Shallotte Assisted Living

Facility Information

License Number: HAL-010-008
Site Address: 520 Mulberry Street
Shallotte, NC 28470
County:Brunswick
Capacity: 80 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 Complaint Statement of Deficiency 2/25/2020 204 No
ACLS Follow-up Statement of Deficiency with Plan of Correction 6/15/2017 6 No
ACLS Follow-up Statement of Deficiency 6/15/2017 6 No
ACLS Annual and Follow-up Statement of Deficiency with Plan of Correction 1/27/2017 56 No
ACLS Annual and Follow-up Statement of Deficiency 1/27/2017 56 No
ACLS Annual and Follow-up Statement of Deficiency 1/27/2017 56 No
ACLS Annual, Complaint, and Follow-up Statement of Deficiency with Plan of Correction 7/2/2015 9 No
ACLS Annual, Complaint, and Follow-up Statement of Deficiency 7/2/2015 16 No
Constr Biennial Follow-up No Deficiencies Cited 4/14/2016 0 No
Constr Biennial Follow-up Statement of Deficiency with Plan of Correction 2/19/2016 4 No
Constr Biennial Follow-up Statement of Deficiency 2/19/2016 4 No
Constr Biennial Statement of Deficiency with Plan of Correction 11/18/2015 17 No
Constr Biennial Statement of Deficiency 11/18/2015 10 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 
(ZERO STARS) (0) -40.25 10/5/2020 0 31 Reissue View Worksheet
(ZERO STARS) (0) -9.25 10/5/2020 0 62 Complaint View Worksheet
(ZERO STARS) (0) 52.75 10/5/2020 0 10 County Monitoring Visit View Worksheet
(ZERO STARS) (0) 62.75 10/5/2020 0 3.5 County Monitoring Visit View Worksheet
(ZERO STARS) (0) 66.25 10/29/2019 2.5 0 County Monitoring Visit View Worksheet
(ZERO STARS) (0) 63.75 10/29/2019 0 10 County Monitoring Visit View Worksheet
One Star (1) 73.75 10/29/2019 5 0 County Monitoring Visit View Worksheet
(ZERO STARS) (0) 68.75 5/8/2018 0 20 County Monitoring Visit View Worksheet
Two Stars (2) 88.75 8/23/2017 8.75 2 Follow-up View Worksheet
Two Stars (2) 82 3/13/2017 3.5 21.5 Annual View Worksheet
Three Stars (3) 101.5 7/17/2015 3.5 2 Annual View Worksheet
Three Stars (3) 92 4/29/2015 0 0 Reissue View Worksheet
(ZERO STARS) (0) 42 5/19/2014 6 4 Annual View Worksheet
(ZERO STARS) (0) 45.75 9/25/2013 16.25 0 Follow-up View Worksheet
(ZERO STARS) (0) 29.5 6/28/2013 15 22.5 Follow-up View Worksheet
(ZERO STARS) (0) 37 4/25/2013 3.5 66.5 Annual View Worksheet
Two Stars (2) 88.5 1/30/2013 2.5 4 Annual View Worksheet
Three Stars (3) 94 4/13/2012 6 2 Annual View Worksheet
Two Stars (2) 89.25 4/13/2012 3.75 0 Follow-up View Worksheet
Two Stars (2) 85.5 7/18/2011 0 13.5 Complaint View Worksheet
Three Stars (3) 99 7/18/2011 1 2 Annual View Worksheet
Three Stars (3) 96.5 3/24/2010 2.5 2 Follow-up View Worksheet
Three Stars (3) 96 1/14/2010 3.5 7.5 Annual View Worksheet

Penalties

Penalties imposed during the last 36 months are listed.

Penalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
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 Paid in Full $9,000.00 1/8/2020
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
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
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
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
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
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 accountability of the personal funds for residents sampled. Settlement Agreement 08/20/2021 Appealed 09/18/2020