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.

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 110250 Unabated Type 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.
Merciful Hands FCL-001-114 9/21/2016 $1,000.00 Type A2 10A NCAC 13G .0601 (b) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure residents were not left alone in facility without staff. Paid in Full $1,104.17 12/30/2016
Springview - Ross Building HAL-001-017 1/20/2017 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .1304 Special Care Unit Building; G.S. 131D-21 (2) Declaration of Residents' Rights Facility did not provide adequate supervision to 1 of 3 residents residing in a special care unit with a diagnosis of Alzheimer's Disease who wandered out of facility, fell and sustained a head injury. Paid in Full $1,000.00 3/30/2017
Alamance House HAL-001-148 10/10/2017 10/10/2017 Type A1 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 in accordance with each resident's assessed needs, care plan and current symptoms for 2 of 7 sampled residents who received injuries due to falls. Paid in Full; 05/29/2018 Settlement Agreement for $4,500.00; Appealed 11/01/2017 $4,500.00 7/2/2018
Agape FCH II (Closed) FCL-001-143 2/7/2018 3,500.00 Type A2 10A NCAC 13G .0601 Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure 2 of 7 staff had Health Care Personnel Registry checks completed prior to hire.
B and N Family Care Home FCL-001-144 2/28/2018 8,000.00 Type A1 10A NCAC 13G .0906 Other Resident Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to immediately notify a resident's responsible person, the appropriatee law enforcement agency and the county department of social services when whereabouts of the resident were unknown. Referred to Controller's Office

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 6/8/2017 20,000.00 Type A2 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to keep resident free from sexual abuse resulting ina resident sexually assaulting a female resident and displaying sexually inappropriate behaviors to other female residents. Paid in Full; 06/11/2018 Settlement Agreement for $4,000.00; Appealed 07/03/2017 $4,000.00 8/3/2018
Alexander Assisted Living HAL-002-004 6/30/2017 12,000.00 Type A2 10A NCAC 13F.0901 Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure 1 of 3 sampled residents with a diagnosis of dementia was supervised in accordance with assessed needs of wandering, disorientation and current symptoms of behaviors. Paid in full $12,000.00 8/30/2017
Alexander Assisted Living (Closed) HAL-002-004 3/22/2018 12,000.00 Type A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-25 Facility failed to provider supervision for residents in accordance with each resident's assessed needs, care plan and current symptoms for 2 residents with physical decline and histroy of falls resulting in the potential for serious injury when 1 resident fell down outside steps in wheelchair and 1 resident falls resulted in medical treatment at the ER for a closed head and left wrist injury and a compound fracture of the first lumbar vertebra. Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 3/22/2018 12,800.00 Unabated Type B 10A NCAC 13F .1008 (a) Controlled Substances ; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure readily retrievable records were available to account for the disposition of controlled substances (hydromorphone, Endocet, methadone, oxycodone and ativan) and ensure an accurate reconciliation of those controlled sustances for 3 residents Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 3/22/2018 16,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure medications were administered to 4 residents by failure to administer a pain medication (Percocet) to 1 resident when requested due to the facility's electronic medication administration system was not operating; failed to administer readmission medications from a hospitalization to 1 resident as ordered due to the orders not being sent to pharmacy almost three weeks later; and failed to administer medications as ordered for 2 residents. Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 5/2/2018 111,000.00 Type A2 G.S. 131-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure accurate records of receipt, use and disposition of medications which included pharmacy delivery sheets, controlled drug sheets, medication administration records and medications brought into the facility were maintained in the facility and available upon request for review for 3 residents. Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 5/2/2018 16,000.00 Type A2 10A NCAC 13F .0904 (4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure all therapeutic diets for 6 residents were served as ordered related to puree, honey thick liquids, no concentrated sweets, vegetarian, lactose free, and chopped meat diet orders. Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 5/2/2018 12,400.00 Unabated Type B G.S. 131D-4.4 (A) (b) ACH Infection Prevention Requirements; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure implement proper infection control procedures consistent with Centers for Disease Control and Prevention guidelines on infection control for 2 residents with orders for FSBS monitoring by sharing of glucose meters including a resident with a diagnosis of hepatitis C without proper disinfection; and exposed residents to the risk of contracting serious blood borne illnesses including hepatitus and human immunodeficency virus Settlement Agreeement 04/01/2019
Alexander Assisted Living (Closed) HAL-002-004 5/2/2018 125,250.00 Type A2 G.S. 131-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the total operation of the facility met and maintained rules and regulations related to personal care and supervision, health care, housekeeping and furnishing, fire drills, LHPS, pharmaceutical services, nutrition and food service, medication administration, examination and screening for presence of controlled substances, labels, accurate record receipt, use and disposition of controlled substances. Settlement Agreeement 04/01/2019

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 Type 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 2000 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.
A Sharpe Haven FCL-008-038 1/31/2019 55500 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.

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 8000 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 2 of 6 residents who had dementia. One resident has history of attempting to ambulate without assistance and multiple falls with injuries, sustained multiple facial fractures and a fractured wrist. Another has history of moving excessively in bed, became entangled in the bed covers with her head stuck between the bed and bed rail with body on floor. Appealed (02/15/2019)

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 4000 Type 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.
Shallotte Assisted Living HAL-010-008 12/13/2018 4000 Type 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.
Leland House HAL-010-007 10/13/2017 16,000.00 Type A1 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to supervise 2 of 6 residents sampled in the dining room with the facility's dining room during the supper meal in accordance with established procedures resulting in an incident between the two residents in which one of the residents was injured in a manner causing death. Paid in Full; 4/13/2018 Settlement Agreement for $7,000.00 Appealed 11/13/2017 $7,000.00 07/03/2018 06/07/2018
Leland House HAL-010-007 10/13/2017 1,000.00 Type A1 Reduced to Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify the physician of the health care needs of 1 of 6 sampled residents related to behaviors exhibited by the resident and failed to notify the physician about the recommendation by a psychotherapist that the resident was not able to safely function in assisted living. Paid in Full; 4/13/2018 Settlement Agreement no change in penalty amount imposed; Appealed 11/13/2017 $1,000.00 07/03/2018
Shallotte Assisted Living HAL-010-008 4/5/2018 2,000.00 Type 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 residents diagnose with Dementia resulting in residents wandering unsupervised. Paid in Full 2,000.00 4/19/2018

Buncombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Fairview Family Care Home #4 FCL-011-025 12/13/2018 3500 Type 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 for 1 resident related to a small bowel obstruction and subsequent hospitalization.
White Fawn Family Care Home (Pty #1) (Closed) FCL-011-297 12/13/2018 3600 Unabated Type 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.
Woodland Terrace Family Care Home #4 FCL-011-342 2/26/2019 5100 Unabated Type 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
Woodland Terrace FCH #6 FCL-011-351 3/18/2019 2000 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
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 1000 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 of 3 sampled residents including clozapine (the generic name for Clozaril) for Resident #1 and clozapine, Trazodone, docusate-senna, and cholecalciferol
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 1000 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.
Chase Samaritan Assisted Living HAL-011-133 12/2/2016 $13,600.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications (Augmentin, Neurontin, Oxycodone) were administered as ordered. Paid in Full $13,600.00 12/28/2017
Angel House IV FCL-011-264 12/22/2016 2,000.00 Type A2 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure every resident was free from mental and physical abuse as related to a resident grabbing other residents' cigarettes and lighters, placing hands on other residents, and frequently requesting cigarettes and lighters from other residents resulting in at least 4 residents expressing fear of the resident and two residents being inappropriately touched by the resident. Paid in full $2,000.00 9/11/2017
Chase Samaritan Assisted Living HAL-011-133 4/20/2017 8,000.00 Type A2(2) 10A NCAC 13F.0601(a) Mgmt of a facility with a capacity or census of 7-30 residents, 10A NCAC 13F.1004(a) Medication Administration, 10A NCAC 13F .1008(a), G.S. 131D-21(2)(4) Declaration of Resident's Rights Facility failed to assure the total operation of the facility related to resident's rights (exploitation and privacy), medication administration, controlled substances, pharmaceutical care, transferring medications to another container and controlled substance medication storage. Facility failed to assure accurate reconciliation and readily retrievable records for the receipt, administration and and disposition of controlled substance being unaccounted for. Paid in Full $8,000.00 12/28/2017
Mountain Valley Retirement Home FCL-011-032 6/30/2017 7,000.00 Type A2 10A NCAC 13G .0601(b) Management and Other Staff, G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure there was one administrator or supervisor-in-charge who was directly responsible for seeing that all required duties are carried out in the home and for assuring that at no time a resident was left alone in the home without a staff member for 6 of 6 resident in the home. Paid in Full 7,229.17 12/29/2017
Serenity Heart #234 FCL-011-319 8/10/2017 $2,000.00 Type A2 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights Facility failed to assure 1 of 2 staff had no substantiated findings on the Health Care Personnel Registry
Serenity Heart #230 FCL-011-310 8/10/2017 $6,000.00 Type A1 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Faciity failed to assure that the preparation and administration o medications and treatments by staff were in accordance with physician orders as maintained in the resident's record and rules in thei Section and the facility's policies and procedures resulting in one resident taking another residen's medications and having to be hospitalized.
Soundview Family Care Home-Unit I FCL-011-236 8/11/2017 $2,000.00 Type A2 10A NCAC 13G .0601(b) Management and Other Staff, G.S. 131D-21(2) Declaration of Residents' Rights The administrator failed to be responsible for the operation of the home as evidenced by the continued employment of a staff after reported allegations of sexual assault and exploitation with no investigation by the facility or reporting to the Health Care Personnel Registry ; and failed to investigate additional allegations of sexual abuse and exploitation reported by residents or report to the HCPR until investigation by the local county department of social services Paid in Full $2,000.00 10/4/2017
Soundview Family Care Home-Unit H FCL-011-235 8/11/2017 $1,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were free of abuse as evidenced by the former supervisor-in-charge verbally and mentally abusing two of six residents and exposing the other four residents to verbal and mental abuse and allowing one resident to maintain a knife for 3 days after threatening his roommate with the knife. Paid in Full $1,000.00 10/4/2017
Evergreen Living Home #12 FCL-011-288 10/20/2017 500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide increased supervision for 1 of 1 resident related to toileting and falls. Paid in Full $500.00 11/1/2017
Evergreen Living Home #2 FCL-011-194 4/5/2018 500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 1 resident was supervised in accordance with assessed needs and current symptoms including wandering behavior. Paid in Full 500.00 4/17/2018
Evergreen Living Home #2 FCL-011-194 4/5/2018 1,000.00 Type A2 10A NCAC 13G .0601 (d) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure additional staff was employed as needed for 1 resident identified as having ongoing wandering behaviors and known to escape facility at night. Paid in Full 1,000.00 4/17/2018
Evergreen Living Home #2 FCL-011-194 4/5/2018 500.00 Type A2 10A NCAC 13G .0312 (e) Outside Entrance and Exit; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure all entrances and exits were free of obstructions and impediments to allow for full instant use in case of fire or other emergency. Paid in Full 500.00 4/17/2018
Plemmons Family Care Home #2 (closed) FCL-011-036 12/11/2017 10,700.00 Unabated Type B 10A NCAC 13G .0317 (a) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to remove from premises trash, automobile parts, containers of petroleum products in close proximity to combustible items inside and outside the home; failed to keep clean and repaired walls, floors, ceilings and fixtures; failed to prevent use of non-surge protected extension cord and outdoor extension cord with exposed wiring and failed to maintain on premises most current fire and environmental health inspection reports 06/07/2018 Settlement Agreement for Penalty Elimination; Appealed 01/03/2018
Plemmons Family Care Home #2 (closed) FCL-011-036 12/11/2017 10,700.00 Unabated Type B 10A NCAC 13G .0601(a) Management and Other Staff, G.S. 131D-21(2) Declaration of Residents' Rights Facility administrator failed to assure total operation of facility and maintained rules related to resident care plan, resident contract, medication administration, orders, and storage, resident rights, Medication Aide Training and Competency and failed to assure staff completed a 2-step Tuberculosis (TB) test 06/07/2018 Settlement Agreement for Penalty Elimination; Appealed 01/03/2018
Woodland Terrace Family Care Home #6 FCL-011-351 11/16/2017 18,500.00 Unabated Type B 10A NCAC 13G .1005 (a) Self-Administration of Medication; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to obtain a current physician order permitting 1 of 1 residents to self-administer Victoza, Levemir and Novolog, and to self-perform capillary blood glucose levels necessary for self-administration of sliding scale Novolog. Referred to Controller's Office
Woodland Terrace Family Care Home #6 FCL-011-351 11/16/2017 500.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications (Plavix and ProAir) were administered as ordered by the prescribing practitioner for 1 of 3 sampled residents Referred to Controller's Office
Chunn's Cove Assisted Living HAL-011-262 6/25/2018 16,000.00 Type A1 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 3 residents were supervised in accordance with their assessed needs and current symptoms related to 2 residents with aggressive behaviors resulting in hospitalization and subsequent death of a resident and 1 resident stealing another resident's items which provoked other altercations with a resident. Appealed 07/19/2018
Leicester Heights FCH FCL-011-021 5/23/2018 12,000.00 Unabated Type B 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 1 resident refusing eye drops and for 1 resident for clarification of a medication order. Referred to Controller's Office
White Fawn Family Care Home (Pty #1) FCL-011-297 6/25/2018 8,800.00 Unabated Type B 10A NCAC 13G .0406 (a) (7) Other Staff Qualifications ; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure 2 staff had a criminal background check completed prior to hire date.
White Fawn Family Care Home (Pty #2) FCL-011-297 6/25/2018 8,800.00 Unabated Type B G.S. 131D-45 Examination and Screening for Controlled Substances Facility failed to assure examination and screening for the presence of controlled substance was performed for 4 staff prior to employment after 10/01/2013.
White Fawn Family Care Home (Pty #3) FCL-011-297 6/25/2018 8,800.00 Unabated Type B 10A NCAC 13G .0406 (a) (5) Other Staff Qualifications; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure 4 staff had no substantiated findings listed on the North Carolina Health Care Personnel Registry (HCPR).
Richmond Hill Rest Home #5 HAL-011-188 9/13/2018 1,000.00 Type 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 resulting in a right hip fracture. Paid in Full 1,000.00 9/25/2018
White Fawn Family Care Home (Closed) FCL-011-297 9/12/2018 2,000.00 Type A2 10A NCAC 13G .0906 (f)(4) Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to immediately notify the appropiate 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

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 16000 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 for 1 resident who had errors related to Haldol olanzapine and trazodone.
The Living Center of Concord HAL-013-044 10/20/2017 2,000.00 Type A2 10A NCAC 13F.1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for 3 of 6 sampled residents related to medications including Symbicort, ipratropium, coenzyme Q10, Amitiza, endicrin, Miralax, tramadol, ioderm patch, multivitamin, potassium, Imdur and Tylenol not on hand or not ordered. Paid $2,000.00 5/7/2019
The Living Center of Concord HAL-013-044 11/1/2017 21,300.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure physician notification for 2 of 8 sampled residents with physician's orders for thromboembolism-deterrent hose and weights Paid $6,000.00 2/1/2019
Concord House HAL-013-038 1/24/2019 12000 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 for 2 residents related to clonazepam and buspirone
Concord House HAL-013-038 2/19/2019 16000 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).
Concord House HAL-013-038 2/19/2019 14000 A1 10A NCAC 13F .1004(a) Medication Administration; 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 degrees (F).
Concord House HAL-013-038 2/19/2019 7000 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 (MAR) for 2 of 4 sampled residents related to clonazepam and buspirone
The Living Center of Concord HAL-013-044 2/26/2019 1000 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 2 of 6 sampled staff had no substantiated findings on the North Carolina Health Care Personnel Registry (HCPR).
Concord House HAL-013-038 4/4/2019 $35,200.00 Unabated Type B 10A NCAC F .0311(a) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights "Facility failed to assure all plumbing equipment including the hot water on the back hall, a toilet and shower on the back hall in the common bathroom and the heating system were maintained in a safe and operating condition. "
Concord House HAL-013-038 4/4/2019 $35,200.00 Unabated Type 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 as related to roaches observed in the kitchen and dining room and evidence of rodents observed in the food pantry and resident room #209.

Caldwell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brockford Inn HAL-014-014 1/20/2017 13,600.00 Unabated Type B 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to protect residents by not investigating allegations for injury of unknown source for 1 resident and upon investigation of verbal abuse of a resident by a staff member, the faciity did not report to the Health Care Personnel Registry. Paid in Full Payment Plan $15,155.29 07/24/2017 04/19/2017 02/20/2017
Brookdale Lenoir HAL-014-010 7/24/2017 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure residents are free from mental and physical abuse. Settlement Agreement 05/13/2019
Brookdale Lenoir HAL-014-010 7/24/2017 $62,250.00 Unabated A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free from mental abuse by one resident who took personal items and exhibited verbal and physical aggression. Settlement Agreement 05/13/2019
Brockford Inn HAL-014-014 11/16/2017 $7,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision of residents in accordance with each resident's assessed needs, care plan and current symptoms for 1 of 5 residents. Paid in Full $7,000.00 1/16/2018
Carolina Oaks Enhanced Care Center HAL-014-002 2/28/2018 14,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure physician referral and notification for 5 of 6 sampled residents related to shortness of breath and medication refusals for one resident, refusing mental health and blood pressure medications for one resident, a gynecological referral for one resident, a cardiology referral for one resident and a physician referral for one resident for care of a broken toe. Referred to Controller's Office
Carolina Oaks Enhanced Care Center HAL-014-002 2/28/2018 18,000.00 Type A1 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 to 2 of 6 sampled residents. Referred to Controller's Office
Carolina Oaks Enhanced Care Center HAL-014-002 2/28/2018 14,000.00 Type A2 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 4 residents related to blood pressure checks and wound care for one resident. Referred to Controller's Office
Carolina Oaks Enhanced Care Center HAL-014-002 2/28/2018 18,000.00 Type A1 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Faclity failed to assure the total operation of the facility to meet and maintain rules related to housekeeping and physical environment, staff training and qualifications, competency validations of staff, TB testing, personal care and supervision, health care, nutrition and food service, activities, licensed health professional support, residents' funds, discharge of residents and medication administration. Referred to Controller's Office
The Shaire Center HAL-014-004 11/1/2017 $1,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision related to falls for 2 of 5 sampled residents in accordance with each resident's assessed needs, care plan and current symptoms. Paid in Full $1,000.00 11/15/2017
Brockford Inn HAL-014-014 6/4/2018 $16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to make a referral to a physician or hospital to address the acute health care needs of 1 resident with symptoms of a stroke. Paid in Full; 01/03/2019 Settlement Agreement for $8,000.00 & Training; Appealed 06/06/2018 $8,000.00 1/25/2019
Carolina Oaks Enhanced Care Center HAL-014-002 7/27/2018 213,000.00 Type A1 10A NCAC 13F .0902 (b) 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 of 2 residents by failing to notify physician of the need for orders, including medication and oxygen for 1 resident diagnosed with chronic obstructive pulmonary disease, respiratory failure and sepsis admitted to facility after hospitalization, history of tracheostomy and a skilled nursing home stay without recieving medications or oxygen for almost 24 hours who later died; and failed to schedule dermatology appointments and notify physician of refusals for personal care due to shortness of breath and worsening of a rash for 1 resiednt resulting in hospitalization and later died.
Carolina Oaks Enhanced Care Center HAL-014-002 7/27/2018 7,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide appropriate supervision for 3 residents with wandering behaviors who exited facility unsupervised.
Carolina Oaks Enhanced Care Center HAL-014-002 7/27/2018 4,000.00 Type A2 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to make a referral to a physician to address the acute health care needs for a resident with a colostomy.
Carolina Oaks Enhanced Care Center HAL-014-002 7/27/2018 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to make a referral to a physician to address the acute health care needs for a resident with a colostomy.

Caswell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Jones Family Care #4 FCL-017-030 12/8/2016 $500.00 Type A2 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident with a history of smoking inside the facility. Paid in Full $500.00 12/20/2016
Caswell House HAL-017-054 1/31/2019 2000 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision necessary to prevent 3 residents with known physical aggression and sexual expressive behaviors from hitting and pushing other in the Special Care Unit resulting in one resident sustaining a broken pelvis and another, incapable of consenting due to cognitive status, being lured into an unwitnessed sexual encounter. Appealed 03/08/2019
Caswell House HAL-017-054 1/31/2019 2000 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 from assault by Resident #9 who was know to have aggressive behaviors; and residents on SCU were protected from assault by Resident #1 who was also known to have aggressive behavior. Appealed 03/08/2019
Caswell House HAL-017-054 1/31/2019 1000 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 be resident on the Care unit on 34 of 45 shifts sampled from 5/19/17-5/20/17; 5/31/17-6/1/17; 7/1/17-7/2/17; 10/21/17-10/22/17; 12/9/17-12/10/17 ,resulting in an undocumented fall with hip injury and incidents of residents assaulting each other. Appealed 03/08/2019

Catawba County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Austin Adult Care HAL-018-023 6/8/2017 2,000.00 Type A2 G.S. 131D-21-4.4A(b); G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection procedures were implemented for blood glucose monitoring for at least 4 of 7 residents with orders for finger sticke blood sugars by borrowing a lancet device or glucose meter from a discharged resident for 2 of 7 residents and borrowing lancet devices from other creent residents for 2 of 7 residents. Paid in Full $2,000.00 6/27/2017
Heritage Care of Conover HAL-018-018 8/11/2017 $4,000.00 Type A1 10A NCAC 13F.1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure 1 of 5 sampled residents were administered medications in accordance with orders by a licensed health professional. Paid in Full; 02/23/2018 Settlement Agreement for $2,00.00 & Training; Appealed 08/17/2017 $2,000.00 3/13/2018
Heritage Care of Conover HAL-018-018 8/10/2017 $1,000.00 Type A2 G.S. 131D-4.5(B)(b) (1)(2) Adult Care Homes Medication Aides Training and Competency Evaluation Requirements Facility failed to assure 2 of 8 sampled residents had previously worked as a medication aide during the previous 24 months or had received the 5-hour training developed by the Department prior to performing unsupervised medcation aide duties, and failed to assure 1 of 8 sampled medication aides had a clinical skills consistent with Rule 13F .0503 prior to performing unsupervised medication aide duties. 02/23/2018 Settlement Agreement for Training; Appealed 08/17/2017
Springs of Catawba pty#1 HAL-018-032 9/12/2018 10,000.00 Type 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 for 2 residents. Appealed 10/12/2018
Springs of Catawba pty#2 HAL-018-032 9/12/2018 10,000.00 Type 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. Appealed 10/12/2018
Heritage Care of Conover HAL-018-018 12/13/2018 2000 Type 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 for 2 residents with orders for continuous oxygen at 2L/M and portable oxygen at 2L/M during activity. Appealed 01/02/2019
Heritage Care of Conover HAL-018-018 12/13/2018 2000 Type 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. 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 10/5/2016 $1000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Suervision; 10A NCAC 13F .0504(a) Competency Validation for LHPS Staff Failure to provide personal care according care plan and to assure competency validation for staff for catheter care. 06/26/2017 Settlement Agreement Penalty Eliminated; Appealed 11/01/2016
Chatham Ridge Assisted Living HAL-019-021 12/8/2016 $2,000 Type A2 10A NCAC 13F .0901(a) Personal Care and Supervision; 10A NCAC 13F .0902(b) Health Care; Facility failed to provide supervision for a resident in accordance with current symptoms of respective fall resulting in injury. Paid in Full $2,000.00 12/22/2016
Coventry of Siler City HAL-019-018 4/4/2019 $15,200.00 10A NCAC F .0306(a)(5) Adult car 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/
Liselotte Rest Home FCL-019-006 4/4/2019 $1,400.00 Unabated Type 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 by 6 of 6 residents (#1, #2, #3, #4, #5, #6) who were physically and/or cognitively impaired residing in the facility and being unable to evacuate the facility independently without verbal or physical assistance.

Chowan County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Edenton Prime Time Retirement Village HAL-021-008 4/5/2018 500.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to meet the acute health care needs of 1 resident by failing to notify the primary care provider of a fall resulting in an injury, changes in level of consciousness with decreased oral intake and failing to schedule follow-up appointment related to resident's fall and injury. Paid in Full; 01/04/2019 Settlement Agreement for $500.00; Appealed 05/01/2018 $500.00 1/25/2019

Cleveland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Greene Haven Family Care FCL-023-037 6/8/2017 500.00 Type A2 10A NCAC 13G.0601 Management and Other Staff, G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure resident was not left alone without supervision at the facility. Paid in Full 500.00 11/20/2017
Lean's 3 Family Care Home FCL-023-049 1/18/2019 500 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)

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 Type 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 which resulted in a resident being left without monitoring or intervention while experiencing a narcotic drug withdrawal; a resident being treated for bed bug infection; and for residents being subjets to threats of retaliation for talking to regulatory monitoring staff. Appealed 09-20-2018
Lake Pointe AL (pty#2) HAL-024-011 8/23/2018 4,000.00 Type 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. Appealed 09-20-2018
Lake Pointe AL (pty#3) HAL-024-011 8/23/2018 2,000.00 Type 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 ordely discharge for 1 resident as evident by resident being discharged to a family member's home who was unable to meet the resident's needs resulting in the resident being admitted to the hospital on the same day as discharge due to wound care treatment needs. Appealed 09-20-2018
Lake Pointe Assisted Living HAL-024-011 1/18/2019 16000 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 14000 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 14000 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, which resulted in local police returning him to the facility. Resident left to hitchhike to another county without staff notifying local law enforcement. This resulted in an out of county police department having to contact local law enforcement to return resident back to facility Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 16000 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 20000 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 for residents as related to failing to follow facility policy and calling 911 for a resident with blood sugar of 33 until being prompted. Failure to send a resident to the hospital for evaluation and treatment after a fall with a head injury (the resident later died); and failed to assure follow up with the primary care provider (PCP) for a resident as ordered after hospital visits. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 20000 A2 G.S. 131D-25 Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility were implemented to maintain each residents' right Which resulted in significant noncompliance with rules and statutes related to health care. tire alarm system, personal care and other staffing. personal care and supervision. medication administration. controlled substances, ACH infection prevention requirements, ACH medication aide training and competency, housekeeping and furnishings, training on care Of the diabetic resident, and residents rights. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 14000 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 during blood sugar monitoring for 5 residents with orders for FSBS monitoring resulting in glucometers and lancet pens being shared including one with a diagnosis of an infectious blood borne virus. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 14000 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 for 5 residents to include oral antidiabetics, insulin, blood thinner, and pain medication. Appealed 01/28/2019
Lake Pointe Assisted Living HAL-024-011 2/19/2019 17800 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 as evidenced by loose, unattached, uneven floor covering, a wet sub flooring with scattered areas of a black build-up substance resulting in one resident having breathing problems related to wet odors and an accumulation of a foul smell.
Lake Pointe Assisted Living HAL-024-011 2/19/2019 7000 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the health needs of 5 residents. Failing to report an infected wound on the back of resident's right thigh/buttock to the health care provider, failing to follow-up with referral to a cardiologist regarding Coumadin therapy for resident. Failing to follow-up with the health care provider as indicated by an emergency department (ED) referral after resident was treated for a wound and after resident was treated for seizure activity and gastritis, and failing to notify the health care provider regarding resident's tooth pain.

Craven County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
New Bern House HAL-025-035 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to contact resident's physician regarding orders for medications for 1 of 6 sampled residents. Paid in Full; 09/21/2017 Settlement Agreement for $1,500.00; Appealed 01/20/2017 $1.500.00 08/07/2017 07/24/2017 07/03/2017
Riverview HAL-025-031 12/22/2016 7,000.00 Type A2 10A NCAC 13F .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure follow-up with medical providers for 1 of 5 residents that were out of medications. Paid in Full; 08/15/2017 Settlement Agreement for $6,750.00; Appealed 01/20/2017 $6,750.00 12/07/2017 11/14/2017 10/09/2017 09/18/2017
New Bern House (name change to The Gardens of Trent) HAL-025-035 3/27/2018 1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure follow-up to meet the health care needs of 4 residents who had orders for blood glucose levels to be faxed to physician, urinary analysis, follow-up hospital visit, pain medication to be administered and an x-ray. Paid in Full; Referred to Controller's Office $1,116.67 10/3/2018
New Bern House (name change to The Gardens of Trent) pty#1 HAL-025-035 8/23/2018 2,000.00 Type 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; one with second degree burns, one who did not receive a Foley catheter, and one who missed doses of heart/blood pressure medication after hospitalization. Appealed 09/21/2018
New Bern House (name change to The Gardens of Trent) pty#2 HAL-025-035 8/23/2018 1,000.00 Type 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. Appealed 09/21/2018
New Bern House (name change to The Gardens of Trent) pty#3 HAL-025-035 8/23/2018 5,000.00 Type A1 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to protect 1 resident from neglect which resulted in second degree burns on resident's neck and shoulder when staff pushed resident's bed against heater and allowed resident to lie on heater. Appealed 09/21/2018
New Bern House (name change to The Gardens of Trent) pty#4 HAL-025-035 8/23/2018 2,000.00 Type A2 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administred as ordered for 3 residents by prescribing practitioner. Appealed 09/21/2018
Croatan Village HAL-025-037 1/24/2019 4000 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 residents, resulting in failure to send resident to the emergency room after initial symptoms of pain and leg injury. Paid in Full 4000 3/25/2019
Croatan Village HAL-025-037 1/18/2019 4000 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 residents who had a diagnosis of dementia, a history of attempting to ambulate without assistance, and multiple falls with injuries. Paid in Full 4000 3/25/2019

Cumberland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Countryside Villa HAL-026-046 12/8/2016 $7,000.00 Type A2 10A NCAC 13F .0306 (a) (5) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure home was maintained in a clean, orderly manner, free of all obstructions and hazards.
Valley Pines Adult Care HAL-026-052 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 1 of 3 sampled residents was free from physical and mental abuse relating to verbal and physical mistreatment of the resident a staff person. Paid in Full $2,000.00 11/16/2017
Valley Pines Adult Care HAL-026-052 8/10/2017 $15,200.00 Type B 10A NCAC 13F .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 health care needs of 3 of 4 sampled residents as related to failure to coordinate doctor's orders for a change from Humalog to Novolog, failure to notify doctor of a new wound for a diabetic resident, failure to notify doctor of health changes and failure to notify doctor of weight changes as ordered for residents. 01/18/2019 Training Completed; Paid in Full; 10/22/2018 Settlement Agreement for $4,000.00 and Training; Appealed 09/08/2017 $4,000.00 11/20/2018
Eastover Gardens Special Care HAL-026-055 9/20/2017 12,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights (4) Facility failed to report and investigate known allegations of abuse of 3 residents by a staff person to the Health Care Personnel Registry. 01/18/2019 Training Approved; Paid in Full; 10/12/2018 Settlement Agreement for $10,000.00 and Training for Penalties Imposed 09/20/2017 $10,000.00 12/14/2018
Eastover Gardens Special Care HAL-026-055 9/20/2017 14,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to follow its established routine and expectation of every 30 minute safety checks and every 2 hour incontinence checks for every resident by allowing a resident to go unchecked for a period of 2 1/2 - 7 hours and was reported as found with rigor mortis by Emergency Medical Service first responders; and failed to protect residents from abuse by allowing staff who had been reported to be aggressive and abusive with residents while providing care, to continue to work as the supervisor after 1 of 3 sampled residents was slapped and 2 of 3 sampled residents were assaulted, resulting in injuries and requiring emergency room visits. 01/18/2019 Training Approved; 10/12/2018 Settlement Agreement for $10,000.00 and Training for Penalties Imposed 09/20/2017

Currituck County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Currituck House HAL-027-003 6/30/2017 2,000.00 Type A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medication such as cardiovascular agents, anit depressants, seizure medications, hypnotic medications for diabetes for 2 of 5 sampled residents Appealed 07/28/2017
Currituck House HAL-027-003 6/30/2017 1,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed ensure supervision for 1 of 7 sampled residents with continued falls that resulted in injuries. Appealed 07/28/2017

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 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 1 sampled resident (Resident #8) who eloped from the Special Care Unit (SCU). Paid in Full 500 3/28/2019

Davidson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Lexington HAL-029-006 3/22/2018 2,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide supervision for 1 resident who required assistance with transfers and ambulation with frequent falls in accordance with residents' assessed needs and current symptoms which resulted in injuries including a fractured hip, fractured phalanges and a shoulder dislocation. Paid in Full 2,000.00 4/17/2018

Davie County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Somerset Court of Mocksville HAL-030-008 2/7/2018 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 2 sampled residents with frequent falls in accordance with the residents's assessed needs and current symptoms. 07/17/2018 Settlement Agreement for Training in Lieu of Penalty; Appealed 03/09/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 12,000.00 Type 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 reportings, discharges, resident's rights, health care, nutrition and food services, activities and medication administration. Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 7,000.00 Type 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 as evident by another resident who repeatedly went into resident's room and inappropriately touched resident. Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 7,000.00 Type 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 as ordered by physician regarding finger stick blood glucose and sliding scale insulin for 1 resident. Appealed 10/02/2018
The Heritage of Cedar Rock HAL-030-007 9/12/2018 7,000.00 Type A2 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D(2) & G.S. 131-21D(4) Declaration of Residents' Rights Facility failed to protect 3 residents from mental, physical, and sexual abuse. Appealed 10/02/2018

Duplin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Golden Care (Pty 1) HAL-031-003 5/23/2018 15,000.00 Unabated Type B 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 5 staff had criminal background check in accordance with G.S. 114-19.10 and 131D-40. Appealed 06/08/2018
Golden Care (Pty 2) HAL-031-003 5/23/2018 90,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0601 (a) Management and Other Staff, G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 3 residents by failing to notify primary care provider for 1 resident complained of pain during staff transfer from the bed, failing to notify PCP for 1 resident that did not have test strips for glucometer testing; and failing to assure 1 resident was taken to dental appointments; and Administrator failed to assure the management and overall operations of the facility by failing to meet and monitor rules related to housekeeping and furnishings, health care, staff qualifications, and resident rights. Appealed 06/08/2018
Golden Care (Pty 3) HAL-031-003 5/23/2018 7,000.00 Type 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 3 residents receiving insulin and medications for heart/blood pressure, diabetes, prevention of blood clots, diuretic, hypothyroidism, anxiety, infection and narcotic pain medications. Appealed 06/08/2018
Golden Care (Pty 4) HAL-031-003 5/23/2018 12,000.00 Type 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 resident who was known to wander into residents' room, took food from a resident, attempted to climb into bed with a resident and allegedly sexually assaulted another female resident without consent. Appealed 06/08/2018
Golden Care (Pty 5) HAL-031-003 5/23/2018 15,000.00 Unabated Type B G.S. 131D4-4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the federal Center for Disease Control and Prevention guidelines to assure proper infection control procedures for the use of glucometers for 9 diabetic residents with orders for blood glucose monitoring resulting in the shared use of glucometers. Appealed 06/08/2018
Golden Care (Pty 6) HAL-031-003 5/23/2018 15,000.00 Unabated Type B 10A NCAC 13F .0311 (d) Other Requirements; G.S 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures at 7 fixtures used by residents were maintained between 100 degrees Fahrenheit (F) and 116 degrees F. Appealed 06/08/2018
Golden Care (Pty 7) HAL-031-003 5/23/2018 15,000.00 Unabated Type B 10A NCAC 13F .0407 (a) (5) Other Staff Qualifications; G.S 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 3 staff had no substantiated findings listed on the NC Health Care Personnel Registry upon hire according to G.S. 131E-256. Appealed 06/08/2018
Golden Care (Pty 8) HAL-031-003 5/23/2018 15,000.00 Unabated Type B 10A NCAC 13F .0505 Training On Care Care of Diabetic Residents; G.S 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 2 medication aides received training by a licensed health professional on the care of diabetic residents prior to administering insulin to residents. Appealed 06/08/2018
Golden Care (Pty 9) HAL-031-003 5/23/2018 15,000.00 Unabated Type B 10A NCAC 13F .0306 (a) (4) Housekeeping and Furnishings; G.S 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain an approved sanitation classification in the facility with a NCDE Health Sanitation score of 85 or above at all times. Appealed 06/08/2018
Golden Care (Pty 10) HAL-031-003 5/23/2018 90,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 3 residents were protected from mental and sexual assault from a resident who wandered into a residents' room, stole a resident's food, tried to get into bed with a resident and touched a resident in a sexual manner without consent; failed to assure 2 residents were free from physical abuse by 2 staff; failed to assure two residents were free of neglect by ensuring resident's personal care needs were met and was forced to sit at nurse's desk by a staff, and personal care was provided to a resident who was lying on top of a heating pad and received burns and blisters to back; and failed to pick up a resident from a local store after a reasonable amount of time. Appealed 06/08/2018
Golden Care (Pty 11) HAL-031-003 5/23/2018 67,500.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to report allegations of abuse and neglect and drug diversion to the NC Health Care Personnel Registry and conduct investigations for four staff and failed to investigate and report injuries of unknown origin for 2 residents to HCPR Appealed 06/08/2018
Golden Care (Pty 1) HAL-031-003 5/23/2018 12,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to report allegations of abuse to the North Carolina Health Care Personnel Registry for 1 staff and failed to conduct an investigation. Appealed 06/08/2018
Golden Care (Pty 2) HAL-031-003 5/23/2018 12,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0601 (a) Management and Other Staff, G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 3 residents by failing to notify the Primary Care Provider for a resident with pain during transfer from bed; a resident with no glucometer test strips; and failing to take a resident to dental appointments. Facility administrator failed to assure the management and overall operations of the facility. Appealed 06/08/2018
Golden Care (Pty 3) HAL-031-003 5/23/2018 12,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect 1 resident from physical abuse and being fearful of a staff. Appealed 06/08/2018

Durham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
NuCare Family Care Home FCL-032-105 8/11/2017 $500.00 Type A2 10A NCAC 13G .0909 Resident Rights; 10A NCAC 13G .0601 Management and Other Staff Facility failed to notify the Department of allegations of abuse, assure residents were free of mental and physical abuse and residents were not left alone at any time without a staff member. Paid in Full $500.00 12/21/2017
Richardson Family Care FCL-032-107 8/14/2017 $500.00 Type A2 10A NCAC 13G .1004(p) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure intramuscular injections were administered only by authorized licensed persons for a resident with orders for such injections.
Richardson Family Care FCL-032-107 8/14/2017 $1,000.00 Type A2 G.S 131D-4.4 A Adult Care Home Minimum Safety Requirements; G.S 131D-21-4 Declaration of Residents' Rights The administrator failed to assure rules were met and maintained related to staff qualifications, residents' rights, medication administration, and infection prevention.
Spring Valley Living @ Oak Grove FCL-032-144 8/23/2018 6,100.00 Unbated Type 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 Type 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.

Edgecombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Heritage Care of Rocky Mount HAL-033-005 9/21/2016 $1000.00 Type A2; Reduced to Type B 10A NCAC 13F .0901(b) Personal Care and Supervision; 10A NCAC 13F .0305(b)(4) Physical environment Failure to provide supervision for wandering resident who eloped and to assure 2 exit door alarms were activated with sufficient volume to alert staff. Paid in Full; 03/24/2017 Settlement Agreement for $500.00; Appealed 09/24/2016 $500.00 4/6/2017
Kinillie Family Care Home FCL-033-015 1/24/2019 500 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 (Resident #3) who had multiple seizures and staff was not available to assess the resident.
Kinillie Family Care Home FCL-033-015 1/24/2019 2000 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
Kinillie Family Care Home FCL-033-015 1/24/2019 2000 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,
Open Fields Assisted Living HAL-033-001 1/18/2019 4000 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 Agreement 05/02/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 4000 Type 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 with a diagnosis of Dementia who was constantly disoriented and required but routinely refused assistance with personal care who developed an open, odiferous wound of the left breast diagnosed as fungating cancer of the breast. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 20000 Type 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 18000 Type 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 who had a history of assaultive behaviors, was known to have a prior felony for sexual assault and was listed on the state sex offender registry to prevent 1 resident from being murdered and 1 resident from being raped. Paid in Full $18,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 4000 Type 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 with an order for Thromb-embolitic Deterrent Hose (TED) of when to apply and when to remove. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 20000 Type 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 who has a history of assaultive behaviors and was known to have a prior felony for sexual assault; history of wandering, verbal abuse and aggressive behaviors; disruptive, verbally abusive and aggressive behaviors with an altercation. 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 (Staff C) had no substantiated findings on their Health Care Personnel Registry (HCPR).
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 residents (#2) related to medication used to treat mood disorders.

Forsyth County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Salem Terrace HAL-034-098 1/31/2017 $7,000.00 Type A G.S. 131D-4.4 A (b); G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement infection Control procedures related to the use of fingerstick lancing pens. Paid in Full $7,000.00 4/3/2017
Homestead Hills Assisted Living HAL-034-023 6/30/2017 5,700.00 Unabated Type B G.S. 131D-4.5(B)(b) Rules Adopted by Medical Care Commission; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure that staff hired as Medication Aides successfully complete the 15 hour Medication Administration Training and Medication Clinical Skills Validation prior to administering medications. Paid in Full $5,700.00 7/11/2017
C.R.T. Golden Lamb Rest Home HAL-034-019 11/1/2017 13,150.00 Unabated Type B 10A NCAC 13F .0407 (a)(5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure 2 of 4 sampled staff had no substantial findings listed on the NC Health Care Personnel Registry prior to hiring. Paid in Full; 10/22/2018 Settlement Agreement for both penalties imposed 11/01/2017 for $3,000.00 and Training; Appealed 11/16/2017 $3,000.00 11/6/2018
C.R.T. Golden Lamb Rest Home HAL-034-019 11/1/2017 13,150.00 Unabated Type B 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a criminal background check was completed prior to hire for 4 of 4 sampled staff. Paid in Full; 10/22/2018 Settlement Agreement for both penalties imposed 11/01/2017 for $3,000.00 and Training; Appealed 11/16/2017
Hines Good Samaritan Home (Closed) FCL-034-096 4/5/2018 2,000.00 Type 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 operation of the facility were in compliance with rules and regulations related to staff PC training, LHST competency validation and evaluation for residents, resident register, care plans, health care, nutrition and food service, medication administration, infection prevention and medication aide training and competency. Referred to Controller's Office
Hines Good Samaritan Home (Closed) FCL-034-096 4/5/2018 2,000.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered to residents as prescribed by physician orders. Referred to Controller's Office
Salem Terrace HAL-034-098 6/25/2018 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physician notification for 1 resident related to physically and verbally aggressive behaviors toward staff, other residents and outside agency staff members. Paid in Full 2,000.00 8/24/2018
Salem Terrace HAL-034-098 6/25/2018 7,400.00 Unabated Type B 10A NCAC 13F .1104 (b) Accounting For Resident's Personal Funds; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure each transaction involving the use of personal funds was maintained in the facility and signed by the resident with two witnesses' signatures at least monthly verifying accuracy of disbursed funds. Paid in Full 7,400.00 8/24/2018
Carillon Assisted Living of Clemmons HAL-034-099 1/25/2019 0 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 3000 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. Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 2000 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. Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 1000 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. Appealed 02/11/2020
Memory Care of the Triad HAL-034-068 1/31/2019 1000 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 Appealed 02/11/2021

Franklin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Essex Manor Assisted Living Facility Louisburg HAL-035-027 9/21/2016 $12,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004 Medication Administration Facility failed to ensure resident did not receive cardiovascular meds, antibiotic, pain meds and a hyopglycemic med because unavailable.
Franklin Manor Assisted Living Center HAL-035-024 9/21/2016 $4,000.00 Type A1 10A NCAC 13F .0901(a) Personal Care and Supervision Facility failed to ensure a resident needing 2-person assist received leg laceration while staff assisting. Paid in Full $4,416.67 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/8/2016 $1,000.00 Type 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 for resident related to contacting emergency medical services for a fractured hip and knee. Paid in Full 1,000.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/8/2016 $2,000.00 Type A2 10A NCAC 13F .0902(c) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to avoid delay of MD orders for urine screen and antibiotics and failed to implement MD orders for 2 residents requiring use of walker, resulting in multiple falls with injuries. Paid in Full 2,000.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/22/2016 $10,600.00 Unabated Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure assure staff administered Vitamin D, Zyprexa, Sertraline, Namenda an Tylenol as ordered for 1 of 8 residents. Paid in Full $10,600.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/22/2016 86,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Faility failed to ensure personal care was provided to 2 of 5 residents based on their assessed needs, resulting in excoriation of the skin and rib and hip fractures. Paid in Full 86,000.00 1/13/2017
The Jordan (Facility Closed) FCL-035-017 4/21/2017 $7,000.00 A1 10A NCAC 13G .0801(d) Resident Assessment, G.S. 131D-21(2) Facility failed to assure immediate referral was made for a singnificant change in 1 of 2 sampled residents that posed an immediate risk to resident health and safety resulting in the death of a resident. Appealed 06/08/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 6/8/2017 2,000.00 Type 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 in accordance with each residents in accordance with each resident's assessed needs, care plan and current symptoms for 1 of 6 sampled residents related to behaviors leading to hospitalization. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 07/07/2017 $500.00 9/27/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 6/8/2017 4,000.00 Type A2 10A NCAC 13F.0909, Resident Rights; G.S. 131D-21(4), Declaration of Residents' Rights Facility failed to assure 2 of 5 sampled residents were free from resident to resident abuse. Resident was assaulted by a resident who had a history of aggressive behavior and another residnet was sexually exploited by a staff person. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 07/07/2017 $500.00 9/27/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 8/11/2017 $7,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure physician contact for 3 of 6 sampled residents as evidenced by failure to notify doctor of a medication error with narcotic pain medication, increased pain and a need for more frequent narcotic pain medication for a resident diagnosed with metastatic cancer; failed to coordinate labwork for dispensing of an antipsychotic medication and failure to notify doctor of the unavailability of this medication resulting in resident diagnosed with a mental illness experincing symptoms of paranoia; and failed to notify the primary care physician and mental health provider that a resident with diagnoses of paranoid schizophrenia, anxiety and agitation who required treatment with psychotropic medications had left facility over a month ago wihtout her medications and her whereabouts were unknown. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 8/11/2017 $12,000.00 Type A1 10A NCAC 13F .0906(f) Other Care and Services; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to immediately notify law enforcement and the county department of social services when the whereabouts were unknown for a resident who had diagnoses of paranoid schizophrenia, anxiety and agitation that required daily management with psychotropic medications and who had left the facility over a month ago. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 8/11/2017 $14,000.00 Type A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights; G.S 131D-25 Implementation Facility failed to administer medications as ordered for 5 of 13 residents observed during the medication passes, including errors with insulin, pancreatitis medication, anxiety medication, pain medication and a topical gel for pain an inflammation and antipsychotics. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living of Louisburg HAL-035-022 8/11/2017 $7,000.00 Type A2 10A NCAC 13F .1008(a) Controlled Substances; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure readily retrievable records and failed to account for the use and administration of controlled substances for 2 of 4 residents sampled including a resident with 2 controlled substance pain medications for a diagnosis of metastatic cancer and a resident with a controlled substance pain medication for daignoses of of knee and back pain whose pain medications were either unavailable or missing resulting in multiple missed doses and causing pain symptoms for both residents. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and 6/08/2017 and imposed to Autumn Wind AL 8/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Pinewood Manor Assisted Living FCL-035-030 10/10/2018 2,000.00 Type 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. 01/03/2019 Settlement Agreement for both penalties imposed 10/10/2018 for $1,000.00 $500.00 11/9/2019
Pinewood Manor Assisted Living FCL-035-030 10/10/2018 6,000.00 Type 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 disordely 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. 01/03/2019 Settlement Agreement for both penalties imposed 10/10/2018 for $1,000.00
Franklin Manor Assisted Living Center HAL-035-024 12/13/2018 14000 Type 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 12000 Type 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

Gaston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Terrace Ridge Assisted Living HAL-036-023 4/21/2017 6,000.00 Type A1 10A NCAC 13F.0909 Residents' Rights, 10A NCAC 13F.0902(b) Health Care, G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure physician notification for 1 of 5 sampled residents regarding the resident's wound care resulting in sepsis. Paid in Full $6,000.00 6/14/2017
Wellington House HAL-036-031 2/13/2018 14,000.00 Type A1 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 1 of 1 residents residing in a special care unit and having swallowing difficulty received appropriate supervision to prevent harm. 10/22/2018 Settlelment Agreement for $5,000.00 and Training; Appealed 03/15/2018
Brookdale Robinwood HAL-036-015 2/13/2018 No Penalty Type A2 10A NCAC 13F .0902 ( c)(4) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement infection control procedures consistent with Centers for Disease Control and Prevention guidelines on infection control regarding the sharing of glucometers for 7 residents.
Rosewood Assisted Living pty#1 HAL-036-004 9/13/2018 4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervison for 1 resident who was having suicidal thoughts in accordance with the resident's assessed needs and current symptoms. Settlement Agreement 05/10/2019
Rosewood Assisted Living pty#2 HAL-036-004 9/13/2018 4,000.00 Type 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 Agreement 05/10/2019
Rosewood Assisted Living pty #3 HAL-036-004 9/13/2018 7,000.00 Type 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 Agreement 05/10/2019

Gates County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Gates House (pty #1) HAL-037-001 7/27/2018 2,000.00 Type A2 10A NCAC 13F .0407 (a) (5) Other Staff Qualifications; 10A NCAC 13F .1205 Health Care Personnel Registry; G.S 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff had no substantiated findings listed on the Health Care Personal Registry prior to being hired at the facility. Appealed 8/24/2018 $3,000.00 1/22/2019
Gates House (pty #2) HAL-037-001 7/27/2018 4,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physician notification for 3 residents regarding missing medications used to treat high blood pressure and mental behaviors for 2 residents and medication refusals for 1 resident. Appealed 8/24/2018
Gates House (pty #3) HAL-037-001 7/27/2018 3,500.00 Type A1 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to assure 2 residents were free of physical and mental abuse as evident of reports of alleged mental and physical abuse by staff members. Appealed 8/24/2018

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 3000 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 Appealed (02/22/2019)
Dependable FCH - Pty 1 FCL-039-016 1/25/2019 1000 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 related to bedroom, storage area, housekeeping and furnishings. competency validation for licensed health support tasks, training of diabetic residents,Tubercutosis test and medical examination , Registering resident assessment, plan nutrition and food service, self-administration of medications, medication storage, pharmaceutical care, residents' respect and dignity related to pets' vaccinations not up to date, and medication aide training and competency.
Dependable FCH - Pty 2 FCL-039-016 1/25/2019 1000 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.

Greene County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Snow Hill Assisted Living HAL-040-008 11/9/2017 2,000.00 Type A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide increased supervision in accordance with each resident's assessed needs, care plan and current symptoms for 2 of 5 sampled residents with multiple falls, including falls with injuries requiring emergency medical services Paid in Full $2,000.00 12/7/2017

Guilford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Lawndale Park HAL-041-062 12/8/2016 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure MD orders related wound care implemented resulting in amputations, and to notify MD regarding a resident's refusal of insulin and fingerstick blood sugar monitoring. Paid in Full $2,000.00 12/25/2016
Bennett's Family Care Home FCL-041-002 12/22/2016 10,800.00 Unabated Type B 10 A NCAC 13G .0601 (a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights The facility administrator failed to assure the rules were met and maintained related to physical environment, staffing records and training, management of facilities, health care, accuracy of med. administration records, and medication administration. 04/10/2017 OAH Order for Dismissal of Petitioner's Constested Case; Appealed 01/23/2017
Brookdale High Point HAL-041-030 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 (b) 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 of 2 of 5 sampled residents with orders for neurology and neurosurgery follow-up appointments following acute and chronic hemorrhaging and application of compression stockings. Paid in Full 2,000.00 1/26/2017
Emanuel House Assisted Living FCL-041-076 6/8/2017 7,700.00 Unabated Type B 10A NCAC 13G.0405(a) Test for Tuberculosis; G.S. 131D-21(2), Declaration of Residents' Rights Facility failed to assure 1 of 2 sampled residents was tested for TB disease upon employment in compliance with control measures adopted by the Commission of Health Services.
Emanuel House Assisted Living FCL-041-076 6/8/2017 7,700.00 Unabated Type B 10A NCAC 13G.0406(a), Other Staff Qualifications; G.S. 131D-21(2), Declaration of Residents' Rights Facility failed to obtain criminal background check for 1 of 2 sampled staff.
Greensboro Retirement Center HAL-041-003 7/10/2017 $43,200.00 Unabated Type B 10A NCAC 13F .0306 (a)(5) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the enviroment was free of hazards related oxygen cylinders stored in resident rooms Paid in Full; 07/27/2017 Settlement Letter combinding both penalties for $38,200.00 $0.00 7/24/2017
Greensboro Retirement Center HAL-041-003 7/10/2017 $38,200.00 Unabated Type 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 on the NC Health Care Personnel Registry (HCPR) prior to hire. Paid in Full; 07/27/2017 Settlement Letter combinding both penalties for $38,200.00 $38,200.00 7/24/2017
Brighton Gardens of Greensboro HAL-041-050 10/27/2017 1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow up for 1 of 7 sampled residents who was experiencing respiratory difficulty and low oxygen saturations with exertion. Paid in Full 1,000.00 11/14/2107
Emanuel House Assisted Living (Closed) FCL-041-076 10/30/2017 15,700.00 Unabated Type B G.S. 131D-4.5 B (b) ACH Medication Aides; Training and Competency Evaluation Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 2 of 2 sampled staff who performed medication aide duties met the requirements to administer medications by documentation of completing the 15-hour medication training for new staff.
Brighton Gardens of Greensboro HAL-041-050 2/7/2018 2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision ; G.S. 131D-21 (3) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 2 sampled residents, one requiring ambulation assistance and being a high fall risk and the other having had multiple falls, with assessed needs and current symptoms. Paid in Full 2,000.00 2/28/2018
St. Gales Estates HAL-041-023 3/27/2018 13,800.00 Unabated Type B G.S. 131D4-4 (A) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement infection control procedures consistent with Centers for Disease Control and Prevention guidelines on infection control regarding the sharing of glucometers for 7 residents. Paid in Full $13,800.00 5/14/2018
Westdale Manor FCL-041-027 5/23/2018 1,000.00 Type A2 G.S. 131D4-4a (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement infections control procedures consistent with Centers for Disease Control and Prevention guidelines on infection control regarding use of single-use equipment (glucometer and lancing devices) for more that one resident. Paid in Full $1,000.00 5/24/2018
Brookdale Lawndale Park HAL-041-062 4/4/2019 $1,400.00 Unabated Type B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure physician notification for 1 of 5 sampled residents (Resident #3) regarding blood pressure (BP) results.

Harnett County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Senter's Rest Home HAL-043-024 4/27/2017 2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (1) (4) Declaration of Residents' Rights Facility failed to ensure that a resident was free from physical and verbal abuse related to mistreatment by a staff. Paid in Full; 02/23/2018 Settlement Agreement reducing from Type A2 to Type B penalty; Appealed 05/23/2017 $1,000.00 4/18/2018
Green Leaf Care Center HAL-043-027 10/30/2017 4,000.00 Type 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 2 of 2 sampled residents known to be disoriented, who eloped from the facility, in accordance with each resident's assessed needs. Paid in Full Appealed 11/27/2017 $2,000.00 12/27/2018
Alzheimer's Related Care HAL-043-026 5/23/2018 1,000.00 Type 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 resident known to wander and had exit seeking behaviors, who eloped from facility. Paid in Full 1,108.33 10/4/2018
RBC Healthcare Solutions (closed) FCL-043-033 6/1/2018 2,000.00 Type A1 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the acute and routine health services of 5 residents relating to follow-up with mental health provider, failure to notify MHP and or PCP of aggressive and escalating behaviors, failed to assure 2 residents received required lab work for pharmacy to dispense antipsychotic medications, receipt of home health services, and that residents went to primary care provider appointments as ordered. Referred to Controller's Office
RBC Healthcare Solutions (closed) FCL-043-033 6/1/2018 6,000.00 Type A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to administer medications as ordered for 3 residents including oral antipsychotics, an injectable antipsychotic and a vitamin. Referred to Controller's Office
RBC Healthcare Solutions (closed) FCL-043-033 6/1/2018 6,000.00 Type A2 10A NCAC 13G .0904 (e) (1) Nutrition and Food Service; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure kitchen, dining and food storage areas were kept clean, orderly, and free of contamination as evidenced by the presence of live and dead roaches in the dining room on floors, walls and furniture; in food pantry and refrigerator; kitchen cabinets and drawers used to store pots, pans and eating utensils; and failed to keep kitchen appliances free of contaminants, stains and debris. Referred to Controller's Office
RBC Healthcare Solutions (closed) FCL-043-033 6/1/2018 7,000.00 Type A1 10A NCAC 13G .0601 (a) Management and Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator refused to contact 911 for 1 resident who was psychotic after not receiving his antipsychotic medication for two weeks and failed to assure the overall management, operation and policies and procedures of the facility were implemented to maintain each residents' right to be free of serious harm and neglect; failed to maintain substantial compliance with rules and regulations related to health care, medication administration and storage, staff training in CPR, residents assessment and care plan, housekeeping and furnishings, nutrition, controlled substances and criminal background screening. Referred to Controller's Office
Johnson Better Care Facility HAL-043-003 9/12/2018 1,000.00 Type 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 Type 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 resusciation (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 12800 Unabated Type 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
Absolute Care Assisted Living HAL-043-029 2/19/2019 19000 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, with one fall resulting in an injury to the resident's face Appealed on 03/19/2019
Senter's Rest Home HAL-043-024 12/12/2018 10000 Type 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. Appealed 01/11/2019
Senter's Rest Home HAL-043-024 12/12/2018 500 Type 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. Appealed 01/11/2019
Senter's Rest Home HAL-043-024 12/12/2018 6000 Type 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. Appealed 01/11/2019
Senter's Rest Home HAL-043-024 12/12/2018 2000 Unabated Type 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. Appealed 01/11/2019
Oak Hill Living Center HAL-043-015 6/25/2018 11000 Type 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 by not performing CPR for 1 resident who was unresponsive and did not have a do not resuscitate order (DNR). Paid in Full 11000 2/12/2019

Henderson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor West HAL-045-092 1/4/2017 14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the prescribing physician when lab tests were not completed timely as ordered for 1 of 5 sampled residents resulting in resident's hospital admission and death. Paid in Full; 02/08/2017 Settlement Agreement for $10,000.00; Appealed 01/17/2017 10,000.00 2/15/2017
Blue Ridge Retirement HAL-045-008 10/27/2017 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to respond appropriately by monitoring vitals, not following facility protocol, failing to contact EMS and send resident to hospital for signs and symptoms of possible heart attack. Paid in Full 16,000.00 12/28/2017
Cardinal Care Center-Hendersonville HAL-045-001 4/19/2018 13,400.00 Unabated Type B 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 3 residents in the area of refusal of personal care and failure to administer medications due to unavailability. Paid in Full 13,400.00 5/11/2018

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 7000 Type 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. Appealed 12/21/2018
Pinewood Manor HAL-046-019 12/12/2018 7000 Type 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. Appealed 12/21/2018
Pinewood Manor HAL-046-019 12/12/2018 7000 Type 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. Appealed 12/21/2018
Pinewood Manor HAL-046-019 12/12/2018 4000 Type 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). Appealed 12/21/2018
Pinewood Manor HAL-046-019 12/12/2018 7600 Unabated Type 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. Appealed 12/21/2018
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 retalliation for communicating complaints.
Pinewood Manor Assisted Living HAL-046-019 4/4/2019 $18,000.00 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

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 12/22/2016 7,000.00 Type A1 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 the licensed prescribing practitioner and in accordance with the faciity's polices and procedures for 3 of 9 residents observed during medication passes , including errors with insulin and prn lubricant eyedrops and a resident who received another resident's medications for heart/high blood pressure, depression and tremors and a resident who received another resident's medications for heart/blood pressure, Alzheimer's disease, depression, lowering triglycerides and calciou and vitamin supplements. Paid in Full 7,000.00 1/20/2017
Open Arms Retirement Center HAL-047-009 10/26/2017 1,000.00 Type 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 by a licensed prescribing practitioner in 2 of 5 residents sample. Appealed 11/27/2017
Open Arms Retirement Center HAL-047-009 6/6/2018 4,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to seek acute care an notify the physician of swelling and brusing of a resident's leg which was diagosed as a dislocated knee. Appealed 07/06/2018
Open Arms Retirement Center HAL-047-009 6/6/2018 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure acute and routine health care referral was provided for 3 residents; 1 resident by not notifying physician for leg pain diagnosed as a hip fracture, for 1 resident to unclog a dialysis port and for 1 resident to see cardiologist as ordered by ER physician Appealed 07/06/2018
Open Arms Retirement Center HAL-047-009 6/6/2018 6,000.00 Type 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 residents, 1 with medication used to control phosphorus levels, 1 with an inhaler and steroid nasal spray; and for 4 residents with missed doses of narcotic pain medication, heart/blood presure medication, glaucoma eye drops, sliding scale insulin and with Vitamin D supplement Appealed 07/06/2018
Open Arms Retirement Center HAL-047-009 6/6/2018 7,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights The facility failed to report and investigate known allegations of abuse for 1 resident by a staff to Health Care Personnel Registry (HCPR) Appealed 07/06/2018
Open Arms Retirement Center HAL-047-009 6/6/2018 14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights; G.S. 131D-25 Implementation Facility failed to assure the health care needs of 2 residents were met by failing to notify health care provider of withdrawal symptoms from not receiving pain medication and for 1 resident who became bedbound, totally dependent on staff, and had multiple falls after receiving an antianxiety medication; facility administrator failed to assure the overall management, operations and policies and procedures were implemented to maintain each resident's right to be free of abuse and neglect and failure to maintain substantial compliance with the rules and statutes governing adult care homes. Appealed 07/06/2018
Open Arms Retirement Center HAL-047-009 6/6/2018 14,000.00 Type A1 10A NCAC 13F.0909 Resident Rights, G.S. 131-21D (4) Declaration of Residents' Rights Facility failed to ensure 2 residents were free of physical abuse and neglect; 1 resident alledgedly abused by a personal care aide observed jerking and mistreating resident and 1 resident neglected by being isolated and not allowed to leave his room for almost two months. Appealed 07/06/2018
The Grossings at Wayside HAL-047-011 5/31/2018 7,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for 1 resident in accordance with the resident's assessed needs and current symptoms which resulted in a fall that caused a broken nose, laceration to the abdomen and forehead , and pain. Appealed 06/29/2018
The Grossings at Wayside HAL-047-011 12/13/2018 4,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed administer prescribed medications as ordered by licensed prescribing practitioner for 1 resident. Appealed 01/11/2019
The Grossings at Wayside HAL-047-011 12/13/2018 14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights; G.S. 131D-25 Implementation 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 4000 Type 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.
Open Arms Retirement Center HAL-047-009 1/6/2019 14000 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. Appealed 02/01/2019
The Crossings at Wayside HAL-047-011 12/12/2018 14000 Type 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.

Iredell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Olin Village HAL-049-016 9/21/2016 6,600.00 Unabated Type B G.S. 131D-4.4 A; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented for blood glucose monitoring for a least 3 residents with orders for finger stick blood sugars by sharing glucometers with other residents. Paid in Full $7,287.50 12/21/2016
Crown Colony HAL-049-010 1/20/2017 6,500.00 & Training Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights The facility failed to ensure a resident was free from sexual abuse by a staff member. 11/09/2017 Training Completed; 08/15/2017 Settlement Agreement for Staff Training; Appealed 01/26/2017
Aurora of Statesville HAL-049-028 10/2/2017 16,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the care and services which were adequate, appropriate and in compliance with 2 of 2 special care unit residents that resulted in an altercation resulting in injury to one of the residents. Paid in Full $16,000.00 5/24/2018
Brookdale Peachtree MC HAL-049-021 2/8/2018 2,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a resident was free of neglect and mental abuse by her roommate as evidenced by leaving them in the same room after an altercation and fear of her roommate. Paid in Full 2,000.00 2/26/2018
Brookdale Peachtree MC HAL-049-021 2/8/2018 4,000.00 Type A1 10A NCAC 13F .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the physician for 2 of 5 sampled residents regarding an alercation resulting in injuries. Paid in Full 4,000.00 2/26/2018
Olin Village HAL-049-016 11/9/2017 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for 2 of 5 sampled residents for refusing mental health and Parkinson's medications and not being administered a medicaton to treat diabetic nerve pain. Paid in Full 16,000.00 1/9/2018
Olin Village HAL-049-016 11/9/2017 16,200.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; 10A NCAC 13F .0601 (a) Management and Other Staff; 10A NCAC 13F .1008 (a) Controlled Substances; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by a licensed prescribing practioner to 3 of 5 sampled residents to treat pain and chronic obstructive plulmonary disease. Paid in Full 16,200.00 1/9/2018
Aurora of Statesville HAL-049-028 5/31/2018 4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up for 3 residents with a referral for psychiatry and psychotherapy services and a physician's order for a gastrointestinal (GI) consult and referral for physical therapy. Paid in Full; Referred to Controller's Office $4,433.33 11/14/2018
Aurora of Statesville HAL-049-028 5/31/2018 4,000.00 Type A2 G.S. 131D-25 Implementation; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator failed to assure the total operation of the facility met and maintained rules telated to healthcare referral and follow-up, medication administration, nutritional services, and pharmaceutical care. Paid in Full; Referred to Controller's Office $4,433.34 11/14/2018
Brookdale Peachtree MC HAL-049-021 6/25/2018 4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 2 residents in the Special Care Unit received referral and follow-up with neurology, urinalysis, psych evaluation and psych nursing referral in accordance with resident's needs and physician orders. Paid in Full; 01/10/2019 Settlement Agreement for $2000.00 & Training; Appealed 07/20/2018 $2,000.00 1/18/2019
Brookdale Peachtree MC HAL-049-021 6/25/2018 18,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 2 residents in the Special Care Unit who had aggressive/assaultive behaviors received adequate supervision and resulted in injury to two residents. Paid in Full; 01/10/2019 Settlement Agreement for $9000.00 & Training; Appealed 07/20/2018 $9,000.00 1/18/2019
Olin Village HAL-049-016 12/12/2018 7000 Type 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 7000 1/2/2019

Johnston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Oakview Commons HAL-051-036 7/24/2017 $4,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0603 Management of Facilities with a Capacity or Census of 81 or more Residents; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure a care coordinator was on duty in the Special Care Unit and failed to notify primary care provider of falls head injuries; failed to provide personal care assistance with transfering amulation, toileting, bathing and mouth care resulting in one resident found with partially dried feces in mouth, residents with numerous repeated falls resulting in serious physical injuries
Oakview Commons HAL-051-036 7/24/2017 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervison for six residents resulting in residents having numerous repeated falls resulting in serious physical injuries.
Oakview Commons HAL-051-036 7/24/2017 $4,000.00 Type A1 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care assistance with transferring, ambulation, toileting, bathing and mouth care for six residents.
Autumn Wind Assisted Living HAL-051-037 8/11/2017 $2,000.00 Type A2 10A NCAC 13F .0901(c ) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to respond in any reasonable manor to a resident ingesting harmful substances including toothpaste, moutwash, hand sanitizer and aftershave on 2 occasions within 1 month; and to provide intervention and supervision to prevent continued incidents and harm as evidenced by the resident having free access to a storage closet containing bottles of mouthwash, aftershave and medications of former residents including Trazadone, Prednisone and Clozaril. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and imposed to Autumn Wind AL Louisburg 06/08/2017 and 08/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living HAL-051-037 8/11/2017 $7,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure a safe operational environment with the adult care home as evidenced by violating resident rights, inadequate staffing, absent supervision, failure to report abuse allegations to Health Care Personnel Registry, unsafe medication and a deteriorating, unsafe and unclean physical environment. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and imposed to Autumn Wind AL Louisburg 06/08/2017 and 08/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living HAL-051-037 8/11/2017 $4,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131E-256(g) Health Care Personnel; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to report and investigate known allegations of abuse for 3 residents by a staff person to the Health Care Personnel Registry. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and imposed to Autumn Wind AL Louisburg 06/08/2017 and 08/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Autumn Wind Assisted Living HAL-051-037 8/11/2017 $4,000.00 Type A2 10A NCAC 13F .0604(d) Personal Care and Other Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Faciility failed to assure adequate staffing to provide direct personal assistance and supervision needed by the residents by routinely staffing the facility with one person on each shift who was responsible for administering medications, cooking meals, performing housekeeping duties and supervising 18 residents, one of which had a history of ingesting potentially hazardous substances such as toothpaste, hand sanitizer and aftershave. Paid in Full; 09/25/2017 Settlement Agreement in conjunction with penalties imposed 08/11/2017 and imposed to Autumn Wind AL Louisburg 06/08/2017 and 08/11/2017 for $5,000.00; Appealed 08/18/2017 $500.00 9/27/2017
Ultimate Family Care Home 9 FCL-051-053 8/25/2017 500.00 Type A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify the prescribing practitioner for 1 of 3 residents sampled related to high blood sugars including 4 consecutive blood sugars greater than 500 on one day resulting in resident being hospitalized for symptons of high blood sugar. Paid in full $500.00 8/30/2017
Clayton House HAL-051-041 9/29/2017 7,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure 1 of 2 residents sampled who had a history of wandering in to other residents' rooms was protected from physical harm by another resident who was known not to like wandering residents in his room resulting in resident sustaining a hip fracture after being pushed by other resident; to investigate a family member's concerns for one resident with injuries of unknown origin such as scratches, bruises and knot on head; to follow their established protocol for 2 of 2 residents sampled when bed bug activity was confirmed in one resident's bedroom and bed bug bites were found on another resident to include notifying their contracted service agent. 02/02/2018 Settlement Agreement for Unmodified Penalty; Appealed 10/22/2017 $3,500.00 4/3/2018
Gabriel Manor Assisted Living HAL-051-048 10/26/2017 7,000.00 Type A2 10A NCAC 13F .0305 Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the memory care unit short hall and long hall exit doors were equipped with a sounding device that activated when the doors were opened resulting in 2 of 2 residents exited the memory care unit without staff awareness. Paid in Full; 10/22/2018 Settlement Agreement for $10,000.00 and Training; Appealed 11/27/2017 $10,000.00 11/13/2018
Gabriel Manor Assisted Living HAL-051-048 10/26/2017 19,500.00 Type A1 10A NCAC 13F .0904 Nutrition and Food Service; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to serve mechanical soft diets for 4 of 4 residents which included one resident who choked and later died, 2 of 2 residents with orders for puree diets and 3 of 3 residents with orders for nectar thick liquids. Paid in Full; 10/22/2018 Settlement Agreement for $3,500.00 and Training; Appealed 11/27/2017 $3,500.00 11/13/2018
Clayton House HAL-051-041 3/22/2018 7,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 4 residents with behaviors including wandering and increased agitation and aggression were adequately supervised according to assessed needs, resulting in injuries to residents including a hip fracture requiring surgical intervention. Appealed 04/20/2018 $2,000.00 7/2/2018
Country Wood #4 FCL-051-054 4/5/2018 1,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to meet the health care needs of 2 residents by failing to obtain podiatry care and failing to notify primary care provider of multiple low blood glucose levels for a diabetic resident receiving insulin; and for 1 resident who needed cataract surgery with symptoms of decreased vision including a fall resulting in a brused knee Paid in Full; Referred to Controller's Office $1,117.09 12/28/2018
Oakview Commons (CHOW) HAL-051-036 6/4/2018 4,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0603 Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs of residents and to asure all care and services were provided by management to residents with local, state, and federal regulations and codes. Paid in Full; 01/03/2019 Settlement Agreement for all penalties imposed 06/04/2018 for $6,000.00; Appealed 06/07/2018 $6,000.00 1/18/2019
Oakview Commons (CHOW) HAL-051-036 6/4/2018 4,000.00 Type 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 for 6 residents resulting in numerious repeated falls resulting in head lacerations, hematomas, and broken hip, leg, arm and spine bones. Paid in Full; 01/03/2019 Settlement Agreement for all penalties imposed 06/04/2018 for $6,000.00; Appealed 06/07/2018
Oakview Commons (CHOW) HAL-051-036 6/4/2018 4,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care assistance with transferring, ambulation, toileting, bathing and mouth care for 6 residents resulting in a resident with partially dried feces in mouth, and residents with falls resulting in injuries, skin breakdown, body odor, dirty nails and unclean clothing for several days at a time. Paid in Full; 01/03/2019 Settlement Agreement for all penalties imposed 06/04/2018 for $6,000.00; Appealed 06/07/2018
Ultimate Family Care Home FCL-051-038 5/31/2018 500.00 Type A2 10A NCAC 13G .0906 (f)(4) Other Resident Services; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to immediately notify DSS and appropriate law enforcement agency for 1 resident who did not return to the facility and the facility did not know whereabouts of resident for 10 days. Paid in Full; Referred to Controller's Office $554.17 10/9/2018
Ultimate Family Care Home #4 FCL-051-050 5/29/2018 500.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a resident received medications as ordered by the primary care provider including medications used to control seizures and treat anxiety. Paid in Full $500.00 6/14/2018
Clayton House pty#1 HAL-051-041 9/12/2018 6,000.00 Type 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 mutiple 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 brusing and pain in the buttocks. Settlement Agreement 05/03/2019
Clayton House pty#2 HAL-051-041 9/12/2018 4,000.00 Type 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 Agreement 05/03/2019
Country Wood #3 FCL-051-055 12/12/2018 2000 Type 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.
Country Wood #3 FCL-051-055 12/12/2018 2000 Type 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.
Country Wood #3 FCL-051-055 12/12/2018 2000 Type 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 orderd from pharmacy in a timely manner resulting in a missed injection, and failing to assure residents went to scheduled visit with psychiatric provider.

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 2/5/2018 7,000.00 Type 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.
Leak's Family Care Home FCL-053-013 9/12/2018 6,000.00 Type 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

Lenoir County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Care One Memory Unit of Kinston HAL-054-064 1/31/2017 $2,000.00 Type A2 10A NCAC 13F .0504 (c) Competency Validation for LHPS Tasks; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure staff were competency validated to apply debriding agents to wounds. Paid in Full $2,000.00 3/15/2017
The Village of Kinston HAL-054-067 4/21/2017 15,000.00 Type A1 10A NCAC 13F.0902(b) Health Care, G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure referral of 1 of 5 sampled residents for advanced medical treatment as requested by the resident and as evidenced by a declining medical status change. 7/10/2018 Training Completed; Paid in Full; 02/23/2018 Settlement Agreement for $5000.00 & Training; Appealed 05/02/2017 $5,000.00 2/28/2018
The Village of Kinston HAL-054-067 8/10/2017 3,000.00 Type A2 10A NCAC 13F .0901(a) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure assistance with transfers and ambulation was provided to 1 of 2 sampled residents who required extensive assistance from staff and could not reach her call bell to request assistance, resulting in multiple falls. 7/10/2018 Training Completed; 02/23/2018 Settlement Agreement for Training; Appealed 08/29/2017
Kinston Assisted Living HAL-054-062 8/10/2017 $4,000.00 Type A1 10A NCAC 13F .0901 Personal Care and Supervision Facility failed to ensure that 1 of 5 sampled residents was transferred in a safe manner by one staff person resulting in a fall and sustaining a fractured femur. Paid in full $4,000.00 8/30/2017

Madison County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mintz Family Care Home #2 (Pty # 1) FCL-057-002 6/4/2018 3,500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision to 1 resident who self-administered the wrong insulin resulting in three separate insulin overdoses and a fall with a closed head injury requiring emergency medical treatment at the hospital. 10/22/2018 Settlement Agreement for $2,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office $1,660.00 01/16/2019 12/21/2018
Mintz Family Care Home #2 (Pty # 2) FCL-057-002 6/4/2018 3,500.00 Type A2 10A NCAC 13G .1005 (a) Self Administration of Medications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 2 residents who self-administered insulin had physician's orders to self-administer, failed to notify physician of 1 resident's inability to administer insulin which resulted in insulin being administered by another resident and failed to ensure 1 resident's physician was notified of non-compliance with administration on insulin resulting in three hospitalization for emergency treatment. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 3) FCL-057-002 6/4/2018 3,500.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs of 2 residents related to noncompliance with physician's orders, self-administration of wrong insulin, consistent critically high blood glucose levels and beginning sliding scale insulin coverage. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 4) FCL-057-002 6/4/2018 3,500.00 Type A2 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure the total operation of the facility met and maintained rules and regulations related to sanitation, building service equipment, outside premises, personal care and supervision, health care, nutrition and food service, resident rights, HCPR, and medication orders, administration, self-administration and storage of medicine. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 5) FCL-057-002 6/4/2018 3,500.00 Type A2 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure hot water temperatures at all fixtures used by 6 residents were maintained between 100 degrees Fahrenheit (F) and 116 degrees F. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 6) FCL-057-002 6/4/2018 3,500.00 Unabated Type B 10A NCAC 13G .0317 (a) Building Service Equipment; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure one dining room ceiling fan with lights and one of two kitchen lights were maintained safe and in operable condition. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 7) FCL-057-002 6/4/2018 3,500.00 Unabated Type B 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure all residents were free of mental abuse related to a resident threatening another resident without immediate intervention from staff. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 8) FCL-057-002 6/4/2018 3,500.00 Unabated Type B 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights The facility failed to assure medications were available for administration as needed as ordered by prescribing practitioner for 1 resident who was exhibiting behaviors. 10/22/2018 Settlement Agreement for $1,000.00in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #2 (Pty # 9) FCL-057-002 6/4/2018 3,500.00 Unabated Type B 10A NCAC 13G .0318 (a) Outside Premises; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure the outside grounds were maintained clean and safe which resulted in a resident falling down an embankment due to an unsecured fence and broken chair; and failed to have a side walk and driveway with smooth surfaces. 10/22/2018 Settlement Agreement for $1,000.00 in conjunction with all penalties imposed 06/04/2018 for a total of $10,000.00; Referred to Controller's Office
Mintz Family Care Home #3 (pty #1) FCL-057-003 9/12/2018 8,200.00 Unabated Type 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 Type 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 Type 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
Williamston House HAL-058-011 4/20/2017 1,000.00 Type A2 10A NCAC 13F.0902(b), Health Care, G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute care needs for 3 of 5 residents, one who had multiple falls with fractures, abrasions and laceration injuries, one who requred swallowing precautions and honey-thickened liquids, hematology labwork and occupationsal therapy following a hospitalization, and one who eloped from the facility and was having behaviors. Appealed 05/19/2017
Williamston House HAL-058-011 4/20/2017 1,000.00 Type 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 the licensed prescribing practitioner and in accordance with facility policies and procedures for 1 of 4 residents. Appealed 05/19/2017
Williamston House HAL-058-011 4/20/2017 1,000.00 Type A2 10A NCAC 13F.0901(b) Personal Care and Supervision, G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide increased supervision in accordance with a resident's assessed needs, care plan and current symptoms for 2 of 5 residents Appealed 05/19/2017
Vintage Inn Retirement Village HAL-058-010 1/25/2019 3500 A1 10A NCAC 13F .0901(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 3 residents were supervised for safety on the Special Care unit as evidenced by Resident #3 experiencing 4 incidents of injuries including sternal and spine fractures and a subdural hemorrhage with unknown causes and 4 documented falls from October 2017 through March 2018; Resident experiencing 8 falls in less than 30 days with one documented head injury requiring emergency room evaluation; and Resident having repeated undocumented and unreported falls. Appealed 01/21/2019
Vintage Inn Retirement Village HAL-058-010 1/25/2019 3500 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to meet healthcare needs timely for 5 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 Appealed 01/21/2019
Vintage Inn Retirement Village HAL-058-010 1/25/2019 3500 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. Appealed 01/21/2019

McDowell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
McDowell Assisted Living HAL-059-017 10/20/2017 2,000.00 Type A2 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 1 of 5 sampled residents with a diagnosis of dementia who exited from the facility unsupervised. Paid in Full 2,000.00 12/7/2017
Cedarbrook Residential Center pty #1 HAL-059-021 10/25/2018 1,000.00 Type 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. Appealed 11/02/2018
Cedarbrook Residential Center pty #2 HAL-059-021 10/25/2018 1,000.00 Type 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 agression of violent outburst and threats towards residents and staff. Appealed 11/02/2018
Cedarbrook Residential Center pty #3 HAL-059-021 10/25/2018 1,000.00 Type 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. Appealed 11/02/2018
Cedarbrook Residential Center pty #4 HAL-059-021 10/25/2018 1,000.00 Type 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. Appealed 11/02/2018

Mecklenburg County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Cotswold HAL-060-132 9/20/2016 $1,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration Errors in administration of Novolog insulin, Lantus insulin and Metoprolol. Paid in Full $1,000.00 10/4/2016
Brookdale Cotswold HAL-060-132 9/20/2016 $2,000.00 Type A2 10 A NCAC 13F .0601(a) Management of Facilities Failure to assure compliance in multiple rule areas. Paid in Full $2,000.00 10/4/2016
Brookdale Cotswold HAL-060-132 9/20/2016 $2,000.00 Type A2 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Neglect - not administering pain meds. as ordered; late response to call bells. Paid in Full $2,000.00 10/4/2016
Elmcroft of Little Avenue HAL-060-082 12/22/2016 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to 2 of 5 sampled residents in accordance with each resident's assessed needs, care plan and current symptoms resulting in their being found outside of the special care unit beyond facility grounds after a period of more than 2 hours and 30 minutes. Paid in Full 1,000.00 1/17/2017
Brian Center Health & Rehab Charlotte NH0363 4/23/2018 $20,000.00 Type A 1 10A NCAC 13D .2203 (a) Patients Not to Be Admitted "1) The facility failed to notify the nursing home licensure and certification section about a change in magnitude or scope of services when they provided non-invasive ventilator care to residents. 2) The facility failed to ensure that they were appropriately equipped to admit and readmit residents who required non-invasive mechanical ventilator care. " Penalty impose $20,000.00 5/7/2018
Ranson Ridge at the Villages of Mecklenburg HAL-060-147 4/23/2018 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral for the acute health care needs for 2 residents resulting in the delay of treatment related to gastro-intestinal symptoms which led to the death of 1 resident; and a delay in treatment for 1 resident with a hip fracture resulting in no pain management over 12 hours. Paid in Full $16,000.00 6/18/2018
The The Crossings at Steele Creek HAL-060-130 10/26/2017 4,000.00 Type A2 10A NCAC 13F.0902 (c )(4), Health Care, G.S. 131D-21(2) Declaration of Residents' Rights Facility faied to assure implementation of orders for a resident requiring dressing changes to a suprapubic catheter four time a day and for failure to implement orders for a surgical procedure for 1 of 7 sampled residents. Appealed 11/27/2017
The The Crossings at Steele Creek HAL-060-130 10/26/2017 4,000.00 Type A2 10A NCAC 13F.0901 (b) Personal Care and Supervision, G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure the level of supervision for the residents was modified after two altercations between 2 of 8 sampled residents in special care unit with one altercation resulting in 27 staples to the scalp, repeated falls for 1 of 8 sampled residents with one fall resulting in 11 staples to the scalp and a subsequent fall resulting in hospitalization for hydropneumothorax secondary to to 3 broken ribs. Appealed 11/27/2017
Mint Hill Senior Living (pty #1) HAL-060-136 9/13/2018 500.00 Type 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 1 resident with physician orders for oxygen. Appealed 10/12/2018
Mint Hill Senior Living (pty #2) HAL-060-136 9/13/2018 500.00 Type 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 presure checks to be obtained 3x daily. Appealed 10/12/2018
Senior Retreat at Park Crossing FCL-060-152 9/12/2018 500.00 Type 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 with an indwelling Foley catheter which resulted in multiple ER visits. Paid in Full 500.00 9/24/2018
Brookdale Charlotte East HAL-060-060 2/26/2019 12000 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 as evidenced by the failure to maintain substantial compliance with the rules and statutes governing adult care homes as related to medication administration, resident assessments, supervision, personal care, staffing, nutrition and food service, housekeeping and furnishings, and residents' rights.
Brookdale Charlotte East HAL-060-060 2/26/2019 3500 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 2 residents related to falls, one with injuries including a laceration on the forehead, fracture of the right clavicle, contusion of the left lower extremity and a non-displaced fracture of the left ankle, and a head injury, and a second resident on isolation protocol, with injuries which included a wrist fracture and a subdural hemotoma.
Brookdale Charlotte East HAL-060-060 2/26/2019 7000 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure contact with a medical professional resulting in resident not being served thickened liquids as ordered and being hospitalized with aspiration pneumonia, another resident being isolated in her room causing an increase in dementia and depression. In addition a significant loss of weight, and refusing to wear thrombo-embolic deterrent hose because she needed a larger size.
Regency at Pineville HAL-060-139 2/19/2019 4000 A2 G.S. 131D-25 Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facilicy failed to assure the management and overall operations of the facility by failing to meet and monitor rules related to personal care and supervision, medication administration and storage, resident rights, nutrition and food storage, housekeeping furniture, unpleasant odors and chemical storage.
Regency at Pineville HAL-060-139 2/19/2019 4000 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 out of 6 related to resident unlocking the SCU door, walked into the patio courtyard unsupervised in the dark, another resident was sent to the hospital with a "high risk for clinical death and decline" and was admitted with urosepsis and pulmonary edema, and another resident attempted to seek staff assistance with ADLs unsuccessfully placing her at high risk for falls.
Regency at Pineville HAL-060-139 2/19/2019 4000 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (12) Declaration of Residents' Rights Facility failed to notify the physician for residents regarding blood pressure and edema medications not being available and not referring a resident for treatment for an illness in a timely manner, high blood sugars and diabetic medications not administered, a perineal wound with bleeding and discomfort (#2), fentanyl patch not being available then administered without an order after discontinued and refusals for three medications and with an order for a psychological evaluation and treatment for a resident who displayed aggressive behaviors.

Moore County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Pinehurst HAL-063-024 9/29/2017 1,500.00 Type A2 10A NCAC 13F 1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications (Lantus and Humalog insuling, Seroquel)) were administered as ordered by a licensed prescribing practitioner for 2 of 6 residents Paid in full $1,500.00 10/10/2017

Nash County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Hunter Hill Senior Living (chow) HAL-064-020 2/28/2018 1,000.00 Type 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 in accordance with assessed needs with multiple falls resulting in multiple injuries including closed head injuries, scalp laceration and low back pain. Paid in Full 1,000.00 4/6/2018
Hunter Hill Senior Living (chow) HAL-064-020 2/28/2018 1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to follow up with the physician for falls that required emergency room visits for 1 of 5 residents sampled. Paid in Full 1,000.00 4/6/2018
Hunter Hill Senior Living (chow) HAL-064-020 2/28/2018 2,000.00 Type A2 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the prescribin practitioner for 6 of 19 residents observed during the medication passes, including errors with medications for diabetes for 2 residents, medication for inflammation in the mouth for one resident, a vitamin supplement for one resident, medication for constipation for one resident and eye drops for the treatment of chronic dryness for one resident. Paid in Full 2,000.00 4/6/2018

New Hanover County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Commons at Brightmore HAL-065-002 4/20/2017 6,000.00 Type 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 3 sampled residents with a wrist fracture, contusion of the right ribs and shoulder, and a broken nose due to falls. Paid in Full $6,000.00 5/11/2017
Castle Creek Memory Care HAL-065-034 9/20/2017 4,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to to provide supervision to 1 of 5 residents sampled who exhibited wandering behaviors resulting in a resident exiting and departing the facility unsupervised. Paid in Full; 02/23/2018 Settlement Agreement for $2,000.00; Appealed 10/20/2017 $2,000.00 3/26/2018
Castle Creek Memory Care HAL-065-034 9/25/2017 2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure follow-up for 1 of 5 sampled residents who displayed symptoms of repeated urinary tract infection which included altered mental status (increased confusion), weakness with a fall, unresponsiveness with hospitalization after a delay of 10 days in obtaining 1st urinalysis and not obtaining 2nd recommended urinalysis, Paid in Full; 02/23/2018 Settlement Agreement - penalty remains unmodified at $2,000.00; Appealed 10/20/2017 $2,000.00 3/26/2018
Castle Creek Memory Care HAL-065-034 10/26/2017 4,000.00 Type A2 10A NCAC 13F.0901 (b) Personal Care and Supervision; 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide adequate supervision to 3 of 5 sampled residents with wandering behavior/dementia who exited the facility unsupervised. Paid in Full; 04/13/2018 Settlement Agreement for $2,500.00; Appealed 11/17/2017 $4,000.00 12/31/2018
Fannie Norwood Memorial Home HAL-065-004 4/23/2018 2,000.00 Type 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 of a resident by not notifying physician as ordered when resident's blood glucose levels were below 50. Paid in Full $2,000.00 6/18/2018
Brookdale Wilmington HAL-065-019 7/27/2018 4,000.00 Type 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 4 residents who had multiple falls resulting in a resident sustaining head injury, a resident with brusing to eye and hematoma to forehead, a resident with nasal fracture with eye injury and sutures and a resident with a scalp injury; and a resident who eloped from facility. Paid in Full $4,000.00 12/31/2018
Castle Creek Memory Care (pty#1) HAL-065-034 8/23/2018 4,000.00 Type 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 Agreement 05/03/2019
Castle Creek Memory Care (pty#2) HAL-065-034 8/23/2018 4,000.00 Type 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 related to 1 resident exiting facility unsupervised, and residents who suffered unwitnessed falls causing injury. Settlement Agreement 05/03/2019
Castle Creek Memory Care (pty#3) HAL-065-034 8/23/2018 8,000.00 Type 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 with mouth care and cutting and trimming toenails who were unable to do task themselves. Settlement Agreement 05/03/2019
Castle Creek Memory Care HAL-065-034 1/25/2019 9000 A2 10A NCAC 13F .0901(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents (#1) resulting in the resident having multiple falls, being found on the floor, and sustaining multiple injuries to include bruising, and facial and head injuries.[Refer to Tag D270, 10A NCAC 13F.0901(b) Personal Care and Supervision (Type A2 Violation)]. Appealed (02/22/2019)
Brookdale Wilmington HAL-065-019 1/18/2019 4000 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, as 1 of 5 sampled residents, who had a diagnoses of Senile Dementia Alzheimer's, was able to exit the free standing special care unit unsupervised and without staff knowledge. Paid in full 4000 3/4/2019

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.

Onslow County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Liberty Commons Assisted Living HAL-067-008 10/13/2017 2,000.00 Type A2 10A NCAC 13F .0902(b) Healthcare; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure physician notification for 2 of 5 sampled residents for one residnet with pain and decreased mobility resulting in a fall and for one resident with low and high blood sugars. Paid in Full 2,000.00 10/31/2017
Onslow House HAL-067-023 9/13/2018 1,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 Declaration of Residents' Right Facility failed to notify the primary care provider for 2 residents; a resident with a leg wound and for another resident's decline in condition. Appealed 10/12/2018
Onslow House HAL-067-023 12/12/2018 11000 Type A1 10A NCAC 13F .0901 ( c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff respond immediately for 1 resident who was unresponsive requiring CPR according to facility's polices and CPR training.

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 Type 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 4 residents living in facility. Paid in Full 500.00 11/14/2018

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 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. Appealed 02/07/2019
The Gardens of Pamlico HAL-069-002 1/8/2019 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (7) 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. Appealed 02/07/2019

Pasquotank County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Elizabeth City HAL-070-005 5/7/2018 16,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0305 (h) (4); G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for 3 residents with diagnoses of dementia and known disorientation/confusion resulting in the residents leaving facility unsupervised, without staff's knowledge which resulted in 1 resident death. Paid in Full; 01/28/2019 Settlement Agreement for $7,000.00 & Training; Appealed 06/05/2018 $7,000.00 2/11/2019

Pender County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashe Gardens (pty#1) HAL-071-015 9/12/2018 8,000.00 Type 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 resulting in multiple serious physical injuries to include hip and humerus fractures, head injuries, and for a resident with a documented history of reoccurring physicial altercations with other residents causing a resident to fall resulting in an atypical femoral fracture. Appealed 10/12/2018
Ashe Gardens (pty#2) HAL-071-015 9/12/2018 42,500.00 Type 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 and notify license health care providers regarding behaviors; and failure to notify licensed health care providers for a resident's inability to tolerate an ordered gastrointestinal preparation for ordered GI tests and failing to assure resident went to scheduled GI appointments/tests Appealed 10/12/2018
Ashe Gardens (pty#3) HAL-071-015 9/12/2018 42,500.00 Type A1 G.S. 131D-25 Implementation; G.S. 131D-21 (4) Declaration of Residents' Rights Facility Administrators failed to assure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' right to be free of serious harm and neglect by failing to maintain substantial compliance with rules and statutes governing adult care homes as related to supervision, health care, and residents' rights. Appealed 10/12/2018
Green Acres Family Care Home #2 FCL-071-014 7/24/2017 $2,000.00 Type A1 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 Declaration of Residents' Rights Facility administrator failed to assure total operation of facility and maintained rules related to personal care and supervision, health care, amedication administration, and resident rights; failed to assure administrator or administrator-in-charge in the facility
Green Acres Family Care Home #2 FCL-071-014 7/24/2017 $2,000.00 Type A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure that four residents went to appointment with medical and mental health providers resulting in one resident developing infection; failed to notify health care provider or seek emergency treatment for three residents who request physician visits for pain, one with allegations of being raped and one refusing medication.
Green Acres Family Care Home #2 FCL-071-014 7/24/2017 $2,000.00 Type 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 by the licensed prescribing practitioner and in accordance with facility policies and procedures for three of five residents.
Linwood's FCH (Closed) FCL-071-017 10/27/2017 2,000.00 Type A1 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0601 Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator failed to assure the management, policies, and overall operations of the facility were in substantial compliance with the rules and statutes regarding supervision, health care, staff qualification, and reporting of incidents resulting in violations of the residents' rights.
Linwood's FCH (Closed) FCL-071-017 10/27/2017 2,000.00 Type A1 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to notify a licensed healthcare provider of high risk, injurious behaviors for 2 of 5 residents sampled as related to a resident reporting suicidal ideation and being sexually assaulted by another resident, and a resident exhibiting behaviors such as insomnia, wandering facility halls into other residents' rooms, having aggressive behavior towards staff, other residents, and property, and sexually assulting another resident, and failure to assure 4 of 5 residents sampled went to medical and mental health appointments as directed by licensed healthcare providers.
Ashe Gardens (pty#1) HAL-071-015 7/27/2018 7,000.00 Type A1 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 for 3 residents, a resident resulting in hospitalization with diagnoisis of sepsis, a resident not receiving sliding scale insulin, and a resident not receiving medication for drooling and vomiting; for 2 residents with inhaler and medication used for depression. 01/03/2019 Settlement Agreement for all penalties 07/27/2018 for $18,000.00 & Training; Appealed 8/24/2018 $9,000.00 2/4/2019
Ashe Gardens (pty#2) HAL-071-015 7/27/2018 12,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights; G.S.131D-25 Implementation Facility failed to notify the primary care provider of acute health care needs of 3 residents resulting in one resident hospitalized with Sepsis, one resident with blood glucose levels greater than 401 and for one resident needing a two day follow-up after a hospital visit; and Administrator failed to assure the management, operation and policies and procedures of facility were implemented to ensure and maintain each resident's rights. 01/03/2019 Settlement Agreement for all penalties 07/27/2018 for $18,000.00 & Training; Appealed 8/24/2018
Ashe Gardens (pty#3) HAL-071-015 7/27/2018 13,600.00 Unabated Type B 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 for 4 residents with orders for therapeutic diets, thickened liquids and dietary supplements. 01/03/2019 Settlement Agreement for all penalties 07/27/2018 for $18,000.00 & Training; Appealed 8/24/2018
Ashe Gardens (pty#4) HAL-071-015 7/27/2018 23,600.00 Unabated Type B 10A NCAC 13F .0904 (f) (2) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure residents were provided feeding assistance in a manner which promoting dignity and respect, and staff sat to feed residents requiring assistance. 01/03/2019 Settlement Agreement for all penalties 07/27/2018 for $18,000.00 & Training; Appealed 8/24/2018

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 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 as related to management and other staff, health care personnel registry, and medication administration. Paid in Full 500 4/2/2019

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 Type 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

Randolph County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookstone Haven HAL-079-034 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 4 of seven sampled residents by not obtaining urine culture and sensitivity for one resident, not notifying the medical provider of changes in a resident's medical condition, not following up with a resident's medical provider after ingesting chemical cleaner and was set to hospital, and not notifying the the medical provider for a resident receiving medications late on dialysis days. Appealed 01/23/2017
Caregivers of Liberty I FCL-076-028 5/7/2018 500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate supervision for 1 resident who wandered from facility twice with a visit to the ER. Paid in Full 500.00 7/2/2018
All About Love Family Care Home FCL-076-035 1/18/2019 500 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 management, other resident services, health care, other staff qualifications, training on cardio-pulmonary resuscitation, medication storage, controlled substances, housekeeping and furnishings, building service equipment, outside premises, criminal background check, resident register, resident assessments, medication administration, medication disposition, Adult Care Home infection prevention requirements, staff qualifications, and examination and screening for controlled substances.
All About Love Family Care Home FCL-076-035 1/18/2019 15300 Unabated Type 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.

Robeson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Christa Assisted Living FCL-078-099 12/8/2016 $2,700.00 Unabated Type B 10A NCAC 13G .0315 (a) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Failure to maintain home in a clean, orderly manner and free from hazards as evidenced by cleaning supplies not securely stored; ants in kitchen; buckled floor covering in living room and unattached/missing floor moldings in living room, dining area and kitchen; and unsanitary, cluttered kitchen conditions.
Dial's Family Care Home #4 FCL-078-077 4/18/2017 2,000.00 Type 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 Administrator failed to assure that the management, operations and policies of the facility ensured implementation of resident rights by failing to provide appropriate care and services by not maintaining substantial compliance with rules and statutes regarding medication administration, health care and staff qualifications which is the responsibility of the administrator. Paid in Full 2,000.00 12/28/2017
Parkton Place HAL-078-110 8/11/2017 $4,000.00 Type A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide appropriate supervision, resulting in staff not being aware of the elopement of a resident for at least 11 hours. Subsequently the resident was missing 36 hours and located by law enforcement approx. 25 miles from facility.
Parkton Place HAL-078-110 8/11/2017 $4,000.00 Type A2 10A NCAC 13F. 0311(b) Other Requirements; 10A NCAC 13F. 0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure the facility's septic tank system had been maintained in a safe and operating condition resulting in sewage not properly flushing, causing water to back up in showers, commodes and washing machine.
Parkton Place HAL-078-110 8/11/2017 $4,000.00 Type A2 10A NCAC 13F. 0311(b) Other Requirements; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed assure the hot water temperatures were maintained between 100 degrees Fahrenheit to 116 degrees F for 6 of 15 fixtures.
Dial's Family Care Home #2 FCL-078-075 3/27/2018 1,000.00 Type A2 10A NCAC 13F .0904 (e) (4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure that therapeutic diets and thickened liquids were served as ordered by the resident's physician for 2 residents with orders for pureed diets and thickened liquids. Paid in Full; Referred to Controller's Office $1,121.26 12/31/2018
Morning Star AL # 4 HAL-078-067 4/5/2018 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed meet the health care needs of 2 residents by failure to follow-up with nephrologist after hospitalization for acute renal failure requiring temoprary dialysis and readmission requiring permanent hemodialysis for 1 resident; and failure nofity primary care provider of a recent hospitalization and recurrent urinary track infections and urosepsis for a resident. Paid in Full; Referred to Controller's Office $2,225.00 10/11/2018
Parkton Place (closed) HAL-078-110 3/9/2018 8,200.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to notify the physician of a delay in the pharmacy filling a medication order for 1 of 3 sampled residents for potassium chloride after the resident had a critical lab value of a potassium of 2.4 (normal range is 3.5-5.3). Referred to Controller's Office
Parkton Place (closed) HAL-078-110 3/9/2018 16,000.00 Type A1 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 for 7 of 8 sampled residents by failing to coordinate a referral to an ear, nose and throat specialist for a resident who required follow up for a lesion on her tongue; failing to coordinate a referral to a mental health health provider for a resident for electroconvulsive therapy; failing to coordinate a referral for a sleep study for a residents required for the repacement of of a broken C-PAP machine; failing to follow up to dental appointment (for assessment for oral surgery) for a resident, abdominal pain and foot pain reported by a resident, abdominal distention and pain reported by a resident and 2 residents who sustained bedbug bites. Referred to Controller's Office
Parkton Place (closed) HAL-078-110 3/9/2018 16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were treated with respect an dignity as evidenced by the residents being subjected to an incident between Staff C and staff's family member which escalated and put the residents in harm; by Staff C speaking disrespectfully to residents; by the administrator imposing a fee on residents for smoking in unauthorized areas payable directly from residents' personal funds; and 2 residents affected by bedbug infestations having their belongings taken in a humiliating manner. Referred to Controller's Office
Parkton Place (closed) HAL-078-110 3/9/2018 12,000.00 Type A2 G.S. 131D-21 (1) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the management and overall operation of the facility by not being reachable and available to staff and failing to meet and monitor rules related to personal care and supervision, health care, nutrition an food service and resident rights. Referred to Controller's Office
Parkton Place (closed) HAL-078-110 3/9/2018 12,000.00 Type A1 10A NCAC 13F .0601 Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to supervise 3 of 10 sampled residents as evidenced by failing to supervise one resident with a diagnosis of a communicable disease and known to have unprotected sex and failing to supervise 3 residents who were smoking inside the facility. Two of these residents were known by staff to smoke in their room together with the other resident using oxygen simultaneously. Referred to Controller's Office
B & B Assisted Living #2 FCL-078-103 12/12/2018 2000 Type A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medication were administered as ordered for 2 residents for at least 26 days.
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 of 2 sampled residents (Resident #3) with a diagnosis of dementia and in a special care unit, who fell two times while recieving feeding assistance and sustaining injury in both instances. Appealed on 03/19/2019

Rockingham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type 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 by a licensed prescribing practitioner for 3 of 3 sampled residents.
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to refer and follow-up to meet the routine health care needs for 2 of 3 sampled residents regarding physician notification of noncompliance, discharges to hospital and readmissions to facility, and clarification of order for enzymatic debriding agent.
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type A2 10 A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 2 of 6 sampled staff were tested upon employmnet for TB disease in compliance with standard control measures.
Ellison's Family Care Home #2 FCL-079-040 6/8/2017 1,000.00 Type A2 10A NCAC 13G.0317(d), Building Service Equipment, G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to maintain hot water temperature between 100 and 116 degrees Fahrenheit in 2 of 2 sinks in 2 common bathrooms used by residents.
Kellam's Family Care Home FCL-079-098 8/25/2017 1,000.00 Type A2 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to maintain the hot water temperature between 100 and 116 degrees Fahrenheit in 2 of 2 bathrooms, each with 1 sink and 1 shower/tub combination used by all the residents. Paid in Full $1,000.00 9/18/2017
Magnolia House FCL-079-101 5/29/2018 2,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (11) Declaration of Residents' Rights Facility failed to ensure that 5 residents were encourage to exercise his or her rights as a resident and citizen and permitted to make complaints and suggestions without fear of coercion or retaliation. Referred to Controller's Office
Magnolia House FCL-079-101 5/29/2018 2,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure that all residents were free from physical and mental abuse, neglect and exploitation; the administrator failed to ensure the total operation of facility and meet and maintain rules related to resident's rights, other services, nutrition and food service, residents' funds and HCPR. Referred to Controller's Office
Magnolia House FCL-079-101 6/1/2018 2,000.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 5 residents were free of physical, mental and verbal abuse and exploitation by residents being yelled at, demeaning words in fron of other residents, made to perform facility chores and 1 resident being pushed. Referred to Controller's Office
Magnolia House FCL-079-101 6/1/2018 5,400.00 Unabated Type B 10A NCAC 13G .0407 (a) (7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 2 staff had a consent to check a criminal background prior to hire. Referred to Controller's Office
Magnolia House FCL-079-101 6/1/2018 2,000.00 Type A1 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility administrator failed to assure total operations of the facility by failure to maintain substantial compliance with the rules and statues governing adult care home as related to test for Tuberculosis, other staff qualifications, health care, nutrition and food service, activities, residents' rights, medication administration, staff training and competency and examination and screening for control substances. Referred to Controller's Office
Faith Beyond Measure FCL-079-107 12/12/2018 10800 Unabated Type 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 with an order to check oxygen saturation level at night for one week.
Faith Beyond Measure FCL-079-107 12/12/2018 1000 Type 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 related to management and other staff, health care, medication administration, and infection prevention requirements.

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 Type 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 to assure proper infection control procedures for the use of glucometers for 3 diabetic residents with orders for blood glucose monitoring resulting in sharing of glucometers and lancing devices. Paid in Full $2,000.00 12/27/2018
Angels at Heart Assisted Living HAL-080-020 11/1/2018 2,000.00 Type 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 Type 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 Type 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 in accordance with current symptoms resulting in resident exiting building and being struck by a vehicle resulting in fractured ribs and left scapula. Paid in Full $500.00 4/5/2019
Kannon Creek Assisted Living HAL-080-003 4/18/2017 4,000.00 Type A2 10A NCAC 13F.1004(a) Medication Administration, G.S. 131D-21 Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 4 of 7 sampled residents. Paid in Full $4,000.00 4/28/2017
Kannon Creek Assisted Living HAL-080-003 8/10/2017 $17,800.00 Type B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to obtain required weekly laboratory work for the administration of Clozaril for 1 of 2 sampled residents. Paid in Full 19,728.33 12/28/2017
Bethamy Retirement Center HAL-080-006 10/13/2017 2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights Facilily failed to provide supervision and monitoring to 2 of 6 sampled residents related to drinking rubbing alcohol resulting in a fall with injury and failing to secure the whereabouts of a resident with dementia resulting in resident missing for several hours. 01/03/2019 Settlement Agreement for $1,000.00 & Training; Appealed 11/06/2017
Bethamy Retirement Center HAL-080-006 10/13/2017 2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure physician notification for 2 of 7 sampled residents with regards to low blood pressure (BP) and refusal of medications and meals. 01/03/2019 Settlement Agreement for $1,000.00 & Training; Appealed 11/06/2017
Bethamy Retirement Center HAL-080-006 10/13/2017 2,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administraton; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 2 of 7 sampled residents regarding administering blood pressure medications that had been discontinued and administering anti-anxiety medication without a physician's order. 01/03/2019 Settlement Agreement for $1,000.00 & Training; Appealed 11/06/2017
Kannon Creek Assisted Living HAL-080-003 5/7/2018 14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to obtain orders for colostomy care or notify the physician of frequent bag changes, lack of supplies and changes in skin condition around ostomy site and failed to refer resident for surgical consultation which resulted in hospitalization for septic shock. Paid in Full $14,000.00 06/27/218
Kannon Creek Assisted Living HAL-080-003 12/12/2018 4000 Type 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.

Rutherford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Henderson Care Center HAL-081-010 4/18/2017 2,000.00 Type A2 10 NCAC 13F .1501(a) Use of Physical Restraints and Alternatives, G.S. 131D-21(5) Declaration of Residents' Rights Facility failed to assure physical restraints were used only after an assessment and care planning process had been completed and an MD order obtained for bed rails and gerichair with table top resulting in a resident falling out of bed over the bed rails. Paid in Full $2,000.00 6/19/2017
Nana's Assisted Living Facility #2 HAL-081-051 9/20/2017 5,000.00 Type B 10 NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure home was maintained clean and free of all obstructions and hazards in resident rooms, closet doors off the track, a nail protruding from a box spring, use of extension cords, 2 unsecured toilet seats, exposed lamp sockets, a protruding outlet cover, protruding metal plate on the front of entrance door, no carbon monoxide detector for the gas logs in the living room, and areas that were not clean. Paid in Full $5,520.83 1/8/2018
Restwell Home HAL-081-007 3/18/2019 800 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 4/16/2019

Sampson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Magnolia HAL-082-022 12/8/2016 4,000.00 Type A2 with No Penalty 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up by not scheduling and/or canceling appts. for wound, mental health, obstetric, gynecological and gastrointestinal evaluations and treatments. 06/26/2017 Settlement Agreement for ($0) zero dollors; Appealed 01/06/2017
The Magnolia HAL-082-022 12/8/2016 $7,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were free from neglect as evidenced by picking up Administrator 2 perspective residents from hospital ER in another town and dropping them off in unsupervised locations in same town. Paid in Full; 06/26/2017 Settlement Agreement for $5,000.00; Appealed 01/06/2017 $5,000.00 08/14/2017 08/02/2017
Clinton House HAL-082-018 2/28/2017 4,000.00 Type A2 10A NCAC 13F .0909 (4) Residents' Rights; G.S. 131D-21 (1) Declaration of Residents' Rights Facility failed to ensure one resident with dementia and legally blind was treated with respect and dignity by not providing feeding assistance and for treating resident in a disrespectful manner.
Clinton House HAL-082-018 2/28/2017 4,000.00 Type A2 G.S. 131D-4.4 A (b)(1); G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to maintain infection control procedures consistent with the Federal Center of Disease Control guidelines related to use of glucometers and lancing devices for 10 residents with oders for blood glucose monitoring resulting in shared use of glucometers.
Clinton House HAL-082-018 2/28/2017 4,000.00 Type 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 for the routine and acute health care needs for 3 residents related follow up evaluation to mental health provider, failure to notify physician of skin breakdown for a diabetic resident, and failure to obtain urinalysis per physician's order.
Clinton House HAL-082-018 2/28/2017 12,000.00 Type A2 10A NCAC 13F .0909 (4) Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure 2 residents were free of neglect and 1 resident being denied pain medication and 1 resident not receiving assistance with being repositioned in bed.
Clinton House HAL-082-018 2/28/2017 14,000.00 Type A1 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-25; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that prescription medications were administered as ordered by a licensed prescribing practitioner for 2 residents
Clinton House HAL-082-018 2/28/2017 14,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervison to 1 resident with multiple falls resulting in brusing on the arms, legs, face, and chest wall; lacerations on the forehead and arms with a diagnosis of subdural hematoma.
Clinton House HAL-082-018 3/14/2018 20,000.00 Type A2 10A NCAC 13F .0601 (a) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator failed to assure the management and overall operation of the facility were met by not being reachable and available to staff including lack of adequate supervision for 1 resident with identifed wandering behavior who eloped from facility, failure to assure 6 exit doors accessible to residents with wandering behaviors were alarmed, failure to assure 1 resident was free of allegd abuse from a staff, accurately reporting to Health Care Personnel Registry allegation of resident abuse by staff, failure to report an incident/accident to local law enforcement, failure to assure administration of physician prescribed medications for a resident whom medications were not available for administration, failure to accurately account for 3 residents funds, and use of a portable space heater. Referred to Controller's Office
Clinton House HAL-082-018 3/14/2018 20,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights Facility failed to provide supervision based on the assessed needs of 1 resident who was known to be constantly disoriented and wandered away from facility on multiple dates without staff knowledge. Referred to Controller's Office
Clinton House HAL-082-018 3/14/2018 18,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect 1 resident from physical abuse by a staff member who physically assaulted the resident causing injuries and was allowed to continue working at facility. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 14,000.00 Unabated Type B 10A NCAC 13G .0316 (b) Fire Safety and Disaster Plan; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure a working fire alarm system was maintained by not changing batteries and failing to notify Landlord of the improperly functioning smoke detectors. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 14,000.00 Unabated Type B 10A NCAC 13G .0507 Training on Cardio-Pulmonary; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a least 1 staff member on duty at all times had completed a cardio-pulmonary resuscitation (CPR) and choking management course within the last 24 months. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 14,000.00 Unabated Type B 10A NCAC 13G .0406 (a) (7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff members had a state wide criminal background screening in accordance with G.S. 131D-40 prior to hire. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 3,500.00 Type A1 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator failed to assure the management, operations and policies and procedures of the facility were implemented to maintain each residents' rights by failure to maintain substantial compliance with rules and statues governing adult care homes as it relates to medication administration, health care, other resident services, staff training and qualifications, fire safety and disaster plan, housekeeping and furnishings, and residents rights. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to notify a licensed healthcare provider of high risk behaviors of a resident hearing voices, hallucinating, homicidal ideation, and crawling from the facility window at night, and failing to assure 3 residents went to medical and mental health appointments. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 3,500.00 Type A1 10A NCAC 13G .0906 (a) Other Resident Services; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the provision of transportation for 1 resident who attended school resulting in resident being left to sit outside school for hours in the elements and on one occasion left more that 8 hours without staff knowing whereabout until school security brought resident to facility. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 3,500.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure 1 resident was free of mental abuse by a staff member's friend having a gun on the facility premises and pulling gun on and scaring resident and failed to assure 1 resident had lunch when attending school. Referred to Controller's Office
Green Acres Family Care Home FCL-082-021 3/14/2018 2,000.00 Type 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 1 resident who had a history of mental illness, multiple hospitalizations, auditory hallucinations, and homicidal ideation and medication for mood stabilization. Referred to Controller's Office

Scotland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Willow Place AL & MC HAL-083-019 5/31/2018 2,000.00 Type 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 the licensed prescribing practitioner and in accordance with facility policies and procedures for 7 residents. Appealed 06/07/2018
Willow Place AL & MC HAL-083-019 5/31/2018 2,000.00 Type 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 to maintain rules implemented to ensure and maintain each resident's rights. Appealed 06/07/2018
Willow Place AL & MC HAL-083-019 5/31/2018 2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that 1 resident in the Special Care Unit was protected from assault by a resident. Appealed 06/07/2018

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 Type 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 Gauardian 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 Type 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
Colonial Long Term Care Facility HAL-086-002 3/22/2018 500.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs for 1 resident related to a vagus nerve stimulator (VNS). Paid in Full 500.00 4/16/2018

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 Type B 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 1 residents residing in facility. Paid in Full $1,900.00 12/13/2018
Lynn's Home at Saybrooke FCL-092-147 10/5/2016 $500.00 Type A2 10A NCAC 13G .0901(b) Personal Care and Supervision Facility failed to ensure supervision for four residents with dementia diagnoses who eloped and were found at three different homes located in same neighborhood. 6/26/2017 Settlement Agreement for Penalty Reduction Eliminating $500,00 assessed; Appealed 11/11/2016
Agape FCH #1 FCL-092-208 9/21/2016 $500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for a resident who had dementia, eloped from the facility and was found approximately 10 hours later at a downtown bus station. Paid in Full $552.08 12/20/2016 12/12/2016
Sunrise Assisted Living at North Hills HAL-092-108 9/20/2016 $15,800.00 Unabated A2 10A NCAC 13F .0901(b) Personal Care and Supervision G.S. 131D-21 Declaration of Residents' Rights Failure to ensure supervision based on on assessed needs resuting in fall with injury and elopement of residents; therefore, previously cited A2 violation not abated for 82 days. Paid in Full $15,800.00 10/24/2016
Sunrise Assisted Living at North Hills HAL-092-108 9/20/2016 $61,500.00 Unabated A2 10A NCAC 13F .0311 Other Requirements G.S. 131D-21 Declaration of Residents' Rights Failure to ensure locking mechanism for 1 of 2 exit doors in special care unit was maintained in a safe and operating condition resulting in resident exiting without staff knowledge; therefore, previously cited Type B violation not abated for 79 days. Paid in Full $61,500.00 12/6/2016
Morningside of Raleigh HAL-092-088 12/22/2016 4,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to assure every resident had the right to be free of physical abuse resulting in a resident exhibiting inappropriate sexual behaviors toward females and sexually assaulting a resident. Paid in Full $4,000.00 1/20/2017
North Pointe Assisted Living of Garner HAL-092-186 1/12/2017 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for a resident who was identified as a wanderer, exited the facility and was found approximately 2 hours later in a hole behind the facility, 53 yards from the exit door Paid in Full; 07/26/2017 Settlement Agreement for payment in full; Appealed 02/16/2017 $1,000.00 8/9/2017
North Pointe Assisted Living of Garner HAL-092-186 1/12/2017 2,000.00 Type A2 10A NCAC 13F .0909 (4) Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility neglected to ensure 1 resident, who was non-ambulatory and constantly disoriented, received are and services for stage IV infected, open wounds on sacrum and back. 07/26/2017 Settlement Agreement for Staff Training; Appealed 02/16/2017
Oliver House HAL-092-182 1/31/2017 1,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 14 medications were administered as ordered. Paid in Full; 06/26/2017 Settlement Agreement for payment in full by 8/31/2017; Appealed 02/28/2017 1,000.00 8/2/2017
Carillon Assisted Living of Fuquay Varina HAL-092-159 6/30/2017 1,000.00 A2 10A NCAC 13F .0901(a) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure assistance with transfers, toileting and ambulation was provided in accordance with the assessed needs of 1 of five sampled residents which resulted in physical injuries. Paid in Full $1,000.00 7/17/2017
North Pointe Assisted Living of Garner HAL-092-186 10/18/2017 2,500.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure supervision of residents was provided in accordance with each resident's assessed need resulting in elopement of 2 of 7 samled residents Appealed 11/03/2017
North Pointe Assisted Living of Garner HAL-092-186 10/18/2017 2,500.00 Type A2 10A NCAC 13F .0305(h) (4) Physical Environment; G.S 131D-21(2) Declaration of Residents' Rights Facility failed to assure each exit door accessible by residents had a functioning alarm or alert system device activated when the door was opened for 2 of 2 sampled residents with dementia and disorientation. Appealed 11/03/2017
North Pointe Assisted Living of Garner HAL-092-186 10/20/2017 4,000.00 Type 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 for 3 of 6 residents observed during the medication passes, including insuline medications, Coumadin and psychotropic medication. Appealed 11/03/2017
North Pointe Assisted Living of Garner HAL-092-186 10/23/2017 20,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to notify physician or refer 1 of 7 residents with a diagnosis of bronchitis, and who was exhibiting signs of a wheezing and shortness of breath to the hospital. The resident later died from anoxic brain injury and asthma exacerbation. Appealed 11/03/2017
North Hills Senior Living FCL-092-151 2/7/2018 2,900.00 Unabated Type B 10A NCAC 13G .0206 Capacity; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure that residents' evacuation capabilities were in accordance with the evacuation capability listed on the home's license for 2 of 3 residents who had cognitive and physical impairments which would prevent the residents from independently evacuating the facility. Paid in Full; 10/23/2018 Settlement Agreement for $1,000.00; Appealed 03/06/2018 $1,000.00 11/13/2018
Brookdale Cary HAL-092-023 3/3/2018 1,000.00 Type 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 who required assistance with ambulation with frequent falls in accordance with the residents' assessed needs and current symptoms. Appealed 04/05/2018
Lawndale Manor HAL-092-017 3/27/2018 2,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to provide supervision for 1 resident in accordance with resident's assessed needs and current symptoms related to multiple falls which resulted in a serious injury of multiple fractures of the right arm and right leg. Paid in Full 2,000.00 5/11/2018
Wrenette's Place FCL-092-140 4/23/2018 1,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect 2 residents who had a known histroy of inappropriate sexual behaviors towards children resulting in both residents being arrested for being in an unsupervised environment in the presence of a young child. Paid in Full $1,104.17 7/10/2018
Phoenix Assisted Care HAL-092-131 5/29/2018 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 1 resident identified as a wanderer with history of elopements and exit seeking behaviors who exited the Special Care Unit without staff knowledge twice in one night and found walking 1/2 mile from facility. Appealed 06/12/2018
Brookridge Assisted Living HAL-092-146 1/18/2019 14000 A1 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to contact EMS immediatley for 1 of 5 residents sampled when the resident was non-responsive. Appealed 01/24/2019
Chatham Commons HAL-092-203 1/8/2019 2000 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 requirments met and maintained rules related to water temperatures, housekeeping and furnishings, physical environment, staff qualifications and training, resident assesments and care plans, health care medication administration, pharmacceutical care, and staffing requirments Appealed 02/07/2019
Spring Arbor of Apex HAL-092-037 1/9/2019 500 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 1 residents as evidenced by failure to verify medication orders upon admission on 11/15/16 resulting in resident not receiving medications for transient ischemic attack(TIA), blood pressure, glaucoma and subsequently was rehospitalized for TIA 12/2/16-12/6/16: also failed to clarify clinical summaries rusluting in the resident being hospitalized after a fall on 12/19/16 Paid in full 500 3/12/2019
Val's Place FCL-092-213 2/26/2019 3500 A1 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility Faled to provide supervision for 1 resident with wandering behaviors who had elped without staff knowledge and was found a block away by a neighbor
Val's Place FCL-092-213 2/26/2019 500 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, resulting in resident wandereing off. Had exit seeking behavior and diagnosed with dementia, exiting withough staff knowledge.
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 resulting in Resident #2 eloping. The failure placed other residents at substantial risk for elopin, serious physical harm and neglect. 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 1 orf 5 sampled residents (#2) with wandering and exit seeking behaviors, who elped from the SCU without staff knowledge in a wheelchair. 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 supervise 5 of 5 sampled residents, resultin in 5 residents being left alone.

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 1 of 1 resident from physical abuse, who was assaulted by the Administrator's family member; and two residents being fearful of the Administrator's family member.
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 by failing to meet and monitor rules related to floors, housekeeping and furnishings, building services equipment, outside premises, staff qualifications, staff training, competency, and continuing education, resident rights, health care, medication administration, medication storage, medication disposition, controlled substances, and infection prevention.

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 Type 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 who had fallen out of wheelchair and hit head while being transported in a moving van by not calling 911 according to facility's policies and procedures. Paid in Full Appealed 09/21/2018 $500.00 12/31/2018

Wilkes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wilkes County Adult Care HAL-097-014 6/30/2017 7,000.00 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 for 8 of 9 residents involving low blood sugars, neurologist consult, missed doses of Avonex, podiatry referral, infectious disease specialit referral, medication refusals with associated behaviors, not receiving an ordered monthly anitpsychotic for 3 months, burnt fingertips from smoking, birth control request, and order for a protective helmet to prevent injury from head-banging
Wilkes County Adult Care HAL-097-014 6/30/2017 12,000.00 A2 G.S. 131D-25; G.S. 131D-21(2); 131D-21(4) Adult Care Home Residents' Bill of Rights Facility failed to assure that 4 of 6 coded exit doors accessible by residents were maintained secure with alarms deactivated only by designated staff resulting in 1 resident diagnosed with dementia exiting outside unsupervised at night in freezing weather and falling, causing injury.
Wilkes County Adult Care HAL-097-014 6/30/2017 7,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; 10A NCAC 13F .1002(a) Medication Orders; G.S. 131D-21 Adult Care Home Residents' Bill of Rights Facility failed to ensure verification or clarification of medications of sliding scale Novolin Insulin, Levemir and dpakote Sprinkles for 1 of 5 sampled residents. Physician orders not dated witing 24 hours of admission for same resident.
Wilkes County Adult Care HAL-097-014 6/30/2017 21,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 Adult Care Home Residents' Bill of Rights Facility failed to assure four of six coded exit doors accessible by residents were maintained secure with alarms which could only be deactivated by designated staff, resulting in one resident with dementia exiting outside unsupervised at ight in freezing weather and falling, causing injury.
Wilkes County Adult Care HAL-097-014 6/30/2017 4,000.00 A2 10A NCAC 13F .0305(h) Physical Environment; G.S 131D-21(2) Adult Care Home Residents' Bill of Rights Facility failed to assure four of six coded exit doors accessible by residents were maintained secure with alarms which could only be deactivated by designated staff, resulting in one resident with dementia exiting outside unsupervised at ight in freezing weather and falling, causing injury.
Wilkes County Adult Care HAL-097-014 6/30/2017 7,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Adult Care Home Residents' Bill of Rights Facility failed to assure staff provided supervision in accordance with 9 of 11 residents' assessed needs, care plan and current symptoms resulting in one resident leaving the building unsupervised and without staff knowledge which resulted in a fall, one resident leaving the facility unsupervised and walking across a busy state highway and smoking in the building, one resident twice leaving unsupervised and without staff knowledge , one resident overdosing 3 times, one resident smoking unsupervised resulting in injured fingertips, one resident assaulting another resident, another resident assaulting a resident, one resident leaving the facility unsupervised without staff knowlege and arrested for vandalism and property damage, another resident leaving the facility unsupervised and without staff knowledge and smoking in the building and another resident smoking in the building.
Wilkes County Adult Care HAL-097-014 7/24/2017 138,750,00 A2 10A NCAC 13F .901(b) Personal Care and Supervision; 10A NCAC .0305(h)4 Physical Environment; G.S. 131D-21(4) Adult Care Home Residents' Bill of Rights
Wilkes County Adult Care HAL-097-014 7/24/2017 $138,750.00 A2 10A NCAC 13F . 901(b) Personal Care and Supervision; 10A NCAC .0305(h)4 Physical Environment; G.S. 131D-21(4) Adult Care Home Residents' Bill of Rights Facility failed to assure staff provided supervision in accordance with the assessed needs, care plan and current symptoms for nine residents leaving the building unsupervised without staff knowledge resulting in one resident diagnosed with dementia exiting at night in freezing weather falling causing injury, one resident crossing a busy state highway, one resident leaving twice, one arrested for vandalism and property damage; one resident overdosing three times; residents smoking in building one resulting in injury to fingertips, and residents assaulting other residents. Facility failed to assure that four of six coded exits doors accessible by residents were maintained secure with alarms deactivated only by designated staff.

Wilson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wilson Assisted Living HAL-098-027 8/10/2017 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the level of supervision for the resident was modified after continued repeated fall for 1 of 5 sampled residents with one fall resulting in a hospitalization for a head injury with bilateral subdural hematomas. Paid in Full $1,000.00 8/23/2017
Positive Lifestyles (Closed) FCL-098-033 10/27/2017 3,500.00 Type A1 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21(4) Adult Care Home Residents' Bill of Rights Facility failed to ensure 1 of 1 sampled resident with diagnoses of dementia, altered mental status and psychosis was supervised while outside of the facility, resulting in the elopement and 18 hours in woods being exposed to temperatures below freezing. Paid in Full; 05/29/2018 Settlement Agreement for $1,000.00; Appealed 11/21/2017 $1,000.00 11/06/2018
Spring Arbor of Wilson HAL-098-006 3/27/2018 2,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision for a resident who is a known wanderer who exited the Special Care Unit for an unknown period of time and was found unconscious outside in the courtyard with body temperature of 106 degrees F. Paid in Full 2,000.00 5/8/2018
Parkwood Village HAL-098-029 2/19/2019 16000 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 reciving treatment for complaints of shortness of breath and subsequently expired before arriving to the hospital by EMS and another resident delayed in being sent to the hospital after a fall then diagnosed with a hip fracture. Paid in full 16000 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 5 of 10 residents sampled (Residents #3, #4, #7, #8, and #9) observed during the medication passes including errors with anxiety medication (#3), a medication to regulate phosphate levels (#4), a blood pressure medication (#7), and a medication for constipation (#8 and #9); and to administer medication as ordered by the prescribing physician for 1 of 5 sampled residents (#6) who did not recieve a blood thinner due to the medication being unavailable.
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 2 of 5 residents sampledwho each had a diagnosis of Alzheimer's. Resident #1, who had a history of attempting to ambulate without assistance and multiple falls with injuries, sustained a fractured hip. Resident #2, who had a history of multiple falls with injuries, was found on the floor and was admitted to the hospital and died eleven days later.

Yancey County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mountain Manor Assisted Living HAL-100-002 3/26/2018 2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 Adult Care Home Residents' Bill of Rights Facility failed to provide supervision of the dining room for 2 residents with a history of swallowing problems and 1 resident with falls. Paid in Full 2,000.00 3/26/2018