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 since January 2006.
This is the list of facilities, by county names, that have been found in violation of one or more rules since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Agape Family Care | FCL-001-106 | 4/4/2007 | $1,250.00 | Type A | 10A NCAC 13G .0601 Management & Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident was left unsupervised and locked out of facility | Paid in Full | $1375.00 | 6/14/2007 |
| Alvarado's Family Care | FCL-001-101 | 6/27/2007 | $2,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights | Staff allowed Alzheimer resident to walk on facility grounds unsupervised; she was killed when struck by vehicle backing out of driveway | Partial pmt. Paid in Full |
$1,000.00 $1,000.00 |
07/18/2007 07/25/2007 |
| Angel's Family Care Home | FCL-001-119 | 5/14/2008 | $9,000.00 | Type B Unabated | 10A NCAC 13G .0406 (a)(5)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background checks were not conducted for 6 staff and Health Care Personnel registry verification did not occur for 3 staff | Referred to Controller's Office | ||
| Angels Family Care Home | FCL-001-119 | 1/18/2008 | $2,850.00 | Not corrected Type B | 10A NCAC 13G .1004 (b) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Both staff administering medications had not completed the clinical skills validation prior to administration of medications | Referred to Controller's Office | ||
| Angels Family Care Home II | FCL-001-078 | 11/19/2007 | $4,890.00 | Not corrected Type B | 10A NCAC 13G .1004 Medication Administration, 10A NCAC 13G .0403 (a) Qualifications of Medication Staff; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered to 6 of 6 residents; facility failed to ensure staff administering medications were competency validated to administer medications | Referred to Controller's Office | ||
| Burlington Manor | HAL-001-024 | 1/16/2013 | $1,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident with wandering behaviors resulting in his elopement from the facility | Paid In Full | $1,000.00 | 2/7/2013 |
| Clare Bridge at Burlington Manor dba Discovery Program | HAL-001-028 | 7/20/2011 | $60,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide adequate supervision during meals resulting in a resident's choking and subsequent death | Appealed 8/19/2011 | ||
| Clare Bridge at Burlington Manor dba Discovery Program | HAL-001-028 | 11/10/2010 | $14,000.00 | Type A | 10A NCAC 13F .0305 Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident who entered the kitchen and ingested a chemical degreaser product left on a cart in the kitchen. The resident later expired. | Paid in Full | $14,000.00 | 11/30/2010 |
| Dogwood Forest / Nicole Building | HAL-001-005 | 11/10/2010 | $7,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility staff person threw hot water from the coffee maker on a resident in response to the resident's verbal remarks. The resident suffered second and third degree burns. | Paid in Full; 3/9/2011 Settlement Agreement $6,500.00; Appealed 12/9/2010 | $6,500.00 | 3/10/2011 |
| Hearts of Gold II | FCL-001-124 | 2/14/2012 | $8,500.00 | Type A | 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to one resident with unsafe eating behavior | Appealed 2/29/2012 | ||
| Jeffreys Rest Home | FCL-001-016 | 1/13/2009 | $3,100.00 | Type B Unabated | 10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure at least one staff on duty had cardio-pulmonary resuscitation | Referred to Controller's Office | ||
| L M & S Adult Care No 2 | FCL-001-063 | 7/20/2011 | $500.00 | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure health care referral and follow-up occurred for two residents related to appointment for lab and medication injection as well as to address bleeding that was noted to be occurring | Paid in Full | $500.00 | 12/6/2011 |
| L M & S Adult Care No. 2 | FCL-001-063 | 7/14/2006 | $1,350.00 | Not corrected Type B | 10A NCAC 13G .0406 Other Staff Qualifications | Criminal background checks for 4 staff members were not done before hiring | Partial pmt. Partial pmt. Paid in Full |
$500.00 $500.00 $350.00 |
9/14/2006 10/30/2006 11/07/2006 |
| L M & S Adult Care No. 2 | FCL-001-063 | 3/20/2008 | $2,000.00 | Type B Unabated | 10A NCAC 13G .0406 (a)(5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Healthcare registry verification was not conducted for one staff on first visit and for 3 of 6 staff on revisit | Referred to the Controller's Office Partial pmt. Paid in Full |
$500.00 | 05/29/2008 02/04/2009 |
| McCray Comfort Inn | FCL-001-024 | 12/18/2008 | $100.00 | Type B Unabated | 10A NCAC 13G .0406 (a)(5)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background check and Health Care Personnel registry verification did not occur for one staff person | Paid in Full | $100.00 | 1/16/2009 |
| The Oaks of Burlington | HAL-001-011 | 10/30/2007 | $6,160.00 | Not corrected Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents Rights | Residents continued to not receive medications as ordered | Paid in Full; Settlement Agreement 3/19/08; Appealed 12/3/07 | Training Completed; $2,500.00 | 05/30/2008 04/02/2008 |
| Rainbow of Love #2 | FCL-001-112 | 1/26/2007 | $1,230.00 | Not corrected Type B | 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background checks were not conducted on two staff | Referred to the Controller's Office | ||
| Rainbow of Love #3 | FCL-001-111 | 1/8/2007 | Staff Training | Not corrected Type B | 10A NCAC 13G .0406(a)(7) Other Staff Qualifications | Criminal background checks were not conducted on two staff | Facility Closed | ||
| Rainbow of Love #3 | FCL-001-111 | 1/8/2007 | Staff Training | Not corrected Type B | 10A NCAC 13G .0403 (a) Qualifications of Medication Staff | Staff administering medications had not completed the clinical skills validation prior to administration of medications. | Facility Closed | ||
| A Touch of Country Family Care | FCL-001-121 | 3/20/2013 | $500.00 | Type A2 | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to ensure one of six residents was free of abuse and neglect from staff | |||
None of the facilities in Alexander County have received a penalty since January 2006.
None of the facilities in Alleghany County have received a penalty since January 2006.
None of the facilities in Anson County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Ashe Assisted Living & Memory Care | HAL-005-013 | 2/15/2012 | $3,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of residents residing on the Special Care Unit to prevent falls which resulted in injury | Paid in Full | $3,000.00 | 3/14/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cranberry House | HAL-006-006 | 12/19/2012 | $2,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to provide personal care and supervision for 8 residents related to bathing, incontinence care, nail care and supervision during dining | Appealed 01/18/2013 | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Wooded Acres #6 | FCL-007-017 | 9/15/2011 | $500.00 | Type A | 10A NCAC 13G .0906 (f)(4) Other Resident Services; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to notify appropriate law enforcement agency and county DSS office when one resident left the facility and whereabouts remained unknown | Paid in Full | $500.00 | 11/10/2011 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cherry's Family Care Home | FCL-008-002 | 5/14/2008 | $1,000.00 | Type A | 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medication was not administered as ordered; resident did not receive insulin as ordered resulting in ER treatment | Paid in Full; Referred to Controller's Office | $1,100.00 | 1/9/2009 |
| Cherry's Family Care Home #2 (Facility Closed) | FCL-008-023 | 5/19/2011 | $10,000.00 | Type A | 10A NCAC 13G .0901(b) Personal Care & Supervision; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to meet the behaviorial needs of two residents and failed to provide referral and follow-up for mental health and medical treatment | Referred to Controller's Office | ||
| Cherry's Family Care Home #2 | FCL-008-023 | 3/18/2010 | $1,000.00 | Type A | 10A NCAC 13G .1213 (g) Reporting of Accidents & Incidents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to notify resident's mental health provider of resident's threatening behavior and physical assaults on a resident and staff | Referred to Controllers Office | ||
| Cherry's Family Care #2 | FCL-008-023 | 1/13/2009 | $4,500.00 | Type A | 10A NCAC 13G .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to refer resident for mental health assessment following multiple threats of suicide; resident ingested gasoline and required emergency medical treatment | Paid in Full | $5.210.27 | 1/11/2010 |
| Cherry's Family Care Home #2 | FCL-008-002 | 8/27/2007 | $4,500.00 | Type A | 10A NCAC 13G .0906 Other Resident Services; G.S. 131D-21 (2) Residents' Rights | Staff failed to notify family or law enforcement when resident left and failed to return to the facility | Paid in Full | $5,040.00 | 1/3/2008 |
| Cherry's Family Care Home #7 | FCL-008-018 | 11/19/2007 | $1,000.00 | Type A | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to protect two residents from physical abuse by staff | Decision Upheld Appealed 12/21/07 | $1,000.00 | 5/20/2009 |
| Pathways II | FCL-008-001 | 10/15/2012 | $3,500.00 | Type A1 | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to assure residents were free from physical abuse | Paid in Full | $3,500.00 | 11/16/2012 |
| Pathways III | FCL-008-019 | 6/18/2012 | $1,000.00 | Type A2 | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to ensure one resident was free of physical and mental abuse from a staff person | Paid in Full | $1,000.00 | 8/8/2012 |
| River's Edge Rest Home | HAL-008-017 | 10/31/2007 | $2,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights | Facility failed to obtain medical referral and follow-up as needed for two residents | Referred to Controller's Office | ||
| Windsor House | HAL-008-022 | 7/16/2010 | $6,180.00 | Unabated Type B | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide referral and follow-up with physician to meet needs of two residents | Appealed 9/8/10 | ||
| Windsor House | HAL-008-027 | 4/17/2012 | $1,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure supervision of one resident with disorientation who left the facility unsupervised | Appealed 05/17/2012 | ||
| Windsor House | HAL-008-027 | 9/15/2011 | $500.00 & $1,500.00 Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to two residents with increased needs for supervision and care to prevent falls and injuries | Appealed 10/10/2011 | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| A & C Family Care, Inc | FCL-009-020 | 5/18/2010 | $8,500.00 | Type A | 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to obtain and administer medication as ordered to address resident diabetic condition resulting in hospitalization | Paid In Full; Partial Pmt. 11/8/2010 Settlement Agreement $3,000.00 Appealed 05/24/2010 | $300.00 $350.00 $1,000.00 $350.00 $1000.00 | 3/03/2011 2/2/20011 1/07/2011 1/05/2011 11/10/2010 |
| Bladenboro Assisted Retirement Community | HAL-009-019 | 9/26/2007 | Staff Training | Type A | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents did not receive medications as ordered | Change of Ownership | ||
| Bladenboro Assisted Retirement Community | HAL-009-019 | 2/21/2008 | $2,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to notify physician of one insulin dependent resident' s blood sugars as ordered | Referred to Controller's Office Change of Ownership | ||
| Bladenboro Assisted Retirement Community (Penalty #1) | HAL-009-019 | 5/14/2008 | $3,480.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights | Residents did not receive medications as ordered | Referred to Controller's Office Change of Ownership | ||
| Bladenboro Assisted Retirement Community (Penalty #2) | HAL-009-019 | 5/14/2008 | $3,480.00 | Type B Unabated | 10A NCAC 13F. 0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Residents did not receive personal care assistance with toileting, bathing, grooming and transfers; staff failed to respond to calls during third shift | Referred to Controller's Office Change of Ownership | ||
| Cape Fear Manor (Penalty #1) | HAL-009-001 | 2/19/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to meet surgical consult, podiatry, dental, psychiatric and medical needs of seven residents | |||
| Cape Fear Manor (Penalty #2) | HAL-009-001 | 2/19/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .1002 Medication Orders; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to verify and clarify medication orders for two residents returning to facility from hospitalizations | |||
| Cape Fear Manor (Penalty #3) | HAL-009-001 | 2/19/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure the administrator managed the facility to be in compliance with regulations | |||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Corinthian Place Inc | HAL-010-006 | 1/21/2010 | $14,000.00 | Type A | 10A NCAC 13F. 0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to provide supervision to address three residents increased need for supervision to address falling, increased aggression and wandering behaviors | Referred to Controllers' Office | ||
| Eldo Family Care Home #1 | FCL-010-002 | 04/07/2006 | $500.00 | Type A | 10A NCAC 13G .0601 Management and Other Staff | Nine (three that lived in the facility and 6 from another facility) residents were left unattended and unsupervisedby staff | Paid in Full | $500.00 | 6/8/2006 |
| Shallotte Assisted Living | HAL-010-004 | 2/14/2012 | $7,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to protect two residents from physical and mental abuse by staff | Appealed 2/17/2012 | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Alterra Clare Bridge | HAL-011-035 | 5/3/2007 | $14,000.00 | Type A | 10A NCAC 13F .0902 (a)(b)(c) (1)(2)(3)(4) Health Care; G.S. 131D-21 (2) (4) Declaration of Residents' Rights | Facility failed to implement order for labwork; resident's decline continued with subsequent admission to hospital and death occurring later that day | OAH Decision Rescinded 8/21/2008 Appealed 6/1/07 | ||
| Canterbury Hills Adult Care Home | HAL-011-031 | 5/17/2012 | $13,600.00 | Unabated B | NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct medication admininstration problems by failing to assure six residents received medications as ordered | Appealed 6/15/2012 | ||
| Canterbury Hills Adult Care Home | HAL-011-031 | 3/15/2012 | $3,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide sufficient supervision of residents with aggressive, threatening and inappropriate behavior to prevent injury | Appealed 4/13/2012 | ||
| Clare Bridge of Asheville | HAL-011-035 | 12/19/2012 | $2,000.00 | Type A | 10A NCAC 13F .0901(a)(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure supervision for one resident with a history of exit seeking behavior who exited the facility unsupervised | Paid in Full | $2,000.00 | 1/17/2013 |
| Clare Bridge of Asheville | HAL-011-035 | 2/15/2012 | $12,000.00 | Type A | 10A NCAC 13F .0901(a)(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and services to prevent falls and resultant fractures for one resident | Paid in Full | $12,000.00 | 3/14/2012 |
| Dominion Falls Family Care Home | FCL-011-139 | 4/6/2006 | $500.00 | Type A | 10A NCAC 13G .0909 Resident Rights; 13G .0601 Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff left two residents alone and unsupervised | Paid in Full | $500.00 | 4/23/2007 |
| Dominion Falls Unit K | FCL-011-110 | 5/3/2007 | $1,600.00 | Not corrected Type B | 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal backgorund check not conducted on staff hired as live-in supervisor | Referred to Controller's Office | ||
| Dominion Falls Unit K | FCL-011-110 | 5/3/2007 | $1,600.00 | Not corrected Type B | 10A NCAC 13G .0406 (a)(5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Healthcare registry verification was not conducted for staff hired as live-in supervisor | Referred to Controller's Office | ||
| Dominion Falls Family Care Home Unit N (6) Previously known as Sunrise Family Care Home #5 | FCL-011-240 | 11/1/2007 | $2,000.00 | Type A | 10A NCAC 13G .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise incompetent resident who left the facility unattended; law enforcement not notified about absence and guardian not notified until next day | Referred to Controller's Office | ||
| Dominion Falls Family Care Home Unit O (6) Previously known as Sunrise Family Care Home #6 | FCL-011-239 | 11/1/2007 | $8,500.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise resident; resident left facility without signing self out of facility and facility failed to contact law enforcement when resident did not return | Referred to Controller's Office | ||
| Evergreen Living Homes #8 | FCL-011-245 | 10/15/2008 | $7,000.00 | Type A | 10A NCAC 13G. .0901 Personal Care and Supervision; 10A NCAC 13G .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to provide personal care services to prevent pressure sores; make timely referral to physician to address resident's congestion and notify md of resident's refusal of prescribed medications. | Referred to Controller's Office | ||
| Haywood Heights Family Care Home | FCL-011-207 | 2/21/2008 | $2,000.00 | Type A | 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain hot water temperatures in safe range for resident use in resident bathrooms | Paid in Full | $2,000.00 | 4/14/2008 |
| Heather Glen At Ardenwoods | HAL-011-151 | 4/16/2009 | Staff Training | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131-D21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to residents with wandering/elopement behavior. Residents eloped from the facility without staff knowledge | Training Completed | 6/19/2009 | |
| Holly Springs Family Care Home #5 (Ownership Change) | FCL-011-303 | 11/17/2011 | $1,000.00 & Staff Training | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide referral and follow-up to meet needs of two residents related to labs and diabetic monitoring | Referred to Controller's Office | ||
| Hominy Valley Retirement Center | HAL-011-158 | 3/18/2010 | $6,000.00 | Type A | 10A NCAC 13F .1002 (2) Medication Orders; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to clarify physician orders for 6 of 7 sampled residents including those with orders for coumidin and insulin. | Paid in Full Referred to Controllers Office | $6,650.00 | 12/23/2010 |
| Majorie McCune Memorial Center | HAL-011-011 | 5/15/2012 | $16,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up to meet the acute and routine needs for three residents | 1/31/2013 Settlement Ageement ($3,000.00 for training); Appealed 6/04/2012 | ||
| Marjorie McCune Memorial Ctr. | HAL-011-011 | 11/17/2006 | $2,800.00 | Not corrected Type B | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Insulin not administered as ordered due to blood sugar levels not monitored as ordered for four residents | Paid in Full | $2,800.00 | 12/13/2006 |
| Marjorie McCune Memorial Ctr. | HAL-011-011 | 01/23/2006 | $3,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; 13F .0902 Health Care; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident receiving Coumadin did not have lab work performed as ordered | Paid in Full | $3,000.00 | 6/19/2006 |
| Marjorie McCune Memorial Ctr. | HAL-011-011 | 04/10/2006 | $900.00 | Type A | 10A NCAC 13F .0902 Health Care; 13F .0909 Residents Rights; G.S. 131D-21 Declaration of Residents' Rights | Resident receiving Coumadin did not have lab work performed as ordered | Paid in Full | $900.00 | 6/30/2006 |
| Plemmons Family Care Home #2 | FCL-011-036 | 6/27/2007 | $3,920.00 | Not corrected Type B | 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background check not conducted on two of two staff employed by facility | Partial Payment Paid in Full |
$920.00 $3507.44 |
8/9/2007 06/13/2008 |
| Richmond Hill Rest Home #1 | HAL-011-192 | 5/19/2010 | $7,520.00 | Unabated Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to to administer medications as ordered | Paid in Full | $7,520.00 | 6/22/2010 |
| Richmond Hill Rest Home #2 (Penalty #1) | HAL-011-191 | 1/21/2011 | $2,000.00 | Type A | 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain safe water temperatures at six of six water fixtures utilized by residents | Paid in Full Partial Pmt. | $1,000.00 $1,000.00 | 03/17/2011 02/17/2011 |
| Richmond Hill Rest Home #2 (Penalty #2) | HAL-011-191 | 1/21/2011 | $2,960.00 | Unabated Type B | 10A NCAC 13F .0601 Management of Facilities; 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to meet routine and acute health care needs of four residents and failed to assure medications were administered as ordered | Paid in Full Partial Pmt. | $1,480.00 $1,480.00 | 03/17/2011 02/17/2011 |
| Richmond Hill Rest Home #3 | HAL-011-190 | 07/14/2006 | Staff Training | Type A | 10A NCAC 13F .0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; 13F .0909 Residents Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Staff left residents alone and unsupervised to attend meeting. | Training Completed | 2/7/2007 | |
| Richmond Hill Rest Home #4 | HAL-011-189 | 06/02/2006 | $1,000.00 | Type A | 10A NCAC 13F .0902 Health Care (a)(b)(c); 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident receiving Coumadin did not have lab work performed as ordered | Paid in Full | $1,000.00 | 7/21/2006 |
| Richmond Hill Rest Home #5 | HAL-011-188 | 1/21/2011 | $3,360.00 | Unabated Type B | 10A NCAC 13F .0601 Management of Facilities; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to adminster medications as ordered | Paid in Full Partial Pmt. | $1,680.00 $1,680.00 | 03/16/2011 02/17/2011 |
| Shadybrook Living Center | HAL-011-155 | 11/22/2006 | $6,000.00 $12,000.00 |
Type A | 10A NCAC 13F .1004 (a) Medication Administration; 10A NCAC 13F .1010 Pharmaceutical Services; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident with respiratory congestion did not receive ordered antibiotic timely | Settlement Agreement 5/24/07 Appealed 12/19/2006 | Paid in Full $6,000.00 | 3/6/2008 |
| Shadybrook Living Center | HAL-011-155 | 11/22/2006 | Training $7,500.00 |
Not corrected Type B | 10A NCAC 13F .0902(a)(b)(c)(3)(4) Health Care;G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident did not have blood sugar levels monitored as ordered and did not receive ordered amount of insulin | Settlement Agreement 5/24/07 Training Appealed 12/19/2006 | Training Completed 3/27/08 | |
| Shadybrook Living Center | HAL-011-155 | 2/17/2009 | $4,500.00 | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to ensure smoking did not occur in the facility. Residents aware of no smoking policy but residents continued to smoke in their bedrooms. A fire was started by a resident smoking and using oxygen. | Paid in Full | $5,100.00 | 9/24/2009 |
| Shangri-La Family Care Home | FCL-011-059 | 7/15/2010 | $7,000.00 | Type A | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide a safe and secure environment for the residents in the home from owners personal issues and behaviors | Facility Closed | ||
| Soundview FCH Unit I | FCL-011-236 | 9/16/2008 | $1,000.00 | Type A | 10A NCAC 13G .0601(b)(3) Management and Other Staff; 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility staff left residents in home unattended for one half hour. Additionally,staff did not ensure smoking did not occur in the presence of one resident using oxygen. | Paid in Full | $1,123.32 | 1/14/2009 |
| WNC Family Care Home #6 | FCL-011-256 | 7/16/2010 | $1,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0601 (a) Management & Other Staff; 10A NCAC 13G .0705 (b) Discharge of Residents; G.S. 131D-4.4 (b)( c) Prohibit Smoking in LTC Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to two residents with noncompliance to policies regarding alcohol, smoking and illegal drug use in the facility | Facility Closed | ||
| WNC Family Care Home #10 | FCL-011-281 | 11/18/2009 | $7,000.00 | Type A | 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .1004(a)(1)(2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to monitor resident's condition and administer insulin medications as ordered. Staff failed to communicate and follow-up with referrals to physician. | Referred to Controllers' Office | ||
| WNC Family Care Home #13 | FCL-011-279 | 11/18/2009 | $1,080.00 | Unabated Type B | 10A NCAC 13G .1004(j) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maitain medication administration records and failed to accurately document administration of medications | Referred to Controllers' Office | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Clara's Cottage #1 | FCL-012-038 | 2/20/2013 | $500.00 | Type A2 | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure health care referral and follow-up to address a resident's condition | |||
| Glenda's Plantation | FCL-012-021 | 2/21/2008 | $1,000.00 | Type A | 10A NCAC 13G .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to supervise residents left in vehicle during shopping excursion; one disoriented resident wandered into roadway | Paid in Full | $1,000.00 | 4/14/2008 |
| Longview Assisted Living | HAL-012-022 | 01/23/2006 | $1,350.00 | Not corrected Type B | 10A NCAC
13F .1001 Medication Administration Policies and Procedures;
13F .1004(a) Medication
Administration; G.S. 131D-21 (2) Declaration of Residents' Rights |
Residents did not receive medications as ordered | Paid in Full | $1,350.00 | 1/5/2007 |
| Morganton Long Term Care Facility | HAL-012-007 | 7/21/2011 | $10,000.00 & $2,000.00 Staff Training | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up for two residents related to acute respiratory distress and lab orders for monitoring therapeutic levels of Coumadin | Training Completed Paid in Full | $10,000.00 | 09/26/2011 09/20/2011 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Concord House | HAL-013-038 | 2/19/2013 | $4,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure supervision of a resident who eloped during a community outing | |||
| Concord House (Change of Ownership) | HAL-013-031 | 6/19/2008 | $20,000.00 | Type A | 10A NCAC 13F .0901 (c ) Personal Care and Supervision; 10A NCAC 13F .0909 Resident Rights; G.S.131D-21 (2) Declaration of Residents' Rights | Resident found unresponsive; staff failed to initiate their emergency procedures immediately | 9/17/2010 Settlement Agreement $5,000.00 ($1,000.00 for training and $4,000.00 payable) Appealed 07/17/2008 | ||
| Concord House | HAL-013-031 | 09/14/2006 | $6,000.00 $12,000.00 |
Type A | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 Declaration of Residents' Rights | Resident did not receive medications as ordered, suffered withdrawal effects requiring hospitalization | Settlement Agreement 10/17/07 Appealed 10/13/06 |
$5,925.49 | 10/3/2008 |
| Concord House | HAL-013-031 | 06/02/2006 | $3,420.00 | Not corrected Type B | 10A NCAC 13F .1004(e) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents did not receive medications as ordered | Paid in Full | $3,420.00 | 1/8/2007 |
| Concord Place | HAL-013-019 | 3/16/2011 | $8,640.00 | Unabated Type B | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure resident received medication and obtain lab tests as ordered | Paid in Full | $8,640.00 | 3/31/2011 |
| The Country Home | HAL-013-012 | 4/16/2009 | $5,500.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131-D21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and monitor inappropriate aggressive behavior of 3 residents | 11/20/09 Settlement Agreement violation changed to Type B and $2,000.00 for Training; Appealed 5/15/2009 | Training Completed 12/14/2010 | |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
Camelot Manor d/b/a Brockford Inn |
HAL-014-014 | 07/18/2008 | $4,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights | Staff failed to notify physician of resident's blood sugar levels or administer insulin as ordered | Paid in Full | $4,000.00 | 8/8/2008 |
| Carolina Oaks Enhanced Care Center | HAL-014-002 | 7/16/2009 | $16,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0909 / G.S. 131D-21 (4) Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to protect residents from a resident's verbal and physical aggression | Paid In Full 3/1/10 Settlement Agreement $6,000.00 & Training; Appealed 08/12/2009 | $6,500.00 | 3/18/2010 |
| The Shaire Center | HAL-014-004 | 7/16/2012 | $4,000.00 | Type A1 | 10A NCAC 13F .0901(a)(c) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to transfer one resident using a hoyer lift as care planned resulting in injury | Paid in Full | $4,000.00 | 8/29/2012 |
None of the facilities in Camden County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| The Heritage of Newport | HAL-016-017 | 7/16/2009 | $2,000.00 | Type A | 10 NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for one resident while smoking and leaving the the premises on foot while impaired from alcohol consumption | Paid in Full 11/20/2009 Settlement Agreement & Training; Appealed 8/13/2009 | $1,000.00 | 12/16/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| G. Anthony Rucker Rest Home | HAL-017-040 | 9/15/2011 | $14,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide a resident supervision during eating resulting in the resident requiring hospitalization and ventilator care | Paid in Full | $14,000.00 | 9/23/2011 |
| Jones Family Care #4 | FCL-017-030 | 01/26/2006 | $1,000.00 | Type A | 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights | Resident locked out of facility and left unsupervised until staff returned. | Paid in Full | $1,000.00 | 3/8/2006 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Carillon Assisted Living of Newton | HAL-018-017 | 9/15/2011 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision in accordance with one resident's assessed needs and current symptoms resulting in injury to another resident | Paid in Full | $4,000.00 | 9/29/2011 |
| Walden House | HAL-018-015 | 7/15/2010 | $20,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to resident who had a history of aggressive and noncompliant behaviors resulting in a resident death | 04/17/2012 Settlement Agreement reducing all Type A Violations to Type B Violations and rescinding the penalty Appealed 8/12/10 | ||
| Walden House | HAL-018-015 | 11/19/2007 | $4,000.00 | Type A | 10 NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise two residents who were confused and disoriented who would leave the building and cross nearby four-lane highway. | Paid in Full | $4,000.00 | 12/12/2007 |
| Wingo Family Care d/b/a Sarah's Place (penalty #1) Facility Closed | FCL-018-029 | 12/19/2012 | $4,400.00 | Unabated B | 10A NCAC 13G .0406 (a)(5) Health Care Personnel Registry; 10A NCAC 13G .0406 (a)(7) Health Care Personnel Registry - Criminal Background Checks; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct noncompliance to assure staff had no findings of abuse or neglect listed on the health care personnel registry and that a criminal background check had been completed prior to staff being left alone to care for residents | Referred to Controller's Office | ||
| Wingo Family Care d/b/a Sarah's Place (penalty #2) Facility Closed | FCL-018-029 | 12/19/2012 | $4,400.00 | Unabated B | 10A NCAC 13G .0507 CPR Training; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct noncompliance to assure two of two staff had completed cardio-pulmonary resuscitation and choking training when left as only staff to care for residents | Referred to Controller's Office | ||
None of the facilities in Chatham County have received a penalty since January 2006.
None of the facilities in Cherokee County have received a penalty since January 2006.
None of the facilities in Chowan County have received a penalty since January 2006.
None of the facilities in Clay County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Alterra Sterling House Of Shelby | HAL-023-011 | 10/30/2007 | $16,000.00 | Type A | 10A NCAC 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility staff failed to administer CPR when resident found unresponsive | Paid in Full | $16,000.00 | 11/28/2007 |
| Brooks Family Care Home | FCL-023-024 | 09/14/2006 | $2,340.00 | Not corrected Type B | 10A NCAC 13G .1002 Medication Orders; 13G .1004 Medication Administration | Medication orders were not clarified and meds administered without orders for one resident | Paid in Full | $2,340.00 | 11/2/2006 |
| Openview Retirement Center | HAL-023-004 | 01/23/2006 | $2,000.00 | Type A | 10A NCAC 13F .0307 Fire Alarm System; 13F .0901(b) Personal Care and Supervision; 13F .1212(a) Reporting of Accidents and Incidents; 13F .0407(a) Other Staff Qualifications | Staff failed to respond timely to resident in need of emergency medical services. Room was locked and staff did not have key | Paid in Full | $2,000.00 | 3/28/2006 |
| Openview Retirement Home | HAL-023-004 | 1/18/2008 | Staff Training | Type A | 10A NCAC 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident with history of leaving previous placements without notice left facility during early morning hours; another resident informed staff of resident's absence | Training Completed 3/5/08 | ||
| Somerset Court of Shelby | HAL-023-012 | 3/14/2012 | $2,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of a resident with dementia with a history of falls and who exhibited exit seeking behavior | Paid in Full | $2,000.00 | 4/16/2012 |
| Unique Living (penalty #1) | HAL-023-034 | 3/19/2009 | $20,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Confused resident wandered from facility without staff's knowledge and has not been located | Facility Closed Referred to Controller's Office |
||
| Unique Living (penalty #2) | HAL-023-034 | 3/19/2009 | $20,000.00 | Type A | 10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to ensure exit door alarms were operable and on with doors left unsupervised. Confused resident wandered from facility and has not been located | Facility Closed Referred to Controller's Office |
||
| Unique Living (penalty #3) | HAL-023-034 | 3/19/2009 | $10,000.00 | Type A | G.S. 131D-4.4 (b)( c) Prohibit Smoking in LTC Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to enforce no smoking in the facility; residents known to smoke in their rooms at night were told to keep out of sight | Facility Closed Referred to Controller's Office |
||
| Unique Living | HAL-023-034 | 1/22/2007 | $16,000.00 | Type A | 10A NCAC 13F .0901 Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident wandered from facility, was returned and left again on same day; later found dead | Appealed
02/20/2007 Upheld 07/31/2007 Paid in Full |
$18,850.99 | 2/5/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Lake Pointe Assisted Living | HAL-024-011 | 5/19/2011 | Staff Training | Type A | 10A NCAC 13F .1501(a) Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure restraints were not used for staff convenience and until assessment and care planning had been completed | Training Completed | 7/26/2011 | |
| Lake Waccamaw Senior Living | HAL-024-009 | 1/12/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents (two) wandered from facility without staff's knowledge | Paid in Full | $4,000.00 | 2/9/2007 |
| Lake Waccamaw Senior Living | HAL-024-009 | 1/9/2007 | $4,860.00 | Not corrected Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered | Paid in Full | $4,860.00 | 1/25/2007 |
| Lake Waccamaw Senior Living (penalty #1) | HAL-024-009 | 11/20/2008 | $10,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision (b); G.S. 131D-21 (2) Declaration of Residents' Rights | The facility failed to provide supervision for residents displaying aggressive behaviors resulting in one resident being assaulted | Paid in Full Partial Pmt(s) - Total paid $5746.56 | $957.76 received each date | 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009 |
| Lake Waccamaw Senior Living (penalty #2) | HAL-024-009 | 11/20/2008 | $2,000.00 | Type A | G.S.131D-4.4 Prohibit Smoking in LTC Facilities; G.S.131D-21 (2) Declaration of Residents' Rights | Facility failed to enforce their smoking policy which resulted in one resident continuing to smoke in his bedroom | Paid in Full Partial Pmt(s). - Total paid $1,149.30 | $191.55 received each date | 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009 |
| Lake Waccamaw Senior Living (penalty #3) | HAL-024-009 | 11/20/2008 | $10,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to administer medications including coumidin as ordered for two residents; staff failed to notify physician when medication was not available and not being administered | Paid in Full Partial Pmt(s). - Total paid $5746.56 | $957.76 received each date | 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Alterra Sterling House of New Bern | HAL-025-012 | 2/23/2007 | $2,500.00 | Type A | 10A NCAC 13F .901 (b) Personal Care & Supervision: G.S. 131D-21 (2) Declaration of Residents' Rights | Resident wandered from facility without staff's knowledge | Paid in Full | $2,500.00 | 3/22/2007 |
| Carebridge Assisted Living | HAL-025-007 | 5/19/2010 | $7,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to obtain timely referral and follow-up for a resident | Paid in Full | $7,000.00 | 7/16/2010 |
| Carebridge Assisted Living | HAL-025-007 | 11/20/2008 | $7,000.00 | Type A | 10A NCAC 13F .1002 Medication Orders; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered, one resident received excess insulin resulting in the need for emergency treatment | Paid in Full | $7,000.00 | 1/9/2009 |
| Christian Care of New Bern | HAL-025-018 | 1/9/2007 | $1,000.00 | Type A | 10A NCAC 13F .0906 (f)(4) Other Resident Care & Services; G.S. 131D-21 Declaration of Residents' Rights | Staff failed to identify resident's failure to return to facility and did not notify family or law enforcement abt. missing status | Paid in Full | $1.000.00 | 2/1/2007 |
| Croatan Village | HAL-025-020 | 7/15/2010 | $1,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to transport resident in a electric wheelchair in a secure manner | Paid in Full | $1,000.00 | 8/2/2010 |
| Croatan Village Assisted Living | HAL-025-020 | 1/9/2007 | $3,500.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident wandered from the facility without staff's knowledge | Paid in Full | $3,500.00 | 2/9/2007 |
| Good Shepherd Home for the Aged | HAL-025-023 | 9/15/2011 | $2,000.00 & $2,000.00 Staff Training | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure a resident with skin breakdown was referred to address her acute care needs resulting in hospitalization | 12/30/2011 Training Completed; Paid in Full; training due | $2,000.00 | 11/17/2011 |
| Good Shepherd Home for the Aged | HAL-025-023 | 9/13/2010 | $4,500.00 | Unabated Type B | 10A NCAC 13F. 0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident with a history of elopement who could not safely leave the facility unsupervised | Paid in Full Partial pmt. | $2,250.00 $2,250.00 | 1/03/2011 12/09/2010 |
| Homeplace of New Bern | HAL-025-014 | 3/17/2011 | $4,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure referral and follow-up occurred for a reisdent experiencing a pressure wound | Paid in Full | $4,000.00 | 3/25/2011 |
| Homeplace of Newbern | HAL-025-014 | 01/12/2006 | $2,000.00 | Type A | 10A NCAC 13F .0305 Physical Environment; 13F .1304 Special Care Unit Bldg. Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Two residents(confused/disoriented) wandered from the facility without staff's knowledge | Paid in Full | $2,000.00 | 2/2/2006 |
| Magnolia Place of New Bern | HAL-025-019 | 3/23/2007 | $2,500.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to notify physician when one resident with dementia refused all medications and as result required hospitalization. | Paid in Full | $2,500.00 | 5/30/2007 |
| Riverstone | HAL-025-026 | 2/22/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident in accordance to her current symptoms | Paid in Full | $2,000.00 | 3/12/2013 |
| Riverstone | HAL-025-026 | 3/17/2011 | Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise a resident who was known to elope. Facility was unaware resident had left the facility until located by sheriff the following day | Staff Training Completed | 1/12/2012 | |
| Riverstone | HAL-025-026 | 3/20/2008 | Staff Training | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered including sliding scale insulin for 3 of 3 residents on two separate inspections | Training completed 05/16/ 2008 | ||
| The Courtyards at Berne Village | HAL-025-024 | 7/21/2011 | $2,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervsion for blind resident known to wander. Resident left the facility without staff knowledge and was found on road having fallen from wheelchair | Paid in Full | $2,000.00 | 9/14/2011 |
| The Courtyard at Berne Village | HAL-025-024 | 7/15/2010 | $13,980.00 | 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 | Paid in Full | $13,980.00 | 9/14/2010 |
| The Courtyards at Berne Village Memory Care | HAL-025-025 | 11/17/2011 | $8,000.00 & Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to two residents based on assessed needs and known behaviors resulting in a resident with known wandering behaviors being physically assaulted by a resident identified as having aggressive and abusive behaviors | Training Completed 1/24/2012; Paid in Full | $8,000.00 | 1/17/2012 |
| The Courtyard at Berne Village Memory Care | HAL-025-025 | 7/15/2010 | $7,000.00 | Type A | 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 were experiencing falls | Paid in Full | $7,000.00 | 9/14/2010 |
| The Courtyards at Berne Village | HAL-025-015 | 5/3/2007 | $1,000.00 | Type A | 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident (confused/disoriented) wandered from facility, was returned and left again on same day without staff knowledge. | Referred to Controller's Office | ||
| Water Oak Manor (penalty #1) | HAL-025-031 | 3/20/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0906 (f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to notify law enforcement when a resident eloped from facility and whereabouts was unknown | |||
| Water Oak Manor (penalty #2) | HAL-025-031 | 3/20/2013 | $2,000.00 | Type 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 one resident who had a history of wandering and elopement behavior | |||
| Water Oak Manor | HAL-025-030 | 11/16/2011 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise a resident to prevent the resident from eloping from the special care unit and failed to provide physician follow-up regarding health care needs for three residents | Referred to Controller's Office | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cross Creek Manor Assisted Living, LLC | HAL-026-050 | 6/19/2008 | $2,940.00 | Type B Unabated | 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in a safe range for resident use | Paid in full | $2,940.00 | 8/13/2008 |
| Eastover Gardens Special Care | HAL-026-055 | 3/21/2013 | $2,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to ensure healthcare referral for one resident with a pressure wound | |||
| Eastover Gardens Special Care (penalty #1) | HAL-026-055 | 11/15/2012 | $7,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to provide supervision in accordance to resident's assessed needs, care plan and current symptoms related to falls for two residents with diagnosis of dementia | Referred to Controller's Office | ||
| Eastover Gardens Special Care (penalty #2) | HAL-026-055 | 11/15/2012 | $7,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to make referral to healthcare providers relative to conditions including weight changes, wound care, complaints of pain, swelling and falls for four residents | Referred to Controller's Office | ||
| Forest Hills Rest Home | HAL-026-003 | 01/23/2006 | $2,700.00 | Not corrected Type B | 10A NCAC 13F .1004 Medication Administration G.S. 131D-21 (2) Declaration of Residents' Rights | Staff administering medications had not completed the clinical skills validation prior to administration of medications. | Paid in Full | $2,700.00 | 3/29/2006 |
| Forest Hills Rest Home | HAL-026-003 | 01/23/2006 | $3,000.00 | Type A | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered. | Paid in Full | $3,000.00 | 3/29/2006 |
| Jean's Rest Home | FCL-026-029 | 1/16/2008 | $1,720.00 | Not corrected Type B | 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in a safe range for resident use | Paid in Full Settlement Agreement 8/18/2008 Appealed 02/15/2008 | $800.00 | 9/17/2008 |
| Len-Care of Cedar Creek, Inc | HAL-026-041 | 8/27/2007 | $4,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Medications were not administered as ordered with significant errors including residents did not receive coumidin as ordered; other resident did not receive medication for seizure disorder; residents' medications not administered based on unavailability | Referred to Controller's Office | ||
| Len-Care of Cedar Creek, Inc | HAL-026-041 | 8/27/2007 | $1,200.00 | Not corrected Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Medications were not administered as ordered with significant errors including failure to adminster residents' coumidin and insulin as ordered and failure to notify physician of when resident's blood sugars were high; residents had documentation of medications not administered based on unavailablity | Referred to Controller's Office | ||
None of the facilities in Currituck County have received a penalty since January 2006.
None of the facilities in Dare County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Westanna Family Care | FCL-029-001 | 6/14/2012 | $2,600.00 | Unabated B | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct infection control practices to ensure infection control measures were used when monitoring fingerstick blood sugars for three of three residents | Paid in Full; 2 Partial Payment of $1,300.00 | $2,600.00 | 08/16/2012 07/13/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Davie Place | HAL-030-003 | Amended letter sent 1/2/2008 11/19/2007 | $18,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident utilizing oxygen was consistently noncompliant to facility's smoking policy; she continued to smoke in room with oxygen resulting in explosion | Paid in Full; Settlement Agreement 4/4/08; Appealed 12/19/2007 |
$12,000.00 | 05/05/2008 |
| Davie Place Residential Care | HAL-030-003 | 3/17/2011 | $10,000.00 | Type A | 10A NCAC 13F .0901 Personal Care & Supervision; 10A NCAC 13F .0504(a) Competency Validation for LHPS Tasks; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure staff were trained and competency validated on use of mechanical lift required for a resident's transfers resulting in one resident experiencing a fracture | Paid in Full; Partial pmts of $1,010.00 | Total $11,084.56 | 12/20/2011 09/14/2011 08/12/2011 07/13/2011 06/16/2011 05/11/2011 04/14/2011 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Autumn Village | HAL-031-014 | 4/17/2012 | $6,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure supervision of one resident with wandering behaviors and one resident exhibiting aggressive behaviors towards residents | Paid in Full | $6,000.00 | 6/1/2012 |
| Autumn Village Inc. | HAL-031-014 | 7/21/2011 | $2,000.00 & $2,000.00 Staff Training | Type A | 10A NCAC 13F .0901(a) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide personal care services in accordance with resident's needs. Resident was routinely provided bed bathe but suffered fracture when gotten up to be showered | Paid in Full; Training Completed | $2,000.00 | 09/09/2011 09/26/2011 |
| Golden Care | HAL-031-003 | 09/14/2006 | $2,960.00 | Not corrected Type B | 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background checks had not been done for 3 staff members before hiring; 10 staff members did not have CPR training; 9 shifts did not have a staff member on duty that was CPR qualified | Paid in Full | $2,960.00 | 11/7/2006 |
| Moore's Family Care Home #1 | FCL-031-005 | 5/3/2007 | $1,000.00 | Type A | 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to protect resident from physical abuse and exploitation by staff and residents | Paid in Full | $1,000.00 | 5/11/2007 |
| Moore's Family Care Home #1 | FCL-031-005 | 6/27/2007 | $1,000.00 | Type A | 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Resident's Rights | Hot water temperatures were not maintained in safe range in two residents' bathrooms | Paid in Full | $1,000.00 | 7/2/2007 |
| Windham Hall | HAL-031-006 | 3/21/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0901 (b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for one disoriented resident who left the facility unsupervised and without staff knowledge | |||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Camellia Gardens | HAL-032-071 | 9/26/2007 | Staff Training | Type A | 10A NCAC 13F .1004 (a)(1) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident did not receive medication as ordered | Training Completed | 06/26/2008 | |
| Circle of Daughters | FCL-032-085 | 3/18/2010 | $500.00 | Type A | 10A NCAC 13G .0601(b) Management and Other Staff; 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure resident not left alone and unsupervised in facility | Paid in Full | $500.00 | 4/22/2010 |
| Durham Ridge Assisted Living | HAL-032-080 | 5/14/2008 | $2,940.00 | Type B Unabated | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure follow-ups and referrals occurred to meet health care needs for five residents | Paid in Full | $2,940.00 | 07/11/2008 |
| Durham Ridge Assisted Living | HAL-032-080 | 5/14/2008 | $6,540.00 | Type B Unabated | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights | Residents did not receive medications or treatments as ordered | Paid in Full | $6,540.00 | 07/11/2008 |
| Durham Ridge | HAL-032-080 | 11/19/2007 | $1,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident from Special Care Unit was escorted out of secured unit and left unsupervised. Resident found 6 miles from facility | Paid in Full | $1,000.00 | 11/28/2007 |
| Elsie-Doris Family Care Home | FCL-032-088 | 10/22/2009 | Staff Training | Type B Unabated | 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to adminster medications as ordered | Training Completed | 1/9/2010 | |
| Friendly Rest Home, Inc | HAL-032-003 | 3/20/2008 | $6,160.00 | Type B Unabated | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 Declaration of Residents' Rights | Physicians were not notified for residents' health care needs including pressure sores, psychiatric care, PT and podiatry services | Paid in Full Settlement Agreement 6/18/2008; Appealed 03/24/2008 | $2,000.00 | 6/30/2008 |
| Love and Care Family Care Home | FCL-032-078 | 9/16/2008 | $1,000.00 | Type A | 10A NCAC 13G. 0601 (b) Management and Other Staff; 10A NCAC 13G .0901 Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility staff left two residents unattended in the facility for the majority of a weekend.One resident was directed to prepare meals and administer medication for the other. | Paid in Full | $1,123.32 | 1/5/2009 |
| Love and Care Family Care Home II (penalty #1) | FCL-032-082 | 4/16/2009 | $8,500.00 | Type A | G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure staff and residents did not smoke in the facility. All five residents and staff smoked in the facility. | Paid in Full 5/13/10 Settlement Agreement for $1,000.00 in Conjunction w/penalty #2 imposed 04/16/2009; Appealed 05/14/2009 | $1,000.00 | 6/2/2010 |
| Love and Care Family Care Home II (penalty #2) | FCL-032-082 | 4/16/2009 | $4,500.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Facility failed to provide necessary increased supervision for residents to ensure safe living conditions. Law enforcement was required to respond to conditions in the facility frequently to ensure residents safety. | (Paid in full - See penalty #1) 5/13/10 Settlement Agreement for $1,000.00 in Conjunction w/penalty #1 imposed 04/16/2009; Appealed 05/14/2009 | ||
| Love and Care Family Care Home II | FCL-032-082 | 3/20/2008 | $1,500.00 | Type A | 10A NCAC 13G .0601 (b) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff left facility leaving two residents unsupervised in facility | Paid in Full | $1,667.49 | 6/30/2008 |
| The Meadows of Oak Grove | HAL-032-063 | 2/13/2007 | $1,500.00 | Type A | G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Staff reacted to resident aggression by physical "choking of resident" and verbal threat; facility did not remove staff from resident care during investigation of incident | Referred to Controller's Office | ||
| South Point Manor | HAL-032-072 | 1/12/2007 | $1,000.00 | Type A | 10A NCAC 13F .0311 Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in safe range in residents' bathrooms | Paid in Full | $1,000.00 | 2/14/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Britthaven of Tarboro | HAL-033-001 | 9/26/2007 | $3,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to supervise smoking of residents whose behaviors demonstrated need for increase supervision | Paid in Full | $3,000.00 | 10/11/2007 |
| The Fountains at The Albemarle | NH0352 | 3/18/2010 | $12,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Resident Rights | The facility failed to implement preventative measures for falls after the first fall with injury which resulted in a second fall with injury. | Paid in Full | $12,000 | 5/18/2010 |
| Heritage Care of Rocky Mount | HAL-033-005 | 10/15/2008 | $1,760.00 | Type B Unabated | G.S. 131D-4.4 Mininum Safety Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to prohibit smoking inside facility | OAH and final agency decision overturned violation on 1/15/2010; Appealed 11/14/08 | ||
| Heritage Care of Rocy Mount (penalty #1) | HAL-033-005 | 07/18/2008 | $2,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident whose status required supervision was allowed to leave facility unsupervised | Settlement Agreement in conjunction with penalty #2. Change to Type B Violation and Rescind Penalty 1/27/2010; Appealed 08/15/2008 | ||
| Heritage Care of Rocky Mount (penalty #2) | HAL-003-005 | 07/18/2008 | $1,500.00 | Type A | 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in safe range on one hall serving 29 residents | Settlement Agreement in conjunction with penalty #1 $1500.00 1/27/2010; Appealed 08/15/2008 | $1,500.00 | 2/9/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| The Bradford Village of Kernersville, East | HAL-034-068 | 11/9/2010 | $20,000.00 | Unabated Type A | 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise residents and ensure alarms on doors were engaged. A disoriented resident left the facility during the night without staff knowledge and was found deceased the following morning | Paid in Full | $20,000.00 | 1/6/2011 |
| The Bradford Village of Kernersville - West | HAL-034-069 | 12/19/2012 | $7,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to provide health care referrral and follow-up and supervision for four residents who experienced falls | Appealed 1/18/2013 | ||
| Brighton Gardens of Winston-Salem | HAL-034-026 | 5/20/2010 | $4,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide health care referral and follow-up to meet the needs of residents receiving coumidin and insulin | Paid in Full | $4,000.00 | 6/14/2010 |
| Clemmons Village II | HAL-034-062 | 2/14/2012 | $20,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .1501(a) Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to three residents to prevent falls and injury and used physical restraints which residents were unable to extricate themselves resulting in one death | Appealed 3/1/2012 | ||
| C.R.T. Golden Lamb Rest Home | HAL-034-019 | 9/19/2012 | $7,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up to meet one resident's routine and acute healthcare needs | Paid in Full; Referred to Controller's Office | $7,729.17 | 1/11/2013 |
| C.R.T. Golden Lamb Rest Home | HAL-034-019 | 5/15/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure resident rights were maintained when infection control measures were not used when monitoring fingerstick blood sugars for five residents | Paid in Full | $2,000.00 | 7/6/2012 |
| Dogwood Family Care Home (Facility Closed) | FCL-034-076 | 3/16/2011 | $10,000.00 | Type A | 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident who was constantly disoriented and frequently left the facility premises without supervision | Referred to Controller's Office | ||
| Forest Heights Senior Living Community | HAL-034-087 | 3/17/2011 | $14,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to meet needs of residents resulting in one resident falling from a third floor window and another wandering from the facility at night | Paid in full | $14,000.00 | 4/1/2011 |
| Heritage Woods | HAL-034-003 | 11/9/2010 | $5,280.00 | 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 including failing to administer coumidin | Paid in Full | $5,280.00 | $12/6/2010 |
| Hines Good Samaritan Home | FCL-034-077 | 6/27/2007 | $1,770.00 | Not corrected Type B | 10A NCAC 13G .0405 Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Resident's Rights | Four of five staff members providing personal care had not been tested for tuberculosis | Paid in Full | $1,770.00 | 1/16/2008 |
| The Homestead | HAL-034-032 | 6/19/2008 | $9,240.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident did not receive insulin medication as ordered; facility continued with medication problem for extended period | Paid in Full | $9,240.00 | 6/30/2008 |
| NaRu Family Care Home #1 (6) | FCL-034-071 | 11/1/2007 | $1,000.00 | Type A | 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in safe range for resident use | Paid in Full | $1,000.00 | 12/28/2007 |
| Reynolds House (Ownership Change) | HAL-034-079 | 9/15/2011 | $16,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide adequate supervision to residents who smoked inside the facility resulting in one resident setting his bed and clothing on fire and resulting in his subsequent death | Referred to Controller's Office | ||
| Salem Terrace | HAL-034-078 | 3/14/2012 | $9,000.00 & Staff Training | Unabated B | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct infection control practices to ensure infection control measures were used when obtaining fingerstick blood sugars for six residents | Paid in Full Training Completed 5/16/2012; Payment Plan by Controller's Office for Partial pmt. of $1,121.02 | $10,089.12 | 12/14/2012 11/21/2012 10/23/2012 09/25/2012 09/05/2012 07/17/2012 06/15/2012 05/24/2012 04/25/2012 |
| Salem Terrace | HAL-034-078 | 10/22/2009 | $8,720.00 | Unabated Type B | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to adminster medications and treatments to residents | Paid in Full | $8,720.00 | 12/9/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Alston Family Care Home | FCL-035-008 | 07/14/2006 | $2,040.00 | Not corrected Type B | 10A NCAC 13G .0405 Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights | Personal care staff (2) had not been tested for tuberculosis | Paid in Full | $2,040.00 | 9/18/2006 |
| Carebridge Assisted Living | HAL-035-015 | 11/16/2011 | $7,000.00 | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure one resident was free of mental and physical/sexual abuse | Paid in Full | $7,000.00 | 2/6/2012 |
| Louisburg Gardens | HAL-035-013 | 6/27/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights | Facility failed to provide supervision in accordance to assessed needs and current symptoms for three residents exhibiting aggressive or sexually inappropriate behaviors | Settlement Agreement 09/05/2007 Combined with Type A & Not corrected Type B Penalties Appealed 07/23/2007 | Training Completed $3,250.00 | 12/26/2007 |
| Louisburg Gardens | HAL-035-013 | 5/7/2007 | $2,300.00 | Not corrected Type B | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure four of four residents received timely referral and follow-up for health care needs due to facility not informing practitioners or providing necessary information to ensure services provided | Settlement Agreement 09/05/2007 Combined with Type A & Not corrected Type B Penalties Appealed 05/16/2007 | Training Completed $3,250.00 | 12/26/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Country Time Inn | HAL-036-018 | 5/3/2007 | $4,000.00 | Rescind Type A Violation Type A |
10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in a safe range for use by residents | Training Completed 3/20/08; Settlement Agreement 1/24/08 Training Appealed 05/25/2007 | ||
| Gaston Manor | HAL-036-012 | 9/15/2011 | $10,000.00 & $2,000.00 Staff Training | Type A | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medications to two residents resulting in recurrent gastrointestinal bleeding and hospitalization for one resident | Training Completed 11/21/2011; Paid in Full | $10,000.00 | 10/5/2011 |
| Gaston Place | HAL-036-015 | 3/18/2009 | $2,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility utilized code alert guards on confused residents but failed to ensure they were put on and/or operational | Paid in Full | $2,000.00 | 3/31/2009 |
| Gaston Place | HAL-036-015 | 7/16/2009 | $4,000.00 | Type A | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to document administration of the amount of insulin administered when the resident required sliding scale insulin and notify the physician as ordered | Paid in Full | $4,000.00 | 8/4/2009 |
| Moses Manor Inc. | HAL-036-001 | 1/12/2007 | $55.00 | Not corrected Type B | 10A NCAC 13F .0406 Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Resident Rights | Personal care staff (5) had not been tested for tuberculosis | Referred to Controller's Office | ||
| Rosewood Assisted Living (penalty #1) | HAL-036-004 | 10/22/2009 | $4,050.00 | Unabated Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to residents whose behavior put themselves and others at substantial risk for serious physical harm or death | Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 | $4,500.00 | 11/19/2010 |
| Rosewood Assisted Living (penalty #2) | HAL-036-004 | 10/22/2009 | $2,000.00 | Type A | G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure smoking did not occur inside facility | Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 | $4,500.00 | 11/19/2010 |
| Rosewood Assisted Living (penalty #3) | HAL-036-004 | 10/22/2009 | $7,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure referral and follow-up to address five residents needs including behavior changes, wound care, antibiotic therapy, refusal of medication and use of anti-embolism hose. | Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 | $4,500.00 | 11/19/2010 |
| Rosewood Assisted Living | HAL-036-004 | 12/18/2008 | $20,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision in accordance to needs and current behaviors for four residents exhibiting behaviors harmful to themselves or others including sexually inappropriate behaviors | Paid in Full Settlement Agreement 6/3/09 Appealed 1/16/09 | $3,000.00 | 6/23/2009 |
| Rosewood Assisted Living | HAL-036-004 | 5/14/2008 | $3,240.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered; continued problems with ensuring finger stick blood sugars were taken as ordered and as result insulin not administered as ordered | Paid in Full | $3,240.00 | 07/11/2008 |
| Somerset Court of Cherryville | HAL-036-017 | 5/20/2010 | $12,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide smoking supervision to a resident identified with unsafe smoking behavior. Reident suffered burns requiring hospitalization | Paid in Full | $12,000.00 | 6/29/2010 |
| South Haven Long Term | HAL-036-005 | 5/11/2007 | $3,060.00 | Not corrected Type B | 10A NCAC 13F .0407(a)(2) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Resident's Rights | Facility unable to effectively execute procedures in response to fire drill | Paid in Full | $3,060.00 | 1/3/2008 |
| Trinity Manor (Facility Closed) | FCL-036-028 | 9/15/2011 | $4,500.00 | Type A | 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure three residents were free from verbal and physical abuse and neglect | Referred to Controller's Office | ||
None of the facilities in Gates County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| R&M Family Care Home | FCL-038-004 | 01/12/2006 | $1,000.00 | Type A | 10A NCAC 13G .0801 (c)(d) Resident Assessment; 13G .1002(a) Medication Orders; 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered. Medications orders were not clarified. Resident assessment was not completed when a significant change in condition occurred. | Paid in Full | $1,000.00 | 3/24/2006 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Heritage Meadows Long Term Care Facility | HAL-039-001 | 5/19/2011 | $2,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide monitoring and supervision for three residents who demonstrated the need for increased supervision in the facility with smoking | Paid in full | $2,000.00 | 6/16/2011 |
| Toney Rest Home Inc. | HAL-039-005 | 7/21/2011 | Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to ensure safety of resident known to wander | Training Completed | 9/26/2011 | |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cedar Grove Assisted Living | FCL-040-005 | 2/17/2009 | $500.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide necessary supervision to prevent one resident with a history of wandering from leaving the facility on two occasions requiring law enforcement to locate the resident | Paid in Full Referred to Controllers' Office | $609.15 | 1/14/2011 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Bennett's Family Care Home #2 | FCL-041-029 | 9/13/2010 | $10,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility allowed an incompetent resident to regularly leave the facility without supervision. Resident was found dead | Paid in Full | $11,041.67 | 1/24/2011 |
| Carriage House Senior Living Community (Penalty #1) | HAL-041-065 | 5/19/2011 | $3,480.00 | 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 | Paid in Full | $3,480.00 | 6/1/2011 |
| Carriage House Senior Living Community (Penalty #2) | HAL-041-065 | 5/19/2011 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident residing on the Memory Care Unit resulting in burns from prolonged sun exposure with failure to ensure physician notification and emergency medical care; for three residents failed to ensure referral and follow-up regarding lab testing, missed medications or blood sugar values outside parameters as ordered | Paid in Full | $4,000.00 | 6/1/2011 |
| Clare Bridge at High Point | HAL-041-033 | 6/19/2008 | $3,300.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S.131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered | Paid in Full | $3,300.00 | 7/9/2008 |
| Davis Rest Home #2 | FCL-041-008 | 10/22/2009 | $1,000.00 | Type A | 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to monitor and maintain safe water temperatures. Hot water temperatures were at 140 degrees | Paid in Full | $1,000.00 | 1/11/2010 |
| Elm Villa | HAL-041-045 | 1/16/2013 | $4,000.00 | Type A1 & Type A2 | 10A NCAC 13F .0902(b) Health Care: 10A NCAC 13F .0702(f) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to protect residents from the physically aggressive behavior of another resident | |||
| Friendship Care Assisted Living | HAL-041-002 | 1/18/2008 | $5,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration | Due to lack of payment, ordered medications were not obtained nor administered to 4 residents; physican was not notified of failure to obtain/adminster ordered medications | Settlement Agreement 01/17/2008 $5000.00 Paid in Full |
$5000.00 | 2/21/2008 |
| Friendship Care Assisted living | HAL-041-002 | 1/5/2007 | $2,640.00 | Not corrected Type B | 10A NCAC 13F .0403 Qualifications of Medication Staff G.S. 131D-21 (2) Declaration of Residents' Rights | Two Staff administering medications had not completed the clinical skills validation prior to administration of medications. | Paid in Full | $2,899.98 | 12/4/2007 |
| Friendship Care Assisted Living | HAL-041-002 | 11/17/2006 | $12,000.00 | Type A | 10A NCAC 13F .1004(a) Medication Administration; 13F .0505 Training on Care of Diabetic Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff administering insulin were not trained on diabetic care prior to administering insulin. Two residents did not receive insulin as ordered. | Paid in Full | $12,000.00 | 1/23/2007 |
| Friendship Care Assisted Living | HAL-041-002 | 10/24/2006 | $5,120.00 | Not corrected Type B | 10A NCAC 13F.1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident did not receive medications as ordered. | Paid in Full | $5,120.00 | 1/4/2007 |
| Friendship Care Assisted Living | HAL-041-002 | 08/22/2006 | $3,920.00 | Not corrected Type B | 10A NCAC 13F .0703 Tuberculosis Test, Medical Examination and Immunizations; 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents were not being tested for tuberculosis; medications were not administered as ordered | Paid in Full | $3,920.00 | 1/17/2007 |
| Friendship Care Assisted Living | HAL-041-002 | 07/14/2006 | $12,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Staff failed to protect residents from physical abuse. | Paid in Full | $12,000.00 | 1/4/2007 |
| Greensboro Living Center (penalty #1) | HAL-041-061 | 7/15/2010 | $4,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-4.4 (b)(c) Prohibit Smoking in LTC Facilities; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to supervise resident known to be noncompliant to smoking rules with resident routinely smoking in his room | Paid in Full | $4,000.00 | 10/1/2010 |
| Greensboro Living Center (penalty #2) | HAL-041-061 | 7/15/2010 | $7,120.00 | 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 to five of five sampled residents | Paid in Full | $7,120.00 | 10/1/2010 |
| Loyalton of Greensboro (Name Change to Emeritus of Greensboro) | HAL-041-049 | 11/16/2011 | $16,000.00 | Type A | 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to provide supervision based on assessed needs and behaviors for seven residents with eloping and wandering behaviors, smoking while using oxygen or experiencing falls. Facility failed to assure all exit doors accessible by residents with disorientation, wandering and elopement behaviors were equipped with a sounding device that activated when the door was opened | Paid in Full | $16,000.00 | 12/5/2011 |
| Loyalton of Greensboro | HAL-041-049 | 3/18/2010 | $3,600.00 | 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. | Paid in Full | $3,600.00 | 4/12/2010 |
| Morningview in Greensboro (Name change to Morningview at Irving Park) | HAL-041-052 | 7/21/2011 | $7,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure the referral and follow-up to meet acute health care needs of residents, one regarding elevated blood sugars and one resident with foot wound and decline in functional status | Paid in Full | $7,000.00 | 8/11/2011 |
| Piedmont Christian Home | HAL-041-010 | 9/6/2006 | $12,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; 13F .0902(b) Health Care; 13F .0909 Residents Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Interventions and safety was not provided for a resident with multiple falls when using a Meri-Walker ambulation device | Appealed 10/16/06 Settlement Agreement 6/19/2007 |
$5,000.00 Training Completed 07/11/2007 | 6/19/2007 |
| The Shannon Gray Rehabilitation & Recovery Center | NH0627 | 11/12/10 | $10,000 | Type A | 10A NCAC 13D .2305(a) Quality of Care G.S. 131E-117. Declaration of patient's rights. | Facility failed to assess, monitor, and implement interventions for an unresponsive resident with low blood. | Paid | $10,000 | 12/1/2010 |
| St. Gales Estates, Inc | HAL-041-023 | 2/17/2010 | $17,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medications including insulin and coumidin as ordered for 6 of 8 residents resulting in one resident being found unresponsive on two occasions requiring hospitalization. | Paid in Full | $17,000.00 | 3/31/2010 |
| St. Gales Estates, Inc. | HAL-041-023 | 11/17/2006 | $7,500.00 | Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .1212(e) Reporting of Accidents and Incidents; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to keep all door alarms on to alert staff of residents' exiting building. Resident wandered from facility and was struck by automobile. Resident suffered fractures | Paid in Full | $7,500.00 | 12/20/2006 |
| Wesleyan Arms Retirement Center | HAL-041-047 | 5/20/2010 | $16,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide medications and/or implement treatments as ordered and failed to notify physician of acute health care needs | Training completed 7/28/2011; Paid in Full; 6/16/2011 Settlement Agreement $12,000.00 ($2,000.00 for training and $10,000.00 payable) Appealed 06/11/2010 | $10,000.00 | 7/12/2011 |
None of the facilities in Halifax County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Core Family Care (Change of Ownership) | HAL-043-001 | 11/16/2011 | $14,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for one resident who needed one on one supervision when eating resulting in the resident's death | Partial Payment of $500.00; 3/28/12 Settlement Agreement for $5,000.00; Appealed 12/15/2011 | $5,000.00 | 01/11/2013 12/05/2012 11/15/2012 10/03/2012 09/06/2012 06/28/2012 06/07/2012 05/08/2012 |
| Core Family Care, Inc. | HAL-043-001 | 12/16/2009 | $4,410.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medications as ordered including documenting administration of medications not obtained or available for administration. | Paid in Full | $4,410.00 | 2/22/2010 |
| Core Family Care, Inc. | HAL-043-001 | 1/16/2008 | $5,700.00 | Not corrected Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)Declaration of Residents' Rights | Medications including insulin were not administered as ordered | Paid in Full | $5,700.00 | 3/19/2008 |
| Oak Hill Living Center | HAL-043-015 | 5/15/2008 | $7,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide residents with follow-up and referrals for routine and acute health care needs including high blood sugars, weight loss, and pain | Paid in Full | $7,000.00 | 6/25/2008 |
| Oak Hill Living Center | HAL-043-015 | 5/15/2008 | $3,350.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered including insulin | Paid in Full | $3,350.00 | 6/25/2008 |
| Oak Hill Living Center | HAL-043-015 | 3/20/2008 | $4,000.00 | Type A | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to serve 5 of 8 residents therapeutic diets and thickened liquids as ordered | Paid in Full; Referred to Controller's Office |
$4,446.64 | 10/21/2008 |
| Pinecrest Gardens | HAL-043-022 | 6/19/2008 | $3,500.00 | Type B Unabated | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to serve residents ordered therapeutic diets | Paid in Full Appealed 07/18/2008 | $3,500.00 | 8/18/2008 |
| Pinecrest Gardens of Lillington | HAL-043-012 | 8/27/2007 | Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights | Facility failed to supervise smoking activities of resident with dementia residing in the facility's locked unit. Resident had previously had a fire in her bathroom. | Training Completed | 10/10/2007 | |
| Primrose Villa Retirement II | HAL-043-013 | 9/13/2010 | $1,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervsion to resident to ensure resident with history of elopement did not leave the building unsupervised | Paid in Full | $1,000.00 | 12/13/2010 |
| Primrose Villa Retirement III | HAL-043-017 | 4/16/2009 | $2,000.00 | Type A | G.S. 131D-4.4 Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure residents did not smoke in the facility. Residents smoked in their bedrooms. | Paid in Full Referred to Controllers' Office | $2,000.00 | 12/13/2010 |
| Primrose Villa Retirement III | HAL-043-017 | 9/13/2010 | $1,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to resident with unsafe smoking behavior | Paid in Full | $1,000.00 | 12/13/2010 |
| Primrose Villa Retirement IV | HAL-043-019 | 1/27/2010 | $18,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and set door alarms to ensure resident with dementia did not leave the facility unsupervised. Resident wandered from building and suffered a fatal fall. | Referred to Controllers' Office | ||
| Primrose Villa Retirement IV | HAL-043-019 | 3/20/2008 | $1,080.00 | Type B Unabated | 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in safe range for use in resident and community baths | Paid in Full | $1,080.00 | 6/30/2008 |
None of the facilities in Haywood County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cardinal Care Center - Hendersonville (Penalty #1) | HAL-045-001 | 7/21/2011 | $4,000.00 | Type A | 10A NCAC 13F .0406(a) Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure employees were tested for TB prior to employment resulting in one staff working with active TB | Paid in Full | $4,500.00 | 5/9/2012 |
| Cardinal Care Center - Hendersonville (Penalty #2) | HAL-045-001 | 7/21/2011 | $55,000.00 & $5,000.00 Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for 6 of 11 sampled residents assessed at risk for falls resulting in 4 of 6 residents suffering fractures from falls | 11/09/2012 Training Completed; Paid in Full; Partial pmt. of $6,000.00; 03/27/2012 Settlement Agreement for $18,000.00 & Training; Appealed 07/29/2011 | $18,000.00 | 09/04/2012 07/02/2012 04/04/2012 |
| Cardinal Care Center- Hendersonville | HAL-045-001 | 9/13/2010 | $20,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and implement measures to reduce falls | Paid in Full | $20,000.00 | 10/21/2010 |
| Cherry Springs Village | HAL-045-099 | 6/19/2008 | $4,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered; resident did not receive coumadin as ordered | Paid in Full 10/28/2009 Settlement Agreement $3,000.00 & Training; Appealed 07/18/208 | Training Completed & $2000.00 | 12/7/2009 |
| Druid Hills Living Center #2 | HAL-045-071 | 2/17/2010 | $14,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident with mild dementia who utilized a walker and was at risk for falls who left the facility during evening hours during snow and icy weather conditions to travel on foot with a walker to obtain cigarettes. Access to the store required crossing a five lane intersection. She was struck by a vehicle and killed. | Paid in Full; 1/18/2012 Settlement Agreement $1,000.00; Appealed 03/18/2010 | $1,000.00 | 1/18/2012 |
| Mountain View Assisted Living | HAL-045-015 | 9/16/2008 | $16,000.00 | Type A | 10A NCAC 13F .0604 Personal Care and Other Sfaffing; 10A NCAC 13F .1005 Self-Administration of Medications | Residents were provided medication ahead of scheduled adminstration times and directed to self administer to relieve facility from staffing medication aide. Resident with history of suicide attempts utilized medication to commit suicide. | Paid in Full Settlement Agreement 10/14/09 $6,000.00 partial pmts. & Training; Appealed 10/13/2008 | Training Completed 11/11/2009 Total paid $5,000.00 - received $1,000.00 each date | 01/27/2010 12/17/2009 11/15/2009 10/29/2009 10/05/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Twin Oaks Rest Home | HAL-046-002 Proposal #1 | 4/5/2007 | $810.00 | Not corrected Type B | 10A NCAC 13F .0407 (a) (5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Healthcare registry verifications were not conducted for six staff | Paid in Full | $810.00 | 8/30/2007 |
| Twin Oaks Rest Home | HAL-046-002 Proposal #2 | 4/5/2007 | $810.00 | Not corrected Type B | 10A NCAC 13F .0407 (a) (7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background checks were not conducted for five staff | Paid in Full | $810.00 | 8/30/2007 |
| Twin Oaks Rest Home | HAL-046-002 Proposal #3 | 4/5/2007 | $810.00 | Not corrected Type B | 10A NCAC 13F .0406 (a) Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights | Five of seven staff did not have tuberculois tests | Paid in Full | $810.00 | 8/30/2007 |
| Twin Oaks Rest Home | HAL-046-002 Proposal #4 | 4/5/2007 | $1,080.00 | Not corrected Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered for 7 of 8 residents | Paid in Full | $1,080.00 | 8/30/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Open Arms Retirement Center | HAL-047-003 | 1/30/2007 | $5,250.00 | Not corrected Type B | 10A NCAC 13F .0406 (a) Test for Tuberculosis; 10A NCAC 13F .0504 (a) Competency Validation for Licensed Health Professional Support Task; G.S. 131D-21 (2) Declaration of Residents' Rights | Three of 13 staff did not have tuberculosis test; ten of 13 staff were not competency validated before providing licensed health professional tasks such as oxygen administration, changing dressings, catheter care, using hoyer lift, and other services | Paid in Full; Settlement Agreement 3/13/08; Appealed 3/2/07 | $3,000.00 | 7/28/2009 |
| Raeford Manor | HAL-047-007 | 1/3/2011 | $2,000.00 | Type A | 10A NCAC 13F .0702 Discharge of Residents; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to residents with exit- seeking behaviors and noncompliance to the facility's smoking policy | Referred to Controller's Office | ||
| Raeford Manor | HAL-047-004 | 7/16/2009 | $2,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide Supervision to a resident known to wander | Paid in Full | $2,000.00 | 8/21/2009 |
| Raeford Manor | HAL-047-004 | 9/16/2008 | $1,890.00 | Not corrected Type B | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights | Medication (insulin) was not administered as ordered. Four of four staff were not able to calculate correct dose as ordered. | Paid in Full | $1,890.00 | 11/19/2008 |
None of the facilities in Hyde County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Aurora of Statesville | HAL-049-028 | 11/16/2011 | $12,000.00 | Type A | 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure all exit doors accessible by residents with disorientation, wandering and elopement behaviors were equipped with a sounding device or had an audible alarm resulting in two residents exiting into stairwell and experiencing serious injury. Facility failed to provide supervision based on assessed needs and behaviors for three residents with one experiencing increased falls, one resident who eloped and experienced hypothermia and one resident with suicidal behaviors who experienced physical injury | Paid in Full Payment Plan by Controller's Office for Partial pmt. of $1,123.51 | $13,482.49 | 12/14/2012 11/21/2012 10/23/2012 9/25/2012 9/05/2012 7/17/2012 6/15/2012 5/24/2012 4/20/2012 3/26/2012 2/17/2012 2/1/2012 |
| The Churchill Senior Living Community | HAL-049-025 | 10/22/2009 | Staff Training | Unabated Type B | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service- Therapeautic Diets; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to serve therapeutic diets to four residents on the special care unit ensuing the food form, portions, and food selections were as ordered by the physician. | Training Completed | 12/18/2009 | |
| Summit Place of Mooresville | HAL-049-024 | 5/20/2010 | $16,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .1304 (8) Special Care Unit Building Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident residing on the Alzheimer's special care unit when the facility and courtyard doors were left open. Resident wandered outside the secure area and was deceased when found | Paid in Full | $16,000.00 | 7/16/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| The Hermitage | HAL-050-017 | 9/15/2011 | $4,000.00 & $3,000.00 Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to 3 of 7 residents assessed at risk for falls resulting in fractures and/or hospital treatment | Appealed 10/10/2011 | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Cardinal Care Assisted Living | HAL-051-030 | 9/26/2007 | Staff Training | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to clarify orders with physician which resulted in resident not receiving insulin as ordered | Training Completed | 12/23/2007 | |
| Cardinal Care Assisted Living Village #2 | HAL-051-032 | 11/19/2007 | $3,600.00 | Not corrected Type B | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise resident's smoking behavior. Resident smoked in his room | Paid in Full | $3,600.00 | 1/17/2008 |
| Clayton House | HAL-051-028 | 6/27/2007 | $5,360.00 | Not corrected Type B | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Resident's Rights | Medications were not administered as ordered for 7 of 16 residents | Paid in Full Settlement Agreement 4/4/08; Appealed 7/27/07 |
$3,280.00 | 05/07/2008 |
| Four Oaks Assisted Living | HAL-051-026 | 9/26/2007 | $7,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to supervise the smoking activities of residents whose behavior demonstrated the need for increased supervision | Paid in Full | $7,000.00 | 11/28/2007 |
| Front Street Family Care Home | FCL-051-017 | 02/14/2006 | $2,000.00 | Type A | 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights | Medication not administered as ordered for one resident | Paid in Full | $2,000.00 | 4/28/2006 |
| Smithfield House West | HAL-051-027 | 12/16/2009 | $2,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer sliding scale insulin as ordered to three residents. One resident required hospitalization to address blood sugar levels. | Paid in Full; Referred to Controller's Office | $2,225.91 | 9/3/2010 |
None of the facilities in Jones County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Ashewood Estates Retirement | HAL-053-011 | 5/14/2008 | $16,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to implement measures to prevent falls; physician notification and medical assessment/treatment was not obtained for resident who fell and those who had acute and routine healthcare needs | Paid in Full; Appealed 6/13/08 | $17,600.00 | 12/5/2008 |
| Leaks Family Care | FCL-053-013 | 8/29/2006 | Staff Training | Not corrected Type B | 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents Rights | Medications not administered as ordered | Training Completed | 10/30/2006 | |
| Victorian | HAL-053-010 | 5/20/2010 | $10,560.00 | Unabated Type B | 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G. S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to conduct criminal background checks on employees | Paid in Full Referred to Controllers' Office; | $10,560.00 | 10/5/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Trinity Manor of Kinston, Inc. | HAL-054-003 | 11/20/2008 | $12,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S 131D-21 (2)(4) Declaration of Residents' Rights | Staff failed to refer and seek immediate medical attention for a resident receiving coumidin who was reported to have fallen and presented with an abrasion on his forehead | Paid in Full | $12,000.00 | 12/2/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Boger City Rest Home | HAL-055-002 | 11/15/2012 | $12,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for four residents regarding smoking, physical altercations and falls | Paid in Full | $12,000.00 | 1/11/2013 |
| Boger City Rest Home | HAL-055-002 | 11/15/2012 | $12,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care Referral; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to meet four residents needs regarding burns, falls, refusal of medications and treatments | Paid in Full | $12,000.00 | 1/11/2013 |
| Boger City Rest Home | HAL-055-002 | 10/15/2008 | $11,440.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications continued to not be administered as ordered including insulin | Paid in Full | $11,440.00 | 11/26/2008 |
| Lakewood Care Center | HAL-055-003 | 11/16/2011 | $4,000.00 | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure one resident was free of verbal and physical abuse by staff member | Paid in Full | $4,000.00 | 1/6/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Chestnut Hills of Highland | HAL-056-005 | 11/17/2011 | $3,000.00 & Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for residents relative to fire evacuation, exit seeking behaviors, falls and access to hazardous chemicals | Training Completed 1/25/2012; Paid in Full | $3,000.00 | 1/17/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Hot Springs Family Care Home #1 | FCL-057-007 | 9/19/2012 | $5,300.00 | Unabated B | 10A NCAC 13G .0302(m) Design and Construction; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct and meet sanitation conditions addressing the facility's physical plant, housekeeping, food handling, linen and and furnishings | Paid in Full; Referred to Controller's Office | $5,852.08 | 1/3/2013 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Vintage Inn (Ownership Change) | HAL-058-007 | 1/21/2011 | $16,000.00 | Type A | 10A NCAC 13F .1501 Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure physical restraints were not used for convenience, used only after assessment and care planning had been completed, and only after other less restrictive alternatives had been attempted | Paid in Full; 5/22/2012 Settlement Agreement $3,000.00; Appealed 2/14/2011 | $3,000.00 | 5/30/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| McDowell House | HAL-059-018 | 12/18/2008 | $14,000.00 | Type A | 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide Supervision to prevent or respond to resident elopement. Resident was found dead having wandered from facility. | Settlement Agreement & Training 09/28/2009; Appealed 1/14/09 | Training Completed $10,000.00 | 11/11/2009 11/02/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Charlotte Manor | HAL-060-081 | 3/18/2009 | $18,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and provide appropriate discharge to residents involved with illegal substance abuse and physical and verbal violence in the facility | Paid in Full 09/23/2011 Settlement Agreement ($18,000.00); Appealed 4/17/09 | $18,000.00 | 10/24/2011 |
| Elliott's Manor #2 | FCL-060-092 | 12/18/2008 | $1,720.00 | Type B Unabated | 10A NCAC 13G .0504 (a) Competency Validation; 10A NCAC 13G .1004 (a) Medication | Facility failed to ensure staff were competency validated prior to performing finger stick blood sugars and to administer medication (insulin) as ordered | Paid in Full | $1,720.00 | 12/23/2008 |
| Legacy Heights Senior Living Community | HAL-060-086 | 11/19/2007 | $12,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medication was not administered as ordered resulting in resident being hospitalized | Paid in Full; Referred to Controller's Office | $13,499.90 | 10/21/2008 |
| Oakdale Heights Senior Living | HAL-060-062 | 04/06/2006 | $1,000.00 | Not corrected Type B | 10A NCAC 13F .1004(a) Medication Administration; 13F .0909 Residents Rights; GS 131D-4.4 Adult Care Home Minimum Safety Requirements Rights | Medication for one resident not administered as ordered | Paid in Full | $1,000.00 | 5/12/2006 |
| The Parc at Sharon Amity | HAL-060-103 | 06/20/2012 | $4,000.00 | Type A2 | 10A NCAC 13F .0702 Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to discharge two residents who posed an endangerment to the safety of other residents | Appealed 07/19/2012 | ||
| The Parc at Sharon Amity | HAL-060-103 | 3/17/2011 | $10,000.00 | Type A | 10A NCAC 13F .1004(a)(1)(2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure medications administered as ordered. | Appealed 4/8/2011 | ||
| Pray Until Something Happens Assisted Living (Closed) | FCL-060-121 | 10/15/2012 | $6,100.00 | Unabated B | NCAC 13G .1004(j) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct and maintain residents' medication administration records | Appealed 12/19/2012 | ||
| Pray Until Something Happens Assisted Living (Closed) | FCL-060-121 | 7/16/2012 | $1,000.00 | Type A2 | 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain safe water temperatures in all bathrooms utilized by residents | |||
| Regency Retirement Village | HAL-060-073 | 3/18/2009 | $7,000.00 | Type A | 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supevision to confused residents with wandering and elopement behaviors; one resident left the property and was found on state highway | Paid in Full | $7,000.00 | 5/14/2009 |
| Regency Retirement Village | HAL-060-073 | 1/23/2008 | $6,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medication was not administered as ordered resulting in one resident being hospitalized | Paid in Full | $6,000.00 | 3/17/2008 |
| Slay's Rest Home | HAL-060-038 | 8/27/2007 | $9,120.00 | Not corrected Type B | 10A NCAC 13F .0507 Training On Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to to ensure at least one staff on duty at all times who had CPR course. Facility failed to correct noncompliance for 98 days past date given for correction | Paid in Full | $10,090.00 | 12/21/2007 |
| Slay's Rest Home | HAL-060-038 | 8/27/2007 | $7,840.00 | Not corrected Type B | 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Criminal background checks for 4 of 5 staff were not conducted. Facility failed to correct noncompliance for 98 days past date given for correction | Paid in Full | $8,676/00 | 12/13/2007 |
| Sunrise On Providence | HAL-060-057 | 3/14/2012 | $1,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of a resident with dementia who resided on the secure dementia unit who was found several miles from the facility | Paid in Full | $1,000.00 | 3/28/2012 |
| Weddington Park | HAL-060-042 | 7/21/2011 | $1,000.00 | Type A | 10A NCAN 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to follow physician order to reduce Coumadin dosage resulting in resident requiring emergency room treatment | Paid in Full | $1,000.00 | 8/17/2011 |
| Willow Ridge Assisted Living | HAL-060-070 | 6/2/2006 | $2,500.00 | Type A | 10A NCAC 13F .0906(f) (3)(4) Other Resident Care and Services; 13F .0901(b)(c) Personal Care and Supervision; 13F .1211(a)(6) Written Policies and Procedures; 13F .0802 (a)(f) Resident Care Plan; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Care not planned and resident not supervised; resident failed to return to facility and law enforcment not notified timely | Paid in Full | $2,500.00 | 1/8/2007 |
None of the facilities in Mitchell County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Evans Rest Home (name change - Tillery Chase ACH) | HAL-062-004 | 2/21/2008 | $16,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Resident Rights | Facility failed to enforce no smoking policy when resident noncompliant; fire occurred resulting in evacuation of building and rolcation of 53 residents with two requiring medical treatment | Paid In Full Referred to Controller's Office | $18,346.24 | 11/4/2008 |
| Tillery Chase Adult Care Home (penalty #1) | HAL-062-004 | 3/20/2013 | $4,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up for three of five residents who experienced pressure sores, skin tears, falls and weight loss | |||
| Tillery Chase Adult Care Home (penalty #2) | HAL-062-004 | 3/20/2013 | $30,750.00 | Unabated Type A2 | 10A NCAC 13F .0902(b) Health Care Referral and Follow-up; G.S. 131D-21 (4) Declaration of Residents' Rights-Neglect; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare follow-up and referral for four of five residents who experienced aggressive behaviors, decline in health, need for eye glasses, medication refusal and unreal perceptions | |||
| Tillery Chase Adult Care Home | HAL-062-004 | 7/16/2012 | $8,800.00 | Unabated B | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to correct infection control practices when they failed to assure staff implemented infection control measures for four of four residents when staff shared and failed to clean blood testing devices | Paid in Full | $8,800.00 | 9/12/2012 |
| Tillery Chase Adult Care Home | HAL-062-004 | 11/16/2011 | $2,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to obtain a psychiatric consultation as ordered and physician was notified of resident's inappropriate behavior | Paid in Full | $2,000.00 | 12/7/2011 |
| Tillery Chase Adult Care Home | HAL-062-004 | 7/15/2010 | $3,240.00 | Unabated Type B | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medications including insulin as ordered | Paid in Full | $3,240.00 | 9/7/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Magnolia Gardens | HAL-063-007 | 2/17/2010 | $2,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medications including sliding scale insulin to residents as ordered by their physician | Paid in Full | $2,000.00 | 3/26/2010 |
| Magnolia Gardens of Southern Pines, LLC | HAL-063-007 | 9/16/2008 | $7,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to notify md of resident's low blood sugar. Resident became unresponsive, fell and suffered facial fracture | Paid in Full Settlement Agreement & Training 6/06/2009 Appealed 10/15/08 | Training Completed; $4,000.00 | 08/28/2009 06/09/2009 |
| Michael Lane Alternative House | FCL-063-018 | 9/16/2008 | $1,740.00 | Not corrected Type B | 10A NCAC 13G .0403 Qualification of Medication Staff; G.S. 131D-21(2) Declaration of Residents' Rights | Two of four staff were not clinically validated to administer medications prior to administering medications. Residents experienced medication errors. | Paid in Full | $1,954.58 | 1/5/2009 |
| Penick Village | NH-0127 | 11/15/2012 | $14,000 | Type A1 | 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to initiate emergency medical services, call 911 immediately and perform cardiopulmonary resuscitation for a resident who was a full code. | Invoiced $14,000 | ||
| Seven Lakes | HAL-063-023 | 7/16/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide adequate supervision for one resident residing in the special care unit from eloping on several occasions | Appealed 08/13/2012 | ||
| Southern Pines Manor | HAL-063-012 | 11/15/2006 | $1,000.00 | Type A | 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Hot water temperatures were not maintained in safe range for use in 3 resident rooms and both community bath areas | Appealed
11/27/06 Paid in Full 10/5/07 |
$1000.00 | 10/5/2007 |
| Tara Plantation of Carthage | HAL-063-011 | 11/16/2012 | $2,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident with dementia while in the facility's courtyard | Appealed 12/14/2012 | ||
| Tara Plantation of Carthage | HAL-063-011 | 11/20/2008 | $14.000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility staff failed to ensure health care referral and follow-up for two residents: one who was administered the wrong medication; the other experiencing skin breakdown | Paid in Full 1/12/2010 Settlement Agreement & Training Appealed 12/18/08 | $4,000.00 | 2/4/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Universal Healthcare/ Nashville | NH0500 | 1/25/2011 | $2,000 | Type A | 10A-13D.2208 (e) Safety G.S. 131E-117. Declaration of patient's rights. | Facility failed to prevent a cognitively impaired resident who was identified by the facility with exit seeking behavior from leaving the facility unsupervised. The resident was found by a passing driver across the street from the facility unsupervised. | Paid | $2,000 | 2/8/2011 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Champions Assisted Living | HAL-065-020 | 3/20/2008 | $2,000.00 | Type A | 10A NCAC 13F .0306 (a)(5) Housekeeping & Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights | Disoriented resident fell in unsecured, unoccupied room being renovated | Paid in Full | $2,000.00 | 4/14/2008 |
| Champions Assisted Living | HAL-065-020 | 2/27/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901 (B) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Two confused residents wandered from facility. System to supervise residents not implemented. | Paid in Full Appealed 3/13/07 | $4,000.00 | 4/20/2007 |
| Clare Bridge of Wilmington | HAL-065-019 | 5/19/2011 | Staff Training | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to prevent the elopement of two residents residing on the special care unit | Training Completed | 7/12/2011 | |
| The Commons at Brightmore | HAL-065-002 | 1/16/2013 | $20,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .1501(a)(2) Use of Physical Restraints and Alternatives; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to provide supervision to residents at risk for falls and failed to assure physical restraints (bed rails) were used only with physican order following resident assessment and care planning resulting in resident death and injury | Paid in Full | $20,000.00 | 2/8/2013 |
| GlenCare of Wilmington (Ownership Change) | HAL-065-030 | 3/17/2011 | $7,000.00 | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility neglected to assure the rights of residents were maintained by their failure to investgate causes of residents' bruising in relation to the potential of abuse and the monitoring of weights to address recorded weight losses for accuracy or need for referral | Paid in Full Partial pmt. | $3,500.00 $3,500.00 | 05/11/2011 04/07/2011 |
| GlenCare of Wilmington | HAL-065-030 | 12/16/2009 | $2,000.00 | Type A Reduced to Type B | 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide adequate supervision and health care referral and follow-up to meet the needs of residents on the Special Care Unit. Facility failed to ensure that they did not employ staff who had substantiated findings on the NC Health Care Personnel Registry | Paid in Full; 6/16/2011 Settlement Agreement resulting in change in noncompliance from a Type A to a Type B violation and $2,000.00 fine; Appealed 1/14/2010 | $2,000.00 | 8/1/2011 |
| Hermitage House Rest Home | HAL-065-001 | 5/19/2010 | $4,000.00 | Type A | 10A NCAC 13F .0311 (d) Other Requirements (Hot Water Temperature); G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain hot water temperatures within a safe range for resident use | Paid in Full | $4,000.00 | 6/24/2010 |
| Jasmine Cove Assisted Living | HAL-065-022 | 1/9/2007 | $4,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to obtain medication order and administer insulin as needed requiring resident to be hospitalized; additionally, failed to administer insulin and other medications as ordered for other residents | Referred to Controller's Office | ||
| Jasmine Cove Assisted Living | HAL-065-022 | 08/25/2006 | $2,500.00 | Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident reported intent to leave, left unsupervised, resident found on busy roadway | Paid in Full | $2,500.00 | 1/5/2007 |
| Lowe's Family Care Home #3 | FCL-065-011 | 1/21/2010 | $6,680.00 | Unabated Type B | 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide residents health care referral and follow-up to needs including elevated blood pressures and orders for physical therapy, speech therapy, range-of-motion, and labwork | Appealed 2/18/2010 | ||
| Lowe's Family Care Home #3 | FCL-065-011 | 10/22/2009 | $3,000.00 | Unabated Type B | 10A NCAC 13G .0318 Outside Premises; 10A NCAC 13G .0901 (a) Personal Care & Supervision; 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure 3 residents received personal care and referral and follow-up regarding physician orders for 2 residents. Outside premises were not maintained due to lack of addressing presence of animal waste | Appealed 11/20/2009 | ||
| Lowes Family Care Home #3 | FCL-065-011 | 2/21/2008 | $2,000.00 | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to send resident for medical assessment after fall; resident later determined to have fractures | OAH Decision Rescind 3/30/2009 Appealed 3/21/08; | ||
| Lowes Family Care Home #3 | FCL-065-011 | 08/27/2007 | $1,000.00 | Type A | 10A NCAC 13G .0901 Personal Care and Supervision; 10A NCAC 13G .0312 Outside Entrance and Exits; G.S. 131D-21 (2)Declaration of Resident's Rights | Confused resident wandered from facility without staff knowledge of absence. Door alarm was turned down and not audible at time of elopement. | Paid in Full | $2,500.00 | 1/5/2007 |
| Oakdale Heights of Wilmington | HAL-065-032 | 7/16/2009 | Training | Unabated Type B | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to assure supervision of residents who had histories of falls | Training Completed | 8/27/2009 | |
| Oakdale Heights of Wilmington | HAL-065-024 | 07/23/2008 | $21,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident experiencing confusion wandered from the facility without staff knowledge | Paid in Full; Settlement Agreement 4/1/2009 Appealed 7/28/08 | $4,000.00 | 4/1/2009 |
| Oakdale Heights of Wilmington | HAL-065-024 | 9/26/2007 | Staff Training | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff failed to supervise residents on the Alzheimers' Unit to ensure their safety within the Unit | Training Completed | 11/13/2007 | |
| Pacifica Senior Living Wilmington | HAL-065-032 | 11/15/2012 | $1,000.00 | Type A2 | NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to administer medications as ordered to one resident administering ear drops to the eye on two separate occasions | Paid in Full | $1,000.00 | 1/18/2013 |
| Port South Village / Catherine S. Villa | HAL-065-026 | 1/13/2009 | $14,000.00 | Type A | 10A NCAC 13F .1006(b) Medication Storage; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure medications were stored in a locked and secured manner; controlled medications were obtained resulting in resident death | Paid in Full | $14,000.00 | 4/2/2009 |
| Port South Village Lorraine Villa | HAL-065-010 | 01/12/2006 | $6,000.00 | Type A | 10A NCAC 13F .0906 Other Resident Care and Services; 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Authorities not notified when resident failed to return to facility; resident later found dead | OAH Decision Rescinded 09/25/2007; Appealed 02/10/06 | ||
| Port South Village Teresa C Villa | HAL-065-007 | 01/12/2006 | $2,000.00 | Not corrected Type B | 10A NCAC 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights | The staff person on duty was not qualified to provide cardio-pulmonary resuscitation or choking intervention | OAH Decision rescinded 09/25/2007; Appealed 02/10/06 | ||
| Port South Village Teresa C Villa | HAL-065-007 | 01/12/2006 | $2,000.00 | Type A | 10A NCAC 13F .0604 Personal Care and Other Staffing; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents left unsupervised in facility | OAH Decision rescinded 09/25/2007; Appealed 02/10/06 | ||
| Spring Arbor of Wilmington | HAL-065-014 | 1/26/2007 | $2,500.00 | Type A | 10A NCAC 13F .901 (b) Personal Care & Supervision: G.S. 131D-21 (2) Declaration of Residents' Rights | Resident wandered from facility without staff's knowledge; found in road intersection | Paid in Full | $2,500.00 | 2/15/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Hampton Manor | HAL-066-012 | 7/16/2009 | $3,500.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to increase supervision and notify the resident's physician of a resident's inappropriate sexual statements, behaviors and inappropriate dress in the facility | Paid in Full 5/21/2010 Settlement Agreement $2,500.00 ($1,000.00 for training and $1,500.00 payable) Appealed 08/14/2009 | Training Completed 8/23/2010; Training Due $1,500.00 | 6/18/2010 |
| Highland Gardens of Pleasant Hill | HAL-066-016 | 3/21/2013 | $7,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up for three of eight residents who experienced inappropriate behavior and elevated blood sugar levels | |||
| Pleasant Hill Gardens (penalty # 1) | HAL-066-015 | 3/14/2012 | $7,000.00 | Type A | 10A NCAC 13F .0702(b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to discharge one resident whose medical care needs could not be met and one who's aggressive behavior put others' safety at risk | Appealed 1/2/13 | ||
| Pleasant Hill Gardens (penalty # 2) | HAL-066-015 | 3/14/2012 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of a resident who displayed verbally and physically threatening behaviors endangering others | Appealed 1/2/13 | ||
| Pleasant Hill Gardens (penalty # 3) | HAL-066-015 | 3/14/2012 | $4,000.00 | Type A | 10A NCAC 13F .0901(c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer emergency intervention ( the heimlich maneuver) for one resident experiencing choking during a meal | Appealed 1/2/13 | ||
| Rich Square Manor | HAL-066-011 | 9/19/2012 | $4,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up for one resident with weight loss and pressure ulcer | Appealed 10/15/2012 | ||
| St. Mary's Assisted Living of Pleasant Hill | HAL-066-009 | 5/14/2008 | $16,000.00 | Type A | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident was not served therapeutic pureed diet as ordered resulting in resident choking and suffering full arrest and death | Paid in Full Partial pmt. |
$12,000.00 $4,000.00 | 07/11/2008 5/31/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| The Heritage of Richlands, LLC | HAL-067-016 | 1/13/2009 | $2,000.00 | Type A | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service- Therapeautic Diets; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure therapeutic diets were served resulting in one resident requiring medical treatment | Paid in Full; 8/13/2009 Settlement Agreement $2,000.00 & Training; Appealed 2/11/09 | $2,000.00 | 8/19/2009 |
| Lighthouse Village | HAL-067-013 | 9/15/2010 | $3,720.00 | Unabated Type B | 10A NCAC 13F .0906(f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to respond when resident did not return to facility as scheduled. | Paid in Full | $3,720.00 | 10/14/2010 |
| Lighthouse Village | HAL-067-013 | 9/26/2007 | $4,000.00 | Type A | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Residents' Rights | Facility failed to ensure residents were protected from staff abuse | Paid in Full Settlement Agreement 03/13/08; Appealed 10/17/07 | $1,500.00 | 5/13/2009 |
| Pearl's Family Care Home #4 | FCL-067-014 | 2/21/2008 | $1,920.00 | Not corrected Type B | 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to conduct criminal background checks for 2 of 3 staff on revisit | Paid in Full | $1,920.00 | 2/14/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Carolina House of Chapel Hill | HAL-068-008 | 11/10/2010 | $4,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide healthcare referral and follow-up for residents including for a resident with pressure sores | Paid in Full | $4,000.00 | 11/30/2010 |
| Carrboro Senior Living | HAL-068-022 | 08/22/2006 | $7,500.00 | Type A | 10A NCAC 13F .0906 (f)(3) Other Resident Care Services G.S. 131D-21 (2) Declaration of Residents' Rights | Resident wandered from facility and suffered hypothermia | Paid in Full | $7,500.00 | 10/17/2006 |
| The Stratford | HAL-068-025 | 7/15/2010 | $4,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medication (insulin) as ordered and failed to ensure follow-up and referral with resident's physician | Appealed 9/8/10 | ||
None of the facilities in Pamlico County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Carolina House of Elizabeth City | HAL-070-005 | 1/16/2008 | $7,000.00 | Type A | 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21 (2)Declaration of Residents' Rights | During fire drill, one staff person unsuccessfully attempted to transfer a resident requiring two person assistance; resident reported pain and was found to have fractures | Paid in Full | $7,000.00 | 2/8/2008 |
| Carolina House of Elizabeth City | HAL-070-005 | 08/23/2006 | $11,400.00 $12,000.00 |
Type A | 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2)Declaration of Residents' Rights | Resident wandered from facility and was found dead | Settlement Agreement 2/6/07 Appealed 09/15/06 |
$11,400.00 | 2/28/2007 |
| Waterbrooke of Elizabeth City | HAL-070-008 | 9/14/2010 | $42,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision and referral to health care provider relative to five residents' needs including falls, inappropriate behaviors and pressure wound | Training Completed 7/12/11 Paid in Full 2/24/2011 Settlement Agreement ($8,000.00 - $7,000.00 payable & $1,000.00 for training) Appealed 10/11/2010 | $7,000.00 | 4/13/2011 |
| Waterbrooke of Elizabeth City | HAL-070-008 | 2/17/2010 | $1,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .1304 (4) Special Care Unit Building Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain supervision and secure area for residents residing on the special care unit. Three residents wandered several blocks from the facility when the doors were deactivated for service work in the facility | Paid In Full | $1,000.00 | 3/18/2010 |
| Waterbrooke of Elizabeth City | HAL-070-007 | 9/16/2008 | $1,000.00 | Type A | 10A NCAC 13F .901 Personal Care and Supervision; G.S.131-D(2) Declaration of Residents' Rights | Confused resident at high risk for falls using a rolling walker eloped and was found by EMS staff. Facility not aware of resident's absence from building. | Paid in Full | $1,000.00 | 12/10/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| DaySpring Assisted Living | HAL-071-008 | 01/12/2006 | $3,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | One resident wandered from facility | Paid in Full | $3,000.00 | 1/25/2006 |
| Forest Lane Family Care Home #2 | FCL-071-003 | 6/19/2008 | $3,000.00 | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights | Facility failed to notify physician of resident's continued skin breakdown | Paid in Full Referred to Controller's Office | $3,352.47 | 12/10/2008 |
None of the facilities in Perquimans County have received a penalty since January 2006.
None of the facilities in Person County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Dixon House | HAL-074-033 | 2/17/2009 | Training | Type B Unabated | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to notify physician regarding residents' medication refusals, blood pressure values and contraindications for medication | Training Completed | 4/17/2009 | |
| Freeman Family Care Home #2 (penalty #1) | FCL-074-010 | 11/15/2012 | $7,600.00 | Unabated B | NCAC 13G .0904(a)(1) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct conditions to assure kitchen, dining, and food storage areas were clean and orderly and protected from contamination | Referred to Controller's Office | ||
| Freeman Family Care Home #2 (penalty #2) | FCL-074-010 | 11/15/2012 | $7,600.00 | Unabated B | NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct medication admininstration problems by failing to assure three residents received medications as ordered | Referred to Controller's Office | ||
| Stafford Glen Assisted Living (chow 1/1/2009) | HAL-074-030 | 5/18/2010 | $2,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer medication as ordered resulting in one resident requiring hosptialization | Paid in Full | $2,000.00 | 6/14/2010 |
| Winterville Manor | HAL-074-026 | 1/9/2007 | $4,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Residents did not receive medications as ordered; resident not administered insulin required hospitalization | Paid in Full | $4,000.00 | 1/16/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Twin Lanes Home | HAL-075-002 | 5/3/2007 | $4,000.00 | Type A | 10A NCAC 13F .0305 Physical Environment; 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Exit alarm did not activate at night. While supervisor slept, resident known to wander left the facility. Resident was found cold and had sustained multiple cuts and bruises | Paid in Full | $4,000.00 | 6/1/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Caregivers of Liberty II | FCL-076-033 | 9/15/2011 | $500.00 & $500.00 Staff Training | Type A | 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .0601 Management and Other Staff: G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to address resident's pressure sores and orders for the adminstration of oxygen | Training Completed 12/2/11; Training Due; Paid in Full | $500.00 | 11/15/2011 |
| Carol Lee Family Care Home | FCL-076-021 | 1/21/2011 | $1,590.00 | Unabated Type B | 10A NCAC 13G .0904 (e)(4) Nutrition & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide one resident with therapeutic diet as ordered | Partial pmt. Facility Closed | $1,500.00 | 3/30/2011 |
| Carolina House of Asheboro | HAL-076-007 | 2/20/2013 | $12,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up regarding a resident's aggressive behaviors and another resident's need for a access to continuous oxygen | Paid in Full | $12,000.00 | 3/7/2013 |
| Carolina House of Asheboro | HAL-076-007 | 12/19/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0902 (c)(4) Health Care Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure implementation of physician orders regarding the monitoring of coumidin for one resident | Paid in Full | 1/4/2013 | $2,000.00 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Fisher Adult Care, Inc | HAL-077-008 | 5/18/2010 | $6,100.00 | Unabated Type B | 10A NCAC 13F .0407 (a)(5) Other Staff Qualifications (HCPR); G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide verification with healthcare registry that staff had no findings prohibiting employment in the facility | Referred to Controllers' Office | ||
| Fisher Adult Care, Inc | HAL-077-008 | 12/16/2009 | $36,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to provide referral and follow-up for residents exhibiting high blood pressures or low blood sugars | Referred to Controllers' Office | ||
| Fisher Adult Care (penalty #1) | HAL-077-008 | 10/15/2008 | $2,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; G.S.131D-21(2) Declaration of Residents' Rights | Facility failed to supervise resident to prevent elopement and unsupervised access to traffic intersection | Paid in Full | $2,000.00 | 2/6/2009 |
| Fisher Adult Care (penalty #2) | HAL-077-008 | 10/15/2008 | $4,400.00 | Type B Unabated | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to refer residents to physician and dentist as needed and failed to administer medications including insulin as ordered. | Paid in Full | $4,400.00 | 2/6/2009 |
| Somerset Court of Hamlet | HAL-077-009 | 10/15/2008 | $12,000.00 | Type A | 10A NCAC 13F .0902(c)(3)(4) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to obtain ordered lab test to monitor effects of resident's use of coumidin with resident requiring hospitaliztion for treatment | Paid in Full | $12,000.00 | 10/21/2008 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Golden Years of Pembroke #4 | HAL-078-045 | 08/25/2006 | $4,000.00 | Type A | 10A NCAC 13F .0305 (h)(4) Physical Environment; 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Resident was found in facility's yard; door alarm had not been activated; resident suffered hypothermia | Referred to Controllers' Office; OAH Decision Upheld 1/24/07 Appealed 09/21/06 | ||
| Greenbrier of Fairmont | HAL-078-068 | 2/17/2010 | $2,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to follow physician's orders including administration of medication to infected toe and referral to VA hospital for treatment. Amputation of resident's toe was necessary following onset of gangrene by the time of VA visit | Paid in Full Referred to Controllers' Office | $2,216.67 | 5/13/2010 |
| Green Manor Rest Home (Change of Ownership) | HAL-078-003 | 1/16/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .1212(g) Reporting of Accidents and Incidents; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to respond to protect residents and report behaviors to health and mental health providers when a resident exhibited a change in status and demonstrated physically aggressive behaviors | |||
| Green Manor Rest Home | HAL-078-003 | 6/18/2012 | $7,900.00 | Unabated B | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure medications and treatments were adminstered as ordered for two residents and failed to assure referral and follow-up for one resident | Paid in Full | $7,900.00 | 8/21/2012 |
| Green Manor Rest Home | HAL-078-003 | 4/17/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure supervision of one resident with exit seeking behavior and another who demonstrated inappropriate sexual behavior to other residents | Paid in Full | $2,000.00 | 5/23/2012 |
| Green Manor Rest Home (Penalty #1) | HAL-078-003 | 3/20/2008 | $2,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Medications were not administered as ordered for 3 of 9 residents including sliding scale insulin | Paid in Full | $2,000.00 | 6/17/2008 |
| Green Manor Rest Home (Penalty #2) | HAL-078-003 | 3/20/2008 | $2,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Physicians were not notified for residents' health care needs regarding recent hospitalization, treatment for pressure sores and hyperglycemic conditions | Paid in Full | $2,000.00 | 6/17/2008 |
| Green Manor Rest Home | HAL-078-003 | 5/15/2008 | $4,000.00 | Type A | 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Therapeutic diets were not served as ordered to two residents needing enteral feedings via peg tubes | Paid in Full Referred to Controller's Office | $4,400.00 | 8/12/2008 |
| Greystone Manor (Ownership Change) | HAL-078-040 | 3/17/2011 | $30,000.00 | Type A | 10A NCAC 13F .0901(b)(c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to protect residents from self initated harmful behavior | Paid in Full; 01/11/2012 Settlement Agreeement $15,000.00; Appealed 04/13/2011 | $15,000.00 | 5/1/2012 |
| Greystone Manor (chow 6/1/10 now Red Springs AL) | HAL-078-040 | 2/17/2010 | $12,000.00 | Type A | 10A NCAC 13F .0702 (b) Admission & Discharge 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | The facility failed to provide supervision to a unsafe smoker and failed to provide supervision or initiate discharge to a resident with history of aggression who subsequently sexually assaulted another resident | Paid in Full; Settlement Agreement 8/18/10 for $5,000.00; Appealed 03/11/2010 | $5,000.00 | 9/2/2010 |
| Greystone Manor | HAL-078-040 | 10/15/2008 | $4,240.00 | Type B Unabated | 10A NCAC 13F .0904 (e)(1) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility staff failed to thicken liquids as ordered for two residents | Paid in Full | $4,240.00 | 12/4/2008 |
| Greystone Manor | HAL-078-040 | 1/22/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident found unresponsive, staff failed to initiate CPR | Paid in Full | $4,000.00 | 2/1/2007 |
| Greystone Manor | HAL-078-045 | 10/24/2006 | $5,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; 10A NCAC 13F .1501 Use of Physical Restraints and Alternatives; G.S. 131D-21 (1)(2)(4) Declaration of Residents' Rights | Restraints not applied to resident as ordered | Paid in Full | $5,000.00 | 11/15/2006 |
| L & S Family Care Home - Facility Closed | FCL-078-060 | 1/21/2011 | $3,480.00 | Unabated Type B | 10A NCAC 13G .0403 Qualifications of Medication Staff; 10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; 10A NCAC 13G .0702 Tuberculosis Test & Medical Examination; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure employees who administered medications had passed the written medication test; had an employee working at all times who had completed the cardio-pulmonary resuscitation course; and failed to assure that two of three residents had been tested for TB | Referred to Controller's Office | ||
| L & S Family Care Home (penalty #1) | FCL-078-060 | 11/18/2009 | $3,100.00 | Unabated Type A | G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to prohibit resident from smoking inside the facility | Referred to Controllers Office | ||
| L & S Family Care Home (penalty #2) | FCL-078-060 | 11/18/2009 | $5,670.00 | Unabated Type B | 10A NCAC 13G .0214 Suspension of Admission; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to stop admitting residents when a suspension of admission was in effect due to noncompliance | Referred to Controllers Office | ||
| L & S Family Care Home | FCL-078-060 | 7/16/2009 | $3,650.00 | Unabated Type A | G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure staff and residents did not smoke in the facility | Referred to Controllers Office | ||
| L & S Family Care Home | FCL-078-060 | 4/16/2009 | $1,500.00 | Type A Unabated | G.S. 131D-4.4 Minimum Safety; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure that staff and residents did not smoke in the facility. Staff and residents smoked in bedrooms. | 05/07/2009 Settlement Agreement for $2,800.00 in Conjunction w/penalty imposed 01/13/2009; Partial pmt(s). | ||
| L & S Family Care Home | FCL-078-060 | 1/13/2009 | $2,000.00 | Type A | G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure that residents did not smoke in the facility. Residents smoked in their bedrooms and common rooms | 05/07/2009 Settlement Agreement for $2,800.00 in Conjunction w/penalty imposed 04/16/2009; Partial pmt(s); Appealed 12/16/2008 | Partial pmts $400.00 | 6/23/2009 |
| Sampson's Family Care Home | FCL-078-028 | 11/9/2010 | $5,450.00 | Unabated Type B | 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications (Criminal Background); G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to conduct criminal background checks on employees | Referred to Controllers' Office | ||
| St. Mary's Assisted Living | HAL-078-052 | 6/27/2007 | $7,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to make referral to address resident's pressure sore which had become gangrenous | Partial Pmt. Paid in Full |
$2,000.00 $5691.62 |
7/20/2007 2/4/2008 |
| St. Mary's Assisted Living of Red Springs, Inc. (Penalty #1) | HAL-078-071 | 1/21/2011 | $12,000.00 | Type A | 10A NCAC 13F .0407(a)(2) Other Staff Qualifications (Fire Safety & Emergency Procedures); 10A NCAC 13F .0601(a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure staff were able to apply fire and safety emergency procedures assuring all residents were safely evacuated during a fire. Staff were not aware they had left eight residents in the building during a response to a fire started by a resident | Paid in Full; 6/22/2011 Settlement Agreement for $12,000.00 in conjunction with penalty #2 imposed 1/21/2011 | $12,000.00 | 7/19/2011 |
| St. Mary's Assisted Living of Red Springs, Inc. (Penalty #2) | HAL-078-071 | 1/21/2011 | $2,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide adequate supervision to two residents based on assessed needs; one regarding exit-seeking behaviors and the other due to noncompliance to facility's smoking policy | Paid in Full; 6/22/2011 Settlement Agreement for $12,000.00 in conjunction with penalty #1 imposed 1/21/2011 | ||
| St. Mary's Assisted Living of Red Springs (Penalty #1) | HAL-078-052 | 12/18/2008 | $5,640.00 | Type B Unabated | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure residents received medication (insulin) as ordered | Paid in Full | $5.640.00 | 1/15/2009 |
| St. Mary's Assisted Living of Red Springs (Penalty #2) | HAL-078-052 | 12/18/2008 | $5,040.00 | Type B Unabated | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide follow-up and referral to address residents needs including dental needs and physician notification of residents' refusal to take medication | Paid in Full | $5,040.00 | 1/15/2009 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Ashlee Place Adult Care (Change of Ownership) | FCL-079-083 | 12/19/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (1)(4) Declaration of Residents' Rights | Facility failed to assure residents were free from mental abuse based on the care and interactions with staff | Referred to Controller's Office | ||
| Cornerstone Assisted Living | FCL-079-068 | 9/15/2010 | $1,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0902 (b) Health Care Referral & Follow-up; G.S. 131D-21 (2) Declaration of Residents' Rights; 131D-21 (4) Declaration of Residents' Rights to be free of mental, physical abuse, neglect & exploitation | Facility failed to provide supervision and referral to health care provider to prevent resident to resident abusive behavior | Paid in Full Partial pmt. | $552.12 $500.00 | 12/22/2010 11/16/2010 |
| Faithworks Assisted Living | FCL-079-067 | 7/16/2010 | Staff Training | Type A | 10A NCAC 13G .0902 (b) Health Care Referral & Follow-up; 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to notify physician for follow-up andreferral rgarding medication order failing to administer insulin as ordered | Paid in Full | $1,116.67 | 12/30/2011 |
| Highgrove Long Term Care Center | HAL-079-002 | 3/10/2011 | $12,000.00 | Type A | 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide care and services to prevent the development of pressure sores for two residents | 3/8/2012 Training Completed; Paid in Full; 11/30/2011 Settlement Agreement $6,000.00 ($4,000.00 payable & $2,000.00 training; Appealed 5/2/2011 | $4,000.00 | 12/15/2011 |
| Holman-Hampton Sunshine FCH #1 | FCL-079-062 | 11/18/2009 | $2,000.00 | Type A | 10A NCAC 13G .1004 (a) Medication Administration; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to administer medications as ordered for residents, documented administration of medication and treatments not administered and failed to refer resident suffering from chest pain and chronic foot pain to physician | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #1 | FCL-079-062 | 2/17/2009 | $1,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility staff left three residents unattended to purchase cigarettes. During absence of staff, fight ensued between residents resulting in resident injury | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #2 (penalty #1) | FCL-079-063 | 11/18/2009 | $7,000.00 | Type A | 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to administer insulin to resident as ordered resulting in resident requiring hospitalization | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #2 (penalty #2) | FCL-079-063 | 11/18/2009 | $2,000.00 | Type A | G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to prohibit smoking in the facility by two residents. Three of four residents residing in the facility were nonambulatory | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #2 (penalty #3) | FCL-079-063 | 11/18/2009 | $7,000.00 | Type A | 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident who suffered burns due to being unable to smoke safely without assistance | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #3 (penalty #1) | FCL-079-064 | 11/18/2009 | $1,000.00 | Type A | 10A NCAC 13G .1004(a) Medication Administration; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to administer medications as ordered and failed to notify physician of resident's suicidal ideations | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #3 (penalty #2) | FCL-079-064 | 11/18/2009 | $2,000.00 | Type A | 10A NCAC 13G .0705(b) Discharge of Residents; 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to discharge a resident known to purposely inflict harm to himself when they failed to provide adequate supervision to protect him | Facility Closed Referred to Controllers Office |
||
| Holman-Hampton Sunshine FCH #3 (penalty #3) | FCL-079-064 | 11/18/2009 | $8,500.00 | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to refer resident to physician when the resident experienced physical symptoms after hitting her head on concrete as a result of a fall | Facility Closed Referred to Controllers Office |
||
| Mark's Family Care Home #1 | FCL-079-032 | 11/10/2010 | Staff Training | Type A | 10A NCAC 13G .0909 Resident Rights; 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to investigate allegations regarding a physical altercation between a resident and a staff person. The staff person responded to a resident's verbal aggressiveness with physical intervention | Training Completed | 12/22/2010 | |
| Pine Forrest Home for the Aged | HAL-079-079 | 3/15/2012 | $3,000.00 | Type A2 | 10A NCAC 13F .0904 (e)(4) Nutriction & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to serve thickened liquids as ordered to two residents | Paid in Full | $3,000.00 | 4/25/2012 |
| Pine Forrest Home for the Aged (Ownership Change) | HAL-079-072 | 5/19/2011 | $4,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0904 (3)(4) Nutrition & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide feeding assistance to one resident at risk for choking and failed to assure referral and follow-up for seven residents regarding behavioral, fall and medical status issues | Referred to Controller's Office | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Harris Enterprises of NC d/b/a Deal Care Inn | HAL-080-021 | 1/3/2008 | Staff Training | Type A | 10 NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to make referral to address resident's pressure sores and assure that unlicensed staff did not treat. | Training Completed | 2/8/2008 | |
| Kannon Creek Assisted Living | HAL-080-003 | 2/20/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0901 (c) Personal Care and Supervision; G.S. 131D-21 (3) Declaration of Residents' Rights | Facility failed to intervene and provide CPR when a resident was found unconscious | Paid in Full | $2,000.00 | 3/12/2013 |
| The Meadows of Rockwell Retirement Center | HAL-080-008 | 9/15/2011 | $2,000.00 & $2,000.00 Staff Training | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to one resident with history of wandering and elopement resulting in resident found near highway on one of several elopements | Training Completed 11/21/2011; Paid in Full | $2,000.00 | 10/13/2011 |
| Salisbury Gardens | HAL-080-011 | 10/30/2007 | $16,000.00 | Type A | 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to set door alarms and supervise resident with history of elopement. Following elopement, resident fell and suffered fatal injury. | Paid in Full | $16,000.00 | 11/28/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Haven-N-Hills Living Center (penalty #1) | HAL-081-041 | 1/21/2010 | $7,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident adjudicated incompetent allowing the resident to leave the facility unsupervised | Paid in Full Referred to Controllers' Office | $7,816.67 | 1/31/2011 |
| Haven-N-Hills Living Center (penalty #2) | HAL-081-041 | 1/21/2010 | $12,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure seven residents were administered medications as ordered and failed to make health care referrals to the physician. Residents did not receive sliding scale insulin, seizure medication, medication for pain management and oxygen as ordered | Paid in Full Referred to Controllers' Office | $13,753.88 | 1/31/2011 |
| Haven-N-Hills Living Center | HAL-081-041 | 10/22/2009 | $2,000.00 | Type A | G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure residents did not smoke inside facility | Paid in Full | $2,000.00 | 1/5/2010 |
| Haven-N-Hills | HAL-081-041 | 07/18/2008 | $7,000.00 | Type A | 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Resident with history of elopement was found on highway in wheelchair, door alarms were not functioning and staff had no knowledge of his absence | Paid in Full | $7,822.22 | 12/31/2008 |
| Haven-N-Hills | HAL-081-041 | 01/12/2006 | $1,000.00 | Type A | 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to provide supervision to one resident with problematic behaviors that resulted in physical abuse to four residents | Paid in Full | $1,000.00 | 3/3/2006 |
| Hillcrest Rest Home | HAL-081-046 | 12/20/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure heathcare referral and follow-up for two residents to address medication refusal and and pressure sores | Paid in Full | $2,000.00 | 1/31/2013 |
| Hillcrest Rest Home (Penalty #1) | HAL-081-046 | 9/19/2012 | $7,000.00 | Type A2 | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure a medication, an antibiotic, was administered as ordered for one resident | 1/29/2013 Settlement Agreement - payment plan | $1,732.50 | 02/12/2013 01/18/2013 |
| Hillcrest Rest Home (Penalty #2) | HAL-081-046 | 9/19/2012 | $5,000.00 | Type A2 | 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain safe water temperatures in multiple resident bathroom sinks and at the resident common bathroom shower and sink. | 1/29/2013 Settement Agreement for $2,000.00 - payment plan | ||
| Hillcrest Rest Home (Penalty #1) | HAL-081-046 | 2/15/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for one resident identified with wandering behaviors who wandered from the facility premises | Paid in Full; Partial Payment; 5/30/2012 Appeal Dismissed; Appealed 3/1/2012 | $2,000.00 | 12/14/2013 11/14/2012 09/20/2012 08/23/2012 |
| Hillcrest Rest Home (Penalty #2) | HAL-081-046 | 2/15/2012 | $4,000.00 | Type A1 | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure staff implemented infection control measures for eight diabetic residents when staff shared and failed to clean blood testing devices | Paid in Full; 5/30/2012 Appeal Dismissed; Appealed 3/1/2012 | $4,000.00 | 12/14/2012 |
| Open Arms Family Care Home | FCL-081-045 | 1/21/2011 | $7,000.00 | Type A | 10A NCAC 13G .0902 Health Care; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to ensure a medication resident was noted to be allergic to was not administered | 6/25/12 Training Completed, 3/8/12 Settlement Agreement $1,000.00 training; Appealed 2/9/11 | ||
| Tipton's Family Care Home #4 | FCL-081-020 | 9/18/2006 | $2,000.00 | Type A | 10A NCAC 13G .0406(4) Other Staff Qualifications; 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Staff sent resident to obtain alcohol for staff' personal use during work providing resident with alcohol; resident required treatment for alcohol abuse | Paid in Full | $2,000.00 | 11/20/2006 |
| Tipton Retirement Home #4 | FCL-081-020 | 10/22/2009 | $2,500.00 | Type A | 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain stove in working order. Pliers were neded to utilize burners resulting in a fire due to inability to determine their on/off status | Paid in Full | $2,500.00 | 11/17/2009 |
| Union Mills Living Center #2 (Facility Closed) | FCL-081-034 | 3/16/2011 | $7,000.00 | Type A | 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed ensure healthcare referral and follow-up for residents experiencing elevated blood sugars or needing ordered labs. Additionally, the facility failed to administer medications as ordered. | Referred to Controller's Office | ||
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Clinton House (penalty #1) | HAL-082-015 | 9/13/2010 | $1,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure referral and follow-up for residents with physician regarding appointments, medication refusal, and labwork | Paid in Full | $1,000.00 | 10/25/2010 |
| Clinton House (penalty #2) | HAL-082-015 | 9/15/2010 | $1,000.00 | Type A | 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure medications and treatments administered as ordered and documentation was accurate | Paid in Full | $1,000.00 | 10/25/2010 |
| Forest Trail Retirement Center | HAL-082-014 | 9/26/2007 | $4,440.00 | Not corrected Type B | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure medications were administrated as ordered | Paid in Full; Settlement Agreement $2,400.00 & Training 7/28/2008; Appealed 10/15/07 | $2,400.00 | 07/14/2009 Training Completed 10/7/2008 10/22/2008 |
| Forest Trail Retirement Center | HAL-082-014 | 07/14/2006 | $1,920.00 | Not corrected Type B | 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights | Door alarms did not function for 2 of 6 doors potentially affecting 18 residents with diagnosis of disoriented or wandering behavior | Paid in Full | $1,920.00 | 9/5/2006 |
None of the facilities in Scotland County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Albemarle House | HAL-084-006 | 5/19/2011 | Staff Training | Type A | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer a medication to one resident with a history of seizures and failed to notify the physician of the missed medication | Training Completed; Appealed 6/20/2011 | 7/13/2011 | |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Priddy Manor Assisted Living | HAL-085-007 | 12/16/2009 | $4,000.00 | Type A | 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | The facility failed to provide supervision to residents while off of the Special Care unit resulting in a resident wandering from the facility. | Paid in Full | $4,000.00 | 1/27/2010 |
| Walnut Ridge Assisted Living | HAL-085-005 | 2/15/2012 | $4,000.00 | Type A | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for residents residing on the Special Care Unit resulting in one resident elopement and multiple falls for four residents | Paid in Full; Appealed 2/22/2012 | $4,000.00 | 5/1/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Central Care | HAL-086-001 | 10/15/2012 | $18,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up to the routine and acute needs for two residents addressing respiratory distress and referral appointments | Paid in Full | $18,000.00 | 12/28/2012 |
| David's House | HAL-086-012 | 5/15/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up for one resident with continuing low blood pressure | Paid in Full | $2,000.00 | 7/6/2012 |
| Heritage Care of Elkin (Penalty #1) - Ownership Change | HAL-086-011 | 11/16/2011 | $7,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up for five residents relative to health care needs, noted increase in pyschotic behaviors, obtaining lab work and the continued implementation of orders | Paid in Full; 9/24/2012 Settlement Agreement $3,250.00; Appealed 12/14/2011 | $3,250.00 | 10/2/2012 |
| Heritage Care of Elkin (Penalty #2) - Ownership Change | HAL-086-011 | 11/16/2011 | $7,000.00 | Type A | NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure medications and treatments were administered as ordered to four residents | Paid in Full; 9/24/2012 Settlement Agreement $3,250.00; Appealed 12/14/2011 | $3,250.00 | 10/2/2012 |
None of the facilities in Swain County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Transylvania Living Center (Facility Closed) | FCL-088-003 | 5/19/2011 | $4,500.00 | Type A | 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; | Facility failed to ensure administered medications were taken by the resident to prevent the distribution to other resident; failed to respond to resident with referral and follow-up when resident reported sexual encounter which occurred while being transported to community activity | Referred to Controller's Office | ||
| Transylvania Living Center | FCL-088-003 | 09/14/2006 | $500.00 | Type A | 10A NCAC 13G .0601 Management and Other Staff; GS 131D-4.3 (a)(5) Adult Care Home Rules; G.S. 131D-21 (1)(2)(4) Declaration of Residents' Rights | Four residents left unsupervised in facility | Paid in Full | $500.00 | 12/13/2006 |
None of the facilities in Tyrell County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Clare Bridge at Monroe Square | HAL-090-022 | 9/15/2010 | $2,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facilility failed to provide supervision and implement measure to reduce falls | Paid in Full | $2,000.00 | 10/5/2010 |
| White Store Road Family Care Home of Monroe - Penalty #1 (Closed) | FCL-090-012 | 5/17/2012 | $3,300.00 | Unabated B | 10A NCAC 13G .1009(b) Pharmaceutical Care; 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct medication adminstration problems to assure three residents received medications as ordered | Referred to Controller's Office | ||
| White Store Road Family Care Home of Monroe - Penalty #2 (Closed) | FCL-090-012 | 5/17/2012 | $18,000.00 | Unabated A2 | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to correct healthcare referral and follow-up problems to assure the referral and follow-up of acute and routine needs for one resident was met | Referred to Controller's Office | ||
| White Store Road Family Care Home of Monroe - Penalty #3 (Closed) | FCL-090-012 | 5/17/2012 | $2,000.00 | Type A | 10A NCAC 13G .0601(b) Management & Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure that management took responsibility for the total operation of the facility to meet residents care and service needs | Referred to Controller's Office | ||
| White Store Road Family Care Home of Monroe (Closed) | FCL-090-012 | 3/15/2012 | $5,000.00 | Type A2 | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to meet the routine and acute health care needs of two residents including access to mental health services, medication and lab work | Referred to Controller's Office | ||
None of the facilities in Vance County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Ann's Family Care Home II | FCL-092-110 | 12/7/2006 | Staff Training | Not corrected Type B | 10A NCAC 13G .0405 (a)(b) Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights | Three staff were not tested for tuberculosis | Training Completed | 2/26/2007 | |
| Brookridge Assisted Living | HAL-092-146 | 3/20/2013 | $1,000.00 | Type A2 | 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to administer a medication, coumadin, for one of two residents | |||
| Brookridge Assisted Living Inc. | HAL-092-146 | 1/21/2011 | $12,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure timely referral and follow-up was made when residents presented with a change in physical condition | 01/06/2012 Training Completed; Paid in Full; Partial Payment; 10/26/11 Settlement Agreement $4,000.00 (1,000.00 payable & 3,000.00 for training) Appealed 2/16/2011 | $400.00 $600.00 | 12/19/2011 11/09/2011 |
| Carolina House of Wake Forest | HAL-092-032 | 8/27/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (4) Residents Rights | Facility failed to provide timely supervision checks on one resident to ensure needs met after resident experienced a fall | Paid in Full | $4000.00 | 11/1/2007 |
| Elmcroft of Northridge | HAL-092-124 | 12/13/2011 | $4,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision for three residents relative to their need for physical assistance and failed to ensure referral and follow-up to meet acute and routine needs of 5 residents relative to mental health evaluations, aggressive behaviors and wound care | Paid in Full | $4,000.00 | 1/6/2012 |
| The Haven | FCL-092-054 | 9/16/2008 | $6,200.00 | Not corrected Type B | 10A NCAC 13G .0702(a) Tuberculosis Test and Medical Exmination; G.S. 131D 4.4 Adult Care Home Minimum Safety Requirements; G.S.131D-21(2) Declaration of Residents' Rights | Facility failed to prohibit smoking in the facility and did not ensure residents had TB tests | Facility Closed; Settlement Agreement 03/18/2009; Appealed 10/16/2008 | ||
| The Haven | FCL-092-054 | 5/15/2008 | $1,000.00 | Type A | 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21(2) Delcaration of Residents' Rights | Resident experiencing seizures did not receive follow-up and referral as ordered to address evaluation of medication dosage | Facility Closed; Referred to Controller's Office | ||
| James Rest Home | HAL-092-007 | 5/20/2010 | Staff Training | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide referral and follow-up with physician regarding blood sugar readings | Training Completed | 7/23/2010 | |
| Jones Family Care Home | FCL-092-016 | 9/16/2008 | $800.00 | Not corrected Type B | 10A NCAC 13G .0405(a)(b) Test for Tuberculosis;10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to ensure staff had TB tests, training on CPR, and criminal background checks | Paid in Full | $800.00 | 12/31/2008 |
| Lawndale Manor | HAL-092-017 | 6/18/2012 | $4,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide increased supervision of a resident exhibiting exit seeking behavior who eloped | Paid in Full | $4,000.00 | 8/17/2012 |
| Lawndale Manor | HAL-092-017 | 1/21/2011 | $18,000.00 | Type A | 10A NCAC 13F .0902(C) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to implement physician's orders including the use of side rails | Paid in Full | $18,000.00 | 3/18/2011 |
| Oliver House | HAL-092-158 | 11/18/2011 | Staff Training | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure adequate and appropriate care and services were provided to residents relative to a resident's fall and addressing reported area of blood soiled carpet | Appealed 12/16/2011 | ||
| Parkway Retirement Home | HAL-092-118 | 11/19/2007 | $16,000.00 | Type A | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights | Medication was not administered as ordered resulting in resident being admitted to hospital's ICU | Paid in Full in Conjunction w/ penalty imposed 10/30/2007 | 5/18/2009 | |
| Parkway Retirement Home | HAL-092-118 | 10/30/2007 | $16,000.00 | Type A | 10A NCAC 13F .1501 (a) Use of Physical Restraints and Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility continued to utilize side rail on bed after resident needed medical assessment when previously found with head between siderail and mattress. Several weeks later, staff discovered resident dead in same position. | Paid in Full Settlement Agreement in Conjunction w/penalty imposed 11/19/07; Appealed 11/28/07; Partial pmt(s). | $7,000.00 $5,000.00 $2,000.00 $2,000.00 | 05/18/2009 05/12/2009 10/17/2008 11/16/2008 |
| Phoenix Assisted Care, LLC | HAL-092-131 | 5/19/2011 | $12,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up with physician for resident with severe bruises from unknown origin and for to obtain wound care forone resident needing home health services | 1/29/2013 Training Completed; 7/24/2012 Settlement Agreement ($2,000.00 for training) Appealed 6/17/2011 | ||
| Pine Tree Villa | HAL-092-121 | 5/11/2007 | $7,000.00 | Type A | 10A NCAC 13F .0901( c) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to provide supervision to two residents sharing a room to prevent physical abuse after earlier episodes of physical attacks | Paid in Full; Settlement Agreement $1,000.00 & Training 6/22/2009; Appealed 6/6/07 | Training Completed; $1000.00 | 08/31/2009 07/27/2009 |
| Rose Haven | HAL-092-015 | 5/3/2007 | $1,860.00 | Not corrected Type B | 10A NCAC 13F .0407 (a)(5) HCPR; G.S. 131D-21 (2) Residents' Rights | Healthcare registry verifications were not conducted for either of the staff currently employed | Facility Closed; Referred to Controller's Office | ||
| Summer Manor | FCL-092-136 | 2/14/2012 | $7,000.00 | Type A | 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up to meet one resident's need for routine and acute care to address pressure sores | Appealed 3/26/2012 | ||
| Sunrise Assisted Living at North Hills | HAL-092-108 | 6/18/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of a disoriented resident who wandered from the facility | Paid in Full; Referred to Controller's Office | $2,216.67 | 9/27/2012 |
| Sunrise Assisted Living of North Hills | HAL-092-108 | 8/27/2007 | $4,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to provide timely supervision checks on one resident. Resident experienced hypothermia after being found outside in secured courtyard | Paid in Full | $4,000.00 | 9/19/2007 |
| Sunrise of Cary (penalty #1) | HAL-092-152 | 1/16/2013 | $1,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to a resident with exit seeking behaviors to prevent elopement from the facility | |||
| Sunrise of Cary (penalty #2) | HAL-092-152 | 1/16/2013 | $2,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to protect a resident at risk for falls and with exit seeking behaviors from leaving the facility unsupervised | |||
| Wake Assisted Living | HAL-092-144 | 11/10/2010 | $2,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision related to elopement/wandering, smoking, and mental health related behaviors for 5 of 8 residents residing on the special care unit | Paid in Full Referred to Controllers' Office | $2,000.00 | 2/18/2011 |
| Wake Forest Care Center | HAL-092-020 | 7/16/2012 | $4,000.00 | Type A2 | 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 residents including administering the correct dosage of insulin | Paid in Full; Settlement Agreement 8/13/2012 in conjunction with penalties 1 & 2 issued 4/17/2012 for $22,500.00 | $22,500.00 | 8/15/2012 |
| Wake Forest Care Center (penalty #1) | HAL-092-020 | 4/17/2012 | $20,000.00 | Type A1 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure supervision of a resident with dementia resulting in the resident's death when he left the facility unsupervised | Paid in Full see penalty issued 07/16/12; Settlement Agrement 8/13/2012; Appealed 5/01/2012 | ||
| Wake Forest Care Center (penalty #2) | HAL-092-020 | 4/17/2012 | $14,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure supervision of three residents with aggressive behaviors resulting in physical altercations with residents and staff | Paid in Full see penalty issued 07/16/12; Settlement Agreement 8/13/2012; Appealed 5/01/2012 | ||
| Wake Forest Care Center (penalty #1) | HAL-092-020 | 5/20/2010 | $5,700.00 | 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 | Paid in Full; Settlement Agreement 9/27/10 Penalties 1 & 2 combined for $6,000.00; Appealed 06/17/2010 | $6,000.00 | 12/21/2010 |
| Wake Forest Care Center (penalty #2) | HAL-092-020 | 5/20/2010 | $4,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to supervise resident known to be noncompliant to smoking rules resulting in facility fire | Paid in Full (see penalty #1) Settlement Agreement 9/27/10 Penalties 1 & 2 combined for $6,000.00; Appealed 06/17/2010 | ||
| Wake Forest Care Center, Inc (penalty #1) | HAL-092-020 | 10/22/2009 | $16,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure referral and follow-up for two residents with one resident who developed an infected pressure sore and the other resident needing dental services | Paid in Full | $16,000.00 | 1/12/2010 |
| Wake Forest Care Center, Inc (penalty #2) | HAL-092-020 | 10/22/2009 | $4,000.00 | Type A | G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensured smoking did not occur inside facility. One resident set clothes and bed covers on fire twice while smoking in bed | Paid in Full | $4,000.00 | 1/12/2010 |
| Wake Forest Care Center | HAL-092-020 | 12/15/2006 | $12,000.00 | Type A | 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | One resident wandered from facility and was found dead | Paid in Full | $12,000.00 | 1/17/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Floyd B McKissick Sr. Assisted Living (penalty #1) | HAL-093-009 | 7/15/2010 | $1,400.00 | Unabated Type B | 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications (Criminal Background); G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to conduct criminal background checks for 14 of 14 staff | Referred to Controllers' Office | ||
| Floyd B McKissick Sr. Assisted Living (penalty #2) | HAL-093-009 | 7/15/2010 | $1,400.00 | Unabated Type B | 10A NCAC 13F .0504 (c) Competency Validation for LHPS Task; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide competency validation prior to one staff performing dressing changes and compression wraps | Referred to Controllers' Office | ||
| Floyd B McKissick Sr. Assisted Living (penalty #3) | HAL-093-009 | 7/15/2010 | $1,400.00 | Unabated Type B | 10A NCAC 13F .0505 Training on Care of Diabetic Residents; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure 5 of 5 staff who administered insulin had training prior to adminstering insulin; staff failed to administer medications as ordered | Referred to Controllers' Office | ||
| Floyd B McKissick Sr. Assisted Living (penalty #4) | HAL-093-009 | 7/15/2010 | $1,400.00 | Unabated Type B | 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide referral and follow-up for coumidin lab order and physician notification of high blood pressure and skin problems | Referred to Controllers' Office | ||
| Floyd B McKissick Sr. Assisted Living (penalty #5) | HAL-093-009 | 7/15/2010 | $4,000.00 | Type A | 10A NCAC 13F .0601 (a) Management of Facilities with Seven to Thirty Residents; 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 with wandering behaviors | Referred to Controllers' Office | ||
| Sainte's Assisted Independent Living, Inc./Floyd B. McKissick Sr. AL Center | HAL-093-003 | 1/2/2008 | $1,000.00 | Type A | 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain hot water temperatures in safe range for resident use in resident rooms and community bathrooms | Paid in Full | $1,000.00 | 1/16/2008 |
None of the facilities in Washington County have received a penalty since January 2006.
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Mountain Care Facilities | HAL-095-002 | 3/14/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure infection control measures were used when obtaining fingerstick blood sugars for eight residents | Paid in Full with 2 Partial Payments of $1,000.00; Partial Payment | $2,000.00 | 04/25/2012 03/21/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Britthaven of LaGrange | HAL-096-001 | 9/16/2008 | $4,100.00 | Not corrected 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 including insulin, anti-seizure and antihypertensives | Paid in Full | $4,100.00 | 10/6/2008 |
| Faithful Family Care | FCL-096-033 | 12/15/2009 | $500.00 | Type A | 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights | Facility failed to provide adequate supervision to a resident known to be an elopement risk | Paid in Full | $500.00 | 1/21/2010 |
| Freemont Rest Center | HAL-096-024 | 1/16/2013 | $1,000.00 | Type A2 | 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision of a resident to ensure his safety from deliberate self infliction of injury | Appealed 1/30/2013 | ||
| Glen Care of Mt. Olive | HAL-096-028 | 7/20/2011 | $16,000.00 | Type A | 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure 6 of 6 sampled diabetic residents (including 4 recently deceased residents) requiring fingerstick blood sugar testing received the appropriate care and services in accordance with infection control measures | Paid in Full; Partial Payment | $8,000.00 $8,000.00 | 08/19/2011 08/10/2011 |
| Goldsboro Assisted Living & Alzheimer's Care | HAL-096-031 | 9/19/2012 | $14,000.00 | Type A1 | 10A NCAC 13F .0906(f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to notify law enforcement and responsible party when a resident's whereabouts was unknown and there was reason for safety concern. Resident was struck by vehicle on roadway | Paid In Full | $14,000.00 | 10/12/2012 |
| Pikeville Assisted Living | FCL-096-035 | 2/17/2010 | $2,000.00 | Type A | 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to seek health care referral following a resident's fall from bed injuring her eye | 3 Partial Payments Facility Closed Referred to Controllers' Office |
$188.33 | 09/01/2010 08/03/2010 07/02/2010 |
| Renu Life Extended, Inc | HAL-096-022 | 4/16/2009 | Staff Training | Type A | 10A NCAC 13F .0305 (h)(4) Physical Enviornment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to several residents who had known history of wandering behavior; residents eloped from the premises. | Training Completed | 6/12/2009 | |
| Waylin Life Care Center (Change of Ownership) | HAL-096-028 | 6/18/2012 | $2,000.00 | Type A2 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 Declaration of Residents' Rights | Facility failed to assess and notify physician of the condition of a resident with pressure sores | Paid in Full | $2,000.00 | 6/25/2012 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Wilkes County Adult Care | HAL-097-014 | 12/19/2012 | $4,000.00 | Type A1 | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights | Facility failed to assure healthcare referral and follow-up for two residents relative to obtaining x-rays and orthopedic consult | Referred to Controller's Office | ||
| Wilkesboro Living Center | HAL-097-012 | 10/22/2009 | $1,000.00 | Type A | 10A NCAC 13F .0702(b) Discharge of Residents; 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure resident was supervised regarding smoking behaviors. Resident continued to smoke inside facility where oxygen was being used. | Paid in Full | $1,000.00 | 1/5/2010 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Applewood Assisted Living, LLC | HAL-098-019 | 7/15/2010 | $1,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to resident who presented with active symptoms of her mental illness including noncompliance to smoking policy resulting in a facility fire | Paid in Full | $1,000.00 | 9/1/2010 |
| Dilda's Home Care, Inc | FCL-098-026 | 12/16/2009 | $7,000.00 | Type A | 10A NCAC 13G .0902 Health Care; 10A NCAC 13G .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to call a physician or seek immediate medical evaluation of a resident who sustained a fall resulting in injury | Referred to Controller's Office | ||
| Friendly Elm City Assisted Living | HAL-098-016 | 01/23/2006 | $2,000.00 | Type A | 10A NCAC 13F .0604 Personal Care and Other Staffing; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Facility failed to provide supervision to residents with problematic behaviors that resulted in injury for one resident | Paid in Full | $2,000.00 | 3/29/2006 |
| Friendly Elm City Assisted Living | HAL-098-016 | 01/23/2006 | $5,000.00 | Type A | 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights | Medication not administered as ordered for two residents | Paid in Full | $5,000.00 | 3/29/2006 |
| The Meadows of Wilson | HAL-098-015 | 01/26/2006 | $8,000.00 | Type A | 10A NCAC 13F .1004 (a)(g)(j) Medication Administration G.S. 131D-21 (2)(4) Declaration of Residents' Rights; 131D-4.4 Adult Care Home Minimum Safety Requirements | Resident's condition not reassessed, medications not administered as ordered, physician visit and labs not obtained as ordered upon return from hospitalization | Settlement Agreement 6/19/06 | $8,000.00 | 6/6/2006 |
| Wilson Assisted Living | HAL-098-024 | 5/3/2007 | $2,000.00 | Type A | 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to one resident (adjudicated incompetent) who left the facility multiple times | Paid in Full | $2000.00 | 6/11/2007 |
| Facility Name | License Number | Penalty Issued Date | Penalty Amount | Penalty Type | Reason for Issuance | Current Status | Amount Paid | Date of Payment | |
|---|---|---|---|---|---|---|---|---|---|
| Rule Cited | Nature of Violation | ||||||||
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) | HAL-099-013 | 7/21/2011 | $7,000.00 | Type A | 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure referral and follow-up for 3 residents related to significant weight loss,obtaining labs for monitoring lithium levels, and obtaining STD screening and treatment | 7/11/2012 Settlement Agreement for $19,000.00 in conjunction with 5 penalties issued 12/14/2011 - payment plan; Appealed 8/17/11 | $8,000.00 | 03/28/2013 02/25/2013 12/27/2012 11/26/2012 10/22/2012 09/17/2012 08/20/2012 07/18/2012 |
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #1 | HAL-099-013 | 12/14/2011 | $7,000.00 | Type A | 10A NCAC 13F .0407(a)(2) Other Staff Qualifications; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to provide supervision to residents noncomplaint to smoking policies and failed to ensure staff were trained on fire safety and emergency procedures to protect residents | 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012 | ||
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #2 | HAL-099-013 | 12/14/2011 | $7,000.00 | Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to assure mental health referral and follow-up for two residents and physician notification regarding medication refusals for one resident | 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012 | ||
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #3 | HAL-099-013 | 12/14/2011 | $14,000.00 | Type A | 10A NCAC 13F .0305 Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to maintain outside grounds in a safe conditon resulting in one resident suffering fractures when stepping into an established hole in the yard | 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012 | ||
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #4 | HAL-099-013 | 12/14/2011 | $6,200.00 | Unabated Type A | 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility continued to fail to ensure health care referral and follow-up occurred for 2 residents | 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012 | ||
| Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #5 | HAL-099-013 | 12/14/2011 | $2,700.00 | Unabated Type B | 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights | Facility failed to ensure management directed care and services to meet needs of residents and maintain compliance to rules | 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012 | ||
| Piedmont Village at Yadkinville | HAL-099-012 | 07/18/2008 | $4,000.00 | Type A | 10A NCAC 13F .0702 (b) Discharge of Residents; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131D-21 (2) Declaration of Resident's Rights | Staff failed to address resident's increased aggressive behaviors resulting in resident setting room on fire | Paid in Full | $4,000.00 | 9/12/2008 |
None of the facilities in Yancey County have received a penalty since January 2006.