NC DHSR ACLS: Inspections, Ratings and Penalties

Listing of Facilities with Penalties

This is a listing of penalties that have been imposed for adult care home and family care home violations in accordance with G.S. § 131D-34 within the last 36 months. Click on the link to access the inspection report related to the penalty. For any penalty where there is no link, please send an email to [email protected] to obtain a copy of the inspection report.

Alamance County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
A Vision Come True	HAL-001-103	12/8/2020	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	8/31/2021	Paid in Full
A Vision Come True	HAL-001-103	12/8/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Above and Beyond Family Care II (Closed)	FCL-001-139	4/1/2019	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	7/21/2021	Not Paid - Referred to Controller's Office
Above and Beyond Family Care II (Closed)	FCL-001-139	4/1/2019	10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	7/21/2021	Not Paid - Referred to Controller's Office
Above and Beyond Family Care II (Closed)	FCL-001-139	4/1/2019	10A NCAC 13G .1701 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	7/21/2021	Not Paid - Referred to Controller's Office
Alamance House	HAL-001-148	1/24/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$29,000.00	9/21/2022	Appealed
Alamance House	HAL-001-148	6/20/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$2,000.00	3/8/2023	Appealed
Alamance House	HAL-001-148	6/20/2022	10A NCAC 13F .0902(b) Health Care	A2	$2,000.00	3/8/2023	Appealed
Alamance House	HAL-001-148	6/20/2022	10A NCAC 13F .1004(a) Medication Administration	Unabated A2	$60,000.00	3/8/2023	Appealed
Alamance House	HAL-001-148	6/20/2022	10A NCAC 13F .1308(a) Special Care Unit Staff	A2	$2,000.00	3/8/2023	Appealed
Bethany Tender Love and Care	FCL-001-047	6/25/2021	10A NCAC 13G .1701 (c) Infection Prevention & Control Program (temp);	Unabated B	$9,400.00	4/20/2022	Paid in Full
Bountiful Blessings FCH (Closed)	FCL-001-146	9/9/2019	10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	8/24/2020	Not Paid - Referred to Controller's Office
Bountiful Blessings FCH (Closed)	FCL-001-146	9/9/2019	10A NCAC 13G .0601 (c-2) Mangement And Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Golden Years Assisted Living	HAL-001-026	10/20/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/17/2022	Paid in Full
Moher Family Care (Closed)	FCL-001-107	8/14/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	7/7/2021	Not Paid - Referred to Controller's Office
Moher Family Care (Closed)	FCL-001-107	8/14/2020	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	7/7/2021	Not Paid - Referred to Controller's Office
Moher Family Care (Closed)	FCL-001-107	8/14/2020	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	7/7/2021	Not Paid - Referred to Controller's Office
Moher Family Care (Closed)	FCL-001-107	8/14/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	7/7/2021	Not Paid - Referred to Controller's Office

Alexander County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
A New Outlook of Taylorsville	HAL-002-007	9/11/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$12,000.00	8/31/2021	Settlement Agreement

Anson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Meadowview Terrace of Wadesboro	HAL-004-003	7/26/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/14/2020	Settlement Agreement
Meadowview Terrace of Wadesboro	HAL-004-003	7/26/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/14/2020	Settlement Agreement
Meadowview Terrace of Wadesboro	HAL-004-003	8/11/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/31/2021	Settlement Agreement

Ashe County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Forest Ridge	HAL-005-016	8/4/2022	10A NCAC 13F .0901(c) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	2/15/2023	Paid in Full

Avery County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Cranberry House	HAL-006-007	11/17/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Paid in Full
The Heritage of Sugar Mountain	HAL-006-005	5/4/2021	10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	2/4/2022	Settlement Agreement

Beaufort County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Pantego Rest Home	HAL-007-015	8/26/2020	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Settlement Agreement
Pantego Rest Home	HAL-007-015	8/26/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Settlement Agreement

Bertie County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Pathways	FCL-008-030	6/22/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	4/20/2022	Paid in Full

Bladen County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Comfort Living Family Care Home	FCL-009-022	3/5/2020	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$375.00	5/4/2021	Paid in Full
Oak Grove Family Care Home	FCL-009-028	6/6/2019	10A NCAC 13G .0312(g) Outside Entrance And Exits; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$15,600.00	7/21/2021	Settlement Agreement
West Bladen Assisted Living	HAL-009-025	10/22/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$500.00	8/31/2022	Paid in Full
West Bladen Assisted Living	HAL-009-025	10/22/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2022	Paid in Full

Brunswick County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Ocean Isle Operations	HAL-010-011	8/2/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/26/2021	Paid in Full
Shallotte Assisted Living	HAL-010-008	10/18/2019	10A NCAC 13F .1104(b) Accounting For Resident's Personal Funds; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$34,000.00	8/24/2020	Settlement Agreement
Shallotte Assisted Living	HAL-010-008	2/25/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$16,000.00	8/24/2020	Settlement Agreement
Shallotte Assisted Living	HAL-010-008	2/25/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$12,000.00	8/24/2020	Settlement Agreement
Shallotte Assisted Living	HAL-010-008	2/25/2020	10A NCAC 13F .1008(a) Controlled Substances; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/24/2020	Settlement Agreement
Shallotte Assisted Living	HAL-010-008	2/25/2020	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$14,000.00	8/24/2020	Settlement Agreement
Shallotte Assisted Living	HAL-010-008	2/25/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$16,000.00	8/24/2020	Settlement Agreement
TerraBella Southport	HAL-010-010	11/2/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,250.00	8/17/2022	Paid in Full
TerraBella Southport	HAL-010-010	1/12/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	9/21/2022	Paid in Full
The Bluefields (formerly named Leland House)	HAL-010-007	5/29/2019	10A NCAC 13F .0406(a) Test For Tuberculosis; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$6,900.00	10/1/2020	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	8/6/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$14,000.00	10/1/2020	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	8/6/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	10/1/2020	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	8/6/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	10/1/2020	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .0801(c)(1) Resident Assessment; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$13,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$13,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$13,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .1308(a) Special Care Unit Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	10A NCAC 13F .1308(b) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	10/15/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$13,000.00	8/31/2021	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	7/27/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$20,000.00	8/31/2022	Settlement Agreement
The Bluefields (formerly named Leland House)	HAL-010-007	7/27/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	8/31/2022	Settlement Agreement

Buncombe County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Becky's Rest Home #1	HAL-011-002	9/13/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/7/2020	Paid in Full
Brooks-Howell Home	NH0017	10/14/2022	10A NCAC 13D .2208(e) Safety	A2	$10,000.00	11/8/2022	Paid in Full
Chunn's Cove Assisted Living	HAL-011-262	11/14/2019	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$16,400.00	8/7/2020	Settlement Agreement
Chunn's Cove Assisted Living	HAL-011-262	5/23/2022	10A NCAC 13F .0901(b) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	2/15/2023	Paid in Full
Fairview Family Care #2 (Closed)	FCL-011-023	4/22/2022	10A NCAC 13G .0909 Residents' Rights G.S. 131D-21(4) Declaration of Resident's Rights	A1	$6,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Fairview Family Care #3 (Closed)	FCL-011-024	4/22/2022	10A NCAC 13G .0909 Residents' Rights G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-024	3/2/2021	#N/A	A2	$1,000.00	3/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	5/3/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	4/20/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	5/3/2021	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	4/20/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	5/3/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$25,125.00	4/20/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	6/25/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	5/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	6/25/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$13,500.00	5/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #1(Closed)	FCL-011-022	6/25/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$11,500.00	5/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #2	FCL-011-023	6/22/2021	10A NCAC 13G .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	5/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #2	FCL-011-023	6/22/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	5/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #4 (Closed)	FCL-011-025	1/13/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	3/16/2022	Not Paid - Referred to Controller's Office
Fairview Family Care Home #4 (Closed)	FCL-011-025	3/18/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$1,300.00	3/16/2022	Not Paid - Referred to Controller's Office
Heather Glen at Ardenwoods	HAL-011-371	8/20/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,500.00	8/26/2021	Paid in Full
Richmond Hill Rest Home #1	HAL-011-376	6/2/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	5/16/2022	Settlement Agreement
Richmond Hill Rest Home #1	HAL-011-376	6/2/2021	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	5/16/2022	Settlement Agreement
Richmond Hill Rest Home #1	HAL-011-376	10/13/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$21,200.00	9/21/2022	Settlement Agreement
Richmond Hill Rest Home #2	HAL-011-375	6/2/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	5/16/2022	Settlement Agreement
Richmond Hill Rest Home #2	HAL-011-375	6/2/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,000.00	5/16/2022	Settlement Agreement
Richmond Hill Rest Home #2	HAL-011-375	4/1/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	12/21/2022	Appealed
Richmond Hill Rest Home #2	HAL-011-375	4/1/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	12/21/2022	Appealed
Richmond Hill Rest Home #3	HAL-011-374	6/1/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #3	HAL-011-374	6/1/2021	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #4	HAL-011-373	6/1/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #4	HAL-011-373	6/1/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #5	HAL-011-372	6/1/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #5	HAL-011-372	6/1/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #5	HAL-011-372	8/25/2021	G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$36,000.00	6/10/2022	Settlement Agreement
Richmond Hill Rest Home #5	HAL-011-372	10/8/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$20,000.00	9/21/2022	Settlement Agreement
Richmond Hill Rest Home #5	HAL-011-372	4/5/2022	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,500.00	12/21/2022	Appealed
Richmond Hill Rest Home #5	HAL-011-372	4/5/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,500.00	12/21/2022	Appealed
Richmond Hill Rest Home #5	HAL-011-372	4/5/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$5,500.00	12/21/2022	Appealed
St. Mary Rosa's Family Care Home	FCL-011-326	1/5/2022	10A NCAC 13G .1701 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,000.00	8/31/2022	Settlement Agreement

Burke County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Clara's Cottage #1	FCL-012-042	11/24/2020	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	12/17/2021	Paid in Full
Morganton Long Term Care, Southview Facility	HAL-012-007	3/3/2022	10A NCAC 13F .0604(e) Personal Care And Other Staffing; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	12/21/2022	Not Paid - Referred to Controller's Office
Morganton Long Term Care, Southview Facility	HAL-012-007	10/27/2021	G.S. 131D-21(1) Declaration of Resident's Rights	Unabated B	$2,700.00	4/20/2022	Paid in Full
Morganton Long Term Care, Southview Facility	HAL-012-007	10/27/2021	10A NCAC 13F .0407(a)(7) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$3,700.00	4/20/2022	Paid in Full
Morganton Long Term Care, Southview Facility	HAL-012-007	10/27/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$2,325.00	4/20/2022	Paid in Full

Cabarrus County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Concord Place	HAL-013-045	10/13/2022	10A NCAC 13F .0901(c) Personal Care and Supervision	A1	$3,500.00	2/15/2023	Paid in Full
The Living Center of Concord	HAL-013-044	9/30/2020	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	8/31/2021	Settlement Agreement
The Living Center of Concord	HAL-013-044	9/30/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	8/31/2021	Settlement Agreement
The Living Center of Concord	HAL-013-044	9/30/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	8/31/2021	Settlement Agreement
The Living Center of Concord	HAL-013-044	9/30/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Settlement Agreement
The Living Center of Concord	HAL-013-044	9/30/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/31/2021	Settlement Agreement

Caldwell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brockford Inn	HAL-014-014	2/13/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	10/19/2021	Paid in Full
Brockford Inn	HAL-014-014	7/9/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,000.00	8/26/2021	Paid in Full
Grandview Villa Assisted Living	HAL-014-015	7/16/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/26/2021	Paid in Full

Carteret County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carteret House	HAL-016-018	1/29/2021	10A NCAC 13F .0604(e)(1)(E) Personal Care and Other Staffing; G.S. 131D-21(1) Declaration of Resident's Rights	A2	$1,000.00	3/16/2022	Paid in Full
Carteret House	HAL-016-018	1/29/2021	#N/A	A2	$1,000.00	3/16/2022	Paid in Full
Carteret House	HAL-016-018	5/17/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	3/16/2022	Paid in Full
Carteret Landing	HAL-016-023	6/29/2020	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$500.00	8/26/2021	Paid in Full

Caswell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Caswell House	HAL-017-054	9/19/2019	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$10,200.00	10/1/2020	Settlement Agreement
Caswell House	HAL-017-054	9/19/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$10,200.00	10/1/2020	Settlement Agreement
Humphrey Family Care Home	FCL-017-052	10/8/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$5,300.00	6/10/2022	Paid in Full
Humphrey Family Care Home	FCL-017-052	10/8/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$5,300.00	6/10/2022	Paid in Full
Poole's Rest Home (Closed)	HAL-017-006	7/30/2019	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$24,000.00	10/1/2020	Not Paid - Referred to Controller's Office
Poole's Rest Home (Closed)	HAL-017-006	7/30/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$24,000.00	10/1/2020	Not Paid - Referred to Controller's Office
Taylor Family Care Home #2	FCL-017-058	7/2/2021	10A NCAC 13G .0902(c)(3)(4) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$6,700.00	6/10/2022	Appealed
Taylor Family Care Home #2	FCL-017-058	7/2/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$6,700.00	6/10/2022	Appealed
Taylor Family Care Home #2	FCL-017-058	7/2/2021	G.S. § 131D-4.5B (b) ACH Medication Aides;Training and Competency; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$5,025.00	6/10/2022	Appealed

Catawba County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Austin Adult Care	HAL-018-023	2/26/2021	10A NCAC 13F .0702 (f) Discharge Of Residents; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	3/16/2022	Paid in Full
TerraBella Newton	HAL-018-036	4/22/2022	10A NCAC 13F .0901(b) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,250.00	2/15/2023
TerraBella Newton	HAL-018-036	4/22/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/15/2023
TerraBella Newton	HAL-018-036	4/22/2022	10A NCAC 13F .1004(a) Medication Administration G.S. 131D-21(2) Declaration of Resident's Rights	A2	$750.00	2/15/2023

Chatham County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Chatham Ridge Assisted Living (CHOW)	HAL-019-021	3/12/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	2/4/2022	Paid in Full

Cherokee County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carolina Care Home #2	HAL-020-002	5/12/2021	10A NCAC 13F .0402 Qualifications Of Administrator-In-Charge; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	9/30/2021	Settlement Agreement
Carolina Care Home #2	HAL-020-002	5/12/2021	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	9/30/2021	Settlement Agreement
Carolina Care Home #2	HAL-020-002	5/12/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	9/30/2021	Settlement Agreement
Carolina Care Home #2	HAL-020-002	5/12/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/30/2021	Settlement Agreement
Carolina Care Home #2	HAL-020-002	5/12/2021	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/30/2021	Settlement Agreement
Elaine's Care #2	FCL-020-016	5/3/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	2/4/2022	Paid in Full
L and N Family Care Home	FCL-020-011	10/28/2021	10A NCAC 13G .1701 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	8/5/2022	Paid in Full

Cleveland County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Cleveland House	HAL-023-045	11/25/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$5,250.00	10/1/2020	Settlement Agreement
Cleveland House	HAL-023-045	11/25/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	10/1/2020	Settlement Agreement
Cleveland House	HAL-023-045	1/31/2020	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$18,000.00	8/31/2021	Settlement Agreement
Cleveland House	HAL-023-045	1/31/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Settlement Agreement
Cleveland House	HAL-023-045	1/31/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$8,400.00	8/31/2021	Settlement Agreement
Lean's 3 Family Care Home (Closed)	FCL-023-049	9/4/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Not Paid - Referred to Controller's Office
Serenity Living #4	FCL-023-052	5/7/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	3/16/2022	Paid in Full
Cleveland House	HAL-023-045	1/31/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/31/2021	Settlement Agreement
Cleveland House	HAL-023-045	1/31/2020	G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Settlement Agreement
TerraBella Shelby (Formerly named Elmcroft of Shelby)	HAL-023-048	9/14/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/31/2021	Paid in Full

Columbus County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Liberty Hill Family Care (Closed)	FCL-024-012	4/22/2019	10A NCAC 13G .0315(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$14,300.00	8/24/2020	Not Paid - Referred to Controller's Office

Craven County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Croatan Village	HAL-025-037	7/17/2019	10A NCAC 13F .0309 (d) Plan For Evacuation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	5/3/2021	Paid in Full
Croatan Village	HAL-025-037	9/16/2022	10A NCAC 13F .0901(b) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	2/15/2023	Not Paid - Referred to Controller's Office
Good Shepard Home for the Aged	HAL-025-023	11/19/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	9/8/2021	Settlement Agreement
Riverstone	HAL-025-026	2/5/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$750.00	9/8/2021	Paid in Full
The Gardens of Trent	HAL-025-035	10/16/2019	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$24,800.00	7/21/2021	Settlement Agreement
Truewood by Merrill New Bern MC	HAL-025-040	4/21/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	12/21/2022

Cumberland County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Fayetteville Manor	HAL-026-054	2/24/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	2/4/2022	Paid in Full
Forest Hill Group Home (Closed)	FCL-026-031	8/13/2019	10A NCAC 13G .0302 (b) Design And Construction; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$15,100.00	7/21/2021	Not Paid - Referred to Controller's Office
Harmony at Hope Mills	HAL-026-065	6/12/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	8/7/2020	Settlement Agreement
Leach's Family Care Home (Closed)	FCL-026-037	5/8/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	7/21/2021	Not Paid - Referred to Controller's Office
Morning Star Special Care Unit	HAL-026-066	12/19/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/7/2020	Paid in Full
Morning Star Special Care Unit	HAL-026-066	12/19/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/7/2020	Paid in Full
Morning Star Special Care Unit	HAL-026-066	12/19/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/7/2020	Paid in Full
Pine Valley Adult Care	HAL-026-048	1/8/2021	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/26/2021	Settlement Agreement
Pine Valley Adult Care	HAL-026-048	1/8/2021	10A NCAC 13F .1801 (a) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/26/2021	Settlement Agreement
Pine Valley Adult Care	HAL-026-048	1/8/2021	10A NCAC 13F .1802 (b) Report & Notification of a Outbreak (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/26/2021	Settlement Agreement
The Addison of Fayetteville	HAL-026-068	12/15/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$9,400.00	8/31/2022	Settlement Agreement

Currituck County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Currituck House	HAL-027-003	1/6/2022	10A NCAC 13F .0602 Management Of Facilities WIth A Capacity Or;	A1	$4,000.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	1/6/2022	10A NCAC 13F .0901(b) Personal Care and Supervision;	A1	$3,500.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	1/6/2022	10A NCAC 13F .0902(b) Health Care;	A2	$2,000.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	1/6/2022	G.S. 131D-21(1) Declaration of Residents' Rights;	A2	$2,000.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	1/6/2022	G.S. 131D-21(4) Declaration of Residents' Rights;	A2	$2,000.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	1/6/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$8,300.00	8/31/2022	Settlement Agreement
Currituck House	HAL-027-003	11/5/2018	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	7/21/2021	Paid in Full

Davidson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookstone Retirement Center	HAL-029-001	10/28/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,000.00	8/24/2020	Paid in Full
Grayson Creek of Welcome	HAL-029-010	7/15/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$19,800.00	8/7/2020	Settlement Agreement
Grayson Creek of Welcome	HAL-029-010	8/7/2020	10A NCAC 13F .0604(e) Personal Care And Other Staffing; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,000.00	7/21/2021	Paid in Full
Grayson Creek of Welcome	HAL-029-010	8/7/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	7/21/2021	Paid in Full
Grayson Creek of Welcome	HAL-029-010	8/7/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	7/21/2021	Paid in Full
Grayson Creek of Welcome	HAL-029-010	8/7/2020	10A NCAC 13F .1501(a) Use Of Physical Restraints And Alternatives; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	7/21/2021	Paid in Full
Grayson Creek of Welcome	HAL-029-010	8/7/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	7/21/2021	Paid in Full
Grayson Creek of Welcome	HAL-029-010	3/18/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$16,000.00	2/4/2022	Settlement Agreement
The Clinard House (Closed)	FCL-029-012	11/5/2020	#N/A	Unabated B	$4,300.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	11/5/2020	#N/A	A2	$2,000.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	11/5/2020	#N/A	Unabated B	$4,300.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	11/5/2020	#N/A	A2	$2,000.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	2/11/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$33,375.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	2/11/2021	10A NCAC 13G .1701 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$33,375.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	3/4/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$8,000.00	12/17/2021	Appealed
The Clinard House (Closed)	FCL-029-012	3/4/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$8,000.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	11/5/2020	10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$4,300.00	8/31/2021	Appealed
The Lyman House (Closed)	FCL-029-011	11/5/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Appealed
The Lyman House (Closed)	FCL-029-011	11/5/2020	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Appealed
The Lyman House (Closed)	FCL-029-011	11/5/2020	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Appealed
The Lyman House (Closed)	FCL-029-011	2/19/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	2/19/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	2/19/2021	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$10,000.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	2/19/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Continued Unabated Type B	$13,100.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	2/19/2021	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$33,375.00	12/17/2021	Appealed
The Lyman House (Closed)	FCL-029-011	3/4/2021	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$8,000.00	12/17/2021	Appealed
The Perryman House (Closed)	FCL-029-009	11/5/2020	10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$4,300.00	8/31/2021	Appealed
The Perryman House (Closed)	FCL-029-009	11/5/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Appealed
The Perryman House (Closed)	FCL-029-009	11/5/2020	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Appealed

Davie County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Mocksville Senior Living and Memory Care	HAL-030-009	5/1/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$8,000.00	5/3/2021	Settlement Agreement
Mocksville Senior Living and Memory Care	HAL-030-009	2/3/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	2/4/2022	Paid in Full
Mocksville Senior Living and Memory Care	HAL-030-009	11/9/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Paid in Full
The Heritage of Cedar Rock (Closed)	HAL-030-007	12/13/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$14,000.00	2/15/2021	Not Paid - Referred to Controller's Office
The Heritage of Cedar Rock (Closed)	HAL-030-007	12/13/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	2/15/2021	Not Paid - Referred to Controller's Office
The Heritage of Cedar Rock (Closed)	HAL-030-007	12/13/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$14,000.00	2/15/2021	Not Paid - Referred to Controller's Office

Duplin County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Moore Family Care Home #2 (Closed)	FCL-031-007	5/23/2018	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	8/7/2020	Paid in Full
Moore Family Care Home #2 (Closed)	FCL-031-007	5/23/2018	10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/7/2020	Paid in Full
Wallace Gardens	HAL-031-016	5/18/2022	10A NCAC 13F .0305(h)(4) Physical Environment G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	2/15/2023	Paid in Full
Wellington Park	HAL-031-006	6/16/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	8/26/2021	Settlement Agreement
Wellington Park	HAL-031-006	6/16/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	8/26/2021	Settlement Agreement
Wellington Park	HAL-031-006	6/16/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	8/26/2021	Settlement Agreement
Wellington Park	HAL-031-006	12/21/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$16,000.00	8/26/2021	Settlement Agreement
Wellington Park	HAL-031-006	12/21/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	8/26/2021	Settlement Agreement

Durham County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
B.J.'s Family Care Home	FCL-032-062	9/30/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$5,700.00	9/21/2022	Paid in Full
Camellia Gardens	HAL-032-071	1/24/2022	10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$10,500.00	8/5/2022	Paid in Full
Carolina Care Homes (Closed)	FCL-032-170	12/21/2021	10A NCAC 13G .0601(d) Management and Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$375.00	6/10/2022	Paid in Full
Durham Ridge Assisted Living	HAL-032-091	5/20/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	7/7/2021	Paid in Full
Durham Ridge Assisted Living	HAL-032-091	11/17/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	7/7/2021	Paid in Full
Durham Ridge Assisted Living	HAL-032-091	11/17/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,000.00	7/7/2021	Paid in Full
Durham Ridge Assisted Living	HAL-032-091	11/17/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,000.00	7/7/2021	Paid in Full
Durham Ridge Assisted Living	HAL-032-091	2/25/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	2/4/2022	Paid in Full
Elsie-Doris Family Care	FCL-032-088	4/30/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	3/16/2022	Paid in Full
Eno Pointe Assisted Living	HAL-032-001	8/25/2022	10A NCAC 13F .1004(a) Medication Administration	A1	$2,000.00	3/8/2023

Edgecombe County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Almarch Family Care	FCL-033-018	11/22/2022	10A NCAC 13G .1006 (g) Medication Storage	A2	$2,000.00	4/5/2023	Appealed
Heritage Care of Rocky Mount	HAL-033-005	9/4/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/26/2021	Settlement Agreement
Heritage Care of Rocky Mount	HAL-033-005	9/1/2022	10A NCAC 13F .0901(c) Personal Care and Supervision	A1	$8,000.00	3/8/2023	Appealed

Forsyth County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
C.R.T. Golden Lamb	HAL-034-019	5/31/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$2,000.00	3/8/2023
Danby House	HAL-034-093	7/26/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	10/1/2020	Settlement Agreement
Danby House	HAL-034-093	11/15/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	10/1/2020	Settlement Agreement
Danby House	HAL-034-093	11/15/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	10/1/2020	Settlement Agreement
Danby House	HAL-034-093	11/15/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	10/1/2020	Settlement Agreement
Danby House	HAL-034-093	1/17/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$14,000.00	10/1/2020	Settlement Agreement
Salem Terrace (Closed)	HAL-034-098	7/19/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$19,000.00	8/26/2021	Paid in Full
Salem Terrace (Closed)	HAL-034-098	10/18/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	2/4/2022	Paid in Full
The Bradford Village of Kernersville - West	HAL-034-069	10/16/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$16,500.00	8/24/2020	Settlement Agreement
The Bradford Village of Kernersville - West	HAL-034-069	10/23/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$6,000.00	7/7/2021	Paid in Full
The Bradford Village of Kernersville - West	HAL-034-069	10/23/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	7/7/2021	Paid in Full
The Bradford Village of Kernersville - West	HAL-034-069	3/19/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$24,800.00	2/4/2022	Paid in Full
The Bradford Village of Kernersville - West	HAL-034-069	10/12/2021	G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$16,800.00	8/31/2022	Settlement Agreement
The Bradford Village of Kernersville - West	HAL-034-069	4/7/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$12,000.00	12/21/2022	Not Paid - Referred to Controller's Office
The Bradford Village of Kernersville - West	HAL-034-069	7/8/2022	10A NCAC 13F .1004(a) Medication Administration G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$13,200.00	2/15/2023	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	2/11/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	2/15/2021	Paid in Full
The Ivy at Clemmons	HAL-034-105	2/11/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	2/15/2021	Paid in Full
The Ivy at Clemmons	HAL-034-105	2/11/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	7/21/2021	Paid in Full
The Ivy at Clemmons	HAL-034-105	2/11/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	7/21/2021	Paid in Full
The Ivy at Clemmons	HAL-034-105	5/7/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$66,000.00	7/7/2021	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/7/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	7/7/2021	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/7/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$66,000.00	7/7/2021	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	10/1/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$55,000.00	7/7/2021	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	1/13/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	3/16/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	4/20/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$18,000.00	4/20/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	4/20/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$13,500.00	4/20/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	4/20/2021	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$18,000.00	4/20/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/17/2022	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	12/21/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/17/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$15,000.00	12/21/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/17/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	12/21/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/17/2022	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	12/21/2022	Settlement Agreement
The Ivy at Clemmons	HAL-034-105	5/17/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	12/21/2022	Settlement Agreement
Tranquility Care	HAL-034-104	5/17/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$16,000.00	3/8/2023	Appealed

Franklin County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Alston Family Care Home	FCL-035-008	10/20/2022	10A NCAC 13G .0302 (b) Design And Construction	Unabated B	$900.00	2/15/2023	Paid in Full
Franklin Manor Assisted Living Center	HAL-035-024	12/8/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$50,250.00	8/5/2022	Appealed
Franklin Manor Assisted Living Center	HAL-035-024	12/8/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/5/2022	Appealed
Heart to Heart Family Care Home	FCL-035-033	7/31/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	8/26/2021	Paid in Full
Louisburg Healthcare & Rehabilitation Center	NH0264		10A NCAC 13G .0904 (c-7) Nutrition And Food Service;	A1	$20,000.00	7/15/2022	Paid in Full
Southern Living for Seniors of Louisburg, NC	HAL-035-031	11/26/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$9,000.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Louisburg, NC	HAL-035-031	11/26/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$9,000.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Louisburg, NC	HAL-035-031	11/26/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$9,000.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Louisburg, NC	HAL-035-031	11/26/2019	G.S. 131D-21(5) Declaration of Resident's Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Louisburg, NC	HAL-035-031	8/14/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	12/10/2021	Paid in Full
Southern Living for Seniors of Louisburg, NC	HAL-035-031	8/4/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$12,000.00	5/16/2022	Paid in Full
Southern Living for Seniors of Louisburg, NC	HAL-035-031	4/29/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	12/21/2022	Not Paid - Referred to Controller's Office

Gaston County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Country Time Inn	HAL-036-018	4/8/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/26/2021	Paid in Full
Rosewood Assisted Living	HAL-036-004	9/7/2022	10A NCAC 13F .0305(h)(3) Physical Environment G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	2/15/2023	Paid in Full
TerraBella Cramer Mountain	HAL-036-039	7/7/2022	10A NCAC 13F .0904(e)(4) Nutrition and Food Service	Unabated B	$13,800.00	3/8/2023
Woodlawn Haven	HAL-036-006	5/19/2020	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$10,500.00	8/26/2021	Paid in Full
Wellington House	HAL-036-031	10/12/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	8/26/2021	Settlement Agreement

Granville County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Harris Home (Closed)	FCL-039-002	7/2/2019	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$8,700.00	8/7/2020	Paid in Full
Toney Rest Home	HAL-039-017	12/30/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	9/9/2021	Settlement Agreement
Toney Rest Home	HAL-039-017	6/17/2021	G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$9,000.00	4/20/2022	Paid in Full

Greene County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
A Safe Place (Closed)	FCL-040-011	2/18/2022	10A NCAC 13G .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	8/5/2022	Not Paid - Referred to Controller's Office
A Safe Place (Closed)	FCL-040-011	2/18/2022	#N/A	A2	$2,000.00	8/5/2022	Not Paid - Referred to Controller's Office

Guilford County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Agape Care Family Homes (Closed)	FCL-041-078	8/25/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	7/21/2021	Paid in Full
Alpha Concord of Greensboro	HAL-041-082	3/29/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	9/29/2021	Settlement Agreement
Brookdale High Point	HAL-041-030	9/16/2022	10A NCAC 13F .0902(b) Health Care	A2	$1,000.00	3/8/2023	Paid in Full
Brookdale High Point North	HAL-041-033	10/20/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$1,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Brookdale High Point North AL (NC)	HAL-041-039	1/14/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,000.00	7/21/2021	Paid in Full
Brookdale Lawndale Park	HAL-041-062	8/10/2018	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$700.00	9/23/2021	Paid in Full
Brookdale Lawndale Park	HAL-041-062	11/7/2022	10A NCAC 13F .0904(e)(4) Nutrition and Food Service	A1	$14,000.00	3/8/2023	Appealed
Carriage House Senior Living Community	HAL-041-065	7/20/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	6/10/2022	Paid in Full
Carriage House Senior Living Community	HAL-041-065	7/20/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	6/10/2022	Paid in Full
Guilford House	HAL-041-077	12/6/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$6,400.00	6/14/2021	Settlement Agreement
Guilford House	HAL-041-077	8/11/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$16,000.00	6/10/2022	Settlement Agreement
Liggins Family Care Woodmere Center (CLOSED)	FCL-041-071	3/29/2019	10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$30,800.00	2/4/2022	Settlement Agreement
Liggins Family Care Woodmere Center (CLOSED)	FCL-041-071	3/29/2019	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$14,200.00	2/4/2022	Settlement Agreement
Liggins Family Care Woodmere Center (CLOSED)	FCL-041-071	3/29/2019	G.S. § 131D-4.5B (b) ACH Medication Aides;Training and Competency; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$30,800.00	2/4/2022	Settlement Agreement
Liggins Family Care Woodmere Center (CLOSED)	FCL-041-071	7/21/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	7/7/2021	Paid in Full
Liggins Family Care Woodmere Center (CLOSED)	FCL-041-071	7/21/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	7/7/2021	Not Paid - Referred to Controller's Office
Morningview at Irving Park	HAL-041-052	2/21/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/31/2022	Paid in Full
Morningview at Irving Park	HAL-041-052	2/21/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$13,400.00	8/31/2022	Paid in Full
Piedmont Christian Home	HAL-041-010	7/10/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Paid in Full
Piedmont Christian Home	HAL-041-010	7/10/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Paid in Full
Piedmont Christian Home	HAL-041-010	3/4/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	9/21/2022	Paid in Full
Piedmont Christian Home	HAL-041-010	3/4/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	9/21/2022	Paid in Full
St. Gales Estates	HAL-041-023	3/16/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/5/2022	Appealed
St. Gales Estates	HAL-041-023	3/16/2022	10A NCAC 13F .1008(a) Controlled Substances; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/5/2022	Appealed
St. Gales Estates	HAL-041-023	7/28/2022	10A NCAC 13F .0902(b) Health Care ; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$22,400.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	7/28/2022	10A NCAC 13F .0904(e)(4) Nutrition and Food Service; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$22,400.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	7/28/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$129,000.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	9/13/2022	10A NCAC 13F .0604(e) Personal Care And Other Staffing ; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$12,000.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	9/13/2022	10A NCAC 13F .0901(b) Personal Care and Supervision ; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	9/13/2022	10A NCAC 13F .0901(c) Personal Care and Supervision ; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	2/7/2023	Appealed
St. Gales Estates	HAL-041-023	11/23/2022	10A NCAC 13F .0702 (f) Discharge Of Residents	A2	$16,000.00	2/7/2023	Appealed
Wellington Oaks	HAL-041-072	8/19/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$2,000.00	3/8/2023	Paid in Full

Halifax County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carolina Rest Home	HAL-042-005	6/24/2022	10A NCAC 13F .0909 Resident Rights	A1	$7,000.00	3/8/2023	Appealed
Carolina Rest Home	HAL-042-005	6/24/2022	10A NCAC 13F .1205 Health Care Personnel Registry	A2	$3,500.00	3/8/2023	Appealed
Carolina Rest Home	HAL-042-005	6/24/2022	G.S. § 131D-25 Implementation	A1	$7,000.00	3/8/2023	Appealed

Harnett County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	2/27/2018	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	3/15/2018	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated Type B	$23,400.00	8/24/2020	Not Paid - Referred to Controller's Office
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	6/27/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$12,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	10/9/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$20,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	10/9/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$16,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Alzheimer's Related Care of Dunn (Closed)	HAL-043-026	10/9/2019	#N/A	A2	$18,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Arc of Dunn (Closed)	HAL-043-033	10/6/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$6,000.00	8/26/2021	Not Paid - Referred to Controller's Office
Arc of Dunn (Closed)	HAL-043-033	8/23/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	5/11/2022	Not Paid - Referred to Controller's Office
Arc of Dunn (Closed)	HAL-043-033	11/19/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	5/11/2022	Not Paid - Referred to Controller's Office
Arc of Dunn (Closed)	HAL-043-033	11/23/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$6,000.00	5/11/2022	Not Paid - Referred to Controller's Office
Green Leaf Care Center	HAL-043-027	8/2/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$250.00	8/7/2020	Paid in Full
Green Leaf Care Center	HAL-043-027	1/15/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,000.00	12/17/2021	Paid in Full
Johnson Better Care	HAL-043-003	11/25/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	12/17/2021	Paid in Full
Johnson Better Care	HAL-043-003	11/25/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	12/17/2021	Paid in Full
Oak Hill Living Center	HAL-043-015	1/22/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Settlement Agreement
Senter's Rest Home	HAL-043-024	9/18/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	8/7/2020	Paid in Full
Senter's Rest Home	HAL-043-024	6/26/2020	10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/26/2021	Settlement Agreement

Haywood County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Chestnut Park Retirement Center	HAL-044-022	9/15/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
McCracken Rest Home	HAL-044-046	2/2/2021	10A NCAC 13F .0311(b) Other Requirements; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	5/16/2022	Paid in Full
Spicewood Cottages Oaks	HAL-044-040	7/7/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	5/16/2022	Paid in Full

Henderson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carolina Reserve of Hendersonville	HAL-045-125	5/13/2022	10A NCAC 13F .0901(c) Personal Care and Supervision	A1	$12,000.00	3/8/2023
The Gardens of Hendersonville	HAL-045-129	5/14/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,000.00	3/16/2022	Paid in Full
The Landings of Mills River	HAL-045-127	8/8/2019	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/7/2020	Appealed

Hertford County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carver Manor (Closed)	FCL-046-002	12/23/2020	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Paid in Full
Carver Manor (Closed)	FCL-046-002	4/28/2021	10A NCAC 13G .0302 (b) Design And Construction; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$2,500.00	3/16/2022	Not Paid - Referred to Controller's Office
Carver Manor (Closed)	FCL-046-002	6/30/2021	10A NCAC 13G .0601(d) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	3/16/2022	Not Paid - Referred to Controller's Office
Twin Oaks and Twins Adult Home (closed)	HAL-046-018	2/12/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Not Paid - Referred to Controller's Office
Twin Oaks and Twins Adult Home (closed)	HAL-046-018	2/12/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Not Paid - Referred to Controller's Office
Twin Oaks and Twins Adult Home (closed)	HAL-046-018	2/12/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Paid in Full

Hoke County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Open Arms Retirement Center	HAL-047-014	6/7/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/24/2020	Paid in Full
Open Arms Retirement Center	HAL-047-014	6/14/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	5/16/2022	Paid in Full
The Crossings at Wayside (Closed)	HAL-047-011	8/15/2019	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	7/21/2021	Paid in Full
The Crossings at Wayside (Closed)	HAL-047-011	8/15/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	8/30/2021	Paid in Full
The Crossings at Wayside (Closed)	HAL-047-011	8/15/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	7/21/2021	Paid in Full
The Crossings at Wayside (Closed)	HAL-047-011	8/20/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$250.00	8/24/2020	Paid in Full
Wickshire Creeks Crossing (Formerly The Crossings at Wayside)	HAL-047-015	3/4/2022	#N/A	A2	$750.00	8/5/2022	Paid in Full

Iredell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookdale Peachtree Memory Care	HAL-049-021	11/15/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	7/21/2021	Paid in Full

Jackson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Morningstar Assisted Living	HAL-050-016	2/1/2022	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/21/2022	Settlement Agreement
Morningstar Assisted Living	HAL-050-016	6/23/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	2/15/2023	Paid in Full
The Hermitage	HAL-050-017	12/15/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
The Hermitage	HAL-050-017	3/29/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	12/21/2022	Appealed
The Hermitage	HAL-050-017	9/28/2022	10A NCAC 13F .0902(b) Health Care	A2	$1,500.00	3/8/2023	Paid in Full

Johnston County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Classic Care Homes #1	HAL-051-062	10/30/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$18,000.00	3/1/2021	Settlement Agreement
Classic Care Homes #3	HAL-051-063	7/17/2019	10A NCAC 13F .0904(a)(2) Nutrition and Food Service; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$11,000.00	8/24/2020	Settlement Agreement
Classic Care Homes #3	HAL-051-063	9/10/2019	10A NCAC 13F .0507 Training On Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Resident's Rights	Continuing Unabated B	$18,000.00	9/8/2021	Settlement Agreement
Clayton House	HAL-051-041	4/1/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	3/16/2022	Paid in Full
Four Oaks Senior Living	HAL-051-060	8/11/2020	10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/26/2021	Settlement Agreement
Freedom Care Services #1 (closed)	FCL-051-070	7/2/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	12/17/2021	Paid in Full
Freedom Care Services #1 (closed)	FCL-051-070	7/2/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	12/17/2021	Paid in Full
Sam's Family Care Homes (Closed)	FCL-051-067	7/10/2019	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	8/24/2020	Not Paid - Referred to Controller's Office
Sam's Family Care Homes (Closed)	FCL-051-067	7/10/2019	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	8/24/2020	Not Paid - Referred to Controller's Office
The Villas @ Benson 1	FCL-051-056	12/2/2020	10A NCAC 13G .0601(d) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/26/2021	Paid in Full
The Villas @ Benson 1	FCL-051-056	2/9/2021	10A NCAC 13G .0302 (b) Design And Construction; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$1,250.00	9/23/2021	Paid in Full
The Villas at Benson VI (Closed)	FCL-051-079	7/22/2022	10A NCAC 13G .0312(g) Outside Entrance And Exits G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/15/2023	Paid in Full
The Villas at Benson VI (Closed)	FCL-051-079	7/22/2022	10A NCAC 13G .0901(b) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/15/2023	Paid in Full
The Villas at Benson VI (Closed)	FCL-051-079	7/22/2022	10A NCAC 13G .0902(b) Health Care G.S. 131D-21(1) Declaration of Resident's Rights	A2	$750.00	2/15/2023	Paid in Full

Lee County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Leak's Adult Family Care #3 (Closed)	FCL-053-019	6/20/2019	10A NCAC 13G .0315(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	8/7/2020	Not Paid - Referred to Controller's Office
Magnolia House Retirement Center (Closed)	HAL-053-029	5/6/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/31/2021	Not Paid - Referred to Controller's Office
Sanford Manor	HAL-053-030	10/26/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	8/17/2022	Paid in Full
Sanford Senior Living	HAL-053-031	5/5/2022	10A NCAC 13F .0601 (a) Management Of Facilities	A1	$7,000.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-031	5/5/2022	10A NCAC 13F .0901(a) Personal Care and Supervision	A2	$2,000.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-031	5/5/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$4,000.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-031	5/5/2022	10A NCAC 13F .0902(b) Health Care	A2	$2,000.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-032	8/11/2022	10A NCAC 13F .0601 (a) Management Of Facilities	A2	$3,500.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-032	8/11/2022	10A NCAC 13F .0901(a) Personal Care and Supervision	Unabated A2	$38,250.00	3/8/2023	Appealed
Sanford Senior Living	HAL-053-032	8/11/2022	10A NCAC 13F .0902(b) Health Care	Unabated A2	$38,250.00	3/8/2023	Appealed

Lincoln County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Heath House	HAL-055-013	2/4/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2022	Paid in Full
The Addison of Lincolnton	HAL-055-009	11/5/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,000.00	8/17/2022	Paid in Full
The Addison of Lincolnton	HAL-055-009	8/31/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$13,500.00	7/21/2021	Paid in Full

Macon County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Franklin House	HAL-056-006	11/13/2018	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	11/13/2020	Settlement Agreement
Franklin House	HAL-056-006	8/24/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$4,800.00	5/16/2022	Settlement Agreement

Martin County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Vintage Inn Retirement Community	HAL-058-010	9/26/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	3/1/2021	Settlement Agreement
Vintage Inn Retirement Community	HAL-058-010	9/26/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$10,500.00	3/1/2021	Appealed
Vintage Inn Retirement Community	HAL-058-010	9/26/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	3/1/2021	Appealed
Vintage Inn Retirement Community	HAL-058-010	10/16/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$16,000.00	8/26/2021	Settlement Agreement
Vintage Inn Retirement Community	HAL-058-010	3/5/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	2/4/2022	Settlement Agreement
Vintage Inn Retirement Community	HAL-058-010	4/8/2022	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$8,000.00	12/21/2022	Settlement Agreement
Vintage Inn Retirement Community	HAL-058-010	4/8/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$5,250.00	12/21/2022	Settlement Agreement
Vintage Inn Retirement Community	HAL-058-010	4/8/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	12/21/2022	Settlement Agreement
Williamston House	HAL-058-011	5/26/2022	10A NCAC 13F .0902(b) Health Care	A1	$7,000.00	3/8/2023	Appealed
Williamston House	HAL-058-011	5/26/2022	10A NCAC 13F .1004(a) Medication Administration	A1	$7,000.00	3/8/2023	Appealed

McDowell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Cedarbrook Residential Facility	HAL-059-021	8/12/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$2,000.00	3/8/2023	Appealed
Cedarbrook Residential Facility	HAL-059-021	8/12/2022	10A NCAC 13F .0902(b) Health Care	A1	$7,000.00	3/8/2023	Appealed
Cedarbrook Residential Facility	HAL-059-021	8/12/2022	10A NCAC 13F .1212(g) Reporting of Accidents and Incidents	A2	$2,000.00	3/8/2023	Appealed
Lake James Lodge Assisted Living	HAL-059-032	1/6/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	3/1/2021	Paid in Full

Mecklenburg County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Arbor Ridge at Huntersville	HAL-060-170	8/23/2022	10A NCAC 13F .0901(b) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	2/15/2023	Appealed
Arbor Ridge at Huntersville	HAL-060-170	8/23/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	2/15/2023	Appealed
Brighton Gardens of Charlotte	HAL-060-029	11/25/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/31/2021	Paid in Full
Brookdale Carriage Club Providence I	HAL-060-016	11/18/2022	10A NCAC 13F .0901(c) Personal Care and Supervision		$10,500.00	3/8/2023	Appealed
Brookdale Carriage Club Providence II	HAL-060-049	5/14/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	3/16/2022	Paid in Full
Brookdale Carriage Club Providence II	HAL-060-049	4/1/2022	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	12/21/2022	Paid in Full
Brookdale Carriage Club Providence II	HAL-060-049	4/1/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	12/21/2022	Paid in Full
Brookdale Carriage Club Providence II	HAL-060-049	6/16/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Brookdale Carriage Club Providence II	HAL-060-049	11/6/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Paid in Full
Brookdale South Charlotte	HAL-060-101	8/19/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	8/31/2021	Paid in Full
Brookdale South Charlotte	HAL-060-101	6/3/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	3/16/2022	Paid in Full
Brookdale South Charlotte	HAL-060-101	6/3/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	3/16/2022	Paid in Full
Brookdale Weddington Park	HAL-060-042	10/20/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$750.00	3/8/2023	Paid in Full
Cadence Huntersville	HAL-060-160	5/20/2022	10A NCAC 13F .1004(a) Medication Administration G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	2/15/2023
Cadence Senior Living at Mint Hill	HAL-060-159	10/8/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/5/2022	Paid in Full
Cadence Senior Living at Mint Hill	HAL-060-159	2/21/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$2,000.00	3/8/2023	Paid in Full
Charlotte Square	HAL-060-087	8/23/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/24/2020	Paid in Full
Charlotte Square	HAL-060-087	8/17/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	8/31/2021	Paid in Full
Charlotte Square	HAL-060-087	8/17/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	8/31/2021	Paid in Full
Charlotte Square	HAL-060-087	4/1/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	9/30/2021	Paid in Full
Charlotte Square	HAL-060-087	4/1/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$7,000.00	9/30/2021	Paid in Full
Charlotte Square	HAL-060-087	4/1/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	9/30/2021	Paid in Full
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0606 Staffing Chart; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A	$146,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	7/29/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$15,000.00	10/1/2020	Settlement Agreement
East Towne	HAL-060-149	10/18/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$15,000.00	8/24/2020	Settlement Agreement
East Towne	HAL-060-149	7/15/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	2/4/2022	Appealed
East Towne	HAL-060-149	7/15/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	2/4/2022	Appealed
East Towne	HAL-060-149	7/15/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	2/4/2022	Appealed
East Towne	HAL-060-149	7/15/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$15,000.00	2/4/2022	Appealed
East Towne	HAL-060-149	9/22/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,000.00	2/15/2023	Paid in Full
House of Peace	FCL-060-153	4/6/2022	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	12/21/2022	Paid in Full
Legacy Heights Senior Living Community	HAL-060-152	11/22/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	8/5/2022	Paid in Full
McClain's Family Care 1	FCL-060-123	9/4/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	7/21/2021	Paid in Full
McClain's Family Care 1	FCL-060-123	9/4/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	7/21/2021	Paid in Full
Mint Hill Senior Living	HAL-060-136	7/2/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Settlement Agreement
Mint Hill Senior Living	HAL-060-136	1/30/2020	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	6/14/2021	Settlement Agreement
Mint Hill Senior Living	HAL-060-136	12/11/2020	10A NCAC 13F .0311(a) Other Requirements; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,000.00	9/8/2021	Settlement Agreement
Northlake House	HAL-060-150	6/16/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	7/21/2021	Paid in Full
Parker Terrace	HAL-060-054	10/3/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	8/7/2020	Paid in Full
Queen City Assisted Living	HAL-060-126	2/20/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	8/26/2021	Settlement Agreement
Senior Retreat at Stonehaven	FCL-060-159	5/11/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	3/16/2022	Paid in Full
Sunrise on Providence	HAL-060-165	7/28/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/26/2021	Paid in Full
Sunrise on Providence	HAL-060-165	9/23/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$16,000.00	8/31/2021	Paid in Full
TerraBella Little Avenue	HAL-060-156	1/30/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	8/24/2020	Paid in Full
The Charlotte Assisted Living	HAL-060-158	8/6/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$750.00	7/21/2021	Paid in Full
The Charlotte Assisted Living	HAL-060-158	11/12/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	8/31/2021	Paid in Full
The Charlotte Assisted Living	HAL-060-158	11/12/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$7,000.00	8/31/2021	Paid in Full
The Charlotte Assisted Living	HAL-060-158	6/24/2022	10A NCAC 13F .0305 (d) Physical Environment	A1	$12,000.00	3/8/2023
The Charlotte Assisted Living	HAL-060-158	6/24/2022	10A NCAC 13F .0909 Resident Rights	A1	$12,000.00	3/8/2023
The Crossings at Steele Creek (Closed)	HAL-060-130	11/14/2019	10A NCAC 13F .0704(a)(1) Resident Contract, Information On Home And; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	8/24/2020	Paid in Full
The Crossings at Steele Creek (Closed)	HAL-060-130	3/5/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$8,000.00	5/3/2021	Paid in Full
The Crossings at Steele Creek (Closed)	HAL-060-130	8/13/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	12/17/2021	Paid in Full
The Haven in Highland Creek	HAL-060-162	5/14/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	3/16/2022	Paid in Full
The Parc at Sharon Amity	HAL-060-125	9/13/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	10/1/2020	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	9/13/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	10/1/2020	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	9/27/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,250.00	10/1/2020	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	9/27/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$5,250.00	10/1/2020	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	12/22/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	8/31/2021	Appealed
The Parc at Sharon Amity	HAL-060-125	1/20/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	9/8/2021	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	1/20/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	9/8/2021	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	1/20/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	9/8/2021	Settlement Agreement
The Parc at Sharon Amity	HAL-060-125	1/19/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$5,250.00	8/31/2022	Paid in Full
The Post at Providence	FCL-060-165	8/31/2022	10A NCAC 13G .0317(d) Building Service Equipment G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/15/2023	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	6/10/2022	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	6/10/2022	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	6/10/2022	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	6/10/2022	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	6/10/2022	Paid in Full
The Social at Cotswold (Closed)	HAL-060-132	7/13/2021	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	6/10/2022	Paid in Full
Wickshire Steele Creek	HAL-060-166	5/13/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Wickshire Steele Creek	HAL-060-166	5/13/2022	10A NCAC 13F .1004(a) Medication Administration G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Willow Ridge Assisted Living	HAL-060-111	1/11/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	12/17/2021	Settlement Agreement
Willow Ridge Assisted Living	HAL-060-111	1/11/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	12/17/2021	Settlement Agreement
Willow Ridge Assisted Living	HAL-060-111	6/23/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	5/16/2022	Paid in Full
Willow Ridge Assisted Living	HAL-060-111	10/13/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/17/2022	Settlement Agreement
Willow Ridge Assisted Living	HAL-060-111	2/24/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	8/31/2022	Settlement Agreement
Sunrise on Providence	HAL-060-165	1/15/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	3/16/2022	Paid in Full

Mitchell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
B & L Family Care Home	FCL-061-008	7/31/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	12/17/2021	Paid in Full
Mitchell House	HAL-061-011	11/24/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$8,000.00	6/10/2022	Settlement Agreement

Moore County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookdale Pinehurst	HAL-063-024	2/18/2022	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	9/21/2022	Paid in Full
The Coventry	HAL-063-016	9/1/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$1,500.00	3/8/2023

Nash County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brekenridge Retirement Center	HAL-064-004	3/24/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$500.00	8/17/2022	Paid in Full
Hunter Hill Senior Living	HAL-064-032	6/3/2022	10A NCAC 13F .1004(a) Medication Administration	A2	$1,000.00	3/8/2023	Paid in Full
Hunter Hill Senior Living	HAL-064-032	6/3/2022	10A NCAC 13F .0902(b) Health Care	A1	$2,000.00	3/8/2023	Paid in Full
Somerset Court of Rocky Mount	HAL-064-029	2/28/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	3/1/2021	Settlement Agreement
Trinity Retirement Villas #1 (CLOSED)	HAL-064-014	3/1/2021	G.S.§ 131D-4.5B(b) ACH Medication Aides; Training and Competency; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$11,800.00	2/4/2022	Settlement Agreement

New Hanover County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookdale Wilmington	HAL-065-019	8/6/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	6/10/2022	Paid in Full
Castle Creek Memory Care	HAL-065-034	3/18/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,000.00	8/17/2022	Settlement Agreement
Castle Creek Memory Care	HAL-065-034	3/18/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	8/17/2022	Settlement Agreement
Castle Creek Memory Care	HAL-065-034	3/18/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	8/17/2022	Settlement Agreement
Coastal Cove of Wilmington	FCL-065-046	9/16/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	12/17/2021	Paid in Full
Coastal Cove of Wilmington	FCL-065-046	9/13/2022	10A NCAC 13G .0904(c)(4) Nutrition and Food Service	A2	$14,000.00	3/8/2023
Morningside of Wilmington	HAL-065-045	7/27/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Morningside of Wilmington	HAL-065-045	7/2/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/17/2022	Paid in Full
Morningside of Wilmington	HAL-065-045	7/2/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/17/2022	Paid in Full
Morningside of Wilmington	HAL-065-045	9/15/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/17/2022	Paid in Full
Morningside of Wilmington	HAL-065-045	9/15/2021	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/17/2022	Paid in Full
New Hanover House	HAL-065-036	3/23/2018	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$250.00	8/31/2021	Paid in Full
New Hanover House	HAL-065-036	3/23/2018	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$250.00	8/31/2021	Paid in Full
Spring Arbor of Wilmington	HAL-065-014	11/1/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	8/7/2020	Paid in Full
Spring Arbor of Wilmington	HAL-065-014	11/1/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	8/7/2020	Paid in Full
Spring Arbor of Wilmington	HAL-065-014	11/10/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Paid in Full
Spring Arbor of Wilmington	HAL-065-014	11/10/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$5,250.00	8/26/2021	Paid in Full
Spring Arbor of Wilmington	HAL-065-014	12/6/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$1,500.00	2/15/2023

Northampton County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Hampton Manor	HAL-066-012	4/14/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	3/1/2021	Settlement Agreement
Pine Forest Rest Home	HAL-066-001	10/22/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Paid in Full

Onslow County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Pearl's Family Care Home #3	FCL-067-020	11/6/2019	10A NCAC 13G .1206 Health Care Personnel Registry;	A2	$500.00	12/17/2021	Paid in Full
Pearl's Family Care Home #3	FCL-067-020	11/6/2019	G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,500.00	12/17/2021	Paid in Full
The ARC Community	HAL-067-004	10/26/2020	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$14,000.00	8/26/2021	Settlement Agreement
The ARC Community	HAL-067-004	10/26/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/26/2021	Settlement Agreement
The ARC Community	HAL-067-004	10/26/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/26/2021	Settlement Agreement
The ARC Community	HAL-067-004	10/26/2020	10A NCAC 13F .1501(b) Use Of Physical Restraints And Alternatives; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$12,000.00	8/26/2021	Settlement Agreement

Orange County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Carlisle at Carborro	HAL-068-036	9/23/2022	10A NCAC 13F .0906(f)(4) Other Resident Care and Services	A1	$14,000.00	3/8/2023	Paid in Full
Cedar Grove Family Care Home # 1	FCL-068-031	9/15/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	7/7/2021	Paid in Full
Cedar Grove Family Care Home #2	FCL-068-033	9/15/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,000.00	8/31/2021	Paid in Full

Pasquotank County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookdale Elizabeth City	HAL-070-005	6/16/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$1,500.00	3/8/2023	Paid in Full
Waterbrooke of Elizabeth City	HAL-070-008	1/14/2020	10A NCAC 13F .0901(c) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$500.00	3/8/2023	Appealed
Waterbrooke of Elizabeth City	HAL-070-008	2/4/2022	10A NCAC 13F .0702 (f) Discharge Of Residents	A1	$6,000.00	3/8/2023	Appealed
Waterbrooke of Elizabeth City	HAL-070-008	2/4/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$12,000.00	3/8/2023	Appealed
Waterbrooke of Elizabeth City	HAL-070-008	2/4/2022	10A NCAC 13F .0902(b) Health Care	A1	$9,000.00	3/8/2023	Appealed
Waterbrooke of Elizabeth City	HAL-070-008	4/11/2022	10A NCAC 13F .0901(c) Personal Care and Supervision	A1	$8,000.00	3/8/2023	Appealed

Pender County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Poplar Grove (Formerly named Ashe Gardens)	HAL-071-015	9/24/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	10/1/2020	Settlement Agreement
Poplar Grove (Formerly named Ashe Gardens)	HAL-071-015	9/24/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$10,000.00	10/1/2020	Settlement Agreement
Poplar Grove (Formerly named Ashe Gardens)	HAL-071-015	9/24/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	10/1/2020	Settlement Agreement
Poplar Grove (Formerly named Ashe Gardens)	HAL-071-015	9/24/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$10,000.00	10/1/2020	Settlement Agreement

Perquimans County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Hertford Manor	HAL-072-013	3/11/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$16,000.00	5/3/2021	Settlement Agreement
Hertford Manor	HAL-072-013	3/11/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	5/3/2021	Settlement Agreement
Hertford Manor	HAL-072-013	9/10/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	2/4/2022	Settlement Agreement

Person County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Maple Heights Assisted Living	HAL-073-010	2/19/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	2/4/2022	Settlement Agreement
Maple Heights Assisted Living	HAL-073-010	2/19/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	2/4/2022	Settlement Agreement
Maple Heights Assisted Living	HAL-073-010	2/19/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	2/4/2022	Settlement Agreement
Maple Heights Assisted Living	HAL-073-010	2/19/2021	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	2/4/2022	Settlement Agreement
Maple Heights Assisted Living	HAL-073-010	2/19/2021	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	2/4/2022	Settlement Agreement

Pitt County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Care One Assisted Living of Greenville	HAL-074-044	6/11/2021	10A NCAC 13F .0906(f)(4) Other Resident Care and Services; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Paid in Full
Cypress Glen Retirement Community Memory Care Cottage	HAL-074-042	3/19/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,000.00	3/16/2022	Paid in Full
Winterville Manor	HAL-074-026	2/18/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/26/2021	Settlement Agreement
Brookdale Dickinson Avenue	HAL-074-011	10/7/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	6/10/2022	Paid in Full
Brookdale W. Arlington Boulevard	HAL-074-012	7/31/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Brookdale W. Arlington Boulevard	HAL-074-012	7/31/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	8/31/2021	Paid in Full
Care One Assisted Living of Greenville	HAL-074-044	6/11/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	3/16/2022	Paid in Full

Randolph County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Brookstone Haven	HAL-076-034	1/19/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	9/16/2022	Settlement Agreement
Brookstone Haven	HAL-076-034	1/19/2022	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	9/16/2022	Settlement Agreement
Brookstone Haven	HAL-076-034	1/19/2022	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	9/16/2022	Settlement Agreement
North Pointe	HAL-076-027	2/7/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$16,000.00	8/5/2022	Settlement Agreement
North Pointe Assisted Living Of Archdale	HAL-076-032	6/11/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	4/20/2022	Settlement Agreement

Richmond County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Hamlet House	HAL-077-010	2/18/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2022	Paid in Full
Hamlet House	HAL-077-010	5/18/2022	10A NCAC 13F .0902(b) Health Care	Unabated A2	$50,063.00	3/8/2023	Appealed
Hamlet House	HAL-077-010	5/18/2022	10A NCAC 13F .1004(a) Medication Administration	A2	$1,500.00	3/8/2023	Appealed
Hamlet House	HAL-077-010	8/1/2022	10A NCAC 13F .0901(c) Personal Care and Supervision	A1	$12,000.00	3/8/2023	Appealed
Hermitage Retirement Center	HAL-077-012	12/3/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	8/31/2022	Paid in Full
Hermitage Retirement Center	HAL-077-012	12/3/2021	#N/A	A2	$1,000.00	8/31/2022	Paid in Full

Robeson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Covenant Care	HAL-078-038	1/17/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2021	Paid in Full
Dial's Family Care Home # 10	FCL-078-079	5/31/2019	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	8/24/2020	Paid in Full
Dial's Family Care Home #4	FCL-078-077	5/1/2019	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	12/20/2021	Not Paid - Referred to Controller's Office
Lumberton Assisted Living	HAL-078-084	12/12/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	3/1/2021	Settlement Agreement
Lumberton Assisted Living	HAL-078-084	12/12/2019	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	3/1/2021	Settlement Agreement
Morning Star Assisted Living #3	HAL-078-065	2/5/2021	10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Red Springs Assisted Living	HAL-078-083	8/26/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	5/16/2022	Settlement Agreement

Rockingham County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Beverly Rucker's Family Care Home #2	FCL-079-033	5/28/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	4/20/2022	Paid in Full
Beverly Rucker's Family Care Home #2	FCL-079-033	5/28/2021	10A NCAC 13G .0906 (f)(1)-(4) Other Resident Services; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	4/20/2022	Paid in Full
Brookdale Reidsville	HAL-079-007	9/12/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	8/7/2020	Settlement Agreement
Ezana's Scarlet Oaks (Closed)	FCL-079-106	8/23/2019	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	7/21/2021	Not Paid - Referred to Controller's Office
Moyer's Agape Assisted Living (Closed)	HAL-079-105	8/25/2022	10A NCAC 13F .0902(b) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/15/2023	Paid in Full
R & D Wilson Home Care	FCL-079-075	7/8/2021	10A NCAC 13G .0302 (b) Design And Construction; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$5,700.00	5/16/2022	Paid in Full

Rowan County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Angels at Heart Assisted Living	HAL-080-029	8/25/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	7/7/2021	Paid in Full
Angels at Heart Assisted Living	HAL-080-029	3/31/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$7,000.00	2/4/2022	Appealed
Angels at Heart Assisted Living	HAL-080-029	3/31/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	2/4/2022	Appealed
Best of Care Assisted Living	HAL-080-019	1/28/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	2/15/2021	Settlement Agreement
Best of Care Assisted Living	HAL-080-019	1/28/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$12,000.00	2/15/2021	Settlement Agreement
Bethamy Retirement Center	HAL-080-032	3/31/2022	10A NCAC 13F .1004 (i) Medication Administration ; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	2/7/2023	Not Paid - Referred to Controller's Office

Rutherford County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Sunnyside Retirement Center	HAL-081-042	4/14/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	12/21/2022	Paid in Full
Sunnyside Retirement Center	HAL-081-042	4/14/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	12/21/2022	Paid in Full

Stanly County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Woodhaven Court	HAL-084-009	7/31/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,000.00	8/26/2021	Settlement Agreement

Stokes County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Rose Tara Senior Living	HAL-085-008	2/17/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$750.00	2/4/2022	Paid in Full

Surry County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Central Care	HAL-086-001	8/18/2021	G.S.§ 131D-4.5B(b) ACH Medication Aides; Training and Competency; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$2,400.00	5/16/2022	Paid in Full

Transylvania County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Kingsbridge House	HAL-088-075	10/30/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/26/2021	Appealed
Kingsbridge House	HAL-088-075	10/30/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	8/26/2021	Appealed
Kingsbridge House	HAL-088-015	1/22/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$30,375.00	6/10/2022	Settlement Agreement
Kingsbridge House	HAL-088-015	1/22/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$37,500.00	12/17/2021	Settlement Agreement
Kingsbridge House	HAL-088-015	1/22/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	12/17/2021	Settlement Agreement

Tyrrell County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Tyrrell House	HAL-089-002	5/17/2019	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	5/17/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	5/17/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	5/17/2019	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	5/17/2019	10A NCAC 13F .1308(a) Special Care Unit Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	5/17/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	8/20/2019	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	8/20/2019	10A NCAC 13F .1212(d) Reporting of Accidents and Incidents; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	8/20/2019	10A NCAC 13F .1310 Other Applicable Rules For Special Care Units; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	10/30/2019	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$69,750.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	10/30/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$11,850.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	10/30/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$69,750.00	10/1/2020	Settlement Agreement
Tyrrell House	HAL-089-002	11/30/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$13,500.00	8/26/2021	Settlement Agreement
Tyrrell House	HAL-089-002	11/30/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$9,000.00	8/26/2021	Settlement Agreement
Tyrrell House	HAL-089-002	1/28/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$9,000.00	12/17/2021	Appealed
Tyrrell House	HAL-089-002	9/1/2022	10A NCAC 13F .0902(b) Health Care	A2	$14,000.00	3/8/2023	Appealed

Union County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Poplin Terrace (Closed)	FCL-090-018	7/13/2020	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	6/11/2021	Settlement Agreement
The Addison of Indian Trail	HAL-090-035	11/5/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	8/17/2022	Paid in Full

Wake County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Allcare Assisted Living (Closed)	FCL-092-018	10/31/2019	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	7/7/2021	Paid in Full
Allcare Assisted Living (Closed)	FCL-092-018	10/31/2019	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	7/7/2021	Paid in Full
Avendelle Assisted Living at Heritage (closed)	FCL-092-230	7/11/2022	10A NCAC 13G .0504 (c) Competency Validation For Licensed Health Pro; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	12/21/2022	Paid in Full
Avendelle Assisted Living at Heritage (closed)	FCL-092-230	7/11/2022	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	12/21/2022	Paid in Full
Avendelle Assisted Living at Waterford Landing	FCL-092-127	7/18/2019	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	9/8/2021	Paid in Full
Avendelle Assisted Living on Tryon	FCL-092-272	8/19/2022	10A NCAC 13G .0902(c)(3)(4) Health Care G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	2/15/2023	Paid in Full
Brighton Gardens of Raleigh	HAL-092-024	5/13/2022	10A NCAC 13F .0305(h)(4) Physical Environment	A2	$1,500.00	3/8/2023	Paid in Full
Brookdale Wake Forest	HAL-092-032	4/13/2022	10A NCAC 13F .0902(b) Health Care	A2	$3,000.00	3/8/2023	Paid in Full
Cadence at Wake Forest	HAL-092-213	12/16/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	9/16/2022	Paid in Full
Cadence at Wake Forest	HAL-092-213	12/16/2021	10A NCAC 13F .1308(a) Special Care Unit Staff; G.S. 131D-21(6) Declaration of Resident's Rights	A2	$2,000.00	9/16/2022	Paid in Full
Cadence at Wake Forest	HAL-092-213	12/16/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	9/16/2022	Paid in Full
Cadence at Wake Forest	HAL-092-213	3/10/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	9/16/2022	Paid in Full
Cadence at Wake Forest	HAL-092-213	5/27/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$10,500.00	3/8/2023	Paid in Full
Cadence at Wake Forest	HAL-092-213	5/27/2022	10A NCAC 13F .0906(f)(4) Other Resident Care and Services	A2	$3,000.00	3/8/2023	Paid in Full
Cadence Garner	HAL-092-215	1/20/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2021	Paid in Full
Cadence Garner	HAL-092-215	1/20/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	8/31/2021	Paid in Full
Cadence North Raleigh	HAL-092-214	4/28/2022	10A NCAC 13F .0901(c) Personal Care and Supervision G.S. 131D-21(4) Declaration of Resident's Rights	A1	$3,500.00	2/15/2023
Carillon Assisted Living of Knightdale (Closed)	HAL-092-166	1/16/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	6/14/2021	Not Paid - Referred to Controller's Office
Chatham Commons	HAL-092-203	9/16/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$6,000.00	9/14/2020	Settlement Agreement
Chatham Commons	HAL-092-203	2/12/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	2/4/2022	Settlement Agreement
Chatham Commons	HAL-092-203	2/12/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$14,000.00	2/4/2022	Settlement Agreement
Chatham Commons	HAL-092-203	6/2/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$67,500.00	4/20/2022	Appealed
Destiny Family Care Home #4	FCL-092-290	6/22/2022	10A NCAC 13G .0906 (f)(1)-(4) Other Resident Services G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,000.00	2/15/2023	Not Paid - Referred to Controller's Office
Falls River Court Memory Care Community	HAL-092-141	11/30/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	8/17/2022	Paid in Full
Falls River Village Assisted Living Community	HAL-092-142	4/14/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	12/21/2022	Not Paid - Referred to Controller's Office
Heart to Live	FCL-092-252	6/17/2021	10A NCAC 13G .0901(c) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$875.00	4/20/2022	Paid in Full
Heartfields at Cary	HAL-092-156	5/13/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A1	$55,500.00	9/14/2020	Paid in Full
Kelley's Family at Drayton Reserve	FCL-092-251	7/3/2019	10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/24/2020	Paid in Full
LiveWell Cary (Closed)	FCL-092-258	10/31/2022	10A NCAC 13G .0902 (c-2) Health Care	A1	$16,000.00	3/8/2023	Appealed
Morningside of Raleigh	HAL-092-217	12/22/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	8/26/2021	Paid in Full
Morningside of Raleigh	HAL-092-217	3/30/2022	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$14,000.00	12/21/2022	Paid in Full
Morningside of Raleigh	HAL-092-217	5/20/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$12,000.00	3/8/2023	Paid in Full
Morningside of Raleigh	HAL-092-217	5/20/2022	10A NCAC 13F .0902(b) Health Care	A2	$2,000.00	3/8/2023	Paid in Full
Morningside of Raleigh	HAL-092-217	6/10/2022	10A NCAC 13F .0305(h)(4) Physical Environment	A2	$4,000.00	3/8/2023	Paid in Full
Morningside of Raleigh	HAL-092-217	6/10/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$14,000.00	3/8/2023	Paid in Full
Morningside of Raleigh	HAL-092-217	9/13/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$15,000.00	4/5/2023	Paid in Full
Novelty Healthcare III	FCL-092-249	2/28/2020	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	3/1/2021	Paid in Full
Novelty Healthcare III	FCL-092-249	2/28/2020	10A NCAC 13G .0906 (f)(1)-(4) Other Resident Services; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$500.00	3/1/2021	Paid in Full
Novelty Healthcare Services II	FCL-092-228	8/3/2021	G.S. 131D 4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$540.00	5/16/2022	Paid in Full
Oliver House	HAL-092-182	6/21/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	8/7/2020	Settlement Agreement
Oliver House	HAL-092-182	12/22/2020	10A NCAC 13F .1801 (a) (b) Infection Prevention & Control Program (Emer); G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Settlement Agreement
Oliver House	HAL-092-182	8/19/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$12,000.00	5/16/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	2/16/2021	10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	2/4/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	2/16/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	2/4/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	2/16/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	2/4/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	2/16/2021	10A NCAC 13F .1801 (c) Infection Prevention & Control Program (temp); G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	2/4/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	2/16/2021	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	2/4/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	5/14/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$7,300.00	5/16/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	5/14/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	5/16/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	5/14/2021	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$7,300.00	5/16/2022	Settlement Agreement
Phoenix Assisted Care	HAL-092-131	5/14/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	5/16/2022	Settlement Agreement
Spring Arbor of Cary	HAL-092-204	9/13/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	6/10/2022	Paid in Full
Sunrise at North Hills	HAL-092-218	8/27/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	5/16/2022	Paid in Full
Sunrise of Cary	HAL-092-209	10/4/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$2,000.00	2/15/2023	Paid in Full
Sunrise of Cary	HAL-092-209	10/4/2022	10A NCAC 13F .1308(a) Special Care Unit Staff	A1	$500.00	2/15/2023	Paid in Full
The Addison of Fuquay-Varina	HAL-092-219	11/12/2021	10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$16,000.00	8/17/2022	Appealed
The Addison of Fuquay-Varina	HAL-092-219	11/12/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Appealed
The Addison of Fuquay-Varina	HAL-092-219	8/6/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,500.00	5/16/2022	Paid in Full
The Addison of Fuquay-Varina	HAL-092-219	8/6/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	5/16/2022	Paid in Full
The Addison of Fuquay-Varina	HAL-092-219	9/3/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	8/17/2022	Paid in Full
The Addison of Fuquay-Varina	HAL-092-219	9/3/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	8/17/2022	Appealed
The Addison of Fuquay-Varina	HAL-092-219	9/3/2021	10A NCAC 13F .0909 Resident Rights;	A1	$7,000.00	8/17/2022	Appealed
The Addison of Fuquay-Varina	HAL-092-219	11/12/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$64,500.00	8/17/2022	Appealed
The Addison of Knightdale	HAL-092-220	11/12/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,500.00	8/17/2022	Paid in Full
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .0305(h)(4) Physical Environment G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$54,000.00	2/15/2023	Not Paid - Referred to Controller's Office
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .0309 (d) Plan For Evacuation; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2022	Appealed
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .0311(a) Other Requirements; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	8/31/2022	Appealed
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .0605 Staffing Of Personal Care Aide Supervisors; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/31/2022	Appealed
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	8/31/2022	Appealed
The Addison of Knightdale	HAL-092-220	2/8/2022	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/31/2022	Appealed
The Addison of Knightdale	HAL-092-220	2/8/2022	G.S. § 131D-25 Implementation; G.S. 131D-21(1) Declaration of Resident's Rights	A1	$12,000.00	8/31/2022	Appealed
The Covington	HAL-092-181	3/12/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	5/3/2021	Settlement Agreement
The Manor at Edgewater	FCL-092-153	6/30/2022	10A NCAC 13G .0902(b) Health Care G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	2/15/2023	Paid in Full
Wake Assisted Living	HAL-092-144	3/19/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	4/20/2022	Paid in Full
Wake Assisted Living	HAL-092-144	7/14/2022	10A NCAC 13F .0902(b) Health Care	A1	$4,000.00	3/8/2023	Paid in Full
Waltonwood Lake Boone	HAL-092-210	9/26/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$1,000.00	6/14/2021	Paid in Full

Warren County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Pivotal Care (Closed)	FCL-093-012	11/4/2020	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	7/7/2021	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	11/4/2020	10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,500.00	7/7/2021	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	11/4/2020	10A NCAC 13G .1701 (a) (b) Infection Prevention & Control Program (emer); G.S. 131D-21(2) Declaration of Resident's Rights	A1	$1,750.00	7/7/2021	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	2/5/2021	10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$11,800.00	2/4/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	4/16/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	3/16/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	4/16/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	3/16/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	10A NCAC 13G .0312(g) Outside Entrance And Exits; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$1,600.00	4/20/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	10A NCAC 13G .0405(a)(b) Test For Tuberculosis; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$1,600.00	4/20/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$11,625.00	4/20/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$11,625.00	4/20/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	G.S. § 131D-4.5B (b) ACH Medication Aides;Training and Competency; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$17,900.00	4/20/2022	Not Paid - Referred to Controller's Office
Pivotal Care (Closed)	FCL-093-012	6/4/2021	G.S. 131D 4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	4/20/2022	Not Paid - Referred to Controller's Office

Washington County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Marie Webb's Family Home Care (Closed)	FCL-094-003	6/2/2020	10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/26/2021	Settlement Agreement

Wayne County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Countryside Village	HAL-096-049	8/24/2020	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Settlement Agreement
Countryside Village	HAL-096-049	8/24/2020	10A NCAC 13F .1212(d) Reporting of Accidents and Incidents; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/26/2021	Settlement Agreement
Countryside Village	HAL-096-049	8/24/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Settlement Agreement
Countryside Village	HAL-096-049	7/21/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$16,000.00	3/8/2023	Appealed
Countryside Village	HAL-096-049	7/21/2022	10A NCAC 13F .0902(b) Health Care	A2	$12,000.00	3/8/2023	Appealed
Countryside Village	HAL-096-049	7/21/2022	10A NCAC 13F .1004 (i) Medication Administration	A2	$9,000.00	3/8/2023	Appealed
Countryside Village	HAL-096-049	11/1/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A2	$12,000.00	4/5/2023
Eagle's Pointe	HAL-096-051	8/26/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	6/14/2021	Settlement Agreement
Eagle's Pointe	HAL-096-051	12/16/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	7/21/2021	Appealed
Countryside Village	HAL-096-049	2/14/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$3,500.00	3/1/2021	Paid in Full
Countryside Village	HAL-096-049	2/14/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$1,500.00	3/1/2021	Paid in Full
Countryside Village	HAL-096-049	8/24/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$4,000.00	8/26/2021	Settlement Agreement
Countryside Village	HAL-096-049	8/24/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Settlement Agreement
Eagle's Pointe	HAL-096-051	7/16/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$10,500.00	8/26/2021	Appealed
Eagle's Pointe	HAL-096-051	7/16/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$5,250.00	8/26/2021	Appealed
Eagle's Pointe	HAL-096-051	7/16/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	8/26/2021	Appealed
Eagle's Pointe	HAL-096-051	7/16/2020	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$9,000.00	8/26/2021	Appealed
Eagle's Pointe	HAL-096-051	7/16/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$4,000.00	8/26/2021	Settlement Agreement
Fremont Rest Center	HAL-096-024	4/16/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$5,250.00	4/20/2022	Settlement Agreement
Fremont Rest Center	HAL-096-024	4/16/2021	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	8/31/2021	Settlement Agreement
Fremont Rest Center	HAL-096-024	4/16/2021	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	4/20/2022	Settlement Agreement
Fremont Rest Center	HAL-096-024	4/16/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$6,000.00	4/20/2022	Settlement Agreement
Fremont Rest Center	HAL-086-024	7/11/2022	10A NCAC 13F .0909 Resident Rights	A1	$7,000.00	3/8/2023	Appealed
Goldsboro Assisted Living & Alzheimer's Care	HAL-096-031	1/9/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$500.00	12/17/2021	Paid in Full
Somerset Court of Goldsboro	HAL-096-047	12/4/2020	10A NCAC 13F .0306(a)(4) Housekeeping And Furnishings; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	12/10/2021	Paid in Full
Somerset Court of Goldsboro	HAL-096-047	12/4/2020	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$1,000.00	12/10/2021	Paid in Full
Somerset Court of Goldsboro	HAL-096-047	12/4/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$7,000.00	12/10/2021	Settlement Agreement
Somerset Court of Goldsboro	HAL-096-047	12/4/2020	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$16,000.00	12/10/2021	Settlement Agreement
Somerset Court of Goldsboro	HAL-096-047	3/1/2021	10A NCAC 13F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A2	$80,250.00	9/13/2022	Appealed
Somerset Court of Goldsboro	HAL-096-047	3/1/2021	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$2,000.00	8/17/2022	Appealed
Somerset Court of Goldsboro	HAL-096-047	9/23/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$14,500.00	8/17/2022	Appealed
Woodard's Retirement Village	HAL-096-009	10/2/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$4,000.00	11/8/2021	Settlement Agreement
Woodard's Retirement Village	HAL-096-009	10/2/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	11/8/2021	Settlement Agreement
Woodard's Retirement Village	HAL-096-009	10/2/2020	10A NCAC 13F .1308(a) Special Care Unit Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	11/8/2021	Settlement Agreement
Woodard's Retirement Village	HAL-096-009	10/2/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	11/8/2021	Settlement Agreement
You're At Home With Sozo (Closed)	FCL-096-052	7/7/2020	#N/A	A2	$2,000.00	8/26/2021	Paid in Full
You're At Home With Sozo (Closed)	FCL-096-052	7/7/2020	#N/A	A2	$2,000.00	8/26/2021	Paid in Full

Wilkes County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Rose Glen Manor	HAL-097-015	11/6/2019	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated B	$3,750.00	8/24/2020	Settlement Agreement

Wilson County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Called 2 Care Family Home #3 (Closed)	FCL-098-034	1/31/2020	10A NCAC 13G .0601 (b)(2) Management And Other Staff; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	6/14/2021	Settlement Agreement
Called 2 Care Family Home #3 (Closed)	FCL-098-034	5/15/2020	10A NCAC 13G .0302 (b) Design And Construction; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated B	$9,975.00	9/8/2021	Settlement Agreement
Called 2 Care Family Home #3 (Closed)	FCL-098-034	5/15/2020	10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$2,000.00	6/14/2021	Settlement Agreement
Parkwood Village	HAL-098-030	10/15/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$7,000.00	8/26/2021	Paid in Full
Wilson Assisted Living	HAL-098-027	7/16/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$8,000.00	9/14/2020	Paid in Full
Wilson Assisted Living	HAL-098-027	7/16/2019	G.S. § 131D-25 Implementation; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$9,000.00	9/14/2020	Paid in Full
Wilson Assisted Living	HAL-098-027	9/28/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$15,000.00	8/26/2021	Paid in Full
Wilson Assisted Living	HAL-098-027	9/28/2020	#REF!	A1	$15,000.00	8/26/2021	Paid in Full
Wilson Assisted Living	HAL-098-027	2/15/2021	#REF!	A2	$12,000.00	8/31/2021	Paid in Full
Wilson Assisted Living	HAL-098-027	9/29/2022	10A NCAC 13F .0901(b) Personal Care and Supervision	A1	$9,000.00	3/8/2023
Wilson House	HAL-098-023	3/10/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$4,000.00	5/3/2021	Settlement Agreement
Wilson House	HAL-098-023	6/8/2020	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	7/21/2021	Settlement Agreement
Wilson House	HAL-098-023	6/8/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$10,000.00	7/21/2021	Settlement Agreement
Wilson House	HAL-098-023	6/8/2020	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$8,000.00	7/21/2021	Settlement Agreement
Wilson House	HAL-098-023	6/8/2020	10A NCAC 13F .1308(a) Special Care Unit Staff; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$3,500.00	7/21/2021	Settlement Agreement
Wilson House	HAL-098-023	6/8/2020	G.S. § 131D-25 Implementation; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$8,000.00	7/21/2021	Settlement Agreement
Wilson House	HAL-098-023	12/22/2021	10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$14,000.00	8/31/2022	Settlement Agreement

Yadkin County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Patriot Living of Yadkinville	HAL-099-015	3/11/2020	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$3,000.00	8/26/2021	Paid in Full
Patriot Living of Yadkinville	HAL-099-018	6/10/2022	10A NCAC 13F .0902(b) Health Care	A2	$2,000.00	3/8/2023

Yancey County

Facility	Facility License	Inspection Date & Nature of Validation	Rules Areas Cited	Level Cited	Penalty Amount	Date Penalty Imposed	Current Status
Southern Living for Seniors of Burnsville, NC	HAL-100-006	10/16/2019	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$16,000.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	10/16/2019	10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$126,000.00	8/7/2020	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	2/18/2022	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$16,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	2/18/2022	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	2/18/2022	10A NCAC 13F .0604(e) Personal Care And Other Staffing; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$16,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	3/17/2022	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	3/17/2022	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$3,750.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	3/17/2022	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Resident's Rights	Unabated A1	$5,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	3/17/2022	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0407(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Resident's Rights	A2	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A1	$32,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0601 (b) Management Of Facilities With A Capacity Or; G.S. 131D-21(4) Declaration of Resident's Rights	Unabated A2	$24,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Resident's Rights	A1	$2,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .1008 (h) Controlled Substance; G.S. 131D-21(4) Declaration of Resident's Rights	A2	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .1104(c) Accounting For Resident's Personal Funds; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$20,000.00	8/17/2022	Settlement Agreement
Southern Living for Seniors of Burnsville, NC	HAL-100-006	5/10/2022	10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Resident's Rights	A1	$2,000.00	8/17/2022	Settlement Agreement

NC Division of Health Service Regulation

Adult Care Licensure Section