 A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for 2 residents. Paid in Full $2,000.00 6/11/2019
Lumberton Assisted Living HAL-078-084 3/18/2019 $7,000.00 A1 10A NCAC 13F .0904(f)(2)   Nutrition and Food Service; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide assistance with meals that promoted dignity and respect for 1 resident. Settlement Fulfilled 03/04/2020 Settlement Agreement 08/23/2019 Appealed 03/19/2019 $500.00 3/4/2020
B & B Assisted Living #2 FCL-078-103 7/15/2019 $2,000.00 A1 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents who had eloped from the facility. Paid in Full $2,000.00 12/16/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10 A NCAC 13F .0601(a)   Management of Facilities; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to provide compliance to state rules and regulations specific to personal care, health care referral and follow up, supervision, housekeeping and furnishings, personal care and other staffing. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to provide personal care for 3 residents and every two hour repositioning for 1 resident who had impaired mobility. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 2 residents who demonstrated need for increased supervision. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to assure referral and follow up for the acute and routine health care needs of 2 residents. Appealed 12/12/2019
Lumberton Assisted Living HAL-078-084 3/1/2021 $4000.00 A2 10A NCAC 13F .0909   Resident Rights, G.S. 131-21(4)   Declaration of Residents' Rights Based on observations, interviews, and record review, Facility failed to protect 2 of 2 sampled residents (#3 and #7) from physical abuse by Staff B.
Lumberton Assisted Living HAL-078-084 3/1/2021 $7000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(4)   Declaration of Residents' Rights Based on interviews and record reviews Facility failed to report allegations of physical abuse to the North Carolina Health Care Personnel Registry (HCPR) within 24 hours of the allegation for 1 of 1 sampled staff (B). Appealed 03/04/2021

Rockingham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Faith Beyond Measure FCL-079-107 12/12/2018 $10,800.00 Unabated B 10A NCAC 13G .0902(c)(3)(4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement physician's orders for 1 resident. Referred to Controller's Office 04/09/2019
Faith Beyond Measure FCL-079-107 12/12/2018 $1,000.00 A2 10A NCAC 13G .1004 (a)   Medication Administration; 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility Administrator failed to assure the management and overall operations of the facility by failing to implement rules and regulations governing adult care homes. Referred to Controller's Office 04/09/2019
Safe Haven #3 FCL-079-102 6/4/2019 $2,650.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents with cognitive and physical impairments were able to independently evacuate the facility in accordance with the license capacity. Paid in Full $2,650.00 2/17/2020
Brookdale Reidsville HAL-079-007 8/7/2020 $7,000.00 A1 10A NCAC 13 F .1004 Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner for 1 of 5 sampled resident with an order for an anticoagulant medication. Appealed 09/10/2020

Rowan County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Angels at Heart Assisted Living HAL-080-020 11/1/2018 $2,000.00 A2 G.S. 131D-4.4A(b)   Infection Prevention Requirements; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the Federal Center for Disease Control and Prevention guidelines. Paid in Full $2,000.00 12/27/2018
Angels at Heart Assisted Living HAL-080-020 11/1/2018 $2,000.00 A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner for 2 residents. Paid in Full $2,000.00 12/27/2018
Kannon Creek Assisted Living HAL-080-003 12/12/2018 $4,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure 1 resident was not exploited by staff by failing to investigate allegatins of inappropriate behavior by staff. Paid in Full $4,000.00 2/12/2019
The Meadows of Rockwell Retirement Center HAL-080-026 9/12/2018 $500.00 A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 1 resident resulting in resident injury. Paid in Full $500.00 4/5/2019
Kannon Creek Assisted Living HAL-080-003 12/12/2018 $4,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 1 resident was not exploited by staff when it failed to fully investigate allegastions of inappropriate behavior by a staff who was later terminated. Paid in Full $4,000.00 2/12/2019
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $150.00 Unabated B 10A NCAC 13F .0407(a)(7); G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure 1 staff had a criminal background check completed upon hire. Paid in Full $150.00 1/16/2020
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $3,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for residents with aggressive behaviors, medication refusals and medications not available. Paid in Full $3,000.00 1/16/2020
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $5,250.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility neglected to assure residents' rights were maintained and residents were safe and free from being inappropriately touched by a resident. Paid in Full $5,250.00 1/16/2020
Bethamy Retreat FCL-080-001 7/1/2019 $1,000.00 A2 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure hot water temperatures were maintained between 100 degrees Fahrenheit (F) and 116 degrees F . Paid in Full $1,000.00 8/16/2019
Carillon Assisted Living of Salisbury HAL-080-013 7/15/2019 $1,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to report incidents of aggressive behavior towards multiple residents and failed to follow-up with residents. Paid in Full $1,000.00
Carillon Assisted Living of Salisbury HAL-080-013 7/15/2019 $3,500.00 A1 10A NCAC 13F .1004(a)(1)(2) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for sampled residents. Paid in Full $3,500.00
The Meadows of Rockwell Retirement Center HAL-080-026 7/15/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide increased supervision for resident in accordance with current symptoms. Settlement Agreement 02/17/2020 Appealed 08/14/2019
Alpha Concord Plantation HAL-080-027 11/18/2019 $10,500.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to notify the primary care physician or mental health provider of behavior changes in resident who had a history of suicide attempts. Appealed 12/18/2019
Compass Assisted Living Rowan HAL-080-028 12/9/2019 $500.00 A2 10A NCAC 13F .0902  Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to notify the physician of a change in the condition and medical treatment for 1 resident. Paid in Full $500.00 1/15/2020
The Meadows of Rockwell Retirement Center HAL-080-026 12/9/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered and in accordance with the facility's policies for 2 residents. Appealed 1/8/2020
The Meadows of Rockwell Retirement Center HAL-080-026 12/9/2019 $3,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure physician referrals and notifications for 3 residents. Appealed 1/8/2020
Best of Care Assisted Living HAL-080-019 2/15/2021 $12000.00 A1 10A NCAC 13F .1004 (a)(1)   Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for 1 of 2 sampled residents who were prescribed an anti-coagulant medication resulting in a critical international normalized ratio (INR). Appealed 02/16/2021
Best of Care Assisted Living HAL-080-019 2/15/2021 $12000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for 1 of 2 sampled residents with orders for blood thinner. Appealed 02/16/2021

Rutherford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Restwell Home HAL-081-007 3/18/2019 $800.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure that referral was made to meet acute Health care need for 1 resident. Paid in Full $800.00 4/16/2019

Stanly County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Administrator failed to assure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' right. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents as evidenced by not performing checks in accordance with the resident's care plan and the facility's falls management team protocol. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the routine and acute healthcare needs were met for residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $3,000.00 A2 10A NCAC 13F .0902(c) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the implementation of physician's orders for residents with fall risks. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $3,000.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure adequate staffing to meet the needs of Special Care Unit residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019
Woodhaven Court HAL-084-009 9/11/2019 $3,000.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure adequate staffing to meet the needs of Special Care Unit. Residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019

Stokes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rose Tara Senior Living HAL-085-008 12/9/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide adequate supervision resulting in resident wandering away from the facility without staff knowledge. Appealed 01/08/2020

Surry County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Colonial Long Term Care Facility HAL-086-002 9/12/2018 $500.00 A2 10A NCAC 13F .0906 (f)(4)   Other Resident Services; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify law enforcement, the department of social services and Guardian when the whereabouts of a resident was unknown. Paid in Full $500.00 10/18/2018
Riverwood Assisted Living Facility HAL-086-014 9/12/2018 $500.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure a resident was free of physical abuse by a staff member. Paid in Full $500.00 9/19/2018
Elkin Assisted Living HAL-086-013 11/13/2019 $18,750.00 Unabated Type B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to notify health care providers for 3 residents. Appealed 11/25/2019

Swain County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Bryson Senior Living HAL-087-009 6/4/2019 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure medications were administered to residents. Settlement Agreement 03/02/2020 Appealed 07/02/2019

Tyrrell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to protect 1 of 1 sampled residents (#8) from exploitation, who had a diagnosis of vascular dementia, was adjudicated incompetent and resided in the special care unit (SCU), by allowing a male resident to visit her unsupervised in the resident's room resulting in a sexual encounter between the two residents. Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13F .1212(d) Reporting of Incidents and Accidents; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to immediately notify the local county Department of Social Services (DSS) for 1 of 1 sampled residents (Resident #8), who had been neglected and exploited by staff. Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13F .1310 Other Applicable Rules for Special Care Units; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement policies and procedures for the special care unit (SCU) that promoted a safe, secure and consistent environment resulting in staff allowing a male resident from the assisted living (AL) unsupervised visitation to a female resident on the SCU, who had diagnoses of vascular dementia and schizoaffective disorder, had been adjudicated incompetent, and was unable to consent to a sexual relationship with the male resident; and another resident (#7), who resided on the SCU and had a diagnosis of vascular dementia, being allowed to leave the SCU and facility with a visitor, who had been previously banned from Facility by management staff. Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $6,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow up for routine and acute health care needs for 6 of 10 sampled residents (#2, #3, #4, #6, #10, and #17) as evidenced by failing to obtain routine and weekly lab work (#2, #10); report a resident heart rate of 38 to the physician (#6); obtain a pressure release cushion for a resident's wheelchair and a referral to podiatry (#3); obtain a stool culture as ordered due to diarrhea and to follow up with the PCP for a recheck visit after a fall and unsteady gait (#2); report a fall with injury and emergency department visit to the physician (#17); and assure a resident received ordered testing . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $2,000.00 A2 10A NCAC 13F .1308   Cooperation with Case Managers; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure there was enough staff present on the special care unit and attentive to meet the personal care, supervision and health care needs of the residents for 14 of 27 sampled shifts . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $2,000.00 A2 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide assistance for the personal care needs 7 of 8 sampled residents (#1, #2, #4, #5, #6, #8 and #15) who were unable to attend to themselves including incontinence care, toileting, bathing and dressing . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $7,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan, and current symptoms for 2 of 2 sampled residents (#1, #7, #8, #11), who resided on the special care unit (SCU), including a resident (#8), who had diagnoses of vascular dementia and schizoaffective disorder, had been deemed incompetent and was unable to consent to a witnessed sexual encounter with a male resident from assisted living (AL), and a resident (#7), who had a diagnosis of vascular dementia and was allowed to leave the SCU and the premises with a person who was banned from Facility; and 2 of 2 sampled residents (#11 and #1), who resided on the AL, including, a male resident (#11), who was allowed by staff to visit the SCU unsupervised with a resident who had a diagnosis of dementia, and a resident (#1), who had four falls within five days resulting in contusions to his scalp and leg. Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to complete Health Care Personnel Registry (HCPR) reporting and investigation requirements within the 24 hour and 5 day requirements for 3 of 3 sampled residents (#8, #11 and #12) sustaining physical abuse and injuries of unknown origin . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $7,000.00 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 supervision, health care, personal care and other staffing, personal care, health care personnel registry reporting, special care unit staffing, residents' rights, medication administration, controlled substances, housekeeping and furnishings, hot water requirements, training on cardio-pulmonary resuscitation, and nutrition and food service . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $11,850.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practitioner for 1 of 4 residents observed during the medication pass including an error with eye drops (#6); and 3 of 8 residents sampled for record review (#3, #4, #5) including errors with an antihypertensive medication, a blood thinner and a stool softener (#3); a pain medication (#4); a blood pressure medication and a medication used to treat anemia (#5). Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $69,750.00 Unabated A 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide assistance for the personal care needs 7 of 8 sampled residents (#1, #2, #4, #5, #6, #8 and #15) who were unable to attend to themselves including incontinence care, toileting, bathing and dressing . Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $69,750.00 Unabated A 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 supervision, health care, personal care and other staffing, personal care, health care personnel registry reporting, special care unit staffing, residents' rights, medication administration, controlled substances, housekeeping and furnishings, hot water requirements, training on cardio-pulmonary resuscitation, and nutrition and food service . Appealed 10/30/2020

Wake County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Agape House - Forest Drive (closed) FCL-092-235 9/12/2018 $1,900.00 Unabated B 10A NCAC 13G .0206 Capacity; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure resident's evacuation capabilities were in accordance with the evacuation capability listed on the home's license for 1 resident residing in facility. Paid in Full $1,900.00 12/13/2018
Brookridge Assisted Living HAL-092-146 1/18/2019 $14,000.00 A1 10A NCAC 13F .0901© Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to contact EMS immediately for 1 resident who was non-responsive. Settlement Fulfilled 02/20/2020 Settlement Agreement 11/15/2019 Appealed 01/24/2019 $2,000.00 2/20/2020
Chatham Commons HAL-092-203 1/8/2019 $2,000.00 A2 G.S. 131D-45   Examination and screening for the presence of controlled substances; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to assure the total operation requirements were met and maintained related to rules governing adult care homes. Settlement Fulfilled 12/12/2019 Settlement Agreement 11/18/2019 Appealed 02/07/2019 $1,000.00 12/12/2019
Spring Arbor of Apex HAL-092-037 1/9/2019 $500.00 A1 10A NCAC 13F .1002(a)(1)   Medication Orders, 10A NCAC 13F .1004(a)(1)   Medication Administration; G.S. 131D-21(4)  Facility failed to verify and clarify readmission medication orders for residents. Paid in full $500.00 3/12/2019
Val's Place FCL-092-213 2/26/2019 $3,500.00 A1 10A NCAC 13G .0901(b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 resident with wandering behaviors. Paid in Full $500.00 12/3/2019
Val's Place FCL-092-213 2/26/2019 $500.00 A2 10A NCAC 13G .0312(g)   Outside Entrance and Exits; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure 1 of 2 exit doors in the facility were activated with a sounding device when opened. Paid in Full $500.00 12/3/2019
Morningside of Raleigh HAL-092-088 4/4/2019 $2,000.00 A2 10A NCAC 13F .0311(a)   G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure the alarms on the doors of the SCU were in safe operating condition. Paid in Full $2,000.00 4/24/2019
Morningside of Raleigh HAL-092-088 4/4/2019 $2,000.00 A2 10A NCAC F .0901(b)   G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to provide supervision for SCU residents with wandering and exit seeking behaviors. Paid in Full $2,000.00 4/24/2019
R & S Family Care Home # 1 FCL-092-030 4/4/2019 $1,000.00 A2 10A NCAC 13G .0601(b)  Management and other Staff G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 5 residents in accordance with each residents' assessed needs, care plan, and current symptoms. Paid in Full $1,104.00 9/9/2019
Carillon Assisted Living of Knightdale HAL-092-166 6/17/2019 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered. Paid in Full $2,000.00 8/22/2019
Heartfields at Cary HAL-092-156 8/5/2019 $7,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure health care referral and follow up for residents. Paid in Full $7,000.00 8/21/2019
North Pointe Assisted Living of Garner HAL-092-186 7/15/2019 $16,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents in accordance with each residents' assessed needs, care plan, and current symptoms. Settlement Fulfilled 03/24/2020 Settlement Agreement 02/17/2020 Appealed 7/26/2019 $16,000.00 3/24/2020
Brighton Gardens of Raleigh HAL-092-024 9/24/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-2 (2) Declaration of Residents' Rights Facility failed to give supervision in accordance with each resident's assessed needs, care plan and current symptoms. Paid in Full $2,000.00 10/22/2019
Chatham Commons HAL-092-203 9/24/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to administer medications as ordered for residents. Settlement Fulfilled 02/05/2020 Settlement Agreement 01/10/2020 Appealed 10/21/2019 $1,000.00 2/5/2020
A Good Life FCH FCL-092-106 9/24/2019 $16,700.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the building was equipped and maintained for residents who were physically and/or cognitively unable to evacuate the facility independently. Appealed 10/10/2019
Sunrise Assisted Living at North Hills HAL-092-108 10/22/2019 $5,000.00 A1 10A NCAC 1310A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)    Facility failed to provider personal care in accordance with resident's care plan. Paid in Full $5,000.00 11/6/2019
Chatham Commons HAL-092-203 11/13/2019 $9,000.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision for residents on the Special Care Unit in accordance with each resident's' assessed needs, care plan, and current symptoms. Appealed 12/13/2019
Kelley's Family at Drayton Reserve FCL-092-251 8/24/2020 $1,000.00 A2 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the hot water temperatures at 4 of 5 fixtures (sinks and shower) used by and accessible to the residents in the kitchen, common bathroom and shared bathroom were maintained at a minimum of 100 degrees Fahrenheit (F) and did not exceed 116 degrees F including hot water temperatures as high as 138 degrees F. Paid in Full $1,000.00 9/9/2020
Oliver House HAL-092-182 8/7/2020 $5,250.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to contact the physician for 1 of 7 sampled residents who had a stage III wand on the left ankle. Appealed 09/03/2020
Heartfields at Cary HAL-092-156 9/14/2020 $55,500.00 Unabated Type A1 10A NCAC 13 F .0902Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the physician was notified for 1 of 5 sampled residents (#1) related to an unwitnessed fall, which resulted in a left hip fracture and uncontrolled pain for 3 days.
Chatham Commons HAL-092-203 9/14/2020 $6,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents who had left sided paralysis from a stroke sustained, in accordance with the resident's assessed needs and symptoms.
Novelty Healthcare III FCL-092-249 3/1/2021 $500.00 A2 10A NCAC 13 G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify the mental health and/or primary care physician for 1 of 1 sampled resident, who refused medications, had increased symptoms of dpression leading to self harm.
Novelty Healthcare III FCL-092-249 3/1/2021 $500.00 A2 10A NCAC 13G .0906 Other Care and Services; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify the mental health and/or primary care physician for 1 of 1 sampled resident, who refused medications, had increased symptoms of dpression leading to self harm.

Warren County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Moore's Rest Home FCL-093-011 4/4/2019 $2,000.00 A2 10A NCAC 13G .0909   Resident Rights G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to protect resident from physical abuse. Referred to Controller's Office 08/28/2019
Moore's Rest Home FCL-093-011 4/4/2019 $2,000.00 A2 10A NCAC 13G .0601(a)   G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to assure the management and overall operation of the facility. Referred to Controller's Office 08/28/2019
Moore's Rest Home FCL-093-011 7/1/2019 $3,900.00 Unabated B 10A NCAC 13G .0315 Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure walls and floors were kept clean and in good repair in 4 resident rooms. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure sampled staff had a criminal background check upon hire. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure sampled staff were tested upon hire for tuberculosis (TB) disease. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the implementation of physician's order for sampled residents. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G . 0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure supervision was provided for resident who eloped from the facility. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered for sampled residents. Referred to Controller's Office 09/18/2019
Moore's Rest Home FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .0601 Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to assure the management and overall operations of the facility by failing to meet and monitor rules related to personal care and supervision. Referred to Controller's Office 09/18/2019

Wayne County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Eagle's Pointe HAL-096-051 8/23/2018 $500.00 A2 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond immediately to an accident or incident involving 1 resident. Paid in Full $500.00 12/31/2018
Brookdale Country Day Road HAL-096-026 8/5/2019 $2,000.00 A2 10A NCAC 13F .0604(e) Personal Care and Other Staffing; G.S. 131D-21(4) Declaration of Residents' Rights (4) Facility failed to assure aide hours met the minimum requirements on 14 shifts. Paid in Full $2,000.00 9/4/2019
Brookdale Country Day Road HAL-096-026 8/5/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure adequate supervision was provided for sampled residents who had multiple falls. Paid in Full $500.00 9/4/2019
Countryside Village HAL-096-049 3/1/2021 $3500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referrals were made for 2 of 2 sampled residents (#4, #5) who had orders for physical therapy and occupational therapy (#4) and orders for una boots to be applied by a Home Health nurse (#5).
Countryside Village HAL-096-049 3/1/2021 $1500.00 A1 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 1 of 6 residents (#5) observed during the medication pass, including errors with an anticoagulant, a mineral supplement, and a nasal spray.

Wilkes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rose Glen Manor HAL-097-015 8/24/2020 $3,750.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 4 of 6 residents sampled including a pain medication and eye drops (Resident #1), eye drops (Resident #6) and a blood pressure/angina medication (Resident #5) being unavailable to administer, and a medication for nerve pain and blood pressure/angina (Resident #3). Appealed 09/23/2020

Wilson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Parkwood Village HAL-098-029 2/19/2019 $16,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral to meet the acute health care needs of 2 residents who were delayed in receiving treatment and subsequently expired and another resident delayed in being sent to the hospital after a fall. Paid in full $16,000.00 3/13/2019
Wilson Assisted Living HAL-098-027 4/4/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were available for administration for residents. Paid in Full $4,000.00 6/4/2019
Wilson Assisted Living HAL-098-027 4/4/2019 $7,000.00 A1 10A NCAC 13F .0901(b)   G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement interventions to address the current symptoms and assessed needs for residents according to diagnosis. Paid in Full $7,000.00 6/4/2019
Wilson Assisted Living HAL-098-027 12/9/2019 $20,000.00 A2 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The Administrator failed to assure the overall management, operations, and policies and procedures of the facility were developed and implemented. Referred to Controller's Office 04/07/2020
Wilson Assisted Living HAL-098-027 12/9/2019 $20,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to assure the primary care provider was notified of changes in condition and acute health care needs for 3 residents. Referred to Controller's Office 04/07/2020
Wilson Assisted Living HAL-098-027 12/9/2019 $75,375.00 Unabated A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to assure 4 residents received their medication as ordered by the primary care provider. Referred to Controller's Office 04/07/2020
Wilson Assisted Living HAL-098-027 9/14/2020 $8,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 3 of 7 sampled residents (#4, #5, and #10) including a resident (#4) who left the facility by climbing over the special care unit secured fence two times unsupervised, and two residents ( #4, and #10) who sustained multiple falls in 6 months resulting in injuries and visits to the emergency room.
Wilson Assisted Living HAL-098-027 9/14/2020 $9,000.00 A2 G.S. 131D-25   Declaration of Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to assure the overall management, operations, and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing adult care homes as related to health care, medication administration, personal funds, personal care and supervision.

Yancey County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $1,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Paid in Full $1,500.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $4,000.00 A2 10A NCAC 13F .0902(c)(4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure primary care provider orders were implemented for sampled residents. Paid in Full $4,000.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $3,000.00 A2 10A NCAC 13F .0305(h)(3) Physical Environment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure that all exit doors were easily operable, by a single hand motion from the inside at all times without keys. Paid in Full $3,000.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer medications as ordered for 2 residents. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to follow-up to obtain a three night sleep study for 1 resident. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1002(a)   Medication Orders; G.S. 131D-21   Declaration of Residents' Rights The facility failed to ensure clarification of medication orders for 2 residents. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 8/7/2020 $16,000.00 A2 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 3 sampled residents (#5) who, without staff's knowledge, eloped from facility.
Southern Living for Seniors of Burnsville, NC HAL-100-006 8/7/2020 $126,000.00 Unabated A 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow up for 1 of 4 sampled residents (#2) with a physician's order for physical therapy for evaluation and treatment.