Providence Assisted Living

Facility Information

License Number: HAL-051-061
Site Address: 4302 NC 210
Smithfield, NC 27577
County:Johnston
Capacity: 20 Beds

Statement of Deficiencies

Statements of Deficiencies (form used by the state to document inspections) are posted for adult care facilities with survey dates beginning November 1, 2014 and deficiencies or violations were identified.

Note:  A Yes under the column, IDR Pending, indicates the facility has requested Informal Dispute Resolution (IDR), a process that gives a facility the opportunity to dispute all or some of the findings of a state inspection. If the Statement of Deficiency is changed as a result of IDR, the web page will be updated.

Inspection TypeDocument TypeInspection DatePagesIDR Pending
ACLS Annual and Follow-up Statement of Deficiency with Plan of Correction 8/11/2022 12 No
ACLS Annual and Follow-up Statement of Deficiency 8/11/2022 9 No
ACLS Annual Statement of Deficiency 1/22/2020 3 No
ACLS Annual and Complaint Statement of Deficiency 1/12/2017 65 No
ACLS Follow-up No Deficiencies Cited 7/31/2015 No
Constr Biennial Follow-up No Deficiencies Cited 10/5/2023 0 No
Constr Biennial Statement of Deficiency 1/16/2020 6 No
Constr Biennial Follow-up No Deficiencies Cited 2/13/2018 0 No
Constr Biennial Statement of Deficiency with Plan of Correction 1/25/2018 8 No
Constr Biennial Statement of Deficiency 1/25/2018 8 No
Constr Biennial Statement of Deficiency 8/3/2016 7 No

Star Rating

Star Ratings are based on the results of DHSR inspections and some inspections by the County Department of Social Services (DSS).

StarsScoreIssue DateMeritsDemeritsInspection Type 
Four Stars (4) 100.5 9/19/2022 2.5 2 Annual View Worksheet
Three Stars (3) 100.5 4/22/2020 2.5 2 Annual View Worksheet
(ZERO STARS) (0) 44.5 3/5/2018 5 0 Reissue View Worksheet
(ZERO STARS) (0) 39.5 2/16/2017 0 60.5 Annual View Worksheet
Three Stars (3) 100 8/7/2015 0 0 Annual View Worksheet
Three Stars (3) 91 7/16/2015 5 0 Reissue View Worksheet
Two Stars (2) 86 5/20/2015 0 10 Reissue View Worksheet
Three Stars (3) 96 5/22/2014 0 4 Annual View Worksheet
Three Stars (3) 98 4/5/2013 0 2 Annual View Worksheet
Three Stars (3) 95.75 10/2/2012 1.25 0 Follow-up View Worksheet
Three Stars (3) 94.5 3/21/2012 0 5.5 Annual View Worksheet
Three Stars (3) 98 10/10/2011 0 2 Annual View Worksheet
Three Stars (3) 96 8/1/2011 0 4 Complaint View Worksheet
Three Stars (3) 100 9/29/2010 0 0 Annual View Worksheet
Two Stars (2) 89 3/24/2010 12.5 2 Follow-up View Worksheet
One Star (1) 78.5 9/23/2009 0 21.5 Annual View Worksheet

Penalties

Penalties imposed during the last 36 months are listed.

This facility has not received any penalties in the last three years.