| License Number: | HAL-030-010 |
| Site Address: |
191 Crestview Drive Mocksville, NC 27028 |
| County: | Davie |
| Capacity: | 40 Beds |
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 Type | Document Type | Inspection Date | Pages | IDR Pending |
|---|---|---|---|---|
| ACLS Complaint | Statement of Deficiency | 9/15/2023 | 35 | No |
| ACLS Complaint | Statement of Deficiency with Plan of Correction | 9/15/2023 | 35 | No |
| ACLS Follow-up | Statement of Deficiency with Plan of Correction | 8/24/2023 | 17 | No |
| ACLS Follow-up | Statement of Deficiency | 8/24/2023 | 17 | No |
| ACLS Follow-up | Statement of Deficiency with Plan of Correction | 5/10/2023 | 49 | No |
| ACLS Follow-up | Statement of Deficiency | 5/10/2023 | 49 | No |
| ACLS Annual and Follow-up | Statement of Deficiency | 2/3/2023 | 87 | No |
| ACLS Annual and Follow-up | Statement of Deficiency with Plan of Correction | 2/3/2023 | 85 | No |
| ACLS Annual and Complaint | Statement of Deficiency with Plan of Correction | 12/31/2019 | 381 | No |
| ACLS Annual and Complaint | Statement of Deficiency | 12/13/2019 | 327 | No |
| ACLS Complaint and Follow-up | Statement of Deficiency | 12/18/2017 | 41 | No |
| ACLS Complaint and Follow-up | Statement of Deficiency with Plan of Correction | 12/8/2017 | 44 | No |
| ACLS Annual and Complaint | Statement of Deficiency with Plan of Correction | 8/26/2017 | 140 | No |
| ACLS Annual and Complaint | Statement of Deficiency | 8/26/2017 | 137 | No |
| ACLS Follow-up | No Deficiencies Cited | 6/21/2016 | No | |
| ACLS Annual | Statement of Deficiency | 2/4/2016 | 19 | No |
| ACLS Annual | Statement of Deficiency with Plan of Correction | 2/4/2016 | 19 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 10/24/2023 | 18 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 10/24/2023 | 18 | No |
| Constr Biennial Follow-up | No Deficiencies Cited | 6/6/2019 | 0 | No |
| Constr Biennial Follow-up | Statement of Deficiency | 3/14/2019 | 5 | No |
| Constr Biennial Follow-up | Statement of Deficiency with Plan of Correction | 3/14/2019 | 7 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 1/4/2019 | 16 | No |
| Constr Biennial | Statement of Deficiency | 1/4/2019 | 11 | No |
| Constr Biennial Follow-up | No Deficiencies Cited | 5/10/2017 | 0 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 3/21/2017 | 3 | No |
| Constr Biennial | Statement of Deficiency | 3/21/2017 | 3 | No |
| Constr Biennial Follow-up | No Deficiencies Cited | 4/28/2015 | 0 | No |
| Constr Biennial | Statement of Deficiency | 3/4/2015 | 4 | No |
| Constr Biennial | Statement of Deficiency with Plan of Correction | 3/4/2015 | 5 | No |
Star Ratings are based on the results of DHSR inspections and some inspections by the County Department of Social Services (DSS).
| Stars | Score | Issue Date | Merits | Demerits | Inspection Type | ||
|---|---|---|---|---|---|---|---|
|
(3) | 102.5 | 1/5/2024 | 2.5 | 0 | Annual | View Worksheet |
| (ZERO STARS) | (0) | 57.25 | 11/1/2023 | 0 | 22 | Complaint | View Worksheet |
|
(1) | 79.75 | 10/5/2023 | 2.5 | 2 | Follow-up | View Worksheet |
|
|
(1) | 79.25 | 6/16/2023 | 6.25 | 10 | Follow-up | View Worksheet |
|
(2) | 83 | 3/9/2023 | 0 | 17 | Annual | View Worksheet |
| (ZERO STARS) | (0) | 25.5 | 1/20/2022 | 5 | 0 | Reissue | View Worksheet |
| (ZERO STARS) | (0) | 20.5 | 3/4/2020 | 0 | 79.5 | Annual | View Worksheet |
| (ZERO STARS) | (0) | 38 | 3/4/2020 | 2.5 | 0 | County Monitoring Visit | View Worksheet |
| (ZERO STARS) | (0) | 35.5 | 4/10/2019 | 0 | 10 | County Monitoring Visit | View Worksheet |
| (ZERO STARS) | (0) | 45.5 | 4/10/2019 | 10 | 0 | Follow-up | View Worksheet |
| (ZERO STARS) | (0) | 35.5 | 2/9/2018 | 27.5 | 14 | Follow-up | View Worksheet |
| (ZERO STARS) | (0) | 22 | 11/7/2017 | 0 | 78 | Annual | View Worksheet |
|
|
(3) | 100.25 | 7/12/2016 | 1.25 | 0 | Follow-up | View Worksheet |
|
|
(3) | 99 | 2/23/2016 | 2.5 | 3.5 | Annual | View Worksheet |
|
|
(3) | 95 | 8/26/2014 | 3.75 | 0 | Follow-up | View Worksheet |
|
|
(3) | 91.25 | 6/23/2014 | 1.25 | 9 | Follow-up | View Worksheet |
|
|
(3) | 99 | 4/3/2014 | 2.5 | 3.5 | Annual | View Worksheet |
|
|
(3) | 96.5 | 1/30/2013 | 2.5 | 6 | Annual | View Worksheet |
|
|
(3) | 102.5 | 4/25/2011 | 2.5 | 0 | Annual | View Worksheet |
|
|
(3) | 97 | 3/24/2010 | 2.5 | 0 | Follow-up | View Worksheet |
|
|
(3) | 94.5 | 12/31/2009 | 0 | 5.5 | Annual | View Worksheet |
Penalties imposed during the last 36 months are listed.
| Facility | Facility License | Inspection Date & Nature of Validation | Rules Areas Cited | Level Cited | Penalty Amount | Date Penalty Imposed | Current Status |
|---|---|---|---|---|---|---|---|
| PS Senior Living of Mocksville | HAL-030-010 | 5/10/2023 | 10A NCAC 13F .1004(a) Medication Administration | A2 | 2000 | 8/2/2023 | Paid in Full |