Listing of Facilities with Penalties

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

Alamance County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Bountiful Blessings FCH (Closed) FCL-001-146 8/24/2020 $500.00 A2 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure hot water temperatures were maintained at a minimum of 100 degrees Fahrenheit (F) to a maximum of 116 degrees F for 6 of 6 fixtures. Referred to Controller's Office 08/09/2021
Bountiful Blessings FCH (Closed) FCL-001-146 8/24/2020 $3,000.00 A2 10A NCAC 13G .0601( c)(2)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure there was a supervisor-in-charge in Facility or within 500 feet of facility. Referred to Controller's Office 08/09/2021
Lane St. Retirement Home (Closed) HAL-001-149 12/13/2018 $110,250.00 Unabated A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure supervision was provided for 1 resident with a history of smoking in the facility. Referred to Controller's Office 04/09/2019
A Vision Come True HAL-001-103 8/31/2021 $15,800.00 A2 10A NCAC 13F .0601(a)   Management of Facilities with a Capacity of Census of Seven to Thirty Residents; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the total operation of the facility to meet and maintain rules related to infection control, medication administration, health care, discharge of residents, and staff qualifications.
A Vision Come True HAL-001-103 8/31/2021 $1,000.00 A2 10A NCAC 13F .1801(a)(b) Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.
Above and Beyond Family Care II (Closed) FCL-001-139 7/21/2021 $2,000.00 A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure Resident was free of physical abuse related to alleged physical abuse by the Administrator
Above and Beyond Family Care II (Closed) FCL-001-139 7/21/2021 $1,000.00 A2 10A NCAC 13G .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to report allegations of physical assault of a resident by a staff to the Health Care Personnel Registry (HCPR) within 24 hours and provide documentation the alleged act was investigated and reported to HCPR within 5 days.
Above and Beyond Family Care II (Closed) FCL-001-139 7/21/2021 $1,000.00 A2 10A NCAC 13G .0901 (b) Personal Care And Supervision; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to provide supervision for 1 of 1 resident who exhibited exit-seeking behaviors and eloped from the facility without staff's knowledge.
Moher Family Care (Closed) FCL-001-107 7/7/2021 $3,500.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure follow-up for acute and routine psychiatric care.
Moher Family Care (Closed) FCL-001-107 7/7/2021 $7,000.00 A1 10A NCAC 13G .0901 (b) Personal Care And Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to provide supervision in accordance with residents assessed needs, care plan and current symptoms.
Moher Family Care (Closed) FCL-001-107 7/7/2021 $7,000.00 A1 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Resident's Rights Administrator failed to ensure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' rights.
Moher Family Care (Closed) FCL-001-107 7/7/2021 $3,500.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NCDHHS) were implemented when caring for residents during the global Coronavirus (COVID-19) pandemic.

Alexander County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $2,000.00 A1 10A NCAC 13F .0601(a) Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management and overall operations of the facility were in substantial compliance by failing to meet and monitor rules related to housekeeping. Settlement Fulfilled 05/19/2021 Settlement Agreement 02/26/2021 Appealed 10/21/2019 $11,000.00 total for 3 penalties 3/26/2021
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $20,000.00 A1 10A NCAC 13F .0902(a) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up for residents who required acute and routine health care needs. Settlement Fulfilled 05/19/2021 Settlement Agreement 02/26/2021 Appealed 10/21/2019 $11,000.00 total for 3 penalties 3/26/2021
A New Outlook of Taylorsville HAL-002-007 9/24/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Settlement Fulfilled 05/19/2021 Settlement Agreement 02/26/2021 Appealed 10/21/2019 $11,000.00 total for 3 penalties 3/26/2021
A New Outlook of Taylorsville HAL-002-007 8/31/2021 $12,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure the recommendations and guidance established by the Centers for Disease Control (CDC), and the North Carolina Department of Health and Human Services (NCDHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/23/2021

Anson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Meadowview Terrace of Wadesboro HAL-004-003 9/14/2020 $2,000.00 A2 G.S. 131D-25 Implementation; Declaration of Residents' Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with rules and statutes governing adult care homes as related to health care, medication administration and nutrition and food services. Settlement Agreement 07/07/2021 Appealed 10/14/2020 $2,500.00 7/1/2021
Meadowview Terrace of Wadesboro HAL-004-003 9/14/2020 $2,000.00 A2 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with the facility's policies for 3 of 6 residents observed during the medication passes and for 4 of 6 residents sampled for record review. Settlement Agreement 07/07/2021 Appealed 10/14/2020 $2,500.00 7/1/2021
Meadowview Terrace of Wadesboro HAL-004-003 8/31/2021 $12,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to ensure supervision for 1 of 5 sampled residents with a diagnosis of dementia.

Ashe County

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

Avery County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cranberry House HAL-006-007 8/31/2021 $2,000.00 A2 10A NCAC 13F .1801(a)(b) Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection to the residents in the facility during the global Coronavirus (COVID-19) pandemic.

Beaufort County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pantego Rest Home HAL-007-015 8/31/2021 $4,000.00 A2 10A NCAC 13F .0601(a)   Management of Facilities with a Capacity of Census of Seven to Thirty Residents; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the total operation of the facility to meet and maintain rules related resident's rights, medication administration, and medication storage. Appealed 09/14/2021
Pantego Rest Home HAL-007-015 8/31/2021 $4,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (DHHS) were implemented and maintained when caring for residents during the global Coronavirus (COVID-19) pandemic. Appealed 09/14/2021

Bertie County

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

Bladen County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Oak Grove Family Care Home FCL-009-028 7/15/2019 $1,500.00 A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications prepared for administration in advance were kept in a sealed container that identified the name and strength. Paid in Full $1,500.00 9/9/2019
Oak Grove Family Care Home FCL-009-028 7/15/2019 $2,625.00 A1 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Declaration of Residents' Rights; Facility failed to ensure residents were not left alone in the facility at any time. Paid in Full $2,625.00 9/9/2019
Oak Grove Family Care Home FCL-009-028 7/15/2019 $2,000.00 A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow up for acute and routine health care needs. Paid in Full $2,000.00 9/9/2019
West Bladen Assisted Living HAL-009-025 1/25/2019 $8,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to supervise by not addressing the current symptoms and needs for residents who had dementia. Settlement Fulfilled 02/03/2020 Settlement Agreement 08/23/2019 Appealed 02/15/2019 $1,000.00 2/3/2020
Oak Grove Family Care Home Bladen 7/21/2021 $15,600.00 Unabated B 10A NCAC 13G .0312(g)   Outside Entrance and Exits; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 2 of 4 exit doors had a sounding device that activated and sounded when the exit doors were opened to alert staff for 1 of 4 residents sampled who was constantly disoriented. Appealed 08/30/2021
Comfort Living Family Care Home FCL-009-022 5/4/2021 $375.00 A2 10A NCAC 13 G .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure 1 sampled residents was supervised in accordance with their assessed needs and current symptoms. Paid in Full $375.00 5/21/2021

Brunswick County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Leland House HAL-010-007 12/9/2019 $5,250.00 A2 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to respond immediately with care and interventions in accordance with their fall policy and policy for accidents. Paid in full $1,500.00 10/7/2020
Leland House HAL-010-007 10/1/2020 $6,900.00 Unabated B 10A NCAC 13G .0406 Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure staff were tested for tuberculosis disease in accordance with control measures established by the Commission of Public Health Settlement Agreement 05/24/2021 Appealed 02/26/2021
Leland House HAL-010-007 10/1/2020 $14,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure the health care needs were met for 5 of 8 sampled residents. Settlement Agreement 05/24/2021 Appealed 02/26/2021
Leland House HAL-010-007 10/1/2020 $14,000.00 A1 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to ensure a safe system was established and maintained for medication administration and failed to ensure medications were administered as ordered. Settlement Agreement 05/24/2021 Appealed 02/26/2021
Leland House HAL-010-007 10/1/2020 $4,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights The Administrator failed to ensure policies and procedures were implemented and maintained to ensure substantial compliance with the rules and statutes of adult care homes. Settlement Agreement 05/24/2021 Appealed 02/26/2021
Shallotte Assisted Living HAL-010-008 12/13/2018 $4,000.00 A2 10A NCAC 13F .1105(b)   Refund of Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that 3 residents' personal funds were dispensed to the appropriate recipient within 30 day after the residents' death. Paid in Full $4,000.00 11/4/2019
Shallotte Assisted Living HAL-010-008 12/13/2018 $4,000.00 A2 10A NCAC 13F .1105(a)  Refund of Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 4 residents' personal funds returned to them or responsible party within 14 days of residents leaving facility. Paid in Full $4,000.00 11/4/2019
Shallotte Assisted Living HAL-010-008 8/5/2019 $9,000.00 A1 10A NCAC 13F .0305(h)(3) Physical Environment; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure fire exits were easily operable with a single hand motion, with the intentional obstruction of fire exit doors Referred to Controller's Office 11/04/2019
Shallotte Assisted Living HAL-010-008 8/24/2020 $34,000.00 Unabated B 10A NCAC 13F .1104(b)   Accounting for Resident's Personal Funds; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 7 of 7 sampled residents who had four specialty referrals (#2), redness and weeping legs and thick, long toenails. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $14,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to report an allegation of misappropriation of a resident's personal money to the North Carolina Health Care Personnel Registry (HCPR) within 24 hours for 1 of 1 sampled resident and failed to ensure allegations of drug diversion were reported to HCPR within 24 hours and 5-day follow-up reporting was completed. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $12,000.00 A1 10A NCAC 13F .1008 (a)   Controlled Substances ; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure readily retrievable records that accurately reconciled the receipt, disposition, and administration of controlled substances for 4 of 5 residents . Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 G.S. 131D-21(5) Assisted Living Residence; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management, total operations, and policies and procedures of Facility were implemented to maintain each residents' right to be free of serious neglect and exploitation as evidenced by the failure to maintain substantial compliance with the rules and statutes governing adult care homes as related to health care. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 7 of 7 sampled residents who had four specialty referrals (#2), redness and weeping legs and thick, long toenails. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered and in accordance with facility's policies for 2 of 3 residents observed. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Shallotte Assisted Living HAL-010-008 8/24/2020 $16,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral for the acute healthcare needs for 1 of 5 sampled residents. Settlement Agreement 08/20/2021 Appealed 09/18/2020
Leland House HAL-010-007 8/31/2021 $13,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow-up to meet the needs of 4 of 10 sampled residents.
Leland House HAL-010-007 8/31/2021 $9,000.00 A2 10A NCAC 13F .0801 Resident Assessment; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure an assessment and care plan was updated within 10 days following a significant change for 3 of 10 sampled residents.
Leland House HAL-010-007 8/31/2021 $9,000.00 A2 10A NCAC 13F .0901(a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure staff provided personal care assistance to 4 of 8 sampled residents.
Leland House HAL-010-007 8/31/2021 $13,000.00 A1 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond immediately to an incident and accident in accordance to their policies and procedures for 1 of 5 sampled residents.
Leland House HAL-010-007 8/31/2021 $9,000.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to enure there was enough staff on the Memory Care Unit (MCU) trained to meet the personal care, supervision and health care needs of residents.
Leland House HAL-010-007 8/31/2021 $9,000.00 A2 10A NCAC 13F .1308(b) Special Care Unit Staffing; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to have a memory care manager (MCM) working in the facility's 24 bed memory care unit (MCU) for 8 hours per day, 5 days per week to supervise the care of the residents residing on the MCU.
Leland House HAL-010-007 8/31/2021 $13,000.00 A1 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights acility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (DHHS) were implemented and maintained during the global COVID-19 pandemic to reduce the risk of transmission and infection.
Leland House HAL-010-007 8/31/2021 $13,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, total operations, and policies and procedures were implemented to maintain each resident's right and to receive appropriate and adequate care and services and to be free from serious neglect.

Buncombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Becky's Rest Home #1 HAL-011-002 8/7/2020 $2,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 3 of 4 residents were free from physical and verbal abuse by a personal care aide. Paid in Full $2,000.00 10/7/2020
Chase Samaritan HAL-011-133 9/24/2019 $20,000.00 A1 10A NCAC F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up. Paid in Full $20,000.00 12/17/2019
Chunn's Cove Assisted Living HAL-011-262 6/4/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents who requested medical transportation to the hospital related to breathing difficulty. Appeal Re-filed 06/01/2021 Appealed 07/08/2019
Chunn's Cove Assisted Living HAL-011-262 6/4/2019 $20,000.00 A1 10A NCAC 13F .0904(e )(4) Nutrition and Food Service; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure therapeutic diets were served as ordered. Appeal Re-filed 06/01/2021 Appealed 07/08/2019
Chunn's Cove Assisted Living HAL-011-262 9/24/2019 $8,100.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications related to pain treatment as ordered. Settlement Fulfilled 08/26/2020 Settlement Agreement 05/27/2020 Appealed 10/14/2019 $8,100.00 8/11/2020
Chunn's Cove Assisted Living HAL-011-262 8/7/2020 $16,400.00 Unabated B 10A NCAC 13 F .0901(c ) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to document the administration of medication immediately following the administration by the staff who had administered the medications. Settlement Fulfilled 03/20/2021 Settlement Agreement 12/10/2020 Appealed 09/10/2020 $6,000.00 1/8/2021
Fairview Family Care Home #4 FCL-011-025 12/13/2018 $3,500.00 A1 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Paid in Full $3,500.00 3/3/2020
White Fawn Family Care Home (Pty 1) (Closed) FCL-011-297 12/13/2018 $3,600.00 Unabated B 10A NCAC 13G .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Referred to Controller's Office 04/09/2019
Woodland Terrace Family Care Home #4 FCL-011-342 2/26/2019 $5,100.00 Unabated B 10A NCAC 13G .1004(a)   Medication Administration, 10A NCAC 13G .0601(a)  Management and other Staff; G.S. 131D-21(2)  Declaration of Residents' Rights Facility failed to ensure medications were administered for residents related to delay in reordering medications. Management failed to maintain compliance in the rule areas regarding, activities program, accurate accounting of 3 controlled medications, medication administration, pre-pouring medications, 3-5 day supply. Referred to Controller's Office 08/20/2019
Woodland Terrace FCH #6 FCL-011-351 3/18/2019 $2,000.00 A2 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(1)   Declaration of Residents' Rights Facility failed to ensure residents were treated with respect and dignity related to Staff speaking to residents in a disrespectful manner and yelling at residents. Referred to Controller's Office 08/20/2019
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 $1,000.00 A2 10A NCAC 13G .1004(a)   Medication Administration; G.S. 131D-21(2)  Declaration of Residents' Rights Facility failed to administer medications as ordered to sampled 2 residents. Referred to Controller's Office 08/20/2019
Woodland Terrace FCH #7 FCL-011-350 3/18/2019 $1,000.00 A2 10A NCAC 13G .0601(a)   Management and Other Staff G.S. 131D-21(2)   Declaration of Residents' Rights Facility Co-Administrators failed to be responsible for the total operation of the facility by failing to meet and maintain all applicable rules and regulations related to Housekeeping and Furnishings, Health Care, Activities, Resident Rights, Medication Administration and Pharmaceutical Care. Referred to Controller's Office 09/03/2019
Heather Glen at Ardenwoods HAL-011-371 8/26/2021 $4,500.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 5 sampled residents in accordance with assessed needs and current symptoms resulting in injuries and the death of one resident. Paid in Full $4,500.00 9/1/2021

Burke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Burke Long Term Care HAL-012-042 9/24/2019 $11,850.00 Unabated B G.S. 131D-4.4 (A) (b) ACH Infection Prevention Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the federal Centers for Disease Control and Prevention guidelines to ensure proper infection control procedures for the use of glucometers. Settlement Fulfilled 01/11/2021 Settlement Agreement 05/20/2020 Appealed 09/26/2019 $3,000.00 9/9/2020

Cabarrus County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Concord House (Closed) HAL-013-038 1/24/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G. S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as prescribed by a licensed practitioner. Referred to Controller's Office 05/17/2019
Concord House (Closed) HAL-013-038 1/24/2019 $12,000.00 A2 10A NCAC 13F .1004(j)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure accurate documentation on the Medication Administration Record. Referred to Controller's Office 05/17/2019
Concord House (Closed) HAL-013-038 2/19/2019 $16,000.00 A1 10A NCAC 13F .0601(a)   Management of Facilities with a Capacity of Census of Seven to Thirty Residents; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the facility had a functional air conditioner or at least one fan per resident in the bedrooms, living areas and dining area when the temperature was above 85 (F). Referred to Controller's Office 05/17/2019
Concord House (Closed) HAL-013-038 2/19/2019 $14,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G. S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as prescribed by a licensed prescribing practitioner for residents. Referred to Controller's Office 05/17/2019
Concord House (Closed) HAL-013-038 2/19/2019 $7,000.00 A2 10A NCAC 13F .1104(f)   Accounting for Resident's Personal Funds; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure accurate documentation on the Medication Administration Record. Referred to Controller's Office 05/17/2019
Concord House (Closed) HAL-013-038 4/4/2019 $35,200.00 Unabated B 10A NCAC F .0311(a)   Other Requirements; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure all plumbing equipment were maintained in a safe and operating condition. Referred to Controller's Office 08/08/2019
Concord House (Closed) HAL-013-038 4/4/2019 $35,200.00 Unabated B 10A NCAC F .0306(a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure the home was maintained clean and free of all obstructions and hazards. Referred to Controller's Office 08/08/2019
Kannapolis Family Care Home FCL-013-046 9/24/2019 $800.00 Unabated B 10A NCAC G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the building was equipped and maintained for residents residing in the facility who had cognitive and physical impairments and were unable to evacuate independently. Paid in Full $800.00 11/20/2019
Suburban Guardianship FCL-013-047 6/4/2019 $1,000.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Paid in Full $1,000.00 12/5/2019
Suburban Guardianship FCL-013-047 6/4/2019 $1,000.00 A2 10A NCAC 13G .1004(a)(1)(2) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification to meet routine and acute health care needs. Paid in Full $1,000.00 12/5/2019
The Country Home HAL-013-042 8/5/2019 $7,000.00 A2 10A NCAC 13F .0407 (a) (5) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to contact the primary care physician for the acute and routine health care needs Paid in Full $7,000.00 11/16/2019
The Living Center of Concord HAL-013-044 2/26/2019 $1,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Settlement Fulfilled 02/10/2020 Settlement Agreement 09/04/2019 Appealed 03/04/2019 $1,000.00 9/3/2019
The Living Center of Concord HAL-013-044 7/1/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Settlement Fulfilled 09/22/2020 Settlement Agreement 03/24/2020 Appealed 07/18/2019 $500.00 9/22/2020
The Living Center of Concord HAL-013-044 8/31/2021 $12,000.00 A1 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure personal care assistance was provided in accordance with assessed needs of 5 of 10 sampled residents related to catheter care, incontinent care, assistance with bathing/showing, dressing, and grooming. Appealed 09/08/2021
The Living Center of Concord HAL-013-044 8/31/2021 $12,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for5 of 10 sampled residents related to change in status, pain, falls, wounds, medication refusals, and daily weights with and without ordered parameters.
The Living Center of Concord HAL-013-044 8/31/2021 $7,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS), and local health departmenty were implemented and maintained when caring for residents during the global Coronavirus (COVID-19) pandemic. Appealed 09/08/2021
The Living Center of Concord HAL-013-044 8/31/2021 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 4 of 9 sampled residents. Appealed 09/08/2021
The Living Center of Concord HAL-013-044 8/31/2021 $12,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with rules and statutes governing adult care homes as related to health care, medication administration, resident rights, and personal care and supervision. Appealed 09/08/2021

Caldwell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Grandview Villa Assisted Living HAL-014-015 8/26/2021 $1,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS)) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $1,000.00 9/10/2021
Brockford Inn HAL-014-014 8/26/2021 $3,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS), and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $3,000.00 9/1/2021
Brockford Inn HAL-014-014 6/14/2021 $1,200.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights The facility failed to ensure health care referral and follow up for 3 sampled residents. Paid in Full $1,200.00 7/6/2021

Carteret County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Carteret Landing HAL-016-022 10/1/2020 $7,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision in accordance to the resident's assessed needs and current symptoms to 1 of 8 residents sampled. Referred to Controller's Office 09/09/2021 Voluntary Dismissal by Licensee 04/15/2021 Appealed 10/30/2020
Shoreline Family Care Home FCL-016-020 6/17/2019 $750.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered. Paid in Full $750.00 6/25/2019
Carteret Landing HAL-016-023 8/26/2021 $500.00 A1 10A NCAC 13 F .0306(a)(5) Housekeeping and Furnishings; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure the hallways were free of hazards resulting on a resident tripping, falling, and sustaining a fracture. Paid in Full $500.00 9/1/2021

Caswell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Caswell House HAL-017-054 1/31/2019 $2,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)  Declaration of Residents' Rights Facility failed to provide supervision to sampled residents in accordance with current symptoms and assessed needs. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $1,000.00 6/30/2020
Caswell House HAL-017-054 1/31/2019 $2,000.00 A1 10A NCAC 13G .0909  Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 8 residents who resided on the (SCU) were free from assault. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $1,000.00 6/30/2020
Caswell House HAL-017-054 1/31/2019 $1,000.00 A2 10A NCAC 13F .1308 Special Care Unit Staffing G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure staffing to meet the needs of residents on the Special Care unit. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $1,000.00 6/30/2020
Caswell House HAL-017-054 7/15/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician notification and referrals. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $2,000.00 6/30/2020
Caswell House HAL-017-054 7/15/2019 $4,000.00 A2 10A NCAC 13F . 0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents with diagnoses of dementia, a history of repeated falls resulting in fractures. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $1,000.00 6/30/2020
Caswell House HAL-017-054 7/15/2019 $3,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to implement their follow-up process when a resident had been transferred to a medical center for a mental health evaluation. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $3,000.00 6/30/2020
Caswell House HAL-017-054 7/15/2019 $5,250.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained. Settlement Fulfilled 12/17/2020 Settlement Agreement 01/10/2020 Appealed 03/08/2019 $3,000.00 6/30/2020
Caswell House HAL-017-054 10/1/2020 $10,200.00 Unabated B 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide personal care assistance for nailcare for 2 of 7 sampled residents. Settlement Fulfilled 06/25/2021 Settlement Agreement 06/09/2021 Appealed 02/26/2021 $15,000.00 total for 2 penalties 6/11/2021
Caswell House HAL-017-054 10/1/2020 $10,200.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance to Facility's policy for 5 of 9 residents. Settlement Fulfilled 06/25/2021 Settlement Agreement 06/09/2021 Appealed 02/26/2021 $15,000.00 total for 2 penalties 6/11/2021
Poole's Rest Home (Closed) HAL-017-006 8/5/2019 $4,000.00 A2 10A NCAC 13F .0909 Resident Rights; F .0601 Management of Facilities; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents were protected from bedbugs; Administrator failed to ensure the management and overall operation of the facility by failing to meet and monitor rules related to resident rights, housekeeping and furnishings. Referred to Controller's Office 10/02/2019
Poole's Rest Home (Closed) HAL-017-006 7/15/2019 $400.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure a medication was administered as ordered by a licensed prescribing practitioner. Referred to Controller's Office 10/02/2019
Poole's Rest Home (Closed) HAL-017-006 7/15/2019 $400.00 Unabated B 10A NCAC 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff member had completed a course on Cardio-Pulmonary resuscitation (CPR) and choking management within the past 24 months Referred to Controller's Office 10/02/2019
Poole's Rest Home (Closed) HAL-017-006 11/18/2019 $12,000.00 A2 10 A NCAC 13F .0601   Management of Facilities; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure the management and overall operation of the facility by failing to meet and monitor rules related to medication administration, health care and adult care home medication aide training. Referred to Controller's Office 04/07/2020
Poole's Rest Home (Closed) HAL-017-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .0902(c)(3-4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure implementation of physician orders for 1 resident. Referred to Controller's Office 04/07/2020
Poole's Rest Home (Closed) HAL-017-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility staff failed to administer medications as ordered for 2 residents. Referred to Controller's Office 04/07/2020
Poole's Rest Home (Closed) HAL-017-006 11/18/2019 $25,800.00 Unabated B 10A NCAC 1310A NCAC 13F .0306(a)(4)   Housekeeping and Furnishings; G.S 131D-21(2)   Declaration of Residents' Rights  The facility failed to ensure the North Carolina Division of Environmental Health sanitation score remained 85 or above at all times. Referred to Controller's Office 04/07/2020
Poole's Rest Home (Closed) HAL-017-006 10/1/2020 $24,000.00 Unabated A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility staff failed to administer medications as ordered for 2 of 3 sampled residents. Referred to Controller's Office 08/09/2021
Poole's Rest Home (Closed) HAL-017-006 10/1/2020 $24,000.00 Unabated A2 10A NCAC 13F .0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management and overall operation of the facility by failing to meet and monitor rules related to housekeeping and furnishings, staff qualifications, nutrition and food service, medication orders, medication administration, medication disposition, and infection prevention. Referred to Controller's Office 08/09/2021

Catawba County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Heritage Care of Conover HAL-018-018 12/13/2018 $2,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2)  Declaration of Residents' Rights Facility failed to refer and follow up with physician and durable medical equipment company to ensure the acute health care needs were met. Settlement Fulfilled 02/25/2020 Settlement Agreement 09/04/2019 Appealed 01/02/2019 Training accepted in lieu of penalty
Heritage Care of Conover HAL-018-018 12/13/2018 $2,000.00 A2 10A NCAC 13F .0902(c)(3-4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement physician orders for 2 residents with physician orders for oxygen administration. Settlement Fulfilled 02/25/2020 Settlement Agreement 09/04/2019 Appealed 01/02/2019 Training accepted in lieu of penalty

Chatham County

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

Chowan County

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

Cleveland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cleveland House HAL-023-045 10/1/2020 $7,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow-up to meet the acute health care needs for 1 of 5 sampled residents related to delays in treatment. Settlement Fulfilled 09/21/21 Settlement Agreement 07/07/2021 Appealed 10/30/2020 $7,500.00 total for 2 penalties 9/16/2021
Cleveland House HAL-023-045 10/1/2020 $5,250.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 5 of 5 sampled residents related to falls. Settlement Fulfilled 09/21/21 Settlement Agreement 07/07/2021 Appealed 10/30/2020 $7,500.00 total for 2 penalties 9/16/2021
Lean's 3 Family Care Home FCL-023-049 1/18/2019 $500.00 A2 10A NCAC 13G .0901(b)   Cooperation with Case Managers; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision to 1 resident who was assessed as disoriented and had a history of wandering. Paid in Full 3/20/2019
Cleveland House HAL-023-045 8/31/2021 $4,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the health care needs were met for 2 of 7 sampled residents related to timely primary care provider (PCP) notification.
Cleveland House HAL-023-045 8/31/2021 $18,000.00 A1 10A NCAC 13F .0901(a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the personal care and supervision needs were met for 2 of 7 sampled residents related to timely primary care and supervision provider (PCP) notification.
Cleveland House HAL-023-045 8/31/2021 $8,400.00 Unabated B 10A NCAC F .0909 Resident Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure personal care was provided to 2 of 5 sampled residents.
Cleveland House HAL-023-045 8/31/2021 $7,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for personal care, referral and follow-up, medication administration, ACH infection prevention requirements, other staff requirements, and resident rights.
Cleveland House HAL-023-045 8/31/2021 $4,000.00 A2 G.S. 131D-4.4A Adult Care Home Infection Prevention Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the federal Centers for Disease Control (CDC) and Prevention guidelines to ensure proper infection control procedures for the use of glucometers for 9 of 9 diabetic residents sampled.
Elmcroft of Shelby HAL-023-048 8/31/2021 $7,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the acute healthcare needs were met for 1 of 5 sampled residents.
Lean's 3 Family Care Home FCL-023-049 8/31/2021 $2,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NCDHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. exit date on paper work reads 03/03/2021, actual exit date is 09/04/20

Columbus County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $16,000.00 A1 10A NCAC 13F .0604(1)(a)(b)(c)   Personal Care and Other Staffing; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure there was enough staff on duty to monitor and meet the needs of the residents according to facility census, for 8 of 8 Shifts sampled from 10/12/18-10/15/18. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to provide scheduled showers, incontinence care, bed linen changes, and assistance with transfers for 3 residents, resulting in one resident falling out of bed. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .0901(a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision resulting in resident leaving facility unsupervised. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $16,000.00 A2 10A NCAC 13F .0307(a)(b)(c)   Fire Alarm System; G.S. 131D-21(4)  Facility failed to ensure the fire alarm system was able to transmit a signal automatically to the local emergency fire department dispatch center and failed to conduct mandatory fire watches. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $20,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure that acute and routine health care needs were met for sampled residents. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $20,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure policies implemented to maintain each residents' rights which resulted in significant noncompliance with rules and statutes. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 G.S. 131D-4.4A(b)   Adult care home infection prevention requirements; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to maintain infection control procedures consistent with the federal CDC guidelines for infection prevention. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 1/18/2019 $14,000.00 A2 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered. Settlement Agreement 12/23/2020 Appealed 01/25/2019
Lake Pointe Assisted Living HAL-024-011 10/24/2019 $17,800.00 Unabated B 10A NCAC 13F .0306(a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure the floors in the hallways, activity room, the dining room and 4 resident rooms were kept safe and free of hazards. Settlement Agreement 12/23/2020 Appealed 11/25/2019
Lake Pointe Assisted Living HAL-024-011 10/24/2019 $7,000.00 A2 10A NCAC 1310A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure the health care needs of residents were met. Settlement Agreement 12/23/2020 Appealed 11/25/2019
Liberty Hill Family Care (Closed) FCL-024-012 12/9/2019 $1,000.00 A2 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(4) The facility failed to provide supervision in accordance with the resident's need for 1 resident. Referred to Controller's Office 04/07/2020
Liberty Hill Family Care (Closed) FCL-024-012 12/9/2019 $2,000.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(4) Administrator failed to ensure the total operation of the facility to meet and maintain rules related to supervision, health care, residents' rights, medication administration, medication disposition, management and other staff and housekeeping and furnishings. Referred to Controller's Office 04/07/2020
Liberty Hill Family Care (Closed) FCL-024-012 8/24/2020 $14,300.00 Unabated B 10A NCAC 13G .0315(a)(5) Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the front living room, back living room, dining room, kitchen, one resident bedroom, bathroom, and walkway areas in Facility were maintained in an uncluttered, clean and orderly manner, free of obstructions and hazards which consisted of broken glass. Referred to Controller's Office 08/09/2021

Craven County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Good Shepard Home for the Aged HAL-025-023 9/8/2021 $12,000.00 A1 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure a sampled resident was free of neglect related to not administering as needed medications and continuous supplemental oxygen; complaints of difficulty breathing; not notifying hospice or calling emergency medical services immediately following an alleged witnessed head injury; and personal care assistance.
Riverstone HAL-025-026 9/8/2021 $750.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure 1 of 5 sampled residents was evaluated medically for 12 days after suffering a fall that resulted in a head injury and bruising.
Croatan Village HAL-025-037 1/24/2019 $4,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to ensure the acute health care needs were met for 1 resident. Paid in Full $4,000.00 3/25/2019
Croatan Village HAL-025-037 1/18/2019 $4,000.00 A1 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision by not implementing interventions to address the current symptoms needs for 1 resident. Paid in Full $4,000.00 3/25/2019
Croatan Village HAL-025-037 8/5/2019 $7,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure the acute health care needs were met for sampled residents, related to failure to seen for medical evaluation. Paid in Full $7,000.00 10/7/2019
Croatan Village HAL-025-037 12/9/2019 $750.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident. Paid in Full $750.00 2/10/2020
Good Shepherd Home for the Aged HAL-025-023 8/5/2019 $2,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(1) Declaration of Residents' Rights Facility failed to ensure residents were treated with dignity and respect and received adequate care and services. Paid in Full $2,000.00 10/2/2019
The Gardens of Trent Craven 7/21/2021 $24,800.00 Unabated B 10A NCAC F .0306(a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure the facility was free of hazards as evidenced by the storage of multiple portable oxygen cylinders in an unsafe manner. Appealed 08/20/2021
Croatan Village HAL-025-037 5/3/2021 $2,000.00 A1 10A NCAC 13F .0309(d) Plan For Evacuation; G.S. 131D-21 (4) Declaration of Resident's Rights The facility failed to ensure an updated disaster and evacuation plan was prepared, and documentation of the submissions at least annually to the local emergency management agency and/or the local agency designated to coordinate special needs sheltering during disasters, was maintained in the facility.

Cumberland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pine Valley Adult Care HAL-026-048 8/26/2021 $7,000.00 A1 10A NCAC 13 F .0601(a) Management of Facilities; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management and total operations of the facility were maintained to ensure substantial compliance with the rules and statutes of adult care homes to protect each residents' right to receive adequate and appropriate care and services and to be free of neglect as related to resident rights, infection prevention and control program, and report and notification of a suspected or confirmed communicable disease outbreak. Appealed 09/23/2021
Pine Valley Adult Care HAL-026-048 8/26/2021 $4,000.00 A2 10A NCAC 13 F .1801(a) Infection Prevention and Control Program; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of residents during the global pandemic of COVID-19. Appealed 09/23/2021
Harmony at Hope Mills HAL-026-065 8/7/2020 $7,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents resulting in the resident having multiple falls and sustaining injuries. Settlement Agreement 06/25/2021 Appealed 09/8/2020 $3,000.00 7/6/2021
Morning Star Special Care Unit HAL-026-066 8/7/2020 $1,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision to meet the needs of 1 of 5 sampled residents who had three falls in less than 30 days. Paid in Full $1,000.00 8/25/2020
Morning Star Special Care Unit HAL-026-066 8/7/2020 $1,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician notification for 2 of 5 residents related to wound care treatment orders and new skin breakdown. Paid in Full $1,000.00 8/25/2020
Morning Star Special Care Unit HAL-026-066 8/7/2020 $2,000.00 A2 10A NCAC 13 F .0902(b)Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered by a physician for 2 of 5 sampled residents related to administering an antidiabetic medication without an order and not administering a medication to improve urinary flow for 12 consecutive days. Paid in Full $2,000.00 8/25/2020
Pine Valley Adult Care HAL-026-048 8/26/2021 $7,000.00 A1 10A NCAC 13 F .1802(a) Report and Notification of an Outbreak; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to report COVID-19 diagnoses to the local health department (LHD) when one resident and one staff member tested positive for COVID-19 and failed to report suspected COVID-19 for one resident to the LHD. Appealed 09/23/2021
Forest Hill Group Home Cumberland 7/21/2021 $15,100.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to be equipped and maintained in a manner to ensure the safety of 2 of 3 sampled residents who had physical impairments and could not evacuate independently in an emergency. .
Leach's Family Care Home Cumberland 7/21/2021 $3,500.00 A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure 5 of 5 sampled residents were free of neglect by not being allowed to live in the facility every day due to the absence of the Administrator and qualified staff in the facility and by failing to comply with recommendations and guidance by the Centers for Disease Control (CDC) to protect the residents during the global coronavirus (COVID-19) pandemic.

Currituck County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Currituck House Currituck 7/21/2021 $2,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure the residents with significant history of falls in the SCU (Special Care Unit) resulting in hospitalizations, lacerations, fractures, and injuries. Appealed 08/20/2021

Dare County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor of the Outer Banks HAL-028-001 3/18/2019 $500.00 A2 10A NCAC 13F .0901(b)   Personal Care and Supervision G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 sampled resident is accordance wit assessed needs. Paid in Full $500.00 3/28/2019
Spring Arbor of the Outer Banks HAL-028-001 9/24/2019 $500.00 A2 10A NCAC 13F .0909 Residents Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents' rights were protected and maintained. Paid in Full $500.00 9/30/2019
Spring Arbor of the Outer Banks HAL-028-001 9/24/2019 $500.00 Unabated A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision to a sampled resident in accordance with assessed needs. Paid in Full $200.00 9/30/2019

Davidson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookstone Retirement Center HAL-029-001 8/24/2020 $3,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 7 sampled residents residing in the SCU. Paid in Full $3,000.00 10/6/2020
Grayson Creek of Welcome HAL-029-010 8/7/2020 $19,800.00 Unabated B 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered for 3 of 7 sampled residents. Settlement Agreement 05/24/2021 Appealed 09/4/2020 $2,000.00 6/7/2021
Spring Arbor of Thomasville HAL-029-004 11/18/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered and in accordance with the facilities policies for two residents. Paid in Full $2,000.00 1/14/2020
The Lyman House FCL-029-011 8/31/2021 $2,000.00 A2 10A NCAC 13 G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Ffacility failed to provide supervision by a staff for 1 of 3 sampled residents who had a fall resulting in a fractured hip.
The Lyman House FCL-029-011 8/31/2021 $4,300.00 Unabated B 10A NCAC 13G .0507 Training in Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure at least one staff was on the premises at all times who had completed cardio-pulmonary resuscitation (CPR) and choking management within the past 24 months..
The Lyman House FCL-029-011 8/31/2021 $2,000.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Resident's Rights Administrator failed to ensure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' rights as evidenced by the failure to maintain substantial compliance with the rules and statutes governing adult care homes as related to other staff qualifications, training on cardio-pulmonary resuscitation, personal care and supervision, health care, medication administration, and infection prevention and control program.
The Lyman House FCL-029-011 8/31/2021 $2,000.00 A2 10A NCAC 13G .1701 Infection Prevention and Control Program(a)(b); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic regarding infection prevention and control practices to reduce the risk of transmission and infection as related to staff inappropriately wearing face masks, staff not maintaining a social distance of 6 feet from residents when not appropriately wearing face masks, and no screening of staff and visitors.
The Perryman House FCL-029-009 8/31/2021 $4,300.00 Unabated B 10A NCAC 13G .0507 Training in Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure at least one staff person was on the premises at all times who had completed an accredited course on cardio-pulmonary resuscitation (CPR) and choking management within the last 24 months.
The Perryman House FCL-029-009 8/31/2021 $2,000.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Resident's Rights Administrator failed to ensure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' rights as evidenced by the failure to maintain substantial compliance with the rules and statutes governing adult care homes as related to Infection and Prevention Control Program, Health Care Personnel Registry, Training on Cardio-Pulmonary Resuscitation, Other Staff Qualifications, Health Care, and Medication Administration.
The Perryman House FCL-029-009 8/31/2021 $2,000.00 A2 10A NCAC 13G .1701 Infection Prevention and Control Program(a)(b); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic in regards to practicing recommended infection prevention and control practices to reduce the risk of transmission and infection as related to staff not wearing face masks, staff not maintaining a social distance of 6 feet from residents while not wearing face masks, and no screening of staff, residents and visitors.
Grayson Creek of Welcome Davidson 7/21/2021 $1,000.00 A1 10A NCAC 13F .0604(e) Personal Care and Other Staffing; G.S. 131D-21(4) Declaration of Residents' Rights (4) Facility failed to ensure the minimum number of staff were present at all times to meet the needs of residents for 5 of 42 shifts sampled for 14 days from May 2020 through July 2020 resulting in death. Paid in Full $1,000.00 8/18/2021
Grayson Creek of Welcome Davidson 7/21/2021 $8,000.00 A1 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Resident's Rights Facility failed to provide supervision for 5 of 5 sampled residents resulting in serious physical harm and death. Paid in Full $8,000.00 8/18/2021
Grayson Creek of Welcome Davidson 7/21/2021 $2,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $2,000.00 8/18/2021
Grayson Creek of Welcome Davidson 7/21/2021 $8,000.00 A1 10A NCAC 13F .1501(a) Use of Physical Restraints and Alternatives; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physical restraints were used only after an assessment, care and team planning, and use of alternatives were tried and documented for 4 of 5 sampled residents resulting in serious physical harm and death. Paid in Full $8,000.00 8/18/2021
Grayson Creek of Welcome Davidson 7/21/2021 $8,000.00 A1 G.S. 131-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were maintained and implemented to protect each residents' right to receive adequate and appropriate care and services and to be free of neglect as related to the use of physical restraints, personal care and supervision, resident rights, cardiopulmonary resuscitation, health care personnel registry, personal care and other staffing, and special care unit staffing. Paid in Full $8,000.00 8/18/2021

Davie County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Heritage of Cedar Rock (Closed) HAL-028-007 5/15/2019 $7,000.00 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision/monitoring related to safety for 1 sampled resident. Settlement Agreement 10/23/2019 Appealed 05/17/2019 $10,000.00 total for 5 penalties 10/28/2019
The Heritage of Cedar Rock (Closed) HAL-030-007 7/15/2019 $12,000.00 A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Settlement Fulfilled 03/24/2020 Settlement Agreement 03/11/2020 Appealed 7/26/2019 $6,000.00 3/24/2020
Mocksville Senior Living and Memory Care HAL-030-009 8/31/2021 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision;G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 7 residents in accordance with assessed needs and current symptoms.
Mocksville Senior Living and Memory Care HAL-030-009 5/3/2021 $8,000.00 A1 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision in accordance with the resident's assessed needs and current symptoms.
The Heritage of Cedar Rock (Closed) HAL-030-007 2/15/2021 $14000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to contact the health care and mental health providers and specialist health care providers for 7 of 11 sampled residents. Referred to Controller's Office 08/17/2021
The Heritage of Cedar Rock (Closed) HAL-030-007 2/15/2021 $14000.00 A1 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered by a licensed practicing practitioner for 6 of 6 sampled residents. Referred to Controller's Office 08/17/2021
The Heritage of Cedar Rock (Closed) HAL-030-007 2/15/2021 $14000.00 A2 G.S. 131D-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for ACH infection prevention requirements, medication administration, controlled substances, supervision, physical environment, personal care, housekeeping and furnishings, criminal background check, health care personnel registry check, nutrition and food services, residents' rights, health care personnel registry, incident and accident reports, activities, tuberculosis test, health care, ACH medication aides. Referred to Controller's Office 08/17/2021

Duplin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Autumn Village HAL-031-018 11/18/2019 $16,000.00 A2 10A NCAC 13F .0901(c)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to perform cardiopulmonary resuscitation for 1 resident that was found unresponsive with no pulse. Paid in Full $16,000.00 10/6/2020
Moore Family Care Home #2 FCL-031-007 8/7/2020 $750.00 A2 10A NCAC 13 G .0909 Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure the 1 of 3 sampled residents was kept free from verbal and physical abuse by the Administrator. Paid in Full $750.00 8/25/2020
Moore Family Care Home #2 FCL-031-007 8/7/2020 $1,000.00 A2 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure that 1 of 3 residents was kept free verbal and physical abuse. Paid in Full $1,000.00 8/25/2020
Wellington Park HAL-031-006 8/5/2019 $2,000.00 A1 10A NCAC 13F . 0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for residents sampled with ankle wound. Settlement Fulfilled 07/14/2021 Settlement Agreement 01/11/2021 Appealed 11/26/2019 $1,500.00 1/22/2021
Wellington Park HAL-031-006 8/26/2021 $12,000.00 A1 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure 1 of 5 sampled residents was free of exploitation and neglect related to posting pictures of the resident on social media. Appealed 09/08/2021
Wellington Park HAL-031-006 8/26/2021 $8,000.00 A1 G.S. 131D-25 Implementation; Declaration of Residents' Rights; G.S. 131D-21(4)  Declaration of Residents' Rights Administrator failed to ensure the management and total operations of the facility were maintained to ensure substantial compliance with the rules and statutes of adult care homes to protect each residents' right to receive adequate and appropriate care and services and to be free of neglect as related to resident rights and health care. Appealed 09/08/2021
Wellington Park HAL-031-006 8/26/2021 $3,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for 3 of 3 sampled diabetic residents with finger stick blood sugars (FSBS) greater than 400 at the time of the FSBS result. Appealed 09/08/2021
Wellington Park HAL-031-006 8/26/2021 $8,000.00 A1 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic Appealed 09/08/2021
Wellington Park HAL-031-006 8/26/2021 $16,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for a sampled resident who left the facility and did not return. Appealed 09/08/2021

Durham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Central Family Care Home - Clayton Road FCL-032-158 7/1/2019 $28,500.00 Unabated A2 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure sampled staff did not have substantiated findings on the Health Care Personnel Registry (HCPR) prior to employment. Referred to Controller's Office 09/18/2019
Spring Valley @ Beechwood (Closed) FCL-032-133 12/13/2018 8000 A1 10A NCAC 13G .0312   Outside Entrance and Exits; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that exit alarms were of sufficient volume for staff to hear while on duty resulting in 1 resident diagnosis with dementia eloping and being seriously injured. Referred to Controller's Office 04/09/2019
Durham Ridge Assisted Living HAL-032-091 7/7/2021 $12,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights The facility failed to ensure notification of health care providers 2 sampled residents resulting in the death and hospitalization to the intensive care unit Paid in Full $12,000.00 8/31/2021
Durham Ridge Assisted Living HAL-032-091 7/7/2021 $12,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights The facility failed to ensure coordination of health care services for 5 residents sampled. Paid in Full $12,000.00 8/31/2021
Durham Ridge Assisted Living HAL-032-091 7/7/2021 $3,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to implement and maintain recommendations by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS), and directives from the local health department during the global coronavirus (COVID-19) pandemic.. Paid in Full $3,000.00 8/31/2021
Durham Ridge Assisted Living HAL-032-091 7/7/2021 $3,000.00 A2 10A NCAC 13F .1801 Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21 (2) Declaration of Resident's Rights The facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the Local Health Department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $3,000.00 8/31/2021

Edgecombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
A Child's Hope Family Health Care FCL-033-016 12/21/2018 $1,000.00 A1 10A NCAC 13G.0909 Resident Rights; G.S. 131D-21(2) Facility failed to ensure resident's rights were maintained as related to residents not being treated with dignity and respect and right to privacy. Settlement Fulfilled 06/10/2020 Settlement Agreement 02/15/2019 $1,000.00 6/10/2020
Heritage Care of Rocky Mount HAL-033-005 6/19/2019 $1,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Settlement Fulfilled 04/01/2020 Settlement Agreement 03/24/2020 Appealed 06/14/2019
Kinillie Family Care Home (Closed) FCL-033-015 1/24/2019 $500.00 A2 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 4 sampled residents. Referred to Controller's Office 04/09/2019
Kinillie Family Care Home (Closed) FCL-033-015 1/24/2019 $2,000.00 A1 10A NCAC 13G .0902(b)   Health Care, 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure management and overall operations by failing to implement rules and regulations related to management and other health care training. TB skin test for residents, medication administration, resident rights. and building service equipment Referred to Controller's Office 04/09/2019
Kinillie Family Care Home (Closed) FCL-033-015 1/24/2019 $2,000.00 A1 10A NCAC 13G .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 2 of 4 sampled residents were administered medications as ordered. Referred to Controller's Office 04/09/2019
Open Arms Family Services #2 (Closed) FCL-033-011 4/4/2019 $1,000.00 A2 10A NCAC 13G .0406(a) (5) Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 1 of 3 sampled staff had no substantiated findings on their Health Care Personnel Registry (HCPR). Referred to Controller's Office 08/08/2019
Open Arms Family Services #2 (Closed) FCL-033-011 4/4/2019 $500.00 A2 10A NCAC 13G .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medication was administered as ordered for 1 of 3 related to medication used to treat mood disorders. Referred to Controller's Office 08/08/2019
Open Fields Assisted Living HAL-033-001 1/18/2019 $4,000.00 A2 10A NCAC 13F .0901 (b)  Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 7 residents. Resulting in a resident diagnosed with Alzheimer's, constantly disoriented and was known to wander, and eloped from the facility. Settlement Fulfilled 01/07/2019 Settlement Agreement 05/03/2019 Appealed 02/18/2019 $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $4,000.00 A1 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide personal care related to bathing assistance for 1 sampled resident. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $20,000.00 A1 10A NCAC 13F .0603   Management of Facilities with Capacity of 81 or More; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility were developed and implemented resulting in significant noncompliance with state rules and regulations related to each residents' right to be free of serious harm and neglect, supervision of residents, clarification of orders and testing for tuberculosis. Paid in Full $20,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $18,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide the necessary services to ensure the protection of 2 residents. Paid in Full $18,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $4,000.00 A2 10A NCAC 13F .1002 (a)   Medication Orders; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to clarify orders for 1 resident. Paid in Full $4,000.00 1/7/2019
Open Fields Assisted Living HAL-033-001 12/19/2018 $20,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure supervision was provided for 3 residents. Paid in Full $20,000.00 1/7/2019
Heritage Care of Rocky Mount HAL-033-005 8/26/2021 $4,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) and were implemented and maintained to provide protection of residents during a global coronavirus (COVID-19) pandemic, and failed to ensure residents were free of physical abuse regarding allegations of being grabbed and shoved by a staff, and verbal abuse regarding the way staff talked to residents Appealed 09/07/2021

Forsyth County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
C.R.T. - Golden Lamb Rest Home HAL-034-019 12/9/2019 $2,000.00 Unabated B G.S. 131D-4.5B(b) Rules adopted by Medical Care Commission; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure 1 staff who administered medications, had completed the Medication Clinical Skills Competency Validation. Appealed 01/08/2020
Danby House HAL-034-093 10/1/2020 $2,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 3 of 6 sampled residents in the Special Care Unit (SCU) were free of physical abuse and neglect by three staff Settlement Agreement 06/09/2021 Appealed 10/30/2020
Danby House HAL-034-093 10/1/2020 $4,000.00 A1 10A NCAC 13F .0901 (b)  Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision according to residents' assessed needs and current symptoms for 5 of 9 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Danby House HAL-034-093 10/1/2020 $1,000.00 A2 10A NCAC 13F .0909  Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure provision of residents' rights for 10 of 15 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Danby House HAL-034-093 10/1/2020 $3,500.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of Facility were implemented and rules were maintained for personal and other staffing, Special Care Unit staff, personal care and supervision, health care, resident rights, medication administration, reporting of accidents and incidents, settlement of cost of care, Ach infection prevention requirements and Ach medication aides; training and competency. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Danby House HAL-034-093 10/1/2020 $14,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision according to residents' assessed needs and current symptoms for 5 of 9 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Memory Care of the Triad HAL-034-068 1/31/2019 $3,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify the physician for 3 residents with order to contact the physician if blood sugar was over 400, TED hose not applied as ordered, and a resident threatening suicide who had no antipsychotic medication available for administration resulting in behavioral changes. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications for 6 residents including; a behavior medication, a antipsychotic medication, a sleep supplement, high blood pressure medication, cholesterol medication, two dementia medications, a rapid acting insulin and a long-acting insulin, an antipsychotic medication, an antidepressant, and vitamin supplement; a topical steroid cream, and a moisturizing cream. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $1,000.00 A2 10A NCAC 13F .0901(b)  Health Care; G.S. 131D-21(2)  Declaration of Residents' Rights Facility failed to provide supervision for 3 residents who disoriented and semi-ambulatory resulting in repeated falls with injuries to include a broken elbow, subdural hematoma and broken wrist. Settlement Agreement 11/15/2019 Appealed 02/11/2019
Memory Care of the Triad HAL-034-068 1/31/2019 $1,000.00 A2 10A NCAC 13F .1004(a)  Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications for 2 residents observed during the medication pass with errors related to crushing medications that should not be crushed for vitamin B12, metoprolol ER, isosorbide ER, and improper dosing for sertraline liquid; and 3 residents related to furosemide, morphine sulfate 30 mg ER, morphine sulfate oral solution, and lorazepam oral solution, and atenolol Settlement Agreement 11/15/2019 Appealed 02/11/2019
Salem Terrace HAL-034-098 11/18/2019 $7,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered and in accordance with the facility's policies. Paid in Full $7,000.00 1/21/2020
The Bradford Village of Kernersville - West HAL-034-069 8/24/2020 $16,500.00 Unabated B 10A NCAC 13F .1004   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered by a prescribing practitioner for 2 of 5 sampled residents. Settlement Agreement 08/03/2021 Appealed 09/04/2020
Tranquility Care HAL-034-104 7/15/2019 $200.00 Unabated B G.S. 131D-4.5B(b) ACH Medication Aides Training and Competency Evaluation Requirements; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff sampled who administered medications had employment verification or completed the 5-10-15 hour state approved medication administration training courses as required, or had a Medication Clinical Skills Competency checklist completed prior to administering medications. Paid in Full $200.00 8/29/2019
The Ivy at Clemmons Forsyth 7/21/2021 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to administer medications as ordered for 4 residents observed during the medication pass and 5 of 5 sampled residents for record review.
The Ivy at Clemmons Forsyth 7/21/2021 $4,000.00 A1 G.S. 131-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights The former Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for personal care, health care, medication administration, resident rights, and staffing.
The Bradford Village of Kernersville - West HAL-034-069 7/7/2021 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to administer medications as ordered by a licensed prescribing practitioner.
The Bradford Village of Kernersville - West HAL-034-069 7/7/2021 $6,000.00 A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure physician orders were implemented.
The Ivy at Clemmons HAL-034-105 7/7/2021 $12,000.00 A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to administer medications as ordered. Appealed 08/05/2021
The Ivy at Clemmons HAL-034-105 7/7/2021 $66,000.00 Unabated A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure health care referral and follow-up for sampled residents. Appealed 08/05/2021
The Ivy at Clemmons HAL-034-105 7/7/2021 $55,000.00 Unabated A2 10A NCAC 13F .1004(a) Medication Administration G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to administer medications as ordered. Appealed 08/05/2021
The Ivy at Clemmons HAL-034-105 7/7/2021 $66,000.00 Unabated A1 GS 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for health care and medication administration. Appealed 08/05/2021
The Ivy at Clemmons Forsyth 2/15/2021 $4,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure health care referral and follow-up with health care providers, a medical equipment provider, and home health agency for 3 of 6 sampled residents. Paid in Full $4,000.00 4/9/2021
The Ivy at Clemmons Forsyth 2/15/2021 $2,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to protect one resident from abuse by a staff member which resulted in the resident being sent to emergency room. Paid in Full $2,000.00 4/9/2021

Franklin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with facility's policies for 4 of 8 residents. Settlement Agreement 06/25/2021 Appealed 12/30/2020
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of facility were implemented and rules were maintained for other requirements, health care, residents' rights, medication administration, controlled substances, nutrition and food service, health care personnel registry, and activities, all of which are the responsibility of Administrator. Settlement Agreement 06/25/2021 Appealed 12/30/2020
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $5,250.00 A2 G.S. 131D-21(5) Declaration of Residents' Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure Resident was free of chemical restraints. Settlement Agreement 06/25/2021 Appealed 12/30/2020
Franklin Manor Assisted Living Center HAL-035-024 12/13/2018 $14,000.00 A1 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide adequate supervision for 5 residents in the Special Care Unit (SCU) with histories of frequent falls resulting in serious injuries including a femur fracture, subdural hematoma, and bruises and skin tears. Appeal Re-filed 06/02/2021 Appealed 01/11/2019
Franklin Manor Assisted Living Center HAL-035-024 12/13/2018 $12,000.00 A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 2 residents regarding medical evaluation of blood in urine and incontinence brief for 7 to 10 days, and for 1 resident regarding blood pressure refusals. Appeal Re-filed 06/02/2021 Appealed 01/11/2019
Southern Living for Seniors of Louisburg HAL-035-031 8/7/2020 $9,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were free of abuse as evidenced by allegations of Staff verbally and physically abusing exploiting Resident by selling a narcotic medication for anxiety to the resident. Settlement Agreement 06/25/2021 Appealed 12/30/2020
Heart to Heart Family Care Home FCL-035-033 8/26/2021 $500.00 A2 10A NCAC 13 G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.

Gaston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wellington House HAL-036-031 11/18/2019 $4,000.00 A2 10A NCAC 13F .0901(c) Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond immediately in the case of an incident involving a resident and in accordance with the facility's established policy and procedures. Settlement Fulfilled 5/19/2021 Settlement Agreement 08/21/2020 Appealed 12/16/2019 $2,000.00 10/6/2020
Wellington House HAL-036-031 11/18/2019 $4,000.00 A2 10A NCAC 13F .1212 Reporting of Incidents and Accidents; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to immediately notify local law enforcement authorities for 1 resident after staff reported an allegation of sexual assault. Settlement Fulfilled 5/19/2021 Settlement Agreement 08/21/2020 Appealed 12/16/2019 $2,000.00 10/6/2020
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A1 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to ensure personal care for 1 resident who smelled of urine from a leaking Foley catheter. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure supervision was provided to 3 residents related to another resident's alcohol use and possession of drug paraphernalia. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure referral and follow up to the medical providers for 3 residents. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure residents' rights for 2 residents in regards to resident being fearful of threats to other residents. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 " 10a NCAC 13F .1006(b) Medication Storage; G.S. 131D-21(4) Declaration of Residents' Rights" The facility failed to ensure medications were maintained in a safe manner under locked security or under direct supervision. Appealed 12/19/2019
Woodlawn Haven HAL-036-006 12/9/2019 $12,000.00 A2 G.S. 131D-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained. Appealed 12/19/2019
Country Time Inn HAL-036-018 8/26/2021 $2,000.00 A2 10A NCAC 13F .1004(a)  Medication Administration; G.S. 131D-21(4)  Declaration of Residents' Rights The facility failed to administer medications as ordered for 1 of 5 sampled residents. Appealed 09/24/2021
Wellington House HAL-036-031 8/26/2021 $3,500.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/24/2021
Woodlawn Haven HAL-036-006 8/26/2021 $10,500.00 A1 10A NCAC 13 F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide personal care for 1 of 5 sampled residents in accordance with assessed needs related to detection of a stage III pressure ulcer. Appealed 09/24/2021

Granville County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Toney Rest Home HAL-039-017 9/9/2021 $12,000.00 A1 10A NCAC 13F .1801(a)(b) Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS), the local county health department (LHD), and the facility's COVID-19 infection control policy during the global pandemic of COVID-19 were implemented and maintained to provide protection and reduce the risk of transmission and infection to residents regarding the facility's failure to social distance at least six feet during communal dining, cleaning and sanitizing high-touch areas, staff not changing gloves between resident rooms, positive COVID-19 staff working with negative COVID-19 residents, failure to observe quarantine precautions for two residents who were admitted from a hospital setting, staff failing to perform COVID-19 screenings when entering the facility, and staff not trained on infection control specific to COVID-19. Appealed 09/14/2021
Davis Family Care Home FCL-039-011 1/31/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(7)   Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure a staff member had a criminal background check in accordance with G.S. 114-19.10 and 131D-40 Settlement Fulfilled 03/13/2020 Settlement Agreement 06/28/2019 Appealed 02/22/2019 $500.00 3/13/2020
Dependable Family Care Home FCL-039-016 1/25/2019 $1,000.00 A2 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure the management and overall operations of the facility by not implementing rules and regulations. Referred to Controller's Office 05/17/2019
Dependable Family Care Home FCL-039-016 1/25/2019 $1,000.00 A2 10A NCAC 13G .0601(b)(1)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure a staff member was in the home at all times resulting in the residents were left alone. Referred to Controller's Office 05/17/2019
Harris Home FCL-039-002 8/7/2020 $8,700.00 Unabated B 10A NCAC 13G .0901(b) Health Care Personnel Registry; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure supervision was provided for 1 of 2 sampled residents (#2) with a history of smoking in facility. Paid in Full $8,700.00 9/1/2020

Greene County

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

Guilford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $5,250.00 A1 GS 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure 4 staff had a criminal background check. Settlement Fulfilled 09/07/2021 Settlement Agreement 1/11/2021 Appealed 12/18/2019 $3,000.00 3/5/2021
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $3,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident who had a history of sexually inappropriate behavior toward other residents. Settlement Fulfilled 09/07/2021 Settlement Agreement 1/11/2021 Appealed 12/18/2019 $1,500.00 3/5/2021
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $5,250.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to ensure 1 resident was free of verbal abuse and inappropriate sexual behaviors by another resident. Settlement Fulfilled 09/07/2021 Settlement Agreement 1/11/2021 Appealed 12/18/2019 $3,000.00 3/5/2021
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered by a licensed practicing practitioner. Settlement Fulfilled 09/07/2021 Settlement Agreement 1/11/2021 Appealed 12/18/2019 $1,500.00 3/5/2021
Alpha Concord of Greensboro HAL-041-082 11/18/2019 $3,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure allegations of verbal and physical abuse and neglect were reported to the Health Care Personnel Registry. Settlement Fulfilled 09/07/2021 Settlement Agreement 1/11/2021 Appealed 12/18/2019 $1,000.00 3/5/2021
Brookdale Northwest Greensboro HAL-041-031 9/24/2019 $1,000.00 A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the hot water temperatures were maintained between 100 degrees Fahrenheit (F) to 116 degrees F Paid in Full $1,000.00 10/4/2019
Carriage House Senior Living Community HAL-041-065 9/24/2019 $1,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for residents who had suicidal ideations. Paid in Full $1,000.00 11/8/2019
Carriage House Senior Living Community HAL-041-065 9/24/2019 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights "Facility failed to provide supervision for sampled residents who had a diagnosis of Alzheimer's disease who eloped on third shift and was found outside the facility. " Paid in Full $1,000.00 11/8/2019
Holden Heights HAL-041-080 11/18/2019 $2,000.00 A2 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to contact the physician for clarification to determine if the services of the facility met the individual's needs. Settlement Fulfilled 05/19/2021 Settlement Agreement 8/21/2020 Appealed 12/16/2019 $2,000.00 10/6/2020
Liggins Family Care Home Woodmere Center FCL-041-071 9/24/2019 $1,000.00 A2 G.S. 131D-21 (17) Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights "Facility failed to ensure residents were provided a choice prior to being transferred from the licensed facility to the Administrator's private residence. " Paid in Full $1,000.00 12/2/2019
Liggins Family Care Home Woodmere Center FCL-041-071 9/24/2019 $1,000.00 A2 10A NCAC G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing family care homes. Paid in Full $1,000.00 12/2/2019
St. Gales Estates HAL-041-023 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure as needed medication for shortness of breath was administered as ordered by the prescribing physician for sampled residents. Paid in Full $1,000.00 7/10/2019
St. Gales Estates HAL-041-023 7/1/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure as needed medication for shortness of breath was administered as ordered by the prescribing physician for sampled residents. Paid in Full $4,000.00 8/8/2019
Piedmont Christian Home HAL-041-010 8/26/2021 $9,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management and total operations of the facility were maintained to ensure substantial compliance with the rules and statutes of adult care homes to protect each residents' right to receive adequate and appropriate care and services and to be free of neglect. Paid in Full $9,000.00 9/15/2021
Piedmont Christian Home HAL-041-010 8/26/2021 $9,000.00 A1 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic
Agape Care Family Homes (Closed) FCL-041-078 7/21/2021 $1,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (DHHS) were implemented. Paid in Full $1,000.00 9/19/2021
Brookdale High Point North AL (NC) Guilford 7/21/2021 $3,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to ensure that medication was administered as ordered.
Liggins Family Care Home Woodmere FCL-041-071 7/7/2021 $3,500.00 A2 10A NCAC 13G .0601(a) Management and Other Staff G.S. 131D-21 (2) Declaration of Resident's Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing family care homes Paid in Full $3,500.00 9/10/2021
Liggins Family Care Home Woodmere FCL-041-071 7/7/2021 $3,500.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (DHHS) were implemented when caring for 4 residents during the global Coronavirus (COVID-19) pandemic.
Guilford House HAL-041-077 6/14/2021 $6,400.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to administer medications as ordered for 1 resident.

Harnett County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Absolute Care Assisted Living HAL-043-029 1/31/2019 $12,800.00 Unabated B 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for 2 residents which included medications for dementia and allergies , blood clots and heart conditions Settlement Agreement 11/15/2019 Appealed 02/28/2019
Absolute Care Assisted Living HAL-043-029 2/19/2019 $19,000.00 Unabated B 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to supervise 1 of 3 sampled residents who required assistance with ambulation and transfers and had a history of falls. Settlement Agreement 11/15/2019 Appealed 03/19/2019
Absolute Care Assisted Living II HAL-043-031 6/17/2019 $4,000.00 A2 10A NCAC 13F .0504(a) Competency Validation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medication aides were competency validated to administer medication and feedings through a gastrostomy tube. Settlement Fulfilled 11/12/20202 Settlement Agreement 11/15/2019 Appealed 07/17/2019 Training accepted in lieu of penalty
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $9,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 sampled resident. Referred to Controller's Office 08/06/2021
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $23,400.00 Unabated Type B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with facility's policies. Referred to Controller's Office 08/06/2021
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $12,000.00 A2 10A NCAC 13F .0909   Resident Rights, G.S. 131-21(4)   Declaration of Residents' Rights Facility failed to ensure residents were protected from abuse by a staff member. Referred to Controller's Office 08/06/2021
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $18,000.00 A2 10A NCAC 13F .0305(h)(4)   Physical Environment; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure all exit doors were equipped with a sounding device that was activated when the door was opened. Referred to Controller's Office 08/06/2021
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $20,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 2 sampled residents known to wander. Referred to Controller's Office 08/06/2021
Alzheimer's Related Care of Dunn HAL-043-026 8/24/2020 $16,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to meet the acute health care needs of 1 of 5 sampled residents by not contacting emergency medical services immediately for a resident that was barely responsive and later died in the hospital Referred to Controller's Office 08/06/2021
Green Leaf Care Center HAL-043-027 8/7/2020 $250.00 A2 10A NCAC 13 F .0901 Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 3 sampled residents' who had falls. Paid in Full $250.00 9/1/2020
Oak Hill Living Center HAL-043-015 12/12/2018 $11,000.00 A1 10A NCAC 13F .0901 (c)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide care and intervention according to facility's policies and procedures for 1 resident by not performing cardiopulmonary resuscitation (CPR) who was unresponsive and did not have a do not resuscitate (DNR) order. Paid in Full $11,000.00 2/12/2019
Senter's Rest Home HAL-043-024 12/12/2018 $10,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to implement effective interventions as ordered by residents' primary care providers or in accordance with facility's fall management program for 3 residents identified by facility as high risk for falls and experienced multiple falls with injuries. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $500.00 A1 10A NCAC 13F .1308 (a)  Special Care Unit Staffing; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure adequate staffing to meet the needs of residents on 18 of 48 shifts resulting in staff not providing every two hour incontinence care and safety checks for residents. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $6,000.00 A1 G.S. 131D-25  Implementation; G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to ensure consistent responsibility for the operation, administration, management and supervision of the facility resulting in significant noncompliance with state rules and regulations related to personal care, supervision, health care, special care unit staffing, and reporting accidents and incidents. Settlement Fulfilled 02/27/2020 Settlement Agreement 9/11/2019 Appealed 01/11/2019 $3,500.00 2/27/2020
Senter's Rest Home HAL-043-024 12/12/2018 $2,000.00 Unabated B 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide safety and incontinence care checks every two hours for 3 residents resulting in 1 resident's death being unnoticed by staff; 1 resident being hospitalized with sepsis and 1 resident sustaining skin breakdown. Paid in Full $2,000.00 2/8/2019
Senter's Rest Home HAL-043-024 8/7/2020 $1,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were protected from abuse and neglect as evidence by staff who was observed grabbing, shaking and throwing a resident not the bed and slapping the hand of another resident. Appealed 09/04/2020 $1,500.00 5/10/2021
Arc of Dunn HAL-043-033 8/26/2021 $6,000.00 A2 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision in accordance with the assessed needs and current symptoms for 2 of 5 sampled residents resulting in resident elopement.
Senter's Rest Home HAL-043-024 8/26/2021 $9,000.00 A2 10A NCAC 13 F .0305(h)(4) Physical Environment; G.S. 131D-21(4) Declaration of Residents' Rights Facility, which is a Special Care Unit, failed to ensure exit doors accessible were equipped with a sounding device that activated when doors opened resulting in the elopment of by two residents.

Haywood County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Chestnut Park Retirement Center HAL-044-022 8/31/2021 $1,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS), and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $1,000.00 9/7/2021

Henderson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Landings of Mills River HAL-045-127 8/7/2020 $1,000.00 A2 10A NCAC 13 F .0902( c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to implement a physician's order related to keeping a dementia resident inside facility for 1 of 5 residents resulting with the resident being found outside for an undetermined amount of time and being sent to the hospital. Appealed 09/04/2020

Hertford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Carver Manor FCL-046-002 8/31/2021 $4,000.00 A2 10A NCAC 13G .1701 Infection Prevention and Control Program(a)(b); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) during the global COVID-19 pandemic were implemented and maintained to provide protection and reduce the risk of transmission and infection to residents. Paid in Full $4,000.00 9/12/2021
Pinewood Manor (Closed) HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909   Resident Rights; G.S. 131D-25 Implementation; G.S. 131D-21(11)   Declaration of Residents' Rights Facility failed to ensure residents had the right to voice complaints and be free of retaliation by Administrator and a staff by threats of discharge from facility and attempt to have 1 resident involuntarily committed; and failed to ensure 1 hall was free of unpleasant and offensive odors that spread through the entire hall, front sitting and dining room areas. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor (Closed) HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909  Resident Rights; G.S. 131D-21(1)  Declaration of Residents' Rights Facility failed to ensure residents were treated with respect and dignity as evidenced by being yelled at and cursed at by the Administrator, Resident Care Coordinator and other staff. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor (Closed) HAL-046-019 12/12/2018 $7,000.00 A1 10A NCAC 13F .0909  Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 1 resident was free of physical abuse that resulted in both physical harm and emotional distress to resident. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,000.00 1/14/2020
Pinewood Manor (Closed) HAL-046-019 12/12/2018 $4,000.00 A1 10A NCAC 13F .1205  Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to investigate and report known allegations of abuse for 3 residents by 2 staff members to Health Care Personnel Registry (HCPR). Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $4,000.00 1/14/2020
Pinewood Manor (Closed) HAL-046-019 12/12/2018 $7,600.00 Unabated B 10A NCAC 13F .0306 (a)(5)   Housekeeping and Furnishings; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to maintain areas that were uncluttered, clean and orderly manner, free of obstructions and hazards to doors, residents' rooms, bathrooms, showers, common living rooms, and dining areas. Settlement Fulfilled 02/12/2019 Settlement Agreement 12/10/2019 Appealed 12/21/2018 $7,600.00 1/14/2020
Pinewood Manor (Closed) HAL-046-019 6/28/2019 $18,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were treated with dignity and respect and received adequate care and services. Settlement Fulfilled 03/24/2020 Settlement Agreement 01/17/2020 Appealed 07/17/2019 $10,000.00 3/24/2020
Pinewood Manor (Closed) HAL-046-019 6/28/2019 $18,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure residents received care and services which were adequate, appropriate and in compliance with relevant federal and state laws and rules and regulations related to health care and implementation of residents rights. Settlement Fulfilled 03/24/2020 Settlement Agreement 01/17/2020 Appealed 07/17/2019 $2,000.00 3/24/2020

Hoke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Crossings at Wayside HAL-047-011 12/12/2018 $14,000.00 A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral for the acute health care needs for 1 resident who asked to be taken to local hospital for medical evaluation after complaining of severe pain. Settlement Fulfilled 11/06/2020 Settlement Agreement 11/05/2020 Appealed 01/11/2019 $11,000 total - 2 penalties 11/6/2020
Open Arms Retirement Center HAL-047-009 1/6/2019 $14,000.00 A2 10A NCAC 13F .0901(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervisor to sampled residents. Settlement Fulfilled 09/22/2020 Settlement Agreement 04/02/2020 Appealed 02/01/2019 $2,500.00 5/28/2020
Open Arms Retirement Center HAL-047-014 8/24/2020 $1,000.00 A2 10A NCAC 13F .0901 (b)  Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 2 of 6 sampled residents. Paid in Full $1,000.00 12/22/2020
The Crossings at Wayside HAL-047-011 12/12/2018 $4,000.00 A2 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed administer prescribed medications as ordered by licensed prescribing practitioner for 1 resident. Settlement Fulfilled 11/06/2020 Settlement Agreement 11/05/2020 Appealed 01/11/2019 $11,000 total - 2 penalties 11/6/2020
The Crossings at Wayside HAL-047-011 7/1/2019 $10,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for residents sampled in accordance with the resident's assessed needs and current symptoms. Paid in Full $10,500.00 7/22/2019
The Crossings at Wayside HAL-047-011 8/24/2020 $250.00 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 residents in accordance with the resident's assessed needs and current symptoms. Paid in Full $250.00 10/6/2020
The Crossings at Wayside Hoke 8/30/2021 $3,500.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure 1 of 1 sampled resident was protected from abuse and injury.
The Crossings at Wayside Hoke 7/21/2021 $3,500.00 A2 10A NCAC 13F .0901(a)  Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide personal care assistance according to the assessed needs of 3 sampled residents. Paid in Full $3,500.00 8/2/2021
The Crossings at Wayside Hoke 7/21/2021 $7,000.00 A2 G.S. 131-25  Implementation; G.S. 131D-21(4)  Declaration of Residents' Rights Administrator, who was responsible for the overall operations of the facility, failed to ensure responsibility for the implementation of rules and regulations governing personal care, supervision, health care, controlled substances, health care personnel registry reporting and residents' rights. Paid in Full $7,000.00 8/2/2021

Iredell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Aurora of Statesville HAL-049-028 6/7/2019 $12,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were administered medications as ordered by a licensed prescribing practitioner. Settlement Agreement 06/24/2019
Aurora of Statesville HAL-049-028 6/7/2019 $14,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for residents who resided in the Special Care Unit (SCU) Settlement Agreement 06/24/2019
Aurora of Statesville HAL-049-028 6/7/2019 $18,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to notify the physician related to a sampled resident who had a fall and was not administered an anticonvulsant medication as ordered. Settlement Agreement 06/24/2019
Aurora of Statesville HAL-049-028 6/7/2019 $18,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for supervision. Settlement Agreement 06/24/2019
Aurora of Statesville HAL-049-028 6/7/2019 $4,400.00 Unabated B 10A NCAC 13F .0406(a) Test for Tuberculosis; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure staff were tested for tuberculosis (TB) disease upon hire Settlement Agreement 06/24/2019
Aurora of Statesville HAL-049-028 6/7/2019 $4,400.00 Unabated B 10A NCAC 13F .0407(a) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff had no substantiated findings listed on the North Carolina Health Care Personnel Registry (HCPR) prior to hire. Settlement Agreement 06/24/2019
Olin Village HAL-049-016 12/12/2018 $7,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to meet the health care needs of 2 sampled residents by failing to coordinate and schedule referral appointments with specialty health care providers as ordered. Paid in Full $7,000.00 1/2/2019
Brookdale Peachtree Memory Care Iredell 7/21/2021 $12,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to provide supervision to 1 of 5 sampled residents who had a diagnosis of dementia.

Jackson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Hermitage HAL-050-017 8/31/2021 $1,000.00 A2 10A NCAC 13F .1801(a)(b) Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), and the North Carolina Department of Health and Human Services (NCDHHS) and the facility's Infection Control Coronavirus Policy and Procedures were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.

Johnston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Classic Care Homes #3 HAL-051-063 9/8/2021 $18,000.00 Continuing Unabated B 10A NCAC 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure at least one staff person was on the premises at all times who had training in Cardio-Pulmonary Resuscitation and choking management within the past 24 months.
The Villas @ Benson 1 FCL-051-056 9/8/2021 $3,500.00 Unabated B 10A NCAC G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the evacuation capabilities were in accordance with the evacuation capability listed on the facility's current license for 1 of 5 sampled residents who had cognitive impairments and was unable to independently exit the facility during a fire drill.
Classic Care Homes #3 HAL-051-063 8/24/2020 $11,000.00 Unabated B 10A NCAC 13F .0904 (a)(2)  Nutrition and Food Service; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure foods being stored, prepared and served to residents was protected from contamination. Referred to Controller's Office 08/17/2021
Country Wood #3 (Closed) FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medication was administered as ordered for 4 residents. Referred to Controller's Office 04/09/2019
Country Wood #3 (Closed) FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .0601 (a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility Administrator failed to ensure the total operation of the facility to meet and maintain rules related to other staff qualifications, resident care plan, health care, resident's rights, medication administration, and adult care home medication aides training and competency evaluation requirements. Referred to Controller's Office 04/09/2019
Country Wood #3 (Closed) FCL-051-055 12/12/2018 $2,000.00 A2 10A NCAC 13G .0902 (b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to meet the health care needs of 3 residents related to monthly antipsychotic injection that was not coordinated for administration or ordered from pharmacy in a timely manner resulting in a missed injection, and failing to ensure residents went to scheduled visit with psychiatric provider. Referred to Controller's Office 04/09/2019
Gabriel Manor Assisted Living Center HAL-051-048 8/5/2019 $1,750.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure foods were free from contamination related to a wet pink, brown and black build-up substance in the large ice machine in the kitchen; a pink, tan and black build-up on the ice and water dispensing unit in the special care unit; Settledment Fulfilled 09/14/2021 Settlement Agreement 07/07/2021 Appealed 09/04/2019 $1,500.00 8/31/2021
Sam's Family Care Homes (Closed) FCL-051-067 8/24/2020 $6,000.00 A1 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to have sufficient staff on duty and awake at all times to meet the supervision needs for 2 of 4 sampled residents. Referred to Controller's Office 08/06/2021
Sam's Family Care Homes (Closed) FCL-051-067 8/24/2020 $3,500.00 A1 10A NCAC 13G .0902(b)  Health Care; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure healthcare referral and follow up for 1 of 3 sampled residents who had symptoms of heart failure prior to a hospital admission. Referred to Controller's Office 08/06/2021
Four Oaks Senior Living HAL-051-060 8/26/2021 $12,000.00 A1 10A NCAC 13 F .0311(d) Other Requirements; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure air conditioning or at least one fan was available for areas used by residents when the temperature in the main hall exceeded 80 degrees Fahrenheit resulting in a resident requiring hospitalization. Appealed 09/24/2021
The Villas @ Benson 1 FCL-051-056 8/26/2021 $1,000.00 A2 10A NCAC 13F.0601(d) Management and Other Staff; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to have sufficient staff on duty and awake at all times to meet the supervision needs for 2 of 5 sampled residents and failed to ensure staff were accessible to the residents by leaving the facility unattended.
Classic Care Homes #1 HAL-051-062 3/1/2021 $18000.00 Unabated B 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for 3 of 3 sampled residents. Referred to Controller's Office 08/06/2021

Lee County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Magnolia House Retirement Center (Closed) HAL-053-029 8/31/2021 $7,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to provide supervision according to the resident's assessed needs.
Leak's Adult Family Care #3 (Closed) FCL-053-019 8/7/2020 $2,000.00 A1 10A NCAC 13 G .0315(a)(5) Housekeeping and Furnishing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure Facility was kept clean, orderly and free of hazards as evidenced by a bed bug infestation for one year with live bed bugs on the blanket, sheet and mattress in resident room. Referred to Controller's Office 08/06/2021

Lenoir County

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

Lincoln County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Addison of Lincolnton Lincoln 7/21/2021 $13,500.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.

Macon County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Franklin House HAL-056-006 9/27/2019 $3,500.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow up to meet the routine and acute health care needs for 1 of 8 (Resident #6) sampled residents related to the monitoring, assessment, and follow-up of a leg wound. Settlement Fulfilled 02/10/2020 Settlement Agreement 01/10/2020 Appealed 10/21/2019 $2,000.00 2/10/2020
Franklin House HAL-056-006 11/13/2020 $7,000.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 1 of 4 sample residents related to critical laboratory results which resulted in hospitalization. Settlement Agreement 06/25/2021 Appealed 12/11/2020

Martin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Fields Foundation FCL-058-008 11/18/2019 $2,000.00 A2 0A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21(4) The facility failed to report an allegation of verbal and mental abuse toward a resident by one staff to the Health Care Personnel Registry within 24 hours. Referred to Controller's Office 04/07/2020
Fields Foundation FCL-058-008 11/18/2019 $3,500.00 A2 10A NCAC 13G .0909   Residents' Rights; G.S. 131D-21 (4)   Declaration of Residents' Rights The facility failed to ensure 1 resident was protected from verbal abuse and intimidation by another resident. Referred to Controller's Office 04/07/2020
Fields Foundation FCL-058-008 11/18/2019 $3,500.00 A1 10A NCAC 13G .0902 Health Care; G.S. 131D-21 (4)  Declaration of Residents' Rights The facility failed to notify the mental health provider for a resident who had combative behaviors and suicidal ideations. Referred to Controller's Office 04/07/2020
Vintage Inn Retirement Community HAL-058-010 1/25/2019 $3,500.00 A1 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure residents were supervised for safety on the Special Care Unit. Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $1,000.00 total for 3 penalties 2/6/2020
Vintage Inn Retirement Community HAL-058-010 1/25/2019 $3,500.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to meet healthcare needs for sampled residents related to an eye injury of unknown origin, chest bruising and change in condition, red irritated stomach rash not responding to prescribed treatment, itchy rash on the chest, abdomen, back, and arms, and a diabetic resident with thick discolored long toenails Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $1,000.00 total for 3 penalties 2/6/2020
Vintage Inn Retirement Community HAL-058-010 1/25/2019 $3,500.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure full time and consistent responsibility for the operation, administration, management and supervision of the facility which resulted in significant noncompliance with state rules and regulations related to personal care, supervision, health care, medication administration, residents' rights, health care personnel registry, housekeeping and furnishings and reporting incidents and accidents. Settlement Fulfilled 02/06/2020 Settlement Agreement 09/23/2019 Appealed 01/31/2019 $1,000.00 total for 3 penalties 2/6/2020
Vintage Inn Retirement Community HAL-058-010 8/5/2019 $7,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect a sampled resident from falling off the bed, sustaining injury, and subsequently sent to the hospital with diagnoses including fractures of the left shoulder, humerus, and femur, and a right wrist sprain. Settlement Fulfilled 04/30/2020 Settlement Agreement 04/23/2020 Appealed 08/12/2019 $2,000.00 4/30/2020
Vintage Inn Retirement Community HAL-058-010 8/26/2021 $16,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/07/2021
Vintage Inn Retirement Community HAL-058-010 3/1/2021 $5250.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 2 of 5 sampled residents according to their assessed needs related to aggressive behaviors and exit seeking behaviors. Appealed 05/17/2021
Vintage Inn Retirement Community HAL-058-010 3/1/2021 $10500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to contact the primary care provider (PCP) for 2 of 7 sampled residents related to pressure ulcers. Appealed 05/17/2021
Vintage Inn Retirement Community HAL-058-010 3/1/2021 $14,000.00 A1 G.S. 131-25  Implementation; G.S. 131D-21(4)  Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of the facility were implemented and rules were maintained for housekeeping and furnishings, tuberculosis tests, personal care, supervision, health care, nutrition and food service, controlled substances, health care personnel registry reporting and special care unit staffing. Appealed 05/17/2021

McDowell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cedarbrook Residential Center HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 4 residents. Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 4 residents in accordance with the residents' assessed needs and current symptoms. Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center HAL-059-021 10/25/2018 $1,000.00 A2 G.S. 131D-25  Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies and procedures of the facility were implemented to maintain substantial compliance with rules relating to medication administration, residents assessments, supervision and personal care, staffing nutrition and food service, housekeeping and furnishings, and residents' rights. Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Cedarbrook Residential Center HAL-059-021 10/25/2018 $1,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were not threatened by a staff who carried a utility knife at work; verbally threatened by a another staff, and that residents were not spoken to in a dismissive disrespectful manner by staff . Settlement Fulfilled 03/14/2019 Settlement Agreement 02/14/2019
Lake James Lodge Assisted Living HAL-059-032 9/24/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure supervision of residents related to smoking. Paid in Full $2,000.00 10/2/2019
Lake James Lodge Assisted Living HAL-059-032 3/1/2021 $500.00 A2 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 1 of 5 sampled residents was administered medications according to physician's orders. Paid in Full $500.00 3/19/2021

Mecklenbug County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brighton Gardens of Charlotte HAL-060-029 8/31/2021 $12,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer PRN medications to 3 of 5 sampled residents. Paid in Full $12,000.00 9/14/2021

Mecklenburg County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mint Hill Senior Living HAL-060-136 9/8/2021 $3,000.00 A2 10A NCAC F .0311(a)   Other Requirements; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the door alarming system was maintained in a safe and operating condition.
The Parc at Sharon Amity HAL-060-125 9/8/2021 $3,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for a sampled esident.
The Parc at Sharon Amity HAL-060-125 9/8/2021 $3,500.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to provide supervision to 1 of 5 sampled residents who had a diagnosis of dementia.
The Parc at Sharon Amity HAL-060-125 9/8/2021 $7,000.00 A1 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect 3 of 3 sampled residents from sexual abuse by another resident.
East Towne HAL-060-149 10/1/2020 $146,000.00 Unabated A 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for 4 of 7 sampled residents. Settlement Agreement 05/21/2021 Appealed 10/30/2020
Elmcroft of Little Avenue HAL-060-156 9/24/2019 $250.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure medications were administered to sampled residents as ordered by the licensed prescribing practitioner. Paid in Full $250.00 10/14/2019
Elmcroft of Little Avenue HAL-060-156 8/24/2020 $500.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 1 of 5 sampled residents who had a diagnosis of dementia and a know history of exit seeking behaviors and wandering. Paid in Full $500.00 9/15/2020
Legacy Heights Senior Living Community HAL-060-152 8/5/2019 $40,200.00 Unabated B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered for sampled residents including medication errors observed during the medication pass. Paid in Full $40,200.00 9/9/2019
Legacy Heights Senior Living Community HAL-060-152 8/5/2019 $18,000.00 Unabated B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up to meet the health care needs of sampled residents. Paid in Full $18,000.00 9/9/2019
Parker Terrace HAL-060-054 8/7/2020 $3,500.00 A1 10A NCAC 13 F .0902 Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure 1 of 5 sampled residents received healthcare referral and follow-up related to seeking emergency evaluation when the resident's oxygen saturation levels began to fall. Paid in Full $3,500.00 9/9/2020
Brookdale Carriage Club Providence II HAL-060-049 8/31/2021 $1,000.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(2)   declaration of Residents' Rights Facility failed to provide supervision to 1 of 3 sampled residents on two separate occasions with a diagnosis of dementia. Paid in Full $1,000.00 9/8/2021
Brookdale Carriage Club Providence II HAL-060-049 8/31/2021 $2,000.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(2)   declaration of Residents' Rights Facility failed to provide supervision to 2 of 3 sampled residents. Paid in Full $2,000.00 9/9/2021
Brookdale South Charlotte HAL-060-101 8/31/2021 $1,500.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $1,500.00 9/3/2021
Charlotte Square HAL-060-087 8/31/2021 $2,000.00 A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered by a licensed prescribing practitioner for 6 of 7 sampled residents. Paid in Full $2,000.00 9/8/2021
Charlotte Square HAL-060-087 8/31/2021 $15,000.00 A1 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $15,000.00 9/8/2021
Sunrise on Providence HAL-060-165 8/31/2021 $16,000.00 A1 10A NCAC 13F .0901(c)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond immediately and in accordance with the facility's established policy and procedures for 1 sf 5 ampled resident who became unresponsive which required immediate emergency services. Paid in Full $16,000.00 9/21/2021
The Charlotte Assisted Living HAL-060-158 8/31/2021 $4,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to ensure staff provided supervision for 1 of 5 sampled residents, as related to staff not ensuring a resident, who resided in the Special Care Unit (SCU), was supervised while ambulating, which led to a fall and hospitalization.
The Charlotte Assisted Living HAL-060-158 8/31/2021 $7,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents and to reduce the risk of transmission and infection during the global coronavirus (COVID-19) pandemic.
The Parc at Sharon Amity HAL-060-125 8/31/2021 $6,000.00 A1 10A NCAC 13F .1801(a)(b) Infection Prevention and Control Program (Emergency Rules); G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and the local county health department (LHD) during the global pandemic of COVID-19 were implemented and maintained to provide protection and reduce the risk of transmission and infection to residents regarding testing of residents for COVID-19, isolation of COVID-19 positive residents, lack of signs clearly identifying residents who had tested positive resulting in staff not following recommended infection control practices when providing care to those positive residents, improper donning and doffing of personal protective equipment (PPE) by staff, appropriate use of environmental cleaning products to prevent the transmission of the virus, and not quarantining a resident who was COVID-19 positive after he was re-admitted to the facility from the hospital
Brookdale Charlotte East HAL-060-060 2/26/2019 $12,000.00 A1 G.S. 131D-25  Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the management, operations, and policies and procedures were implemented to maintain each residents' rights. Appealed 03/28/2019
Brookdale Charlotte East HAL-060-060 2/26/2019 $3,500.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents related to falls. Appealed 03/28/2019
Brookdale Charlotte East HAL-060-060 2/26/2019 $7,000.00 A1 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure contact with resident's medical professional. Appealed 03/28/2019
Carillon Assisted Living of Huntersville HAL-060-142 8/5/2019 $12,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were free of neglect. Paid in Full $12,000.00 10/1/2019
Carillon Assisted Living of Huntersville HAL-060-142 6/17/2019 $7,000.00 A1 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide personal care as related to identify decubitus ulcers. Paid in Full $7,000.00 9/16/2019
Carillon Assisted Living of Huntersville HAL-060-142 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents medications were administered as ordered . Paid in Full $1,000.00 8/22/2019
Carillon Assisted Living of Mint Hill HAL-060-153 6/19/2019 $1,500.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision according to the resident's assessed needs, care plan, and current symptoms. Paid in Full $2,000.00 8/22/2019
Charlotte Square HAL-060-087 8/24/2020 $2,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up to meet the acute healthcare needs for 2 of 7 sampled residents. Paid in Full $2,000.00 10/16/2020
East Towne HAL-060-149 6/4/2019 $6,000.00 A1 10A NCAC 13F .0902(c)(3-4) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure implementation of physician's orders for sampled residents. Settlement Agreement 05/21/2021 Appealed 07/03/2019
East Towne HAL-060-149 6/4/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Settlement Agreement 05/21/2021 Appealed 07/03/2019
East Towne HAL-060-149 6/4/2019 $6,000.00 A1 10A NCAC 13F .0603(a) Management of Facilities with a Capacity or Census of 81 or more Residents; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure responsibility for the operation, administration, management and supervision of the facility. Settlement Agreement 05/21/2021 Appealed 07/03/2019
East Towne HAL-060-149 6/4/2019 $12,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Settlement Agreement 05/21/2021 Appealed 07/03/2019
East Towne HAL-060-149 9/24/2019 $21,200.00 Unabated B 10A NCAC 13F .0906 Other Resident Care And Services; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents were provided transportation to scheduled physician's appointments. Settlement Agreement 05/21/2021 Appealed 10/21/2019
East Towne HAL-060-149 9/24/2019 $15,900.00 Unabated B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents were treated with respect and dignity regarding staff speaking to residents in a disrespectful manner. Settlement Agreement 05/21/2021 Appealed 10/21/2019
East Towne HAL-060-149 11/18/2019 $128,250.00 Unabated A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to administer medications as ordered related to a resident not receiving insulin as prescribed. Settlement Agreement 05/21/2021 Appealed 10/21/2019
East Towne HAL-060-149 8/24/2020 $15,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the acute and chronic health care needs were met for 1 of 6 sampled residents. Settlement Agreement 05/21/201 Appealed 09/23/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13 F .0902( c)(4) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for 4 of 7 sampled residents. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the management operations, and policies of Facility were implemented and rules were maintained for personal care, supervision, referral and follow-up. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0606 Staffing Chart; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 1 of 7 sampled resident was provided transportation to scheduled physician's appointments. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner 2 of 5 residents observed during a medication pass. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure supervision was provided to 2 of 7 sampled residents in accordance with assessed needs and current symptoms. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $15,000.00 A2 10A NCAC 13F .0901 (c)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to respond to incidents immediately and in accordance with facility's established policy and procedures. Settlement Agreement 05/21/2021 Appealed 10/30/2020
East Towne HAL-060-149 10/1/2020 $20,000.00 A1 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 4 of 7 sampled residents. Settlement Agreement 05/21/2021 Appealed 10/30/2020
Queen City Assisted Living HAL-060-126 6/17/2019 $1,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for residents. Settlement Fulfilled 05/20/2020 Settlement Agreement 11/22/2019 Appealed 7/2/2019 $2,000.00 total for 2 penalties 12/12/2019
Queen City Assisted Living HAL-060-126 6/17/2019 $2,000.00 A2 10A NCAC 13F . 0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow-up to meet the acute needs for residents. Settlement Fulfilled 05/20/2020 Settlement Agreement 11/22/2019 Appealed 7/2/2019 $2,000.00 total for 2 penalties 12/12/2019
Regency at Pineville (Closed) HAL-060-139 2/19/2019 $4,000.00 A2 G.S. 131D-25   Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the management and overall operations of the facility by failing to meet and monitor rules governing adult care homes. Referred to Controller's Office 08/08/2019
Regency at Pineville (Closed) HAL-060-139 2/19/2019 $4,000.00 A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure staff provided supervision for 3 residents in SCU unit. Referred to Controller's Office 08/08/2019
Regency at Pineville (Closed) HAL-060-139 2/19/2019 $4,000.00 A2 10A NCAC 13F .0902(b)   Health Care; G.S. 131D-21(12)   Declaration of Residents' Rights Facility failed to notify resident's physician of changes, medications and failed to refer resident for treatment for an illness in a timely manner. Referred to Controller's Office 08/08/2019
Regency at Pineville (Closed) HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to notify the physician for 5 residents regarding medications not being available and not referring a resident for treatment for an illness in a timely manner. Referred to Controller's Office 04/28/2020
Regency at Pineville (Closed) HAL-060-139 12/9/2019 $16,000.00 A1 G.S. 131D-25   Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the management and overall operations of the facility by failing to meet and monitor rules related to personal care and supervision. Referred to Controller's Office 04/28/2020
Regency at Pineville (Closed) HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to ensure 4 residents were free of neglect and physical abuse. Referred to Controller's Office 04/28/2020
Regency at Pineville (Closed) HAL-060-139 12/9/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to administer medications as ordered for 5 residents. Referred to Controller's Office 04/28/2020
Regency at Pineville (Closed) HAL-060-139 12/9/2019 $7,000.00 A2 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure staff provided personal care assistance for 6 residents. Referred to Controller's Office 04/28/2020
Summit Place of South Park HAL-060-116 8/5/2019 $9,000.00 A2 10A NCAC 13F .1002(a)(3) Medication Orders: G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to clarify orders for medications for residents with conflicting medication list. Paid in Full $9,000.00 8/21/2019
Summit Place of South Park HAL-060-116 10/23/2019 $7,000.00 A1 10A NCAC 13F .0901(c)  Personal Care & Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to respond immediately and provide intervention according to the facility's policies and procedures. Paid in Full $7,000.00 11/7/2019
Summit Place of South Park HAL-060-116 10/23/2019 $7,000.00 A1 10A NCAC 1310A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provider supervision for sampled residents. Paid in Full $7,000.00 11/18/2019
Sunrise on Providence HAL-060-057 7/1/2019 $500.00 A2 10A NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner. Paid in Full $500.00 7/18/2019
The Crossings at Steele Creek FCL-078-077 8/24/2020 $3,500.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision in accordance with their current symptoms and assessed needs for 3 of 4 sampled residents with a history of falls. Paid in Full $3,500.00 10/7/2020
The Haven in Highland Creek HAL-060-108 6/4/2019 $2,000.00 A2 G.S. 131D-21(4) Declaration of Residents' Rights; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure residents were free from neglect, related to staff not seeking immediate medical evaluation and treatment. Paid in Full $2,000.00 6/18/2019
The Parc at Sharon Amity HAL-060-125 8/5/2019 $500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to notify resident's physician of refusals of medications. Paid in Full $500.00 8/16/2019
The Parc at Sharon Amity HAL-060-125 11/13/2019 $500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure physician notification for 2 residents as related to medication refusals. Settlement Agreement 07/07/2021 Appealed 09/04/2019 $500.00 8/16/2019
The Parc at Sharon Amity HAL-060-125 10/1/2020 $9,000.00 A1 10A NCAC 13F .1004 (a)(1)(2)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner Settlement Agreement 07/07/2021 Appealed 09/04/2019
The Parc at Sharon Amity HAL-060-125 10/1/2020 $1,500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Settlement Agreement 07/07/2021 Appealed 09/04/2019
The Parc at Sharon Amity HAL-060-125 10/1/2020 $5,250.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow up for 2 of 6 sampled residents related to notifying the physician for blood sugar levels above the parameters set by the physician (Resident #6) and not notifying the physician of refusals of insulin and delayed mental health referral (Resident #1). Settlement Agreement 07/07/2021 Appealed 09/04/2019
The Parc at Sharon Amity HAL-060-125 10/1/2020 $5,250.00 A2 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 2 of 6 residents observed during the medication pass and for 3 of 5 residents sampled for review. Settlement Agreement 07/07/2021 Appealed 09/04/2019
Mint Hill Senior Living HAL-060-136 8/26/2021 $9,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for 1 out of 5 sampled residents who presented with altered mental status and a change in baseline function. Appealed 09/24/2021
Queen City Assisted Living HAL-060-126 8/26/2021 $5,250.00 A2 10A NCAC 13F .1004(a)  Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer medications as ordered for 3 of 7 sampled residents. Appealed 09/24/2021
Sunrise on Providence HAL-060-165 8/26/2021 $4,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NCDHHS), and directives from the Local Health Department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid in Full $4,000.00 9/9/2021
McClain's Family Care 1 FCL-060-123 7/21/2021 $1,000.00 A2 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the overall management, operations and policies and procedures of the facility to maintain the rights of 5 sampled residents.
McClain's Family Care 1 FCL-060-123 7/21/2021 $1,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (DHHS) were implemented when caring for 5 residents during the global coronavirus (COVID-19) pandemic.
Northlake House HAL-060-150 7/21/2021 $500.00 A2 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Resident's Rights Facility failed to provide supervision to 1 of 5 sampled residents in accordance with assessed needs. Paid in Full $500.00 9/16/2021
Ranson Ridge at the Villages of Mecklenburg Mecklenburg 7/21/2021 $750.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to ensure physician notification for 1 od 4 sampled residents.
The Crossings at Steele Creek HAL-060-130 5/3/2021 $8,000.00 A2 10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to respond immediately and in accordance with the facility's established policy and procedures for 1 sampled resident who had a choking episode which required immediate emergency services. Paid in Full $8,000.00 5/17/2021

Moore County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Tara Plantation of Carthage HAL-063-011 12/9/2019 $4,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the overall management and operations of the facility was maintained in substantial compliance with the rules and statutes for adult care homes. Appealed 1/8/2020
Tara Plantation of Carthage HAL-063-011 12/9/2019 $2,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer a controlled substance medication as ordered for anxiety for 1 resident. Appealed 1/8/2020
Tara Plantation of Carthage HAL-063-011 12/9/2019 $4,000.00 A1 10A NCAC 13F .1004(i)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure Medication Aides observed 1 resident ingest medication at the time of administration. Appealed 1/8/2020

Nash County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Somerset Court of Rocky Mount HAL-064-029 3/1/2021 $1000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to notify 2 of 3 sampled residents guardian when the resident's relative removed the resident from facility and failed to contact law enforcement when a resident did not return to the facility within 24 hours. Appealed 3/31/2021

New Hanover County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Morningside of Wilmington HAL-065-045 HAL-065-045 8/31/2021 $1,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), local health department (LHD), and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to protect to the residents during the global coronavirus (COVID-19) pandemic for reduction of infection and transmission of COVID-19.
New Hanover House HAL-065-036 8/31/2021 $250.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medical exampoination for 1 of 3 resients sampled.
New Hanover House HAL-065-036 8/31/2021 $250.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to provide supervision by not implementing interventions for 2 of 5 residents sampled.
Brookdale Wilmington HAL-065-019 1/18/2019 $4,000.00 A2 10A NCAC 13F .0311(a)   Other Requirements; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to maintain the door alarm system in a safe and operating condition. Paid in full $4,000.00 3/4/2019
Brookdale Wilmington HAL-065-019 9/24/2019 $4,000.00 A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision to resident who was identified as a high fall risk. Paid in Full $4,000.00 11/5/2019
Castle Creek Memory Care HAL-065-034 1/25/2019 $9,000.00 A2 10A NCAC 13F .0901(b)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision for 1 resident resulting in the resident having multiple falls and multiple injuries. Settlement Fulfilled 08/13/2020 Settlement Agreement 10/23/2019 Appealed 02/22/2019 $4,500.00 8/13/2020
Spring Arbor Assisted Living of Wilmington HAL-065-014 8/5/2019 $8,000.00 A1 10A NCAC 13F .0703(d) Tuberculosis Test, Medical Examination and Immunizations; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to coordinate and ensure the acute and routine health care needs were met for two sampled residents who were diagnosed with the flu and had not received the flu vaccination resulting in death. Settlement Agreement 11/15/2019 Appealed 08/22/2019 $6,000.00 11/21/2019
Spring Arbor Assisted Living of Wilmington HAL-065-014 8/7/2020 $2,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow up with the licensed physicians for 3 of 6 sampled residents. Paid in Full $2,000.00 9/15/2020
Spring Arbor Assisted Living of Wilmington HAL-065-014 8/7/2020 $3,500.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure responsibility for the overall management and operations of the facility. Paid in Full $3,500.00 9/15/2020
Spring Arbor of Wilmington HAL-065-014 8/26/2021 $5,250.00 A1 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect 3 of 3 sampled residents who resided in the special care unit from physical abuse by another resident. Paid in Full $5,250.00 9/13/2021
Spring Arbor of Wilmington HAL-065-014 8/26/2021 $9,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan, and current symptoms for 3 of 5 sampled residents resulting in physical altercations and injuries. Paid in Full $9,000.00 9/13/2021

Northampton County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pine Forest Rest Home HAL-066-001 8/31/2021 $4,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS), and the Local Health Department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic and practicing recommended infection prevention and control practices to reduce the risk of transmission and infection as related to staff and residents not wearing proper personal protective equipment (PPE), staff not conducting screening of staff, residents and visitors, and not following social distancing during communal dining and other activities.
Hampton Manor HAL-066-012 6/4/2019 $1,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Settlement Agreement 12/02/2019 Appealed 07/02/2019 $500.00 12/31/2019
Rich Square Manor HAL-066-011 12/12/2018 $2,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect 11 residents from exploitation of their personal funds as evidence by residents' funds not being accounted for. Settlement Fulfilled 09/16/2019 Settlement Agreement 09/18/2019 Appealed 01/11/2019 $2,000.00 9/16/2019
Rich Square Villa HAL-066-010 8/5/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure every resident's rights were maintained as related to failing to keep residents free from neglect. Settlement Fulfilled 03/05/2021 Settlement Agreement 12/23/2020 Appealed 09/04/2019 $1,000.00 3/5/2021
Rich Square Villa HAL-066-010 8/5/2019 $3,500.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure a resident who was unable to give consent was free from sexual abuse by another resident. Settlement Fulfilled 03/05/2021 Settlement Agreement 12/23/2020 Appealed 09/04/2019 $3,500.00 3/5/2021
Hampton Manor HAL-066-012 3/1/2021 $9000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure that 4 of 5 sampled residents were supervised resulting in resident injury when smoking with oxygen in use.

Onslow County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lighthouse Village HAL-067-013 6/18/2019 $7,000.00 A1 10A NCAC 13F .0904(e)(4) Nutrition and Food Service; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide therapeutic diets as ordered for sampled residents. Referred to Controller's Office 08/17/2021
Onslow House HAL-067-023 12/12/2018 $11,000.00 A1 10A NCAC 13F .0901(c)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure staff responded immediately for 1 resident who was unresponsive requiring CPR. Settlement Agreement 10/31/2019 Appealed 01/11/2019 $5,000.00 10/10/2019
The Arc Community HAL-067-004 8/5/2019 $4,000.00 A2 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure that staff had no substantiated findings listed on the North Carolina Health Care Personnel Registry. Paid in Full $4,000.00 12/20/2019
The ARC Community HAL-067-004 8/26/2021 $12,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 5 sampled residents in accordance with assessed needs and a history of falls resulting in serious injuries.
The ARC Community HAL-067-004 8/26/2021 $12,000.00 A1 10A NCAC 13 F .1501(b) Use of Physical Restraints and Alternatives; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure a geri-chair with tray and bed rails used as physical restraints were used only after an assessment and care planning process had been completed through a team process and alternatives had been tried for 1 of 1 residents sampled which resulted in resident injury.
The ARC Community HAL-067-004 8/26/2021 $14,000.00 A1 10A NCAC 13 F .0601(a) Management of Facilities; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the total operation of the facility to meet and maintain substantial compliance with rules related to personal care and supervision, health care, and the use of physical restraints and alternatives.
The ARC Community HAL-067-004 8/26/2021 $12,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to to meet the acute health care needs for 4 of 5 sampled residents related to failing to report symptoms to healt care providers and delay in seeking medical care.

Orange County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cedar Grove FCH #2 FCL-068-033 8/31/2021 $1,000.00 A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. `
The Stratford HAL-068-025 6/4/2019 $2,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure immediate follow-up with the physician regarding residents being administered wrong medication. Settlement Fulfilled 06/09/2020 Settlement Agreement 01/10/2020 Appealed 07/02/2019 $1,000.00 6/9/2020
Cedar Grove Family Care Home # 1 FCL-068-031 7/7/2021 $1,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and directives from the local health department (LHD) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Paid In Full $1,000.00 8/27/2021

Pamlico County

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

Pender County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashe Gardens HAL-071-015 12/9/2019 $15,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Executive Director (Administrator) failed to ensure the total operation of the facility to meet and maintain rules related to personal care and supervision, health care, residents' rights, medication administration, controlled substances, and Health Care Personnel Registry. Settlement Agreement 06/09/2021 Appealed 01/08/2020
Ashe Gardens HAL-071-015 12/9/2019 $15,000.00 A1 10A NCAC 13F .0909   Residents' Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure residents were protected from harm and injury from residents with aggressive behaviors. Settlement Agreement 06/09/2021 Appealed 01/08/2020
Ashe Gardens HAL-071-015 12/9/2019 $13,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 11 residents with assaultive, aggressive, sexually expressive and wandering behaviors. Settlement Agreement 06/09/2021 Appealed 01/08/2020
Ashe Gardens HAL-071-015 10/1/2020 $10,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Executive Director (Administrator) failed to ensure the management, operations, and policies of Facility were implemented and maintained for supervision, health care, medication orders, medication administration, special care unit staffing, adult care home medication aide training, and resident rights. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $20,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 6 of 12 sampled residents in accordance with their current symptoms and assessed needs resulting in injuries. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $20,000.00 A1 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure safe policies and procedures were established and maintained for medication administration and failed to ensure medications were administered as ordered for 2 of 5 residents observed during the medication passes. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Ashe Gardens HAL-071-015 10/1/2020 $10,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow-up for 4 of 12 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Ashe Gardens HAL-071-015 12/9/2019 $10,500.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure referral and follow up for acute and routine health care needs were met for 4 sampled residents. Settlement Agreement 06/09/2021 Appealed 01/08/2020
Ashe Gardens HAL-071-015 12/9/2019 $16,000.00 A1 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer medications as ordered and in accordance with the facility's policies for 3 sampled residents. Settlement Agreement 06/09/2021 Appealed 01/08/2020

Perquimans County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lillian Brothers Family Care Home FCL-072-009 2/19/2019 $500.00 A2 10A NCAC 13G .0601  Management and Other Staff; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure residents were free of abuse and neglect. Paid in Full $500.00 4/2/2019
Merciful Heavenly Home of Woodville (Closed) FCL-072-013 7/15/2019 $2,000.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(7) Declaration of Residents' Rights Facility failed to ensure healthcare referral and follow-up services for a resident. Referred to Controller's Office 10/02/2019
Merciful Heavenly Home of Woodville (Closed) FCL-072-013 7/15/2019 $3,500.00 A2 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights; Administrator failed to ensure the overall management, operations, and policies and procedures of the facility. Referred to Controller's Office 10/02/2019
Hertford Manor HAL-072-013 5/3/2021 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to notify the primary care provider for 1 sampled resident who had significant changes in the ability to perform activities of daily living who required increased assistance by staff.

Person County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cambridge Hills Assisted Living HAL-073-003 8/5/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with the assessed needs and current symptoms of the residents. Paid in Full $500.00 9/4/2019

Pitt County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale W. Arlington Boulevard HAL-074-012 8/31/2021 $1,000.00 A2 10A NCAC F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide the necessary services required to ensure ththat all residents remain free of neglect related to a delcay in care for 1 of 5 sampled residents.
Brookdale W. Arlington Boulevard HAL-074-012 8/31/2021 $4,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow up for the acute and routine health care needs for 1 of 5 sampled residents.
Southern Living Assisted Care HAL-074-038 9/27/2019 $23,200.00 Unabated B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to schedule follow-up orthopedic care for resident. Settlement Fulfilled 06/08/2020 Settlement Agreement 04/23/2020 Appealed 10/28/2019 $6000.00 total for 3 penalties 4/30/2020
Southern Living Assisted Care HAL-074-038 12/9/2019 $4,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure referral and follow up for routine and acute health care needs for 4 residents. Settlement Fulfilled 06/08/2020 Settlement Agreement 04/23/2020 Appealed 10/28/2019 $6000.00 total for 3 penalties 4/30/2020
Southern Living Assisted Care HAL-074-038 12/9/2019 $4,000.00 A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4)  Declaration of Residents' Rights The facility failed to ensure 4 residents were free of neglect and physical abuse. Settlement Fulfilled 06/08/2020 Settlement Agreement 04/23/2020 Appealed 10/28/2019 $6000.00 total for 3 penalties 4/30/2020
Winterville Manor HAL-074-026 8/26/2021 $1,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician's orders were implemented for 1 of 3 sampled residents. Appealed 09/14/2021

Randolph County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
All About Love Family Care Home (Closed) FCL-076-035 1/18/2019 $500.00 A2 10A NCAC 13G .0906(f)(4)   Other Resident Services, 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the overall operations of facility to maintain substantial compliance with rule and regulations governing family care homes. Facility failed to notify law enforcement when the whereabouts of a sampled resident was unknown. Referred to Controller's Office 04/09/2019
All About Love Family Care Home (Closed) FCL-076-035 1/18/2019 $15,300.00 Unabated B 10A NCAC 13G .0406(a)(5)   Other Staff Qualifications; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure a current sanitation report was available for review. Referred to Controller's Office 04/09/2019
Caregivers of Liberty II FCL-076-033 11/18/2019 $375.00 A2 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision for 1 resident who had forgetfulness, needed consistent reminders and had exited the facility without staff's knowledge. Paid in Full $375.00 1/10/2020
North Pointe Assisted Living of Archdale HAL-076-032 7/1/2019 $1,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision to residents who had a history of falls. Settlement Agreement 02/10/2020 Appealed 07/11/2019 $500.00 4/16/2020
North Pointe Assisted Living of Archdale HAL-076-032 7/1/2019 $750.00 A2 10A NCAC 13F .1501(a) Use of Physical Restraints and Alternatives; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physical restraints were used only after an assessment and care planning process had been completed through a team process and after alternatives had been tried and documented in the resident's record. Settlement Agreement 02/10/2020 Appealed 07/11/2019

Robeson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Covenant Care HAL-078-038 8/31/2021 $2,000.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to ensure supervision for 1 of 3 sampled residents in accordance with assessed needs and current symptoms.
Morning Star Assisted Living #3 HAL-078-065 8/31/2021 $1,000.00 A2 10A NCAC 13F .0305(h)(4)   Physical Environment; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 3 of 3 exit doors, which were accessible to residents, were equipped with an alarm that was activated and sounded when the doors were opened to alert staff for 1 of 10 residents wo was intermittenly disoriented and amblatory.
B & B Assisted Living #2 FCL-078-103 12/12/2018 $2,000.00 A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for 2 residents. Paid in Full $2,000.00 6/11/2019
B & B Assisted Living #2 FCL-078-103 7/15/2019 $2,000.00 A1 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents who had eloped from the facility. Paid in Full $2,000.00 12/16/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10 A NCAC 13F .0601(a)   Management of Facilities; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure compliance with state rules and regulations specific to personal care, health care referral and follow up, supervision, housekeeping and furnishings, personal care and other staffing. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights The facility failed to provide personal care for 3 sampled residents. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to provide supervision for 2 residents in accordance with their assessed needs and current symptoms. Appealed 12/12/2019
Cromartie Spring Village Rest Home HAL-078-082 11/13/2019 $4,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure health care referral and follow up for the acute and routine health care needs of 2 sampled residents. Appealed 12/12/2019
Dial's Family Care Home # 10 FCL-078-079 8/24/2020 $2,000.00 A1 10A NCAC 13G .0909   Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the safety of resident during transfers with a mechanical lift device. Paid in Full $2,000.00 12/30/2020
Lumberton Assisted Living HAL-078-084 3/18/2019 $7,000.00 A1 10A NCAC 13F .0904(f)(2)   Nutrition and Food Service; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide assistance with meals that promoted dignity and respect for 1 resident. Settlement Fulfilled 03/04/2020 Settlement Agreement 08/23/2019 Appealed 03/19/2019 $500.00 3/4/2020
Lumberton Assisted Living HAL-078-084 3/1/2021 $4000.00 A2 10A NCAC 13F .0909   Resident Rights, G.S. 131-21(4)   Declaration of Residents' Rights Based on observations, interviews, and record review, Facility failed to protect 2 of 2 sampled residents from physical abuse by one staff. Appeal Re-Filed 08/17/2021 Appeal 03/11/2021
Lumberton Assisted Living HAL-078-084 3/1/2021 $7000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to report allegations of physical abuse to the North Carolina Health Care Personnel Registry (HCPR) within 24 hours of the allegation for 1 of 1 sampled staff. Appeal Re-Filed 08/17/2021 Appealed 03/04/2021

Rockingham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Reidsville HAL-079-007 8/7/2020 $7,000.00 A1 10A NCAC 13 F .1004 Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 1 of 5 sampled resident with an order for an anticoagulant medication. Settlement Fulfilled 08/27/2021 Settlement Agreement 07/28/2021 Appealed 09/10/2020 $7,000.00 8/18/2021
Faith Beyond Measure FCL-079-107 12/12/2018 $10,800.00 Unabated B 10A NCAC 13G .0902(c)(3)(4)   Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement physician's orders for 1 resident. Referred to Controller's Office 04/09/2019
Faith Beyond Measure FCL-079-107 12/12/2018 $1,000.00 A2 10A NCAC 13G .1004 (a)   Medication Administration; 10A NCAC 13G .0601(a)   Management and Other Staff; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the management and overall operations of the facility by failing to implement rules and regulations governing adult care homes. Referred to Controller's Office 04/09/2019
Faithworks Family Care Home FCL-079-067 3/4/2020 $3,500.00 A1 10A NCAC 13G .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide person care assistance to sampled residents. Paid in Full $3,500.00 7/23/2020
Faithworks Family Care Home FCL-079-067 3/4/2020 $3,500.00 A1 10A NCAC 13G .0909 Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure the rights of all residents were maintained related to timely physician notification. Paid in Full $3,500.00 7/23/2020
Faithworks Family Care Home FCL-079-067 3/4/2020 $3,500.00 A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure physician notification for residents. Paid in Full $3,500.00 7/23/2020
Safe Haven #3 FCL-079-102 6/4/2019 $2,650.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure residents with cognitive and physical impairments were able to independently evacuate the facility in accordance with the license capacity. Paid in Full $2,650.00 2/17/2020
Ezana's Scarlet Oaks FCL-079-106 7/21/2021 $2,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(6) Declaration of Residents' Rights Facility failed to maintain the rights of 6 of 6 sampled residents related to personal medical records not being kept confidential and being disclosed without consent.

Rowan County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Alpha Concord Plantation HAL-080-027 11/18/2019 $10,500.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to notify the primary care physician or mental health provider of behavior changes in a resident who had a history of suicide attempts. Settlement Fulfilled 08/31/2021 Settlement Agreement 01/11/2021 Appealed 12/18/2019 $6,000.00 3/5/2021
Angels at Heart Assisted Living HAL-080-020 11/1/2018 $2,000.00 A2 G.S. 131D-4.4A(b)   Infection Prevention Requirements; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement a written infection control policy consistent with the Federal Center for Disease Control and Prevention guidelines. Paid in Full $2,000.00 12/27/2018
Angels at Heart Assisted Living HAL-080-020 11/1/2018 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 2 residents. Paid in Full $2,000.00 12/27/2018
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $150.00 Unabated B 10A NCAC 13F .0407(a)(7); G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure 1 staff had a criminal background check completed upon hire. Paid in Full $150.00 1/16/2020
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $3,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician notification for residents with aggressive behaviors, medication refusals and medications not available. Paid in Full $3,000.00 1/16/2020
Angels at Heart Assisted Living HAL-080-020 7/1/2019 $5,250.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility neglected to ensure residents' rights were maintained and residents were safe and free from being inappropriately touched by a resident. Paid in Full $5,250.00 1/16/2020
Bethamy Retreat FCL-080-001 7/1/2019 $1,000.00 A2 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure hot water temperatures were maintained between 100 degrees Fahrenheit (F) and 116 degrees F . Paid in Full $1,000.00 8/16/2019
Carillon Assisted Living of Salisbury HAL-080-013 7/15/2019 $1,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up related to incidents of aggressive behavior. Paid in Full $1,000.00
Carillon Assisted Living of Salisbury HAL-080-013 7/15/2019 $3,500.00 A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for sampled residents. Paid in Full $3,500.00
Compass Assisted Living Rowan HAL-080-028 12/9/2019 $500.00 A2 10A NCAC 13F .0902  Health Care; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to notify the physician of a change in the condition and medical treatment for 1 resident. Paid in Full $500.00 1/15/2020
Kannon Creek Assisted Living HAL-080-003 12/12/2018 $4,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 1 resident was not exploited by staff when it failed to fully investigate allegations of inappropriate behavior by a staff who was later terminated. Paid in Full $4,000.00 2/12/2019
The Meadows of Rockwell Retirement Center HAL-080-026 7/15/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for resident in accordance with current symptoms. Settlement Fulfilled 03/13/2020 Settlement Agreement 02/17/2020 Appealed 08/14/2019 $1,000.00 3/13/2020
The Meadows of Rockwell Retirement Center HAL-080-026 12/9/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered and in accordance with the facility's policies for 2 residents. Settlement Fulfilled 10/20/2020 Settlement Agreement 08/10/2020 Appealed 1/8/2020 $5,000.00 total for 2 penalties 10/30/2020
The Meadows of Rockwell Retirement Center HAL-080-026 12/9/2019 $3,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure physician referrals and notifications for 3 residents. Settlement Fulfilled 10/30/2020 Settlement Agreement 08/10/2020 Appealed 1/8/2020 $5,000.00 total for 2 penalties 10/30/2020
Angels at Heart Assisted Living HAL-080-029 7/7/2021 $7,000.00 A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.
Best of Care Assisted Living HAL-080-019 2/15/2021 $12000.00 A1 10A NCAC 13F .1004 (a)(1)   Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician notification for 1 of 2 sampled residents who were prescribed an anti-coagulant medication resulting in a critical international normalized ratio (INR). Appealed 02/16/2021
Best of Care Assisted Living HAL-080-019 2/15/2021 $12000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure physician notification for 1 of 2 sampled residents with orders for blood thinner. Appealed 02/16/2021

Rutherford County

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

Stanly County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies and procedures of the facility were implemented to maintain each residents' right. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for residents as evidenced by not performing checks in accordance with the resident's care plan and the facility's falls management team protocol. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $5,250.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the routine and acute healthcare needs were met for residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $5,250.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $3,000.00 A2 10A NCAC 13F .0902(c) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the implementation of physician's orders for residents with fall risks. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019
Woodhaven Court HAL-084-009 8/5/2019 $3,000.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure adequate staffing to meet the needs of Special Care Unit residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019
Woodhaven Court HAL-084-009 9/11/2019 $3,000.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure staffing to meet the needs of Special Care Unit. Residents. Settlement Fulfilled 09/04/2019 Settlement Agreement 06/12/2020 Appealed 09/04/2019 $3,000.00 9/4/2019
Woodhaven Court HAL-084-009 8/26/2021 $3,000.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS), and local county health department were implemented and maintained to provide protection to the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/24/2021

Stokes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rose Tara Senior Living HAL-085-008 12/9/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision resulting in resident wandering away from the facility without staff knowledge. Referred to Controller's Office 09/09/2021 Voluntary Dismissal by Licensee 03/03/2020 Appealed 01/08/2020

Surry County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Elkin Assisted Living HAL-086-013 11/13/2019 $18,750.00 Unabated Type B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to notify health care providers for 3 residents. Settlement Fulfilled 03/29/2021 Settlement Agreement 03/18/2021 Appealed 11/25/2019 $8,500.00 3/29/2021

Swain County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Bryson Senior Living HAL-087-009 6/4/2019 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medications were administered to residents. Settlement Fulfilled 08/13/2020 Settlement Agreement 03/02/2020 Appealed 07/02/2019 $1,000.00 4/20/2020

Transylvania County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Kingsbridge House HAL-088-075 8/26/2021 $2,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 2 of 5 sampled residents related to scheduling follow up appointments and physician notification of missed medications. Appealed 09/24/2021
Kingsbridge House HAL-088-075 8/26/2021 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered by a licensed prescribing practitioner for 3 of 5 sampled residents. Appealed 09/24/2021

Tyrrell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to protect 1 of 1 sampled residents rom exploitation by allowing a male resident to visit her unsupervised in the resident's room resulting in a sexual encounter between the two residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13F .1212(d) Reporting of Incidents and Accidents; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to immediately notify the local county Department of Social Services (DSS) for 1 of 1 sampled residents who had been neglected and exploited by staff. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,500.00 A2 10A NCAC 13F .1310 Other Applicable Rules for Special Care Units; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to implement policies and procedures for the special care unit (SCU) that promoted a safe, secure and consistent environment. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $6,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for routine and acute health care needs for 6 of 10 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $2,000.00 A2 10A NCAC 13F .1308  Special Care Unit Staffing; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure there was enough staff present on the special care unit and attentive to meet the personal care, supervision and health care needs of the residents for 14 of 27 sampled shifts . Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $2,000.00 A2 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide assistance for the personal care needs 7 of 8 sampled residents. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $7,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan, and current symptoms for sampled residents who resided on the special care unit (SCU). Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $1,000.00 A2 10A NCAC 13F .1205   Health Care Personnel Registry; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to complete Health Care Personnel Registry (HCPR) reporting and investigation requirements within the 24 hour and 5 day requirements for 3 of 3 sampled residents (#8, #11 and #12) sustaining physical abuse and injuries of unknown origin . Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $7,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of facility were implemented and rules were maintained for supervision, health care, personal care and other staffing, personal care, health care personnel registry reporting, special care unit staffing, residents' rights, medication administration, controlled substances, housekeeping and furnishings, hot water requirements, training on cardio-pulmonary resuscitation, and nutrition and food service . Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $11,850.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 1 of 4 residents observed during the medication pass and 3 of 8 residents sampled for record review. Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $69,750.00 Unabated A1 10A NCAC 13F .0901 (a)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide assistance for the personal care needs 7 of 8 sampled residents including incontinence care, toileting, bathing and dressing . Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 10/1/2020 $69,750.00 Unabated A1 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, operations, and policies of Facility were implemented and rules were maintained for supervision, health care, personal care and other staffing, personal care, health care personnel registry reporting, special care unit staffing, residents' rights, medication administration, controlled substances, housekeeping and furnishings, hot water requirements, training on cardio-pulmonary resuscitation, and nutrition and food service . Settlement Agreement 06/09/2021 Appealed 10/30/2020
Tyrrell House HAL-089-002 8/26/2021 $13,500.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 residents sampled who had at least ten falls resulting in five emergency room visits and sustaining injuries including head injuries and fractures. Appealed 09/24/2021
Tyrrell House HAL-089-002 8/26/2021 $9,000.00 A2 10A NCAC 13 F .1801(a)(b) Infection Prevention and Control Program; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/24/2021

Union County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Poplin Terrace (Closed) FCL-090-018 6/11/2021 $3,500.00 A1 10A NCAC 13G .0901 (b) Personal Care And Supervision; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure 2 residents were provided supervision in accordance with their assessed needs and current symptoms. Appealed 07/12/2021

Wake County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Avendelle Assisted Living at Southern Oaks FCL-092-209 9/8/2021 $1,000.00 A2 10A NCAC 13G .0901(a) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide personal care to 3 of 3 residents sampled who required assistance with incontinence care and repositioning. Appealed 09/21/2021
Avendelle Assisted Living at Waterford Landing FCL-092-127 9/8/2021 $500.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to ensure referral and follow-up 1 sampled resident, which worsened the resident's acute health conditions. Appealed 09/20/2021
Cadence Garner HAL-092-215 8/31/2021 $4,000.00 A2 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to ensure staff on the memory care unit were available to supervise and meet the needs of the residents to provide any supervision for 1 of 5 sampled residents. Paid inFull $4,000.00 9/22/2021
Cadence Garner HAL-092-215 8/31/2021 $1,000.00 A2 10A NCAC 13F .1801(c) Infection Prevention and Control Program; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance from the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and the Local Health Department (LHD) were implemented and maintained during the global Coronavirus (COVID-19) pandemic. Paid inFull $1,000.00 9/22/2021
A Good Life FCH (Closed) FCL-092-106 9/24/2019 $16,700.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the building was equipped and maintained for residents who were physically and/or cognitively unable to evacuate the facility independently. Settlement Agreement 08/26/2021 Appealed 10/10/2019
Brighton Gardens of Raleigh HAL-092-024 9/24/2019 $2,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-2 (2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan and current symptoms. Paid in Full $2,000.00 10/22/2019
Brookridge Assisted Living HAL-092-146 1/18/2019 $14,000.00 A1 10A NCAC 13F .0901(c) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to contact emergency medical services immediately for 1 resident who was non-responsive. Settlement Fulfilled 02/20/2020 Settlement Agreement 11/15/2019 Appealed 01/24/2019 $2,000.00 2/20/2020
Carillon Assisted Living of Knightdale HAL-092-166 6/17/2019 $2,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered. Paid in Full $2,000.00 8/22/2019
Chatham Commons HAL-092-203 1/8/2019 $2,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21(2)   Declaration of Residents' Rights Administrator failed to ensure the total operation requirements were met and maintained related to rules governing adult care homes. Settlement Fulfilled 12/12/2019 Settlement Agreement 11/18/2019 Appealed 02/07/2019 $1,000.00 12/12/2019
Chatham Commons HAL-092-203 9/24/2019 $4,000.00 A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to administer medications as ordered for sampled residents. Settlement Fulfilled 02/05/2020 Settlement Agreement 01/10/2020 Appealed 10/21/2019 $1,000.00 2/5/2020
Chatham Commons HAL-092-203 11/13/2019 $9,000.00 A1 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision for sampled residents on the Special Care Unit in accordance with each resident's' assessed needs, care plan, and current symptoms. Settlement Fulfilled 08/26/20 Settlement Agreement 05/20/2020 Appealed 12/13/2019 $7,000.00 7/30/2020
Chatham Commons HAL-092-203 9/14/2020 $6,000.00 A1 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents in accordance with the resident's assessed needs and symptoms. Settlement Fulfilled 08/19/2021 Settlement Agreement 07/28/2021 Appealed 10/14/2020 $4,500.00 8/16/2021
Heartfields at Cary HAL-092-156 8/5/2019 $7,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for sampled residents. Paid in Full $7,000.00 8/21/2019
Heartfields at Cary HAL-092-156 9/14/2020 $55,500.00 Unabated A1 10A NCAC 13 F .0902Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the physician was notified for 1 of 5 sampled residents related to an unwitnessed fall, which resulted in a left hip fracture and uncontrolled pain for 3 days. Paid in Full $55,500.00 10/7/2020
Kelley's Family at Drayton Reserve FCL-092-251 8/24/2020 $1,000.00 A2 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the hot water temperatures at 4 of 5 fixtures (sinks and shower) used by and accessible to the residents in the kitchen, common bathroom and shared bathroom were maintained at a minimum of 100 degrees Fahrenheit (F) and did not exceed 116 degrees F including hot water temperatures as high as 138 degrees F. Paid in Full $1,000.00 9/9/2020
Morningside of Raleigh HAL-092-088 4/4/2019 $2,000.00 A2 10A NCAC 13F .0311(a)   G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the alarms on the doors of the SCU were in safe operating condition. Paid in Full $2,000.00 4/24/2019
Morningside of Raleigh HAL-092-088 4/4/2019 $2,000.00 A2 10A NCAC F .0901(b)   G.S. 131D-21(4)  Declaration of Residents' Rights Facility failed to provide supervision for SCU residents with wandering and exit seeking behaviors. Paid in Full $2,000.00 4/24/2019
North Pointe Assisted Living of Garner HAL-092-186 7/15/2019 $16,000.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents in accordance with each residents' assessed needs, care plan, and current symptoms. Settlement Fulfilled 03/24/2020 Settlement Agreement 02/17/2020 Appealed 7/26/2019 $16,000.00 3/24/2020
Oliver House HAL-092-182 8/7/2020 $5,250.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to contact the physician for 1 of 7 sampled residents related to stage III wound. Settlement Fulfilled 030/5/2021 Settlement Agreement 03/26/2021 Appealed 09/03/2020 $5,000.00 3/5/2021
Morningside of Raleigh HAL-092-217 8/26/2021 $500.00 A2 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 2 residents sampled with a history of multiple falls with injuries. Paid in Full $500.00 9/22/2021
R & S Family Care Home # 1 FCL-092-030 4/4/2019 $1,000.00 A2 10A NCAC 13G .0601(b)  Management and other Staff G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision to 5 sampled residents in accordance with each residents' assessed needs, care plan, and current symptoms. Paid in Full $1,104.00 9/9/2019
Spring Arbor of Apex HAL-092-037 1/9/2019 $500.00 A1 10A NCAC 13F .1002(a)(1)   Medication Orders, 10A NCAC 13F .1004(a)(1)   Medication Administration; G.S. 131D-21(4)  Facility failed to clarify readmission medication orders for sampled residents. Paid in full $500.00 3/12/2019
Sunrise Assisted Living at North Hills HAL-092-108 10/22/2019 $5,000.00 A1 10A NCAC 1310A NCAC 13F .0901(a)   Personal Care & Supervision; G.S. 131D-21(2)    Facility failed to provider personal care in accordance with resident's care plan. Paid in Full $5,000.00 11/6/2019
Oliver House HAL-092-182 8/26/2021 $9,000.00 A1 10A NCAC 13 F .1801(a)(b) Infection Prevention and Control Program; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (NC DHHS) and the local county health department (LHD) were implemented and maintained to provide protection of residents during the global coronavirus (COVID-19) pandemic. Appealed 09/24/2021
Val's Place FCL-092-213 2/26/2019 $3,500.00 A1 10A NCAC 13G .0901(b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 1 resident with wandering behaviors. Paid in Full $500.00 12/3/2019
Val's Place FCL-092-213 2/26/2019 $500.00 A2 10A NCAC 13G .0312(g)   Outside Entrance and Exits; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure 1 of 2 exit doors in the facility were activated with a sounding device when opened. Paid in Full $500.00 12/3/2019
Allcare Assisted Living (Closed) FCL-092-018 7/7/2021 $500.00 A2 10A NCAC 13G .0901 (b) Personal Care And Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights The facility failed to provide supervision according to the resident's assessed needs and current symptoms for 1 sampled resident. Paid in Full $500.00 8/23/2021
Allcare Assisted Living (Closed) FCL-092-018 7/7/2021 $500.00 A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights The facility failed to notify the primary care provider for 1 resident sampled, who had multiple falls and a delay in receiving medical treatment after a fall. Paid in Full $500.00 8/23/2021
Carillon Assisted Living of Knightdale (Closed) HAL-092-166 6/14/2021 $4,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights The facility failed to ensure health care referral and follow up for 2 sampled residents.
Waltonwood Lake Boone HAL-092-210 6/14/2021 $1,000.00 A2 10A NCAC 13G .0901 (b) Personal Care And Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to provide supervision for 1 of 5 sampled resident related to falls.
The Covington HAL-092-181 5/3/2021 $2,000.00 A2 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to ensure supervision in accordance with current symptoms.
Novelty Healthcare III FCL-092-249 3/1/2021 $500.00 A2 10A NCAC 13 G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify the mental health and/or primary care physician for 1 of 1 sampled resident, who refused medications, had increased symptoms of depression leading to self harm. Paid in Full $500.00 4/9/2021
Novelty Healthcare III FCL-092-249 3/1/2021 $500.00 A2 10A NCAC 13G .0906 Other Care and Services; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to notify residents guardian when resident's relative removed the resident from facility and failed to contact law enforcement when resident did not return to the facility within 24 hours. Paid in Full $500.00 4/9/2021

Warren County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Moore's Rest Home (Closed) FCL-093-011 4/4/2019 $2,000.00 A2 10A NCAC 13G .0909   Resident Rights G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to protect resident from physical abuse. Referred to Controller's Office 08/28/2019
Moore's Rest Home (Closed) FCL-093-011 4/4/2019 $2,000.00 A2 10A NCAC 13G .0601(a) Management and Other Staff;  G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to ensure the management and overall operation of the facility. Referred to Controller's Office 08/28/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $3,900.00 Unabated B 10A NCAC 13G .0315 Housekeeping and Furnishings; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure walls and floors were kept clean and in good repair in 4 resident rooms. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure sampled staff had a criminal background check upon hire. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $3,000.00 Unabated B 10A NCAC 13G .0406(a)(5) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure sampled staff were tested upon hire for tuberculosis (TB) disease. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .0902(c)(3-4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the implementation of physician's order for sampled residents. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G . 0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure supervision was provided for resident who eloped from the facility. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered for sampled residents. Referred to Controller's Office 09/18/2019
Moore's Rest Home (Closed) FCL-093-011 7/1/2019 $6,000.00 A2 10A NCAC 13G .0601 Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the management and overall operations of the facility by failing to meet and monitor rules related to personal care and supervision. Referred to Controller's Office 09/18/2019
Pivotal Care FCL-093-012 7/7/2021 $6,000.00 A1 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Resident's Rights Administrator failed to ensure the total operation of the facility to meet and maintain rules related to infection prevention and control program related to COVID-19, medication administration, health care, training on cardio-pulmonary resuscitation, test for tuberculosis, adult care home medication aide training and competency evaluation requirements, housekeeping and furnishing, building service equipment, orders for self-administration of medication, and staff qualifications.
Pivotal Care FCL-093-012 7/7/2021 $3,500.00 A1 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure follow-up for acute and routine healthcare needs for 2 sampled residents.
Pivotal Care FCL-093-012 7/7/2021 $1,750.00 A1 10A NCAC 13G .1701 Infection Prevention and Control Program; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance established by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (NC DHHS) were implemented and maintained to provide protection of the residents during the global coronavirus (COVID-19) pandemic.

Washington County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Marie Webb's Family Home Care FCL-094-003 8/26/2021 $2,000.00 A2 10A NCAC 13 G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 3 sampled residents in accordance with assessed needs and current symptoms.
Marie Webb's Family Home Care FCL-094-003 8/26/2021 $2,000.00 A2 10A NCAC 13 G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure total operation of the facility to maintain substantial compliance with rules related to test for tuberculosis, health care, other staff qualifications, training in cardio-pulmonary resuscitation, personal care and supervision, resident care plan, adult care home infection prevention, medication orders, nutrition and food service, and tuberculosis and medical examination.

Wayne County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Fremont Rest Center HAL-096-024 8/31/2021 $4,000.00 A1 10A NCAC 13F .0901(b)  Personal Care and Supervision; G.S. 131D-21(4)   declaration of Residents' Rights Facility failed to provide supervision to 1 of 5 sampled residents. Appealed 09/07/2021
Countryside Village HAL-096-049 8/26/2021 $4,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up to meet the needs of 2 of 4 sampled residents by failing to notify the primary care provider of reported sexual abuse by a staff member and changes in behavior after reported sexual abuse. Appealed 09/21/2021
Countryside Village HAL-096-049 8/26/2021 $9,000.00 A1 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to protect 2 of 2 sampled residents from sexual abuse after witnessed incidences by other staff from Staff B. Appealed 09/21/2021
Countryside Village HAL-096-049 8/26/2021 $4,000.00 A2 10A NCAC 13 F .1212(d) Reporting of Accidents and Incidents; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to immediately notify local law enforcement for 2 of 2 sampled residents after staff reported an allegation of sexual abuse from Staff B. Appealed 09/21/2021
Countryside Village HAL-096-049 8/26/2021 $9,000.00 A1 G.S. 131D-25 Implementation; Declaration of Residents' Rights; G.S. 131D-21(4)  Declaration of Residents' Rights Administrator/Executive Director failed to ensure total operation of the facility to maintain substantial compliance with rules related to health care, resident rights, reporting of accidents and incidents, and health care personnel registry. Appealed 09/21/2021
Brookdale Country Day Road HAL-096-026 8/5/2019 $2,000.00 A2 10A NCAC 13F .0604(e) Personal Care and Other Staffing; G.S. 131D-21(4) Declaration of Residents' Rights (4) Facility failed to ensure aide hours met the minimum requirements on 14 sampled shifts. Paid in Full $2,000.00 9/4/2019
Brookdale Country Day Road HAL-096-026 8/5/2019 $500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure supervision was provided for sampled residents who had multiple falls. Paid in Full $500.00 9/4/2019
Countryside Village HAL-096-049 8/26/2021 $9,000.00 A1 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21(4) Declaration of Residents' Rights Failed to report allegations of sexual abuse of residents by a staff to Health Care Personnel Registry within the 24 hours and 5 days. Appealed 09/21/2021
Eagle's Pointe HAL-096-051 8/26/2021 $10,500.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to provide supervision for 2 of 7 sampled residents according to current symptoms and assessed needs resulting in elopement and injury. Appealed 09/24/2021
Eagle's Pointe HAL-096-051 8/26/2021 $5,250.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care referral and follow up for 4 of 6 sampled residents related to physician notification for changes in condition and a physical therapy referral. Appealed 09/24/2021
Eagle's Pointe HAL-096-051 8/26/2021 $5,250.00 A2 10A NCAC 13 F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (DHHS) and local health department (LHD) were implemented and maintained when caring for the residents during the global coronavirus (COVID-19) pandemic. Appealed 09/24/2021
Eagle's Pointe HAL-096-051 8/26/2021 $4,000.00 A1 G.S. 131D-25 Implementation; G.S. 131D-21(4) Declaration of Residents' Rights Administrator failed to ensure the overall operations of facility to maintain substantial compliance with rule and regulations governing health care, resident rights, personal care and supervision, and medication administration. Appealed 09/24/2021
Eagle's Pointe HAL-096-051 8/26/2021 $9,000.00 A1 10A NCAC 13 F .1004(a) Medication Administration; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to administer medications as ordered and in accordance with the facility's policy for 2 of 5 sampled residents. Appealed 09/24/2021
You're At Home With Sozo FCL-096-052 8/26/2021 $2,000.00 A2 10A NCAC 13 G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC) and the North Carolina Department of Health and Human Services (DHHS) were implemented and maintained when caring for residents during the global Coronavirus (COVID-19) pandemic.
You're At Home With Sozo FCL-096-052 8/26/2021 $2,000.00 A2 10A NCAC 13 G .0601(a) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Administrator failed to ensure the total operation of the facility tomaintain substantial compliance with rules related resident rights, health care, medication administration, adult care home medication aides training and competency, test for tuberculosis, other staff qualifications, training on cardio-pulmonary resuscitation, tuberculosis test and medical examination, resident assessment, nutrition and food service, and examination and screening for the presence of controlled substances for employment in adult care homes.
Eagle's Pointe HAL-096-051 7/21/2021 $7,000.00 A1 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Resident's Rights Facility failed to provide supervision for 2 of 2 sampled residents in accordance with the facility's policies and procedures and each residents' assessed needs and current symptoms resulting in serious physical harm. Appealed 08/20/2021
Eagle's Pointe HAL-096-051 6/14/2021 $4,000.00 A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Resident's Rights The facility failed to administer medications as ordered and in accordance with the facility's policies. Appealed 07/09/2021
Countryside Village HAL-096-049 3/1/2021 $3500.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referrals were made for 2 of 2 sampled residents related to physical therapy and occupational therapy and orders for una boots to be applied by a Home Health nurse. Paid in Full $3,500.00 5/12/2021
Countryside Village HAL-096-049 3/1/2021 $1500.00 A1 10A NCAC 13F .1004 (a)  Medication Administration; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 1 of 6 residents observed during the medication pass, including errors with an anticoagulant, a mineral supplement, and a nasal spray. Paid in Full $1,500.00 5/12/2021

Wilkes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rose Glen Manor HAL-097-015 8/24/2020 $3,750.00 Unabated B 10A NCAC 13F .1004 (a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to administer medications as ordered for 4 of 6 residents sampled. Settlement Fulfilled 05/03/2021 Settlement Agreement 02/26/2021 Appealed 09/23/2020 $3,500.00 4/1/2021

Wilson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Called 2 Care Family Home #3 (Closed) FCL-098-034 9/8/2021 $9,975.00 Unabated B 10A NCAC G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the residents' evacuation capabilities were in accordance with the evacuation capability listed on the facility's current license for 1 of 4 sampled residents.
Wilson Assisted Living HAL-098-027 8/31/2021 $12,000.00 A2 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow up to meet the healthcare needs for 5 of 5 residents sampled for podiatry referral, dermatology, physical and occupational therapy referra, home health skilled nursing referral, delay in notification of wounds, orthopedic, speech and physical therapy referral, and laboratory and dental services.
Parkwood Village HAL-098-030 8/26/2021 $7,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 5 sampled residents in accordance with assessed needs who resided in the special care unit.
Wilson Assisted Living HAL-098-027 8/26/2021 $15,000.00 A1 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 3 of 5 sampled residents with known history of multiple falls with injuries.
Wilson Assisted Living HAL-098-027 8/26/2021 $15,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure health care services and follow up for 3 of 5 sampled residents related to physician notification, diabetic shoes, physical therapy, and failing to send a resident emergency room as instructed by the home health nurse
Parkwood Village HAL-098-029 2/19/2019 $16,000.00 A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral to meet the acute health care needs of 2 residents who were delayed in receiving treatment and subsequently expired and another resident delayed in being sent to the hospital after a fall. Paid in full $16,000.00 3/13/2019
Wilson Assisted Living HAL-098-027 4/4/2019 $4,000.00 A2 10A NCAC 13F .1004(a)   G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure medications were available and administered as ordered for sampled residents. Paid in Full $4,000.00 6/4/2019
Wilson Assisted Living HAL-098-027 4/4/2019 $7,000.00 A1 10A NCAC 13F .0901(b)   G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to implement supervision interventions to address the current symptoms and assessed needs for sampled residents. Paid in Full $7,000.00 6/4/2019
Wilson Assisted Living HAL-098-027 12/9/2019 $20,000.00 A2 G.S. 131D-25 Implemenation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the overall management, operations, and policies and procedures of the facility were developed and implemented. Paid in Full 08/05/2020 Referred to Controller's Office 04/07/2020 $116,375.00 total for 3 penalties 8/5/2020
Wilson Assisted Living HAL-098-027 12/9/2019 $20,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure the primary care provider was notified of changes in condition and acute health care needs for 3 residents. Paid in Full 08/05/2020 Referred to Controller's Office 04/07/2020 $116,375.00 total for 3 penalties 8/5/2020
Wilson Assisted Living HAL-098-027 12/9/2019 $75,375.00 Unabated A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights Facility failed to ensure 4 sampled residents received their medication as ordered by the primary care provider. Paid in Full 08/05/2020 Referred to Controller's Office 04/07/2020 $116,375.00 total for 3 penalties 8/5/2020
Wilson Assisted Living HAL-098-027 9/14/2020 $8,000.00 A2 10A NCAC 13F .0901 (b)   Personal Care and Supervision; G.S. 131D-21(4)   Declaration of Residents' Rights Facility failed to provide supervision for 3 of 7 sampled residents. Paid in Full $8,000.00 10/16/2020
Wilson Assisted Living HAL-098-027 9/14/2020 $9,000.00 A2 G.S. 131D-25 Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the overall management, operations, and policies and procedures of the facility were developed and implemented to maintain substantial compliance with the rules and statutes governing adult care homes as related to health care, medication administration, personal funds, personal care and supervision. Paid in Full $9,000.00 10/16/2020
Wilson House HAL-098-023 7/21/2021 $3,500.00 A2 10A NCAC 13F .1308(a) Special Care Unit Staffing; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure minimum staff were present to meet the needs of Special Care Unit residents (SCU) for 17 of 24 shifts sampled for 8 days from January 2020 to May 2020. Appealed 08/20/2021
Wilson House HAL-098-023 7/21/2021 $10,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure referral and follow up for the acute and routine health care needs for 6 of 12 sampled residents. Appealed 08/20/2021
Wilson House HAL-098-023 7/21/2021 $8,000.00 A1 G.S. 131-25  Implementation; G.S. 131D-21(4)   Declaration of Residents' Rights Administrator failed to ensure the management, total operations, and policies and procedures were implemented to maintain each resident's right and to receive appropriate and adequate care and services and to be free from serious neglect. Appealed 08/20/2021
Wilson House HAL-098-023 7/21/2021 $3,500.00 A2 10A NCAC 13F .0901(b)   Personal Care and Supervision; G.S. 131D-21(2)   Declaration of Resident's Rights Facility failed to provide supervision for 3 of 12 residents sampled with multiple falls resulting in serious physical injuries. Appealed 08/20/2021
Wilson House HAL-098-023 7/21/2021 $8,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure recommendations and guidance by the Centers for Disease Control (CDC), the North Carolina Department of Health and Human Services (DHHS) and directives from the local health department (LHD) were implemented and maintained when caring for the residents during the global coronavirus (COVID-19) pandemic. Appealed 08/20/2021
Called 2 Care Family Home #3 (Closed) FCL-098-034 6/14/2021 $2,000.00 A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure the recommendations and guidance issued by the Centers for Disease Control (CDC) and North Carolina Division of Health and Human Services (NC DHHS) during the global pandemic of COVID-19. r Appealed 06/23/2021
Called 2 Care Family Home #3 (Closed) FCL-098-034 6/14/2021 $13,300.00 Unabated B 10A NCAC 13G .0302(b) Design and Construction; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure the residents' evacuation capabilities were in accordance with the evacuation capability listed on the facility's current license. Appealed 06/23/2021
Wilson House HAL-098-023 5/3/2021 $4,000.00 A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Resident's Rights Facility failed to ensure residents were free of physical abuse. Appealed 06/01/2021

Yadkin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Patriot Living of Yadkinville HAL-099-015 8/26/2021 $3,000.00 A1 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure referral and follow up for 1 of 5 sampled residents related to wounds. ountryside

Yancey County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $1,500.00 A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for sampled residents resulting in the resident with exit seeking behaviors leaving the facility unnoticed by staff. Paid in Full $1,500.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $4,000.00 A2 10A NCAC 13F .0902(c)(4) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure primary care provider orders were implemented for sampled residents. Paid in Full $4,000.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 6/4/2019 $3,000.00 A2 10A NCAC 13F .0305(h)(3) Physical Environment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure that all exit doors were easily operable, by a single hand motion from the inside at all times without keys. Paid in Full $3,000.00 1/6/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1004(a)   Medication Administration; G.S. 131D-21(2)   Declaration of Residents' Rights The facility failed to administer medications as ordered for 2 residents. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to follow-up to obtain a three night sleep study for 1 resident. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 11/18/2019 $12,000.00 A2 10A NCAC 13F .1002(a)   Medication Orders; G.S. 131D-21   Declaration of Residents' Rights The facility failed to ensure clarification of medication orders for 2 residents. Referred to Controller's Office 04/07/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 8/7/2020 $16,000.00 A2 10A NCAC 13 F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision for 1 of 3 sampled residents according to current symptoms and assessed needs. Settlement Agreement 06/25/2021 Appealed 12/30/2020
Southern Living for Seniors of Burnsville, NC HAL-100-006 8/7/2020 $126,000.00 Unabated A 10A NCAC 13 F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure referral and follow up for 1 of 4 sampled residents with a physician's order for physical therapy for evaluation and treatment. Settlement Agreement 06/25/2021 Appealed 12/30/2020