Pine Forest Rest Home

Facility Information

License Number: HAL-066-001
Site Address: 3277 HWY 35
Woodland, NC 27897
County:Northampton
Capacity: 24 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 Follow-up No Deficiencies Cited 3/4/2021 No
Other Statement of Deficiency with Plan of Correction 10/22/2020 13 No
Other Statement of Deficiency 10/22/2020 13 No
ACLS Follow-up Statement of Deficiency with Plan of Correction 1/23/2020 8 No
ACLS Annual and Follow-up Statement of Deficiency 9/19/2019 37 No
ACLS Annual Statement of Deficiency with Plan of Correction 1/13/2016 8 No
ACLS Annual Statement of Deficiency 1/13/2016 7 No
Constr Biennial Follow-up No Deficiencies Cited 9/4/2018 0 No
Constr Biennial Statement of Deficiency with Plan of Correction 8/2/2018 1 No
Constr Biennial Statement of Deficiency 8/2/2018 1 No
Constr Biennial Follow-up No Deficiencies Cited 10/28/2016 0 No
Constr Biennial Statement of Deficiency with Plan of Correction 8/24/2016 6 No
Constr Biennial Statement of Deficiency 8/24/2016 6 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 
Three Stars (3) 91 4/27/2020 7.5 0 Follow-up View Worksheet
Two Stars (2) 83.5 3/4/2020 1 17.5 Annual View Worksheet
Four Stars (4) 103.5 2/10/2016 3.5 0 Annual View Worksheet
Four Stars (4) 103.5 9/6/2013 3.5 0 Annual View Worksheet
Four Stars (4) 103.5 6/27/2012 3.5 0 Annual View Worksheet
Three Stars (3) 103.5 6/21/2011 3.5 0 Annual View Worksheet
Three Stars (3) 99 3/24/2010 1 2 Annual View Worksheet
Three Stars (3) 101 5/19/2009 1 0 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
8/31/2021 $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.