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 | ||||||||
| 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 |
| 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 | ||
| 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 |
| 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 | ||
| 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 | ||
| 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 | Settlement Agreement 3/19/08 Appealed 12/3/07 |
$2,500.00 | 4/2/2008 |
| 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 |
| 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 | |||
| 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 #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 | |||
| 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 | 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/ |
| 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 |
| 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 | ||
| 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 | ||||||||
| 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 | |||
| 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 | |||
| Bladenboro Assisted Retirement Community | 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 | |||
| Bladenboro Assisted Retirement Community | 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 | |||
| 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 | ||||||||
| 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 |
| 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 | ||
| 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 | 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 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 FCH | 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 | |||
| 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 FCH #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 #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 |
| 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. | |||
| 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 |
| 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 | ||||||||
| 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 |
| 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-013-031 | 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 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 | 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 | Staff failed to provide resuscitation when resident discovered unresponsive. | Appealed 07/17/08 |
||
| 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 | Appealed 5/15/2009 | ||
| 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 | ||||||||
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 |
| 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 | ||||||||
| 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 |
| 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 | ||||||||
| 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 | ||||||||
| 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 | ||
| 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 |
| 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 | |||
| 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 | |||
| 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 | |||
| 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 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 | Partial Pmt(s). | $957.76 | 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 | Partial Pmt(s). | $191.55 | 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 | Partial Pmt(s). | $957.76 | 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 | 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. | 1/9/ |
| 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 Assisted Living | HAL-025-020 | 1/9/2007 | $3,500.00 | Type A | 10A NCAC 13F .0901 (a)(h)(4) 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 |
| 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 | 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-025-015 | 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 | ||
| 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 | ||||||||
| 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 | Settlement Agreement 8/18/2008 Appealed 02/15/2008 | $800.00 | 9/17/2008 |
| 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 |
| 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 | ||
| 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 |
| 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 |
| 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 | ||||||||
| 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 | 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 |
| 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. | Appealed 05/14/2009 | ||
| 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. | Appealed 05/14/2009 | ||
| 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 | |
| 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 |
| 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 |
| 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 |
| 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 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 |
| 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 |
| 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 | 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 | 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 | Appealed 08/15/2008 | ||
| 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 | ||||||||
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 | ||||||||
| 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 |
| 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 | ||
| 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 | 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 | Appealed 1/16/09 | ||
| 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 |
| 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 |
| 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 | ||||||||
| 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 | |||
| 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 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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, 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 |
| 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 |
| 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 |
| 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 |
| 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. | |||
| 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 |
| 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 | |
| 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 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 | Appealed 07/18/2008 | ||
| 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. | Appealed 10/13/2008 | ||
| 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 | ||||||||
| 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 | Settlement Agreement 3/13/08; Appealed 3/2/07 | ||
| 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 |
| 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 | ||||||||
| 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 |
| 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 |
| 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 |
| 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 | ||||||||
| 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 | |
| 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 | Appealed 06/13/2008 | ||
| 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 | ||||||||
| 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 | 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 |
| 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 supervison to prevent or respond to resident elopement. Resident was found dead having wandered from facility. | Appealed 1/14/09 | ||
| 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 | Appealed 4/17/09 | ||
| 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 |
| 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 |
| 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 |
| 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 |
| 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 | |||
| 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 |
| 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 |
| 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 |
| 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 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 | Appealed 10/15/08 | ||
| 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 |
| 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 | 11/20/2008 | $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 | Appealed 12/18/08 | ||
| 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 |
| 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 |
| 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 |
| 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; | ||
| 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 | |
| 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 | Appealed 02/10/06 | Referred to Controller's Office | |
| 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 | Appealed 02/10/06 | Referred to Controller's Office | |
| 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 | Appealed 02/10/06 | Referred to Controller's Office | |
| 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 | ||||||||
| 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 | Appealed 2/11/09 | ||
| 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 |
| 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 |
| 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 | ||||||||
| 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 |
| 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 | 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 |
| 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 |
| 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 | ||||||||
| 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 |
| 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 |
| 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 | |||
| 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 | ||||||||
| 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 | OAH Decision Upheld 1/24/07 Appealed 09/21/06 | ||
| 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 | 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 | 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 | ||
| 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). | ||
| 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 (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 | ||||||||
| 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 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 | ||||||||
| 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 |
| 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 | |
| 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 | 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 |
| 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 |
| 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 | ||||||||
| 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 |
| 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 | Settlement Agreement $2,400.00 & Training 7/28/2008; Appealed 10/15/07 | Training Completed 10/7/2008 10/22/2008 | |
| 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 | ||||||||
| 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 |
| 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 | |
| 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 |
| 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 |
| 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 | Appealed 6/6/2007 | ||
| 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 | Referred to Controller's Office | ||
| 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 |
| 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 |
| 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 |
| 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 | 5/18/2009 | |
| 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 | Referred to Controller's Office | ||
| 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 | Settlement Agreement 03/18/2009; Appealed 10/16/2008 | ||
| 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 | ||||||||
| 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 |
| 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 |
| 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. | |||
| 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 | ||||||||
| 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 | ||||||||
| 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 |