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 in the last 36 months.

Alamance County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Alamance House HAL-001-148 9/18/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to increase supervision for one resident in the Special Care Unit who demonstrated combative behaviors resulting in the injury to two residents in the unit Paid in Full, 02/08/2016 Settlement Agreement for $750.00; Appealed 09/24/2014 $750.00 3/15/2016
B and N Family Care Home FCL-001-144 10/16/2014 $9,000.00 Type A1 10A NCAC 13G .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision was provided for one resident who exhibited increase agitation and subsequently hit another resident in the head with a table Paid in Full; 12/03/2015 Settlement Agreement for $5,000.00 in conjunction with penalty imposed 10/16/2014 & 03/18/15 for a total of $7,500.00; Appealed 11/10/2014 $7,500.00 05/31/2016 05/03/2016 03/29/2016 03/01/2016 02/02/2016 1/7/2016
B and N Family Care Home FCL-001-144 10/16/2014 $4,400.00 Unabated Type B 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the primary care physician for 1 resident regarding clarification of a sliding scale insulin order, high blood sugar readings, edematous left foot and resident's threatening behavior 12/03/2015 Settlement Agreement for $2,000.00 in conjunction with penalty imposed 10/16/2014 & 03/18/15 for a total of $7,500.00; Appealed 11/10/2014
D & M Family Care Home (Closed) FCL-001-005 2/20/2015 $3,500.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physician referral to meet the acute needs of two residents experiencing falls
D & M Family Care Home (Closed) FCL-001-005 2/20/2015 $1,000.00 Type A2 10A NCAC 13G .0904 (f) Nutrition and Food Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide feeding assistance to one resident during meal
B and N Family Care Home FCL-001-144 3/18/2015 $1,000.00 Type A2 10A NCAC 13G .0901 (c ) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to respond immediately in case of an emergency when one resident became unresponsive 12/03/2015 Settlement Agreement for $500.00 in conjunction with penalty imposed 10/16/2014 & 03/18/15 for a total of $7,500.00; Appealed 04/02/2015
A Vision Come True HAL-001-103 9/17/2015 $500.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure one resident who had insulin dependent diabetes, required fingerstick monitoring, end stage renal failure and needed assistance or supervision with personal care was free of neglect. Paid in Full $500.00 10/7/2015
Merciful Hands FCL-001-114 9/21/2016 $1,000.00 Type A2 10A NCAC 13G .0601 (b) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure residents were not left alone in facility without staff. Paid in Full $1,104.17 12/30/2016
Springview - Ross Building HAL-001-017 1/20/2017 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .1304 Special Care Unit Building; G.S. 131D-21 (2) Declaration of Residents' Rights Facility did not provide adequate supervision to 1 of 3 residents residing in a special care unit with a diagnosis of Alzheimer's Disease who wandered out of facility, fell and sustained a head injury.

Alexander County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Alexander Assisted Living HAL-002-004 9/18/2014 $7,000.00 Type A1 10A NCAC 13F .0601 (a) Management and Other Staff; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were free of neglect and mental abuse by staff; the administrator failed to assure the total operation of the facility was met and maintained rules related to staff qualifications, activities, resident rights and reporting of accidents Paid in Full $7,000.00 10/17/2014
Alexander Assisted Living HAL-002-004 6/18/2015 $4,000.00 Type A2 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility administrator failed to ensure responsibility for the operation of the facility met and maintained rules related to facility management, nutrition and food service, medication administration, controlled substances, infecton prevention and training, medication aide training and resident rights; failed to assure adequate and appropriate infection control procedures were implemented with assisted glucose monitoring for eight residents resulting in shared use of glucometers without disinfecting and sharing of lancing devices Paid in Full $4,000.00 7/15/2015
A New Outlook of Taylorsville HAL-002-007 6/18/2015 $16,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were free of neglect related to fire evacuation of twenty-seven residents, seven requiring total or extensive assistance with ambulation or transfer and the provision of personal care or services for two residents Settlement Agreement in Conjunction with .0901 (b), .0909 & .0601 (a) for $10,000.00 and Training; Appealed 07/14/2015
A New Outlook of Taylorsville HAL-002-007 6/18/2015 $7,000.00 Type A2 10A NCAC 13F .0601 (a) (b) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility administrator failed to assure total operation of facility and maintained rules related to personal care and supervision , nutrition and food service, and resident rights; failed to assure administrator or administrator-in-charge in the facility or within 500 feet resulting in required duties of staff not carried out during evacuation of twenty-seven residents due to a facility fire Settlement Agreement in Conjunction with .0901 (b), .0909 & .0601 (a) for $10,000.00 and Training; Appealed 07/14/2015
A New Outlook of Taylorsville HAL-002-007 6/18/2015 $7,000.00 Amend to Type B; Type A2 10A NCAC 13F .0311 (j) Other Requirements; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide hand bells or other signaling devices for three residents unable to evacuate without staff assistance and physically and mentally able to use call bells Settlement Agreement Penalty Eliminated; Appealed 07/14/2015
A New Outlook of Taylorsville HAL-002-007 6/18/2015 $12,000.00 Unabated Type B 10A NCAC 13F .1004 (a) (1) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the administration of medications for two residents were in accordance with orders by the prescribing practitioner Settlement Agreement for $2,000.00 & Training; Appealed 07/14/2015
A New Outlook of Taylorsville HAL-002-007 6/18/2015 $16,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for two residents who displayed behaviors causing themselves serious physical harm and placing others at risk of serious physical harm and or death by setting personal belongings or themselves on fire inside facility Settlement Agreement in Conjunction with .0901 (b), .0909 & .0601 (a) for $10,000.00 and Training; Appealed 07/14/2015
Alexander Assisted Living HAL-002-004 10/14/2015 $33,000.00 Unabated Type A2 G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented for blood glucose monitoring for two residents with orders for finger stick blood sugars by borrowing lancet device for one resident who did not have a lancet device available for use 02/03/2017 Training Completed; 06/8/2016 Paid in Full; 04/11/2016 Settlement Agreement for $3,000.00 and Training; Appealed 11/11/2015 $3,000.00 6/8/2016

Ashe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashe Assisted Living and Memory Care HAL-005-013 10/16/2014 $1,000.00 & Staff Training Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free from neglect by withholding food and fluids without a physician's order for approximately 36 hours Training Completed 01/20/2016; Paid in Full $1,000.00 11/26/2014

Beaufort County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wooded Acres Guest Home FCL-007-017 9/17/2015 $3,500.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure the six residents of the facility were free from mental abuse as evidenced by yelling, intimidation and threatening behaviors of one staff. Appealed 10/23/2015

Bertie County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Windsor House HAL-008-034 5/14/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident who exhibited exit seeking behaviors and needed increase monitoring 11/29/2016 Training Completed; Paid in Full; 02/08/2016 Settlement Agreement for $500.00 & Training; Appealed 06/13/2014 $500.00 3/15/2016

Bladen County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Highland Gardens Assisted Living of Clarkton (Change of Ownership) HAL-009-027 5/24/2016 $4,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to report allegations of abuse against one staff to the NC Health Care Personnel Registry (NCHCPR) and have documentation that alleged acts were investigated and reported to the NCHCPR within five days and to protect residents from harm
Highland Gardens Assisted Living of Clarkton (Change of Ownership) HAL-009-027 5/24/2016 $12,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure each resident was free from physical abuse by staff as related to the abuse of two residents; one who was hit and one who was hit and shocked with a stun gun by a staff

Buncombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Candler Living Center HAL-011-285 5/13/2014 $9,400.00 Unabated Type B 10A NCAC 13F .0904 (e) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure therapeutic diets were prepared according to physician's orders for one resident pretaining to honey thickened liquids and a mechanical soft diet Paid in Full; Referred to Controller's Office $10,508.53 1/23/2015
Clare Bridge of Asheville (penalty #1) HAL-011-035 8/20/2014 $2,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the prescribing practitioner for three residents residing in a Special Care Unit Paid in full $2,000.00 9/18/2014
Clare Bridge of Asheville (penalty #2) HAL-011-035 8/20/2014 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Right Facility failed to notify physician or health care provider for three residents related to change in behavior for two residents and development of wounds for one resident Paid in full $4,000.00 9/18/2014
Clare Bridge of Asheville (penalty #3) HAL-011-035 8/20/2014 $18,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for three residents residing in a Special Care Unit in accordance with the residents' assessed needs, care plans and current symptoms who were experiencing falls resulting in serious injury, including a subdural hematoma for one resident Paid in full $18,000.00 9/18/2014
Nana's Assisted Living Facility HAL-011-331 5/13/2014 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute and routine health care needs of five residents related to physician referrals, missed medications , missed physician appointments and reporting fingerstick blood glucose levels as ordered. Paid in full $4,000.00 8/14/2014
Angel House 1 FCL-011-127 9/18/2014 $8,000.00 Type A1 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to contact the physician for evaluation of current healthcare status to address behaviors related to dementia for one resident; the administrator failed to assure responsibility for the total operation of the facility to maintain compliance in the rule areas regarding personal care and supervision, health care, staffing, Health Care Personnel Registry, reporting of death to Division of Health Service Reglation, and resident rights Paid in Full; (collection letter 7/25/2016) 03/18/2015 Settlement Agreement in conjunction with 2nd penalty imposed 09/18/2014 in monthly installments; Appealed 10/01/2014 $16,000.00 10/06/2016 08/02/2016 03/18/2016 12/01/2015 07/13/2015 06/02/2015 04/20/2015
Angel House 1 FCL-011-127 9/18/2014 $8,000.00 Type A1 10A NCAC 13G .0901 (b) Personal Care & Supervision; 10A NCAC 13G .0601 (d) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision and failed to assure a staffing pattern to meet the supervision needs for one resident with wandering and exit seeking behaviors related to dementia who exited the facility without supervision and resident died Paid in Full 10/06/2016; 03/18/2015 Settlement Agreement in conjunction with 1st penalty imposed 09/18/2014 in monthly installments; Appealed 10/01/2014
Evergreen Living Home #3 (penalty #1) FCL-011-195 9/18/2014 $1,000.00 Type A2 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .1301 (a) Use of Physical Restraints and Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident related to falls and failed to assure physician orders were obtained for physical restraints for one resident with bilateral full bedrails Paid in Full; 04/20/2015 Settlement Agreement in conjunction with penalty imposed 09/18/2014 for $1,000.00; Appealed 10/17/2014 $1,000.00 5/12/2015
Evergreen Living Home #3 (penalty #2) FCL-011-195 9/18/2014 $1,000.00 Type A2 10A NCAC 13G .0902 (c)(3)(4) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement the order for thickened liquids for one resident with orders for nectar thick liquid Paid in Full; 04/20/2015 Settlement Agreement in conjunction with penalty imposed 09/18/2014 for $1,000.00; Appealed 10/17/2014
Angel House VI FCL-011-269 8/20/2015 $2,000.00 Type A2 10A NCAC 13G .0601(b)(3) Management and Other Staff; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to assure that at least one staff was in the facility at all times for 6 residents. Paid in Full $2,000.00 9/4/2015
Soundview Family Care Homes -Unit 1 FCL-011-236 8/20/2015 $1,000.00 Type A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident with a history of auditory hallucinations and suicidal ideations. Paid in Full $1000.00 9/16/2015
Evergreen Living Home #3 FCL-011-195 12/29/2015 $5,000.00 & Training Type A1 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .0901 (b) Personal Care & Supervision; 10A NCAC 13G .0601 (a) Management of Facilities; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to assure physician notification for three residents regarding one resident's aggressive behavior towards two residents resulting in injuries needing medical evaluation Paid in Full; 08/29/2016 Settlement Agreement for $1,000.00; Appealed 01/21/2016 $1,000.00 9/13/2016
Brookdale Asheville Walden Ridge HAL-011-035 4/22/2016 $7,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff provided supervison for one resident in accordance with the resident's assessed needs and current symptoms of assaulting staff and residents 01/05/2017 Settlement Agreement for Training; Appealed 05/16/2016
Chase Samaritan Assisted Living HAL-011-133 4/20/2016 $6,000.00 Type A2 10A NCAC 13F .1008 (a) Controlled Substances; 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to assure accurate reconciliation and readily retrievable records for the receipt, administration and disposition of controlled substances for four residents with orders for controlled substances resulting in amounts being unaccounted for; and the Administrator failed to assure the total operation of the facility met and maintained rules related to resident rights, personal care training program, staffing, health care, medication administration, controlled substances, pharmaceutical care, and declaration of resident rights Paid In Full $6,000.00 08/22/2016 07/25/2016 07/22/2016
Chase Samaritan Assisted Living HAL-011-133 12/2/2016 $13,600.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications (Augmentin, Neurontin, Oxycodone) were administered as ordered.
Angel House IV FCL-011-264 12/22/2016 2,000.00 Type A2 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure every resident was free from mental and physical abuse as related to a resident grabbing other residents' cigarettes and lighters, placing hands on other residents, and frequently requesting cigarettes and lighters from other residents resulting in at least 4 residents expressing fear of the resident and two residents being inappropriately touched by the resident.

Burke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Clara's Cottage #2 FCL-012-037 8/18/2014 $1,000.00 Type A2 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the hot water temperatures at all fixtures used by residents were maintained at a safe temperature no greater than 116 degrees (F) Paid in Full $1,000.00 9/2/2014
Windy Hill Assisted Living FCL-012-015 5/11/2015 $4,000.00 Type A1 10A NCAC 13G .0601 (a) Management and Other Staff; 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure responsibility for the operation of the facility, implementation of residents rights, investigation of alleged sexual abuse by staff and reporting allegations to Health Care Personnel Registry; failed to assure residents were free of mental and physicial abuse, and exploitation as evidence by sexual abuse of two residents by one staff 12/30/2015 Settlement Agreement to eliminate both penalties imposed 05/11/2015 and Facility consent to permanent closure
Windy Hill Assisted Living FCL-012-015 5/11/2015 $2,000.00 Type A2 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to investigate allegations of sexual abuse by staff and failure to report allegations to the Health Care Personnel Registry resulting in not protecting residents from physical and mental abuse and exploitation 12/30/2015 Settlement Agreement to eliminate both penalties imposed 05/11/2015 and Facility consent to permanent closure
Clara's Cottage #1 FCL-012-038 8/20/2015 $1,000.00 Type A2 Past Corrected 10A NCAC 13G .0601(a) Management and Other Staff; 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21(2) and (4) Declaration of Residents' Rights Facility administrator failed to assume responsibility to ensure systems were in place to identify issues of noncompliance within the facility in the areas of resident rights, medication administration and pharmaceutical care and facility failed to ensure 3 residents were free of exploitation by diversion of the residents' controlled medications. (collection letter sent 7/8/16) 8/24/2016 & 12/30/2015 Settlement Agreement for $500.00; Appealed 09/14/2015
Clara's Cottage #2 FCL-012-037 8/20/2015 $1,000.00 Type A2 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect residents by not reporting and investigating allegations of abuse, neglect and drug diversion to the Health Care Personnel Registry for one former staff. (collection letter sent 7/8/16) 8/24/2016 & 12/30/2015 Settlement Agreement for $500.00; Appealed 09/14/2015
Morganton Long Term Care, Southview Facility HAL-012-007 5/24/2016 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify resident's primary care provider timely for one resident who had a swollen knee identified by staff and notification of physician was three days later Paid in Full $4,000.00 7/22/2016

Cabarrus County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Country Home HAL-013-042 3/18/2016 $4,000.00 Type A2 10A NCAC 13F .0901 (a) (b) Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision for seven residents as no staff were present in facility for at least one hour Paid in Full $4,000.00 5/16/2016
The Country Home HAL-013-042 3/18/2016 $7,000.00 Type A2 10A NCAC 13F .0601 (b) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Administrator failed to ensure the rules for providing care and services were met and maintained as evidenced by no staff were present in facility for at least one hour for the 7 residents Paid in Full $7,000.00 08/16/2016 05/16/2016
First Assembly Living Center (Change of Ownership) HAL-013-003 6/14/2016 $7,000.00 Type A1 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the physician for two residents resulting in the two residents receiving other residents' medications and one resident required hospitalization due to the medication error Paid in Full $7,000.00 6/24/2016

Caldwell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rose Hill Family Care Home (Closed) FCL-014-004 5/20/2015 $2,000.00 Type A1 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as prescribed for three residents
Brookford Inn HAL-014-014 12/17/2014 $13,200.00 Unabated Type B 10A NCAC 13F .0904 Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure therapeutic diets were served as ordered by physician for one resident requiring thickened liquids Paid in Full; 06/16/2015 Settlement Agreement for $8,000.00; Appealed 12/29/2014 $8,000.00 8/13/2015
Brockford Inn HAL-014-014 2/19/2015 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision an interventions for two residents with falls resulting in severe facial brusing and hip contusion Paid in Full $2,000.00 3/24/2015
Carolina Oaks Enhanced Care Center HAL-014-002 3/18/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for two residents with wandering behaviors who exited the facility unsupervised Paid in Full $4,000.00 3/26/2015
Brockford Inn HAL-014-014 4/20/2016 $4,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect residents by not investigating allegations of neglect for two residents and injuries of unknown source for one resident and not reporting the allegations or the injuries of unknown source to the Health Care Personnel Registry Paid in Full $4,000.00 5/16/2016
Brockford Inn HAL-014-014 4/20/2016 $12,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure three residents received supervision in accordance with the residents' needs in the areas of fall prevention and prevention of injury due to unpadded bedrails Paid in Full; Payment Plan $12,000.00 08/15/2016 06/14/2016
Brockford Inn HAL-014-014 6/14/2016 $7,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the total operation of the facility met and maintained rules related to management of the facility, personal care and supervision, medication administration, Health Care Personnel Registry, and resident rights; failed to assure one resident received supervision in accordance with resident's needs concerning confusion associated with urinary tract infection Paid in Full $7,758.90 10/24/2016
Brockford Inn HAL-014-014 1/20/2017 13,600.00 Unabated Type B 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to protect residents by not investigating allegations for injury of unknown source for 1 resident and upon investigation of verbal abuse of a resident by a staff member, the faciity did not report to the Health Care Personnel Registry.

Caswell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Caswell House HAL-017-054 9/17/2015 $4,000.00 Reduced to Type B 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to provide supervision for 2 residents who staff had recognized to have functional changes after unwitnessed falls. Paid in Full; 10/04/2016 Settlement Agreement for $500.00; Appealed 10/15/2015 $500.00 10/24/2016
Jones Family Care #4 FCL-017-030 12/8/2016 $500.00 Type A2 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident with a history of smoking inside the facility. Paid in Full $500.00 12/20/2016

Catawba County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Springs of Catawba HAL-018-032 4/20/2016 $7,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up for one resident with falls by not sending the resident out for medical evaluation after an unwitnessed fall Appealed 05/18/2016
Springs of Catawba HAL-018-032 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to notify physician concerning three residents related to elopement, bruising and swelling of a resident's forearm, and a resident needing a higher level of care 01/05/2017 Settlement Agreement for $1,000.00 & Training; Appealed 07/13/2016
Springs of Catawba HAL-018-032 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident with a diagnosis of dementia was adequately supervised when at dialysis, after dialysis staff identified the need of assistance needed with supervision to the facility, resulting in the resident leaving dialysis alone 01/05/2017 Settlement Agreement for $1,500.00; Appealed 07/13/2016

Chatham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Careview Rest Home (Closed) HAL-019-010 5/25/2016 $16,000.00 Type A1 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered to one resident by administering medication that was not prescribed for the resident resulting in hospitalization and death
Careview Rest Home (Closed) HAL-019-010 5/25/2016 $2,000.00 Type A2 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (h) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure three exit doors, accessible to five residents know to be disoriented were equipped with a sounding device that activated when the exit doors were opened
Coventry House Of Siler City HAL-019-018 10/5/2016 $1000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Suervision; 10A NCAC 13F .0504(a) Competency Validation for LHPS Staff Failure to provide personal care according care plan and to assure competency validation for staff for catheter care. Appealed 11/01/2016
Chatham Ridge Assisted Living HAL-019-021 12/8/2016 $2,000 Type A2 10A NCAC 13F .0901(a) Personal Care and Supervision; 10A NCAC 13F .0902(b) Health Care; Facility failed to provide supervision for a resident in accordance with current symptoms of respective fall resulting in injury. Paid in Full $2,000.00 12/22/2016

Cleveland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Autumn Years Family Care Home FCL-023-039 4/16/2015 $1,000.00 Type A2 10A NCAC 13G .0901 (b) Personal Care & Supervision; 10A NCAC 13G .0312 (g) Outside Entrance and Exits; 10A NCAC 13G .0601 (b) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure supervision of three residents, including one with diagnosis of dementia and one with changes in behavior, who left facility without staff knowledge Paid in Full $1,112.50 12/7/2015
Openview Retirement Home HAL-023-004 4/16/2015 $1,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure resident was free of exploitation for one resident who was providing housekeeping care and some personal care for facility administrator at the administrator's home Paid in Full $1,000.00 5/11/2015
Helms Family Care Home FCL-023-011 12/17/2014 $2,000.00 Type A2 10A NCAC 13G .0406 Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure one staff on duty was able to apply the home's fire safety procedures resulting in three residents and one staff not evacuating from the facility during a fire drill Paid in Full $2,000.00 1/5/2015
Summit Place of Kings Mountain HAL-023-042 12/17/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for four residents with a history of multiple falls Paid in Full $2,000.00 1/8/2015

Craven County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Courtyards at Berne Village Memory Care HAL-025-034 5/20/2015 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (1),(4) Declaration of Residents' Rights Facility failed to assure residents were treated with respect, consideration, and dignity resulting in physical altercation between one resident and a staff member 08/01/2016 Settlement Agreement for Penalty Elimination; Appealed 07/10/2015
Water Oak Manor (Now Riverview) HAL-025-031 1/15/2015 $16.000.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify residents' physicians of high and abnormal blood glucose levels, follow-up for emergency care, lab testing or regarding an increase in Lasix dosing Paid in Full; 09/08/2015 Settlement Agreement of $10,000.00 in conjunction with other penalty imposed on 01/15/2015. $10,000.00 11/23/2015 11/12/2015 10/22/2015 10/12/2015 08/17/2015
Water Oak Manor (Now Riverview) HAL-025-031 1/15/2015 $16.000.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility to administer medications as ordered by physician for four residents, three taking insulin, one Coumadin and one Lopressor 09/08/2015 Settlement Agreement of $10,000.00 in conjunction with other penalty imposed on 01/15/2015; Appealed 02/13/2015
Homeplace of New Bern HAL-025-032 2/20/2015 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision for one resident known to have multiple falls resulting in fractured ribs Paid in Full $4,000.00 3/6/2015
The Courtyards at Berne Village Memory Care HAL-025-034 11/23/2015 $7,000.00 Type A2 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the personal care needs were met for four residents who required assistance with toileting and incontinent care, resulting in two residents developing stage II pressure sores Paid in Full; 08/01/2016 Settlement Agreement for $2,000.00; Appealed 12/21/2015 $2,000.00 8/29/2016
The Courtyards at Berne Village Memory Care HAL-025-034 11/23/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure notification of health care providers and follow-up for three residents who had 11 pound weight loss; an ordered neurology consult after falls and a fall with head injury 08/01/2016 Settlement Agreement for Penalty Elimination; Appealed 12/21/2015
The Courtyards at Berne Village Memory Care HAL-025-034 11/23/2015 $14,000.00 Type A1 10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility Administrator and Memory Care Coordinator failed to assure all required duties were carried out as related to rule areas of housekeeping and furnishings, training on the care of diabetics, test for tuberculosis, providing personal care and supervision, health care, resident activities, resident rights and medication administration Paid in Full; 08/01/2016 Settlement Agreement for $11,000.00; Appealed 12/21/2015 $11,000.00 8/29/2016
The Courtyards at Berne Village Memory Care HAL-025-034 11/23/2015 $12,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision related to repeated unwitnessed and witnessed falls and falls with injury for three residents and smoking unsupervised outside of the building for one resident Paid in Full; 08/01/2016 Settlement Agreement for $6,500.00; Appealed 12/21/2015 $6,500.00 8/29/2016
The Courtyards at Berne Village Memory Care HAL-025-034 11/23/2015 $10,000.00 & Training Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide services to maintain the physical and mental health by allowing two residents to lie in urine and feces and not providing personal care service resulting in the development of stage II presure sores Paid in Full; 08/01/2016 Settlement Agreement for $5,000.00; Appealed 12/21/2015 $5,000.00 8/29/2016
The Courtyards at Berne Village HAL-025-033 11/23/2015 $1000.00 & Training Type A2 10A NCAC 13F .0305 (h) (4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to have door alarm sounding devices on two exit doors and failed to ensure sounding devices were activated upon doors opening and failed to provide adequate supervision for four residents who were diagnosed with dementia or disoriented, including three residents who had exited the facility unsupervised and for one resident who locked her door and was found mixing clemicals in her room and whose fingerstick blood sugar was not checked due to the locked room door Paid in Full; 08/05/2016 Settlement Agreement $750.00 & Training Appealed 12/21/2015 $750.00 8/29/2016
The Courtyards at Berne Village HAL-025-033 11/23/2015 $1000.00 & Training Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the licensed prescribing practitioner for one resident observed during the medication pass which included errors with medication for swelling, pain, and dizziness; three residents which included errors with dedication for diabetes, dementia, pain, inflammation, allergies, swelling, anxiety, depression, blood presure, infection, acid reflux, leg cramps, cholesterol, calcium, magnesium and potassium supplements, heart prevention and vitamins Paid in Full; 08/05/2016 Settlement Agreement $750.00 & Training Appealed 12/21/2015 $750.00 8/29/2016
Riverstone HAL-025-026 12/29/2015 $4,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure Health Care Personnal Registry was notified within 24 hours after allegation regarding a staff member grabbing a resident around the neck after altercation with the resident Paid in Full; 11/17/2016 Settlement Agreement in conjunction with all 3 penalties imposed 12/29/2015 for $2,000.00; Appealed 01/15/2016 $2,000.00 12/12/2016
Riverstone HAL-025-026 12/29/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision for one resident known to elope from the facility and for one resident known to have behavior problems 11/17/2016 Settlement Agreement in conjunction with all 3 penalties imposed 12/29/2015 for $2,000.00; Appealed 01/15/2016
Riverstone HAL-025-026 12/29/2015 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that every resident was free from mental and physical abuse, neglect and exploitation as related to four residents being choked by a staff member after an altercation between them 11/17/2016 Settlement Agreement in conjunction with all 3 penalties imposed 12/29/2015 for $2,000.00; Appealed 01/15/2016
The Courtyards at Berne Village Memory Care HAL-025-034 4/20/2016 $12,000.00 Type A2 10A NCAC 13F .0901 (a) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure follow-up for one resident who had 10-inch long, incurved toenails in bad formation causing leg pain Paid in Full; 10/20/2016 Settlement Agreement for $6,000.00 & Training; Appealed 05/20/2016 $6,000.00 11/3/2016
The Courtyards at Berne Village HAL-025-033 4/20/2016 $12,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure physician notification of one resident's continuous complaints of pain after a fall Paid in Full; 10/20/2016 Settlement Agreement for $6,000.00; Appealed 05/20/2016 $6,000.00 11/3/2016
Water Oak Manor (Name Change to Riverview) HAL-025-031 4/22/2016 $16,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to assure supervision for two residents residing in the Special Care Unit who demonstrated aggressive and elopement behaviors; and one with wandering behavior residing in the Assisted Living Section exited facility without staff knowledge; and facility neglected to protect every resident from mental and physical abuse from an aggressive and combative resident as related to five residents residing in the Special Care Unit being assulted 12/22/2016 Settlement Agreement in Conjunction with all penalties imposed 4/22/2016 for $6,000.00; Appealed 05/18/2016 $17,000.00 02/10/2017 01/11/2017 01/03/2017
Water Oak Manor (Name Change to Riverview) HAL-025-031 4/22/2016 $16,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute mental health needs for two residents by not notifying and reporting to the mental health provider or the resident's primary physician of the residents' aggressive/assaultive behaviors and wandering and elopement behaviors and by not notifying the resident's primary physician of the acute health care needs of one resident with vomiting 12/22/2016 Settlement Agreement in Conjunction with all penalties imposed 4/22/2016 for $9,500.00; Appealed 05/18/2016
Water Oak Manor (Name Change to Riverview) HAL-025-031 4/22/2016 $16,000.00 Type A1 10A NCAC 13F .0602 (a) Management Of Facilities With Capacity Or Census 31 to 80 Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure an Administrator or Administrator-in-Charge were responsible for the total operation of the home to meet and maintain the rules in rules areas of Personal Care and Supervision, Health Care, Resident Rights, and Physical Environment 12/22/2016 Settlement Agreement in Conjunction with all penalties imposed 4/22/2016 for $6,000.00; Appealed 05/18/2016
Water Oak Manor (Name Change to Riverview) HAL-025-031 4/22/2016 $7,000.00 Type A2 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure exit doors accessible to residents who were known to be disoriented were equipped with a sounding device that activated when door was opened by two residents and faailed to assure exit doors to Special Care Unit were secured to prevent residents from exiting without supervision for one resident in unit who knew code to exit door and opened the door 12/22/2016 Settlement Agreement in Conjunction with all penalties imposed 4/22/2016 for $2,500.00; Appealed 05/18/2016
Water Oak Manor (Name Change to Riverview) HAL-025-031 4/22/2016 $7,000.00 Type A2 10A NCAC 13F .0902 (c)(3-4) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement finger stick blood glucose monitoring for six residents who had orders for finger stick blood glucose testing Settlement Agreement in Conjunction with all penalties imposed 4/22/2016 for $3,000.00 & Training; Appealed 05/18/2016
Brookdale New Bern HAL-025-012 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the physician of increased leg swelling and redness around a leg wound until at least 8 days after swelling and pain were documented; failed to schedule a follow-up appointment related to an ER visit for leg and failed to make a dermatology appointment for excessive dry skin/flaking and warts on arm and hand for one resident Paid in Full $2,233.33 12/30/2016
New Bern House HAL-025-035 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to contact resident's physician regarding orders for medications for 1 of 6 sampled residents. Appealed 01/20/2017
Riverview HAL-025-031 12/22/2016 7,000.00 Type A2 10A NCAC 13F .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure follow-up with medical providers for 1 of 5 residents that were out of medications. Appealed 01/20/2017

Cumberland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Countryside Villa HAL-026-046 5/13/2014 $16,200.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the primary care physician for one resident symptoms while drinking thin liquids and clarification of an order for low sodium Dysphagia III diet with nectar thick liquids Paid in Full; 11/14/2014 Settlement Agreement in Conjunction with penalty imposed 5/16/2013 for $3,500.00 and Training
McLean Family Care Home (Penalty #1) (Closed) FCL-026-040 8/19/2014 $1,000.00 Type A2 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure adequate management in meeting and maintaining state rules and regulations related to housekeeping and furnishings, resident assessments, licensed health professional evaluations, nutrition and food service, health care, medication orders, medication administration and infection control
McLean Family Care Home (Penalty #2) (Closed) FCL-026-040 8/19/2014 $1,000.00 Type A2 10A NCAC 13G .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure medications, such as insulin, antivirals, cardiovascular agents and psychotropics, for three residents were administered according to physician's orders and failed to ensure a safe and effective system for the preparation and administration of medication, in accordance with the rules of this subchapter, was in place to ensure accurate medication administration
Jean's Rest Home (Closed) FCL-026-029 9/18/2014 $8,900.00 Unabated Type B 10A NCAC 13G .1009 (a) (1) Pharmaceutical Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the medication reviews included the identification of medication errors through review of physician's orders, progress notes, and medication administration records for two residents
Eastover Gardens Special Care HAL-026-055 10/16/2014 $7,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S.131D-21 (2) G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan and current symptoms for four residents with multiple falls, agitated and aggressive behaviors and suicidal and homicidal thoughts; failed to notify resident's physician for three residents related to falls, brusing, change in behaviors, skin wound and obtaining mental health services Appealed 11/14/2014
Eastover Gardens Special Care HAL-026-055 10/16/2014 $7,000.00 Type A2 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures throughout the facility were maintained between 100 and 116 degrees Fahrenheit (F) Appealed 11/14/2014
Cumberland Village Assisted Living HAL-026-062 2/20/2015 $1,000.00 Type A2 10A NCAC 13F .0305 (h) (4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the activation of the sounding device on the main entrance door of facility and failed to provide supervison to one resident known to be a wanderer and exited facility without staff knowledge Paid in Full; 07/10/2015 Settlement Agreement for $1,000.00; Appealed 03/05/2015 $1,000.00 7/24/2015
Countryside Villa HAL-026-046 10/14/2015 $16,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to remove oxygen from one resident wearing oxygen prior to going out in the smoking area who caught on fire and later died 11/11/2015 Appealed
Countryside Villa HAL-026-046 10/14/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0601 (a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for three residents regarding oxygen, smoking behavior and one with aggressive and assaultive behavior toward staff and residents. Administrator and Manager failed to assure that all required duties were carried out in the facility relating to resident rights, personal care and supervision, health care, medication administration, death reporting, health care personnel registry, physical environment, housekeeping and furnishings, TB testing, personal care training and competency and nutrition and food service 11/11/2015 Appealed
Countryside Villa HAL-026-046 10/14/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for thirteen residents smoking in their rooms including one resident whose roommate was on continuous oxygen via nasal cannula and one resident who used oxygen in his room as needed 11/11/2015 Appealed
Carillon Assisted Living of Fayetteville HAL-026-056 1/26/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision in the Special Care Unit in accordance with each resident's needs, care plan and current symptoms for two residents who were at risk of wandering and one of two residents at risk of falls Paid in Full $2,000.00 2/9/2016
Countryside Villa HAL-026-046 12/8/2016 $7,000.00 Type A2 10A NCAC 13F .0306 (a) (5) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure home was maintained in a clean, orderly manner, free of all obstructions and hazards.
Valley Pines Adult Care HAL-026-052 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 1 of 3 sampled residents was free from physical and mental abuse relating to verbal and physical mistreatment of the resident a staff person.

Dare County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor of Outer Banks HAL-028-001 9/18/2014 $20,000.00 Type A1 10A 10A NCAC 13F .1501 (a) Use of Physical Restraints and Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the use of less restrictive methods of restraint, current orders for a hospital bed with bedrails, and an assessment for the use of bedrails as a restraint for four residents that bedrails were used for and one resident was caught in the rail and died. Paid in Full; 03/30/2015 Settlement Agreement for $13,000.00; Appealed 10/06/2014 $13,000.00 4/30/2015

Davidson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Grayson Creek of Welcome HAL-029-010 6/18/2015 $2,000.00 Type A2 10A NCAC 13F .0206 Capacity; 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the licensed capacity of the facility was not exceeded and was unaware of current census Paid in Full; Appealed 08/03/2015 $2,216.67 1/8/2016

Duplin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Windham Hall HAL-031-006 4/15/2014 $8,000.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the physicians of one resident's refusal to take medications Paid in Full; 10/29/2014 Settlement Agreement for $4,000.00; Appealed 04/24/2014 $4,000.00 11/5/2014
Autumn Village HAL-031-018 10/16/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident who required two person transfer resulting in the resident falling out of the wheel chair and receiving stitches Paid in Full; 12/30/2015 Settlement Agreement for $800.00; Appealed 11/14/2014 $800.00 2/12/2016

Edgecombe County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Heritage Care of Rocky Mount HAL-033-005 9/21/2016 $1000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; 10A NCAC 13F .0305(b)(4) Physical environment Failure to provide supervision for wandering resident who eloped and to assure 2 exit door alarms were activated with sufficient volume to alert staff. Appealed 09/24/2016

Forsyth County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookstone Terrace HAL-034-094 11/19/2014 $2,000.00 Type A2 G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure infection control procedures were implemented in accordance with the Center for Disease Control's recommendation during fingerstick blood testing for four residents with orders for blood glucose monitorin by the sharing of a house stock glucometer and lancing pen Paid in Full $2,000.00 1/12/2015
The Bradford Village of Kernersville - West HAL-034-069 10/29/2014 $4,000.00 Type A2 G.S. 131D-4.4A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure infection control procedures were implemented in accordance with the Center for Disease Control's recommendation during fingerstick blood sugar testing with lancing pens for 4 residents with orders for blood sugar monitoring and the use of 1 house stock glucometer and lancing pen. Paid in Full $4,000.00 12/17/2014
Quality Professional MultiServices FCL-034-028 3/18/2015 $2,000.00 Type A2 10A NCAC 13G .0901 (b); 10A NCAC 13G .0601 Management and Other Staff (a)(b)(1); G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure supervision was provided to 5 residents, including one known to have seizures, as evidenced by staff not present on multiple occasions resulting in residents responsible for emergency procedures and staff not available to provide care and intervention for one resident Paid in Full; 07/01/2015 OAH Final Decision Petition Dismissed; Appealed 03/30/2015 $2,000.00 12/31/2015
Quality Professional MultiServices FCL-034-028 3/18/2015 $2,000.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; 10A NCAC 13G .0601 (a) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered for two residents and failed to assure a safe and effective system for the preparation and administration of medications; and, the administrator failed to assure responsibility for the total operation of the facility to maintain compliance in the rule areas such as management and other staffing, staff qualification and training, medication administration, controlled substances, criminal background checks and healthcare personnel registry Paid in Full; 07/01/2015 OAH Final Decision Petition Dismissed; Appealed 03/30/2015 $2,000.00 12/31/2015
Salem Terrace Penalty #1 & # 3 HAL-034-098 8/21/2015 $16,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision, notify the physician and refer to mental health services for one resident with violent behavior resulting in the physical assault and subsequent death of another resident. Paid in Full; 12/30/2015 Settlement Agreement for payment plan for both penalties imposed 08/21/2015 $32,115.85 09/12/2016 06/03/2016 04/11/2016 02/29/2016 12/29/2015 12/22/2015
Salem Terrace Penalty #2 HAL-034-098 8/21/2015 $16,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Residents' Rights Facility failed to ensure residents were free of neglect related to failure to provide safety and protection by admitting a resident to the Special Care Unit with a history of violent outbursts and had physical altercations with residents resulting in injury and the death of one resident. 12/30/2015 Settlement Agreement for payment plan for both penalties imposed 08/21/2015
Shuler Health Care Crane Villa HAL-034-009 9/23/2015 $1,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21(4) Declaration of Residents' Rights The facility failed to ensure residents were free from mental abuse and neglect for the twelve residents of the facility as evidenced by the behaviors of one staff. Paid in Full $1,000.00 10/9/2015
Brookdale Reynolda Road HAL-034-035 12/29/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for three residents who were at risk for frequent falls resulting in injury Paid in Full; 01/05/2017 Settlement Agreement in Conjunction with all penalties imposed 12/29/2015 for $7,000.00 & Training; (due) 01/27/2016 Appealed $7,000.00 1/13/2017
Brookdale Reynolda Road HAL-034-035 12/29/2015 $7,000.00 Type A2 10A NCAC 13F .0601 (a) Management Of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the Administrator was responsible for the total operation of the facility to maintain compliance in the rule areas of health care, medication administration, staff qualifications, staffing, training in cardiopulmonary resuscitation, personal care and supervision, infection prevention, resident rights, housekeeping, accuracy of medication administration records, and self-administration of medications Paid in Full; 01/05/2017 Settlement Agreement in Conjunction with all penalties imposed 12/29/2015 for $7,000.00 & Training; 01/27/2016 Appealed
Brookdale Reynolda Road HAL-034-035 12/29/2015 $4,000.00 & Training Type A2 10A NCAC 13GF.1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the licensed prescribing practitioner for two residents observed during medication administration which included errors with medications for vitamin supplementation, elevated lipids, allergies, skin disorders, and convulsion, and for five residents which included errors with medications for chest pain, pain, insomnia, allergies, skin disorders, and convulsions Paid in Full; 01/05/2017 Settlement Agreement in Conjunction with all penalties imposed 12/29/2015 for $7,000.00 & Training; 01/27/2016 Appealed
Brookdale Reynolda Road HAL-034-035 12/29/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to schedule appointments for referrals as ordered by physician for five residents with mental health and new physician referral, dermatologist and mental health referral, ENT and GI referral, dermatologist referral and response to chest pain, and order for hospital bed Paid in Full; 01/05/2017 Settlement Agreement in Conjunction with all penalties imposed 12/29/2015 for $7,000.00 & Training; 01/27/2016 Appealed
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented for wound care for one resident with a stage four sacral wound
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure notification of health department, health care providers or the resident's guardian regarding residents' behaviors for three residents regarding behaviors
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision or monitoring related to safety for four residents who left facility frequently and were known to have guardians or the inability to make safe decisions; and failed to provide additional supervision for one resident who attempted suicide
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $7,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure residents were free from neglect by failing to recognize its role in caring for individuals with communicable infections and those with diminished mental capacity; addressing special care needs, monitoring and reporting; failing to make available and implement preventative measures to protect other residents from transmission of communicable disease and failed to ensure one resident was free of abuse by staff; and failed to ensure Administrator was responsible for the total operation of the facility to maintain compliance
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures in the facility were maintained between 100 and 116 degrees Fahrenheit (F)
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 10A NCAC 13F .0504 (c) Competency Validation for Licensed Health Professional Support Task; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to obtain physician certification and ensure non-licensed staff met the requirements for training and competency validation prior to performing wound care for greater than stage two wound for one resident with a stage four sacral wound
Cornerstone Living Center of Winston-Salem (Change of Ownership) HAL-034-091 1/25/2016 $4,000.00 Type A2 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure prescribed medications were administered as ordered by the licensed prescribing practitioner and in accordance with the facility's policies and procedures for three residents
Homestead Hills Assisted Living HAL-034-023 5/24/2016 $2,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the licensed prescribing practitioner for two residents observed during medication administration of Insulin and Xarelto; for two residents with errors with medication for blood clotting, constipation, and altered thyroid function Paid in Full $2,000.00 6/14/2016

Franklin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Essex Manor Assisted Living Facility HAL-035-027 10/15/2015 $7,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to report to the North Carolina Health Care Personnel Registry and investigate an injury of unknown origin for one resident
Essex Manor Assisted Living Facility HAL-035-027 10/15/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow up to meet the acute mental health and chronic metal health care needs for one resident by not notifying the mental health provider or resident's primary physician of resident's combative and aggressive behaviors; by not following up on a panic lab value; and not assuring resident continued to receive a nenal medication when discharged from hospital
Essex Manor Assisted Living Facility HAL-035-027 10/15/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for one resident with a documented history of combative behavior who assaulted staff, attempted to assault a resident and physically assaulted another resident
Essex Manor Assisted Living Facility HAL-035-027 10/15/2015 $4,000.00 Type A2 10A NCAC 13F .0601 Management Of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure an administrator or administrator in charge was responsible for the operation of the facility to meet and maintain the rules in rule areas of Personal Care and Supervision, Other Staff Qualifications, Health Care, and Health Care Personnel Registry
Essex Manor Assisted Living Facility (Change of Ownership) HAL-035-027 2/22/2016 $12,000.00 Type A1 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to administer medications as ordered by the physician to four residents, one who did not receive insulin resulting in elevated blood glucose levels and one who was an unstable diabetic with hospitalizations
Essex Manor Assisted Living Facility (Change of Ownership) HAL-035-027 5/24/2016 $16,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0311 (a) Other Requirements; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure residents were free of neglect as evidenced by the failure to have safe and continued operating air conditioning or other means of cooling temperatures of resident rooms and areas contributing to generalized weakness for one resident, inpatient hospitalization for dehydration for one resident and emergency room admission for heat related illness for another
Essex Manor Assisted Living Facility Louisburg HAL-035-027 9/21/2016 $12,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004 Medication Administration Facility failed to ensure resident did not receive cardiovascular meds, antibiotic, pain meds and a hyopglycemic med because unavailable.
Franklin Manor Assisted Living Center HAL-035-024 9/21/2016 $4,000.00 Type A1 10A NCAC 13F .0901(a) Personal Care and Supervision Facility failed to ensure a resident needing 2-person assist received leg laceration while staff assisting. Paid in Full $4,416.67 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/8/2016 $1,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up for resident related to contacting emergency medical services for a fractured hip and knee. Paid in Full 1,000.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/8/2016 $2,000.00 Type A2 10A NCAC 13F .0902(c) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to avoid delay of MD orders for urine screen and antibiotics and failed to implement MD orders for 2 residents requiring use of walker, resulting in multiple falls with injuries. Paid in Full 2,000.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/22/2016 $10,600.00 Unabated Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure assure staff administered Vitamin D, Zyprexa, Sertraline, Namenda an Tylenol as ordered for 1 of 8 residents. Paid in Full $10,600.00 1/13/2017
Franklin Manor Assisted Living Center HAL-035-024 12/22/2016 86,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Faility failed to ensure personal care was provided to 2 of 5 residents based on their assessed needs, resulting in excoriation of the skin and rib and hip fractures. Paid in Full 86,000.00 1/13/2017

Gaston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wellington House HAL-036-031 5/20/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure one resident was free of neglect as evidenced by the resident with a diagnosis of dementia and documented as always disoriented and significant memory loss eloped from the facility Paid in Full; 12/30/2015 Settlement Agreement for $3,000.00; Appealed 06/17/2015 $3,000.00 02/18/2016 1/26/2016
Country Time Inn HAL-036-018 10/16/2014 $4,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff provided care and intervention according to policies and procedures regarding cardio-pulmonary resuscitation (CPR) for one resident who was found unresponsive and did not have an Order for Do Not Resuscitate Paid in Full; 12/30/2015 Settlement Agreement for $2,000.00; Appealed 11/24/2014 $2,000.00 2/12/2016
Wellington House HAL-036-031 10/16/2014 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to notify physician of one resident's condition who had sores, pain, bleeding, redness and swelling of the foot and limping. Paid in Full; 12/30/2015 Settlement Agreement for $3,000.00; Appealed 11/24/2014 $3,000.00 2/16/2016
Brookdale Union HAL-036-012 2/19/2015 $4,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents are free of physical and mental abuse causing injuries to one resident and failed to ensure one resident received services necessary to maintain the physical health Paid in Full $4,000.00 3/10/2015
Peak Resources Cherryville NH0403 3/19/2015 $2000 A2 10A NCAC 13F .0901 (b) Personal Care and Supervision Facility failed to assess and care plan smoking supervision needed, communicate changes in the supervision needed, and supervise 1 resident who required supervision when smoking. In addition, the facility failed to implement their policy related to keeping smoking materials secured and posting signs designating the smoking area. A resident was found with smoking materials and smoking in his bed during which he burned a hole in his mattress. Paid in Full $2000 3/20/2015
Heritage Oaks Assisted Living HAL-036-030 3/18/2015 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide appropriate care and services including cardio-pulmonary resuscitation (CPR) for one resident found unresponsive and did not have an order for "do not resuscitate" Paid in Full $4,000.00 5/7/2015
St Mark's Road Care Home FCL-036-024 3/19/2015 $1,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were free from physical, mental and verbal abuse toward three residents by a staff Paid in Full $1,000.00 8/16/2016
Wellington House HAL-036-031 9/30/2015 $7,000.00 Type A2 10A NCAC 13F .1004(a)(1)(2), (k) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure medications were administered as ordered in accordance with facility policies and procedures and regulations to a resident as evidenced by the resident receiving another resident's medications resulting in the resident being hospitalized. Paid in Full; 06/15/2016 Settlement Agreement for $5.000.00; Appealed 10/30/2015 & 10/15/2015 $5,000.00 09/08/2016 08/16/2016 07/15/2016
Rosewood Assisted Living HAL-036-004 4/20/2016 $7,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that residents were free of verbal abuse and mental anguish as evidenced by fears and concerns of one resident Paid in Full $7,000.00 6/29/2016
Rosewood Assisted Living HAL-036-004 4/20/2016 $7,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure two residents were free from neglect regarding illicit drug use and four residents were free from mental abuse from staff Paid in Full $7,000.00 6/29/2016

Granville County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The Zion FCL-039-013 2/20/2015 $750.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for one resident resulting in required in-patient care at a mental health crisis center Paid in Full $750.00 4/14/2015

Greene County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Snow Hill Assisted Living HAL-040-008 1/13/2015 $1,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medication was administered according to physician's order for one resident resulting in increased swelling in leg Paid in Full $1,000.00 2/4/2015

Guilford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Emeritus at Greensboro (Now Brookdale Lawndale Drive) HAL-041-049 4/16/2015 $84,750.00 Unabated Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure supervision was provided in accordance with residents assessed needs and current symptons for three residents in the Special Care Unit resulting in physical injuries for two residents and physical and emotional abuse for one Paid in Full; 02/08/2016 Settlement Agreement for $25,000.00 & Training; Appealed 05/06/2015 $25,000.00 1/25/2016
Westchester Harbour HAL-041-073 8/20/2014 $16,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to increase supervision for two residents with multiple falls, resulting in injuries with one resident sustaining a head injury and subsequently died Paid in Full; 04/30/2015 Settlement Agreement for $10,000.00; Appealed 09/05/2014 $10,000.00 3/11/2015
Emeritus at Greensboro HAL-041-049 12/17/2014 $2,000.00 Type A2 10A NCAC 13F .0904 (e) (4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure one pureed diet was served as ordered for a resident with dysphagia and a history of choking Paid in Full $2,000.00 1/7/2015
Emeritus at Greensboro HAL-041-049 12/17/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure one resident was provided supervision according to their required need who has frequent falls and a history of fracture Paid in Full $2,000.00 1/7/2015
Greensboro Manor (Now Brookdale Northwest Greensboro) HAL-041-031 11/19/2014 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights The facility failed to provide supervision in accordance with each resident's assessed needs, care plan, and current symptoms for two residents with multiple falls resulting in head injuries, black eyes or fractured bones Paid in Full $4,000.00 12/2/2014
Morningview at Irving Park HAL-041-052 10/16/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with resident's assessed needs for one resident who had a history of falls with injuries Paid in Full $1,000.00 12/10/2014
River Landing at Sandy Ridge NH0612 9/17/2015 $4000 Past Corrected A1 10A NCAC 13F .0901 (b) Personal Care & Supervision Facility failed to prevent a resident who was cognitively impaired fromm exiting the facility unsupervised resulting in a hospitalization for hypothermia. Paid in Full $4000 10/5/2015
Guilford Adult Care #2 FCL-041-018 6/14/2016 $1,000.00 Type A2 10A NCAC 13G .0901 (b) Personal Care & Supervision; 10A NCAC 13G .0601 (b) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for three residents who were left unsupervised at facility waiting for staff to return to facility; and failed to assure that at no time was a resident left alone in the home without a staff member present for three residents Paid in Full $1,000.00 12/8/2016
Morningview at Irving Park HAL-041-052 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for two residents with repeated falls which resulted in injury Paid in Full $2,000.00 6/24/2016
Brookdale Lawndale Park HAL-041-062 12/8/2016 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure MD orders related wound care implemented resulting in amputations, and to notify MD regarding a resident's refusal of insulin and fingerstick blood sugar monitoring.
Bennett's Family Care Home FCL-041-002 12/22/2016 10,800.00 Unabated Type B 10 A NCAC 13G .0601 (a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights The facility administrator failed to assure the rules were met and maintained related to physical environment, staffing records and training, management of facilities, health care, accuracy of med. administration records, and medication administration. Appealed 01/23/2017
Brookdale High Point HAL-041-030 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up to meet the routine and acute health care needs of 2 of 5 sampled residents with orders for neurology and neurosurgery follow-up appointments following acute and chronic hemorrhaging and application of compression stockings. Paid in Full 2,000.00 1/26/2017

Halifax County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Woodhaven Rest Home #2 HAL-042-003 4/15/2014 $2,000.00 Type A2 G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to develop and implement an infection control policy to assure appropriate infection control for glucose monitoring of residents resulting in the use of two glucose meters and one lancing device for finger stick blood glucose checks on multiple residents in the facility Paid In Full; Payment Plan $2,000.00 11/21/2014 10/13/2014 07/16/2014 05/08/2014

Harnett County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pinecrest Gardens HAL-043-022 4/15/2014 $16,000.00 Type A1 10A NCAC 13F .0901 (a) (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide personal care and supervision for a resident who choked during meal time and died 12/30/2016 Training Completed; Paid in Full; 02/20/2015 Settlement Agreement for $9,000.00 & Training; Appealed 4/29/2014 $9,000.00 03/08/2016 02/18/2016 01/14/2016 12/17/2015 11/13/2015 09/16/2015 08/14/2015 07/13/2015 06/17/2015 05/18/2015 04/20/2015 03/11/2015
Primrose Villa Retirement III (penalty #1) HAL-043-017 4/15/2014 $2,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure an administrator or administrator in charge was available for the total operation of the home, to meet and maintain the rule related to healthcare, clarification of orders for medications and treatments, medication administration, and infection prevention Referred to Controller's Office
Primrose Villa Retirement III (penalty #2) HAL-043-017 4/15/2014 $2,000.00 Type A2 10A NCAC 13F .1002 (a) Medication Orders; 10A NCAC 13F .1004 (a) Medication Administration G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure contact with physician for one resident whose medication orders were unclear or incomplete and failed to assure medications were administered as ordered by licensed prescribing practitioner Referred to Controller's Office
Primrose Villa Retirement III (penalty #3) HAL-043-017 4/15/2014 $2,000.00 Type A2 G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a written infection control policy was developed and implemented to assure appropriate infection control for two residents resulting in the shared use of a glucose meter and a lancing device Referred to Controller's Office
Alzheimer's Related Care HAL-043-026 10/16/2014 $7,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision or respond to an incident involving two residents which resulted in a serious injury to one resident Paid in Full Appealed 11/05/2014 $7,233.49 11/11/2015 10/23/2015 09/30/2015 08/21/2015 07/10/2015 06/18/2015 05/22/2015 04/24/2015 03/17/2015 02/25/2015 02/02/2015
Alzheimer's Related Care HAL-043-026 1/13/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure adequate supervision for two residents in the special care unit, one resident who exhibited aggressive behaviors toward other residents resulting in injuries, and for one resident who wandered at night into other residents' rooms Paid in Full; Letter from Controllers office sent 07/20/2015 re penalty and interest due 08/20/2015 equals $4466.67. $4,503.93 12/14/2015

Haywood County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Chestnut Park Retirement Center HAL-044-022 10/16/2014 $1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for one resident related to the resident's acute change in condition resulting in hospitalization due to a bowel obstruction Paid in Full $1,000.00 11/24/2014
Haywood House HAL-044-042 6/18/2015 $2,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for four residents 11/29/2016 Training Completed; Paid in Full; 12/31/2015 Settlement Agreement for $500.00 and Training; Appealed 07/15/2015 $500.00 1/20/2016
Chestnut Park Rest Home #1 HAL-044-002 6/13/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure one resident with a diagnosis of dementia was supervised in accordance with the resident's assessed needs of wandering and disorientation and current symptoms of behavioral disturbance

Henderson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Spring Arbor West HAL-045-092 4/22/2016 $16,000.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to assure medications were administered as prescribed for six residents for a total of 22 different medications, including cardiovascular agents and pain medications. Paid in Full; 09/02/2016 Settlement Agreement for $8,000.00 $8,000.00 12/6/2016
Spring Arbor West HAL-045-092 1/4/2017 14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the prescribing physician when lab tests were not completed timely as ordered for 1 of 5 sampled residents resulting in resident's hospital admission and death. Paid in Full; 02/08/2017 Settlement Agreement for $10,000.00; Appealed 01/17/2017 10,000.00 2/15/2017

Hoke County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Open Arms Retirement Center HAL-047-009 10/16/2014 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to notify physician for three residents' as related to a resident's acute change in condition and contacting emergency medical services (EMS) for two residents with low blood glucose levels according to the facility's blood glucose policy Paid in Full $2,000.00 11/17/2014
Open Arms Retirement Center HAL-047-009 2/23/2016 $3,500.00 & Training Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the primary care physician and seek acute care for the medical needs of two residents 01/19/2017 Settlement Agreement for Penalty Elimination; Appealed 03/17/2016
The Crossings at Wayside HAL-047-011 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer prescription medications in accordance with orders by a licensed prescribing practitioner for two residents resulting in coughing, wheezing, shortness of breath, and respiratory distress which required treatment for pneumonia and emergent treatment for diagnosis of atelectasis for one resident and suppositories for the other resident Paid in Full $2,000.00 6/21/2016
The Crossings at Wayside HAL-047-011 12/22/2016 7,000.00 Type A1 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the licensed prescribing practitioner and in accordance with the faciity's polices and procedures for 3 of 9 residents observed during medication passes , including errors with insulin and prn lubricant eyedrops and a resident who received another resident's medications for heart/high blood pressure, depression and tremors and a resident who received another resident's medications for heart/blood pressure, Alzheimer's disease, depression, lowering triglycerides and calciou and vitamin supplements. Paid in Full 7,000.00 1/20/2017

Iredell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Jurney's Assisted Living HAL-049-015 4/16/2015 $1,000.00 Type A2 10A NCAC 13F .0305 (h) (4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure all exit doors accessible by residents were equipped with sounding device that were activated for one resident with diagnosis of dementia who went outside and fell out of wheelchair resulting in a broken neck Paid in Full $1,000.00 7/7/2015
Aurora of Statesville HAL-049-028 9/18/2014 $2,000.00 Type A2 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medication as orderd for one resident with physician orders for Lasix and sliding scale insulin Paid in Full $2,000.00 10/2/2014
Aurora of Statesville HAL-049-028 12/17/2014 $43,500.00 Unabated Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for two residents Paid in Full; Payment Plan $44,946.04 12/22/2015 11/05/2015 10/05/2015 09/03/2015 08/04/2015 07/07/2015 06/05/2015 05/05/2015 04/02/2015 03/03/2015 02/04/2015
Rosewood AssistedLiving HAL-049-004 12/17/2014 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician regarding two residents being without medications during an extended leave of absence Paid in Full $2,000.00 1/5/2015
Olin Village HAL-049-016 10/16/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care and Supervision; G.S.131D-21 (2) Declaration of Resident's Rights Facility failed to assure staff responded immediately to a missing person according to the facility's policies and procedures for one resident who exited the building around 4:45 am when outside temperatures were 32 degrees F (Fahrenheit) or below, resulting in resident being hospitalized 12/28/2015 Training Completed; Paid in Full; 06/01/2015 Settlement Agreement for $1,250.00 ($1,000.00 for Training & $250.00 Payment); Appealed 11/24/2014 $250.00 7/7/2015
Brookdale Churchill HAL-049-029 6/18/2015 $4,000.00 Type A2 10A NCAC 13F .0305 (h) (4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure all exit doors accessible by residents were equipped with sounding device that were activated for two residents with documented intermittent disorientation and confusion exited and eloped resulting in injury to one resident Paid in Full; 12/30/2015 Settlement Agreement for $1,500.00; Appealed 06/30/2015 $1,500.00 1/13/2016
Rosewood Assisted Living HAL-049-004 3/22/2016 $14,000.00 & Training Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident with a history of choking and physician's order for supervision while eating 12/27/2016 Training Completed; Paid in Full $14,000.00 06/08/2016
Rosewood Assisted Living HAL-049-004 6/14/2016 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for two residents who were known to fall asleep while smoking Paid in Full $4,000.00 9/26/2016
Olin Village HAL-049-016 9/21/2016 6,600.00 Unabated Type B G.S. 131D-4.4 A; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented for blood glucose monitoring for a least 3 residents with orders for finger stick blood sugars by sharing glucometers with other residents. Paid in Full $7,287.50 12/21/2016
Crown Colony HAL-049-010 1/20/2017 6,500.00 & Training Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights The facility failed to ensure a resident was free from sexual abuse by a staff member. Appealed 01/26/2017

Johnston County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cardinal Care Assisted Living Village # 2 (Facility Closed ) HAL-051-032 4/16/2015 $8,200.00 Unabated Type B 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure two residents who were known smokers did not smoke inside of the facility
Clayton House HAL-051-041 5/20/2015 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to get a psychiatric evaluation with a Spanish speaker for one resident with aggressive and combative behaviors towards other residents and staff due to language barriers; facility failed to assure other residents were protected and free of mental and physical harm and neglect related to two residents' frequent and continued combative and aggresive behaviors toward other residents Training Completed 11/29/2016; Paid in Full; 12/31/2015 Settlement Agreement for $500.00 and Training; Appealed 06/17/2015 $500.00 1/20/2016
Cardinal Care Assisted Living Village # 3 (Facility Closed) HAL-051-030 1/13/2015 $2,000.00 Type A2 G.S. 131D-4.4 A ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to have written infection control policy and failed to assure proper procedures for the use of glucometer and lancet devices for two diabetic residents resulting in shared use of glucometers and lancet devices
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $12,000.00 Type A1 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Facility administrator failed to assure the total operation of the facility to meet and maintain rules related to personal care and supervision, health care, nutrition and food service, medication administration, health care personnel registry, special care unit staffing, and resident rights Paid in Full $12,000.00 5/3/2016
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $12,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs for five residents: two residents with urinary tract infections resulting in a fall with head injury for one resident and hospital visits for both; coordinating with pharmacy and physician to obtain Potassium supplement for one resident whose potassium levels became critically low causing nausea and vomiting and significant weakness leading to resident being unable to feed self; notifying the physician of significant weight change for one resident with swelling and hospitalization for congestive heart failure; obtaining a glucometer and notifying the physician of a resident whose blood glucose levels and sliding scale insulin was not being done resulting in high blood glucose reading and hospitalization; and coordinating to get a diabetic resident's fingernails trimmed resulting in long jagged nails on both hands Paid in Full $12,000.00 5/3/2016
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $12,000.00 Type A1 10A NCAC 13F .0902 (c ) (3)(4) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure documentation and implementation of physician's orders for seven residents including orders for blood sugars, blood pressures, pulses, weights, ted hose, hot/cold packs and nail care Paid in Full $12,000.00 5/3/2016
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $12,000.00 Type A1 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered by the licensed prescribing practitioner for one resident observed during medicationpasses, including errors with medications for blood thinning, acid reflux and constipation and eight residents related to errors with medications for diabetes, high blood pressure, low potassium levels, infection, inflamation, swelling, constipation, breathing problems, allergies, cough and congestion Paid in Full $12,000.00 5/3/2016
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan, and current symptoms for one resident with multiple falls, including falls with head injuries requiring visits to the emergency room Paid in Full $2,000.00 5/3/2016
Gabriel Manor Assisted Living Center HAL-051-048 3/18/2016 $2,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to report an allegation of abuse against health care personnel for one staff with in 24 hours of facility becoming aware of allegations of staff shoving resident down along with any investigation by facility within 5 business working days Paid in Full $2,000.00 5/3/2016

Lee County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Ashewood Estates Retirement Center (penalty #1) Change of Ownership HAL-053-011 5/13/2014 $2,000.00 Type A2 10A NCAC 13F .1205 Health Care Personnel Registry; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect residents from abuse and neglect by failure to investigate and report to Health Care Registry injuries of unknown causes for two residents and report allegations of abuse and neglect involving one former staff and a staff currently employed at the facility Bankruptcy Order 12/19/14
Ashewood Estates Retirement Center (penalty #2) Change of Ownership HAL-053-011 5/13/2014 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0703 Tuberculosis Test, Medical Examination and Immunizations; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to assure an environment free of mental abuse for residents at the facility through the inadequate response to one resident's aggressive and unsafe behaviors Bankruptcy Order 12/19/14
Ashewood Estates Retirement Center (penalty #3) Change of Ownership HAL-053-011 5/13/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision for three residents exhibiting injurious behaviors such as repeated falls, smoking inside the facility repeatedly, and eloping out of a window Bankruptcy Order 12/19/14
Ashewood Estates Retirement Center (penalty #4) Change of Ownership HAL-053-011 5/13/2014 $4,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to provide personal care for three residents requiring extensive assistance with activities of daily living such as incontinence care, nail care and repositioning to prevent pressure ulcers Bankruptcy Order 12/19/14
Ashewood Estates Retirement Center (penalty #5) Change of Ownership HAL-053-011 5/13/2014 $4,000.00 Type A1 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (1) Declaration of Residents' Rights Facility failed to meet and maintain rules related to Qualifications of Medication Staff, Admission to Special Care Unit, Personal Care and Supervision, Health Care, Residents' Rights, Health Care Personnel Registry, Special Care Unit Staffing and Infection Prevention Requirements Bankruptcy Order 12/19/14
Victorian Manor (Now Royal Oak Assisted Living) HAL-053-027 12/29/2015 $14,000.00 Type A1 10A NCAC 13G .0901 (c ) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure policy and procedures were implemented for one resident as evidenced by staff interventions for the resident's aggressive behavior Appealed 01/26/2016
Royal Oaks Assisted Living HAL-053-027 6/13/2016 $12,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision in accordance with each resident's assessed needs, care plan and current symptoms for one resident who was locked in the bathroom overnight and subsequently expired in the bathroom 01/19/2017 Settlement Agreement in Conjunction with penalties imposed 06/13/2016 for Training; Appealed 07/11/2016
Royal Oaks Assisted Living HAL-053-027 6/13/2016 $2,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the hot water temperatures for seven sink fixtures and five shower fixtures located in resident bathrooms were maintained between 100 degrees Fahrenheit (F) and 116 degrees F, with hot water temperatures ranging from 128 to 138 degrees F 01/19/2017 Settlement Agreement in Conjunction with penalties imposed 06/13/2016 for Training; Appealed 07/11/2016

Lenoir County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Lenoir Assisted Living HAL-054-068 5/20/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to assure referral to the psychologist as ordered for one resident who had worsening suicidal ideation 04/22/2016 Training Completed; Paid in Full; 11/09/2015 Settlement Agreement for $2,500.00 & Training; Appealed 06/17/2015 $2,500.00 11/23/2015
The Village of Kinston HAL-054-067 2/22/2016 $4,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to respond immediately in case of an accident or incident involving two residents related to one resident after a fall and one found unresponsive 01/05/2017 Settlement Agreement for $1,000.00 & Training; Appealed 03/23/2016
The Village of Kinston HAL-054-067 2/22/2016 $2,000.00 Type A2 Reduced to Type B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to assure one resident was free of abuse by one staff 01/05/2017 Settlement Agreement for Training; Appealed 03/23/2016

Lincoln County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Boger City Rest Home HAL-055-002 9/18/2014 $12,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for one resident related to mental health services and resident set herself on fire and suffered third degree burns. Paid in Full $12,000.00 11/7/2014
Lakewood Care Center HAL-055-003 6/14/2016 $16,000.00 Type A1 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff initiated CPR and emergency response procedures when one resident was found unresponsive Paid in Full $16,000.00 7/25/2016

Madison County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mintz Family Care Home #1 FCL-057-001 11/19/2014 $1,000.00 Type A2 10A NCAC 13G .0901 (b) Personal Care & Supervision; 10A NCAC 13G .0312 (g) Outside Entrance and Exits; G.S. 131D-21 (4) Declaration of Residents' Rights Facility, with two residents determined to be disoriented by a physician, failed to assure two exit doors were equipped with a working sounding device that activated when opened and failed to provide supervision for one resident, with dementia and disorientation, who eloped from the facility. Paid in Full $1,166.67 11/21/2016 02/29/2016

Mecklenburg County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Slay's Rest Home HAL-060-038 5/13/2014 $10,800.00 Type Unabated B 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure the administrator was responsible for the total operation of the home to maintain compliance in the rule areas regarding medication administration, Tuberculosis testing, pharmaceutical reviews, self-administration of medications, and other staff qualifications Paid in Full $10,800.00 5/30/2014
Sunrise on Providence HAL-060-057 12/17/2014 $9,800.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure notification of physician for two residents, one with decline in health and condition after a fall and emergency visit and one with swollen legs not wearing TED stockings and an open wound Paid in Full $11,188.33 01/12/2016 12/31/2015
Lawyers Glen Retirement Living Center HAL-060-136 3/22/2016 $4,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that residents were free from abuse as related to one staff member with an alleged sexual abuse on one resident 12/08/2016 Settlement Agreement for Training; Appealed 04/20/2016
The Haven in the Village at Carolina Place HAL-060-107 4/20/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents in accordance with each resident's assessed needs, care plan and current symptoms and as a result one resident was found outside the Special Care Unit in the secured courtyard at night with a dislocated shoulder Paid in Full $2,000.00 5/4/2016
Waltonwood at Providence HAL-060-138 4/20/2016 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision for two residents in the Special Care Unit in accordance with each resident's assessed needs care plan and current symptoms resulting in a resident receiving sunburn and heat-stroke in 94 degree temperature and multiple falls Paid in Full $4,000.00 6/3/2016
Brighton Gardens of Charlotte HAL-060-019 6/14/2016 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate supervision for residents in the Special Care Unit (SCU) when the main exit door was unlocked resulting in two residents eloping from the SCU and facility Paid in Full $2,000.00 6/30/2016
Hunter Village HAL-060-014 6/14/2016 $2,000.00 Type A2 Reduced to Type A2 No Penalty 10A NCAC 13F .0305 (f) (4) Physicial Environment; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to ensure cleaning supplies were monitored by staff while in use resulting in one resident ingesting an unspecified amount of a cleaning agent 01/05/2017 Settlement Agreement for No Monetary Assessment; Appealed 06/27/2016
Brookdale Cotswold HAL-060-132 9/20/2016 $1,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration Errors in administration of Novolog insulin, Lantus insulin and Metoprolol. Paid in Full $1,000.00 10/4/2016
Brookdale Cotswold HAL-060-132 9/20/2016 $2,000.00 Type A2 10 A NCAC 13F .0601(a) Management of Facilities Failure to assure compliance in multiple rule areas. Paid in Full $2,000.00 10/4/2016
Brookdale Cotswold HAL-060-132 9/20/2016 $2,000.00 Type A2 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Neglect - not administering pain meds. as ordered; late response to call bells. Paid in Full $2,000.00 10/4/2016
Elmcroft of Little Avenue HAL-060-082 12/22/2016 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to 2 of 5 sampled residents in accordance with each resident's assessed needs, care plan and current symptoms resulting in their being found outside of the special care unit beyond facility grounds after a period of more than 2 hours and 30 minutes. Paid in Full 1,000.00 1/17/2017

Mitchell County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Mitchell House HAL-061-011 11/25/2015 $12,000.00 Reduced to Passed Corrected Type A1 10A NCAC 13F .1002 (a) Medication Orders; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to clarify medication orders upon admission for one resident prescribed warfarin which resulted in warfarin toxicity and hospitalization 10/04/2016 Settlement Agreement $3,000.00 for training; Appealed 12/22/2015
Mitchell House HAL-061-011 11/25/2015 $4,000.00 Reduced to Type B 10A NCAC 13F .0909 (a) Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that residents were free of abuse as related to one staff to resident verbal and physical abuse 10/04/2016 Settlement Agreement $2,000.00 for training; Appealed 12/22/2015

Moore County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Seven Lakes Assisted Living HAL-063-023 8/19/2014 $12,200.00 Unabated Type B 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct and provide supervision for one resident with exit seeking behaviors and eloped from facility Training Completed 11/29/2016; Paid in Full; 02/08/2016 Settlement Agreement for $6,000.00 & Training: Appealed 09/18/2014 $6,000.00 04/04/2016 3/15/2016
Michael Lane/Alternative House FCL-063-018 11/19/2015 $1,000.00 Type A2 10A NCAC 13G .0901 Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident Paid in Full $1,000.00 1/8/2016
Michael Lane/Alternative House FCL-063-018 11/19/2015 $1,000.00 Type A2 10A NCAC 13G .0906 (f) (4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to immediatedly report an incident to the resident's guardian, local DSS and law enforcement for one resident related to emergency care and elopement from hospital Emergency Room Paid in Full $1,000.00 1/8/2016
Seven Lakes Assisted Living HAL-063-023 6/14/2016 $4,000.00 Type A2 Reduced to Type B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure three resident were free from mental, physical abuse and neglect as related to resident's nipple and chest being pinched, falls, unexplained bruises and hair being cut 12/22/2016 Settlement Agreement for Training; Appealed 07/14/2016

Nash County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Standard Above All FCL-064-023 5/20/2015 $1,000.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free of physical abuse when a staff on duty and a resident became involved in a physical altercation resulting in injury to the resident Paid in Full $1,108.00 10/16/2015
Hunter Hill Assisted Living HAL-064-020 5/13/2014 $7,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure timely referral and follow-up for two residents resulting in one requiring hospitalization 6/26/2015 Training Completed; Paid in Full 03/18/2015 Settlement Agreement for $3,500.00 & Training; Appealed 06/13/2014 $3,500.00 10/02/2015

New Hanover County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Clare Bridge of Wilmington (Now Brookdale Wilmington) HAL-065-019 8/19/2014 $51,750.00 Unabated Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct and assure supervision when doors were disalarmed for one resident who had exit seeking behaviors Paid in Full; 10/28/2015 Settlement Agreement; Appealed 09/15/2014 $57,021.88 12/30/2016 01/07/2016
Champions Assisted Living HAL-065-020 1/13/2015 $1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physician notification for one resident with unexplained bruising, increase pain and reduce range-of-motion in shoulder Paid in Full; 07/10/2015 Settlement Agreement in Conjunction with both penalties imposed 01/13/2015 for $5,500.00; Appealed 02/06/2015 $5,500.00 7/31/2015
Champions Assisted Living HAL-065-020 1/13/2015 $16.000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were free from physical abuse related to the abuse and injuries of one resident by a staff member Paid in Full See Above; 07/10/2015 Settlement Agreement in Conjunction with both penalties imposed 01/13/2015 for $5,500.00; Appealed 02/06/2015
Spring Arbor of Wilmington HAL-065-014 3/18/2015 $9,800.00 Unabated Type B 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident who wandered away from facility Paid in Full; 07/10/2015 Settlement Agreement for $6,000.00; Appealed 04/07/2015 $11,474.17 11/30/2016
Sherwood Manor Rest Home HAL-065-011 2/22/2016 $10,600.00 Type Unabated B 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures were maintained at a minimum of 100 degrees (F) to maximum of 116 degrees (F) for ten fixtures located in the resident shared bathrooms and three fixtures located in the community shower rooms Paid in Full $10,600.00 2/29/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $7,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision of residents according to their assessed needs for four residents who sustained repeated observed and unobserved falls with injury and one resident who eloped Paid in Ful; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016 $20,000.00 10/10/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $7,000.00 Type A1 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility Administrator failed to assure that all required duties were carried out in the facility related to the rule areas of housekeeping and furnishings, other requirements (hot water), test for tuberculosis, staffing, personal care and supervision, health care, nutrition and food service, residents rights, medication administration, reporting of accidents and incidents, special care unit (scu) resident profile and care plan, scu staff orientation and training and medication aides training and competency 10/10/2016 Paid in Full; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the acute needs for two residents; one who fell and hit head and one with skin excoriation and an open wound 10/10/2016 Paid in Full; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $4,000.00 Type A2 10A NCAC 13F .0901 (a) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide appropriate personal care for two residents, one requiring toileting assistance and one needing assistance to dining room for meals 10/10/2016 Paid in Full; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $4,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the hot water temperatures for eight fixtures located in four rooms used by seven residents were maintained between 100 degrees Fahrenheit (F) and 116 degrees F with water temperatures ranging from 120 to 134 degrees F 10/10/2016 Paid in Full; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016
Pacifica Senior Living Wilmington (Change of Ownership) HAL-065-032 3/18/2016 $7,000.00 Type A2 10A NCAC 13F .0604 (e ) (1)(a)(b)(c ) Personal Care And Other Staffing; 10A NCAC 13F .1308 (a) Special Care Unit Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure minimum staffing requirements were met and failed to assure sufficient staffing to meet the needs of the fifty-five residents residing in the assisted living and the thirty-five residents residing in the Special Care Unit 10/10/2016 Paid in Full; 10/06/2016 Settlement Agreement in conjunction with all penaties imposed 03/18/2016 for $20,000.00; Appealed 04/15/2016
Castle Creek Memory Care HAL-065-034 5/24/2016 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect residents from abuse/physical assault for two residents as related to resident being physically assaulted another resident Appealed 06/21/2016

Northamptom County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Rich Square Manor HAL-066-011 6/14/2016 $2,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care with the transferring of one resident in accordance with the resident's care plan resulting in a fractured left femur for the resident Appealed 07/13/2016

Onslow County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Pinewood Harbor (Change of Ownership) HAL-067-022 5/20/2015 $7,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures for five fixtures used by residents were maintained between 100 and 116 degrees Fahrenheit
The Heritage of Richlands HAL-067-016 2/22/2016 No Penalty Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs for one resident with mental illness who frequently refused morning medications and one resident who refused morning heart medication and to wear oxygen as ordered 07/15/2016 Settlement Agreement for No Penalty Imposed Appealed 02/26/2016

Person County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Maple Heights HAL-073-010 2/20/2015 $8,400.00 Unabated Type B G.S. 131D-4.4 A ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement infection control consistent with federal guidelines on procedures with assisted glucose monitoring for seven residents resulting in shared use of glucometers without disinfecting Paid in Full $8,400.00 3/25/2015
Golden Years Family Care Home FCL-073-011 5/20/2015 $2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure follow-up with physician's order related to abnormal lab work resulting in resident being admitted to hospital Paid in Full; 12/15/2015 Settlement Agreement for a Payment Plan $2,000.00 09/12/2016 07/14/2016 05/25/2016 04/11/2016 03/08/2016 02/02/2016 12/30/2015

Randolph County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookstone Haven HAL-079-034 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 4 of seven sampled residents by not obtaining urine culture and sensitivity for one resident, not notifying the medical provider of changes in a resident's medical condition, not following up with a resident's medical provider after ingesting chemical cleaner and was set to hospital, and not notifying the the medical provider for a resident receiving medications late on dialysis days. Appealed 01/23/2017

Robeson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cromartie Spring Village Rest Home HAL-078-082 4/15/2014 $15,800.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure health care referral to meet the acute mental health needs of one resident Paid in Full; 09/30/2014 Training Completed; 08/21/2014 Settlement Agreement for $1,500.00 & Training; Appealed 05/12/2014 $1,500.00 02/16/2015 01/14/2015 12/10/2014 11/12/2014 10/09/2014 09/09/2014
Morning Star AL #2 HAL-078-064 4/15/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility was left unattended when one resident suffered a fall resulting in injury Paid in Full; Referred to the Controller's Office $1,122.53 12/31/2014
Green Manor Rest Home HAL-078-090 11/19/2014 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure a lab was obtain, follow-up with physician when lab was not obtained as ordered for one resident taking Coumadin, and follow-up when discharge from emergency room visit as per instructions and failed to assure timely notification of vaginal bleeding as a result of taking Coumadin Paid in Full $2,000.00 12/31/2014
Morning Star AL #2 HAL-078-064 11/18/2014 $4,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care to one resident's lower extremities to prevent further skin breakdown and failed to report the resident's skin condition of resident's lower extremities. Paid in Full $4,583.33 12/9/2015
B&B Assisted Living #1 FCL-078-091 3/18/2015 $7,000.00 Type A1 10A NCAC 13G .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure adequate supervision for one resident with diagnosis of dementia who wandered out of facility and was hit by a car Paid in Full $7,746.81 09/18/2015 07/10/2015
Dial's Family Care Home #5 FCL-078-078 5/20/2015 $1,000.00 Type A2 10A NCAC 13G .0901 (c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to initiate emergency medical procedures in response to a resident's seizure activity and subsequent cardiac arrest Paid in Full $1,108.33 10/13/2015
West Winds Assisted Living FCL-078-086 6/14/2016 $1,000.00 Type A2 10A NCAC 13G .0901 (c) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide care and intervention regarding CPR to a resident who did not have an order for Do Not Resuscitate Paid in Full $1,104.00 12/15/2016 12/06/2016 08/31/2016
Christa Assisted Living FCL-078-099 12/8/2016 $2,700.00 Unabated Type B 10A NCAC 13G .0315 (a) Housekeeping and Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Failure to maintain home in a clean, orderly manner and free from hazards as evidenced by cleaning supplies not securely stored; ants in kitchen; buckled floor covering in living room and unattached/missing floor moldings in living room, dining area and kitchen; and unsanitary, cluttered kitchen conditions.

Rockingham County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
The East Adult Care Home #1 FCL-079-002 6/18/2015 $2,000.00 Type A2 G.S. 131D-4.4 A(b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented with assisted glucose monitoring for one resident resulting in shared use of glucometers without disinfecting and sharing of residents' lancing devices Paid in full $1000.00 $1000.00 08/18/2015 08/03/2015
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure medications were administered as ordered by a licensed prescribing practitioner for 3 of 3 sampled residents.
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to refer and follow-up to meet the routine health care needs for 2 of 3 sampled residents regarding physician notification of noncompliance, discharges to hospital and readmissions to facility, and clarification of order for enzymatic debriding agent.
Moyer's Rest Home HAL-079-092 12/22/2016 4,000.00 Type A2 10 A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure 2 of 6 sampled staff were tested upon employmnet for TB disease in compliance with standard control measures.

Rowan County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Deal Care Inn HAL-080-023 4/16/2015 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident, identified as an elopement risk, who eloped from facility Paid in Full $2,000.00 6/8/2015
China Grove Retirement Center HAL-080-020 4/15/2014 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident in accordance with the resident's assessed needs, care plan and current symptoms who was experiencing frequent falls, smoking in, and eloping from the facility Paid in Full $2,000.00 5/7/2014
Salisbury Gardens (now Brookdale Salisbury) HAL-080-014 11/19/2014 $2,000.00 Type A2 10A NCAC 13F .1004 (a) (1)(2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer Lasix as ordered for one resident resulting in hospitalization Paid in Full $2,000.00 12/11/2014
China Grove Retirement Center HAL-080-020 8/20/2015 $4,000.00 Type A2 10A NCAC 13F .0901 Personal Care and Supervision; 131D-21(4) Declaration of Residents' Rights Facility failed to respond immediately to an incident of elopement by a resident with dementia. Paid in Full $4,000.00 10/12/2015
Deal Care Inn HAL-080-023 12/22/2015 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free of neglect related to the lack of intervention when the resident exhibited aggressive and threatening behavior Paid in Full $4,543.43 12/7/2016
Deal Care Inn HAL-080-023 12/22/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide mental health care for one resident resulting in an attack on another resident Paid in Full $4,000.00 12/31/2015

Rutherford County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Southern Manor Rest Home HAL-081-008 4/20/2016 $2,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures for three fixtures were maintained between 100 degrees Fahrenheit (F) and 116 degrees F Paid in Full $2,250.00 2/7/2017

Sampson County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Autumn Wind Assisted Living of Roseboro HAL-082-012 8/18/2014 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision of one resident who smoked cigarettes while using oxygen Paid in Full $2,000.00 9/24/2014
Green Acres Family Care Home FCL-082-021 11/19/2014 $1,000.00 Type A2 10A NCAC 13G .0601 (b) Management And Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure an Administrator or Qualified Supervisor-in-Charged was in facility and accountable for all routine based duties resulting in inadequate care and services related to qualification of medication staff, medication administration, incident reporting, health care follow-up, documentation and implementation and controlled substances Paid in Full all penalties imposed 11/19/2014 $2,880.23 10/20/2016
Green Acres Family Care Home FCL-082-021 11/19/2014 $1,000.00 Type A2 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer psychotropic and controlled medications as ordered by physician for two residents resulting in aggressive behavior and hospitalization for one resident Paid in Full all penalties imposed 11/19/2014
Green Acres Family Care Home FCL-082-021 11/19/2014 $500.00 Type A2 10A NCAC 13G .1213 (g)(2) Reporting of Accidents and Incidents; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to implement increased supervision for one resident with known threatening and aggressive behaviors for a period of greater than 30 days resulting in continued aggression toward one resident Paid in Full all penalties imposed 11/19/2014
Clinton House HAL-082-018 9/17/2015 $4,000.00 Type A2 10A NCAC .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for four residents, including errors with medications for liver disease, pain, seizures, anxiety/agitation, dementia, blood pressure and acid reflux, resulting in one resident requiring two separate hospital visits for a diseased liver and chronic pain. Paid in Full 4,416.67 12/31/2015
The Magnolia HAL-082-022 12/8/2016 4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up by not scheduling and/or canceling appts. for wound, mental health, obstetric, gynecological and gastrointestinal evaluations and treatments. Appealed 01/06/2017
The Magnolia HAL-082-022 12/8/2016 $7,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to assure residents were free from neglect as evidenced by picking up Administrator 2 perspective residents from hospital ER in another town and dropping them off in unsupervised locations in same town. Appealed 01/06/2017

Scotland County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Willow Place Assisted Living and Memory Care Community (Penalty #1) HAL-083-013 4/15/2014 $1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify the physician for two residents in the special care unit who had a change in condition, weight loss, abnormal blood pressure results and repeatedly refused blood glucose testing and insulin administration and failed to schedule a follow-up test as recommended by radiologist for one resident Paid in Full; 09/19/2014 Settlement Agreement (no contest) for original penalty of $1,000.00; Appealed 4/25/2014 $1,000.00 10/3/2014
Willow Place Assisted Living and Memory Care Community (Penalty #2) HAL-083-013 4/15/2014 $17,600.00 Type Unabated B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications such as Insulin, Sinemet, Zocor and Gaviscon as ordered by the physician for three residents in the special care unit Paid in Full; 09/19/2014 Settlement Agreement for $9,000.00; Appealed 4/25/2014 $9,000.00 10/3/2014

Stanly County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Woodhaven Court Penalty #1 HAL-084-009 8/20/2015 $2,000.00 Type A2 10A NCAC 13F .1009(a) Pharmaceutical Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to ensure medication reviews by pharmacist included identification of discrepancies with medication orders for a thyroid hormone replacement upon admission to facility for one resident. 12/08/2016 Settlement Agreement Penalty Eliminated; Appealed 09/17/2015
Woodhaven Court Penalty #2 HAL-084-009 8/20/2015 $18,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1002(a) Medication Orders; G.S. 131D-21(2) and (4) Facility failed to notify physician for one resident regarding lab collections for thyroid stimulating hormone not being able to be obtained; failed to notify physician of changes in the resident's mental status; and failed to clarify one of the resident's medication orders used to treat thyroid imbalance ordered on hospital discharge summary but not on admitting FL-2 resulting in resident not receiving the medication for 4 months. Resident was hospitalized, diagnosed with long standing low thyroid levels resulting in a coma and the resident subsequently dying. Paid in Full; 12/08/2016 Settlement Agreement for $10.000.00; Appealed 09/17/2015 10,000.00 02/13/2017 02/09/2017 01/06/2017

Surry County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
David's House HAL-086-012 8/18/2014 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0311 Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain door alarms in a safe and operating condition and provide supervision in accordance with the residents' assessed needs and current symptoms for one resident who left the facility without staff awareness Paid in Full; 09/08/2015 Settlement Agreement for $1500.00 Appealed 09/10/2014 $1,500.00 11/17/2015 10/20/2015 09/17/2015
David's House (Change of Ownership) HAL-086-012 10/16/2014 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure each resident was free of physical and mental abuse and exploitation regarding sexual abuse of one resident by a staff member Paid in Full; 09/08/2015 Settlement Agreement for $3750.00 Appealed 10/21/2014 $3,750.00 12/30/2015 11/17/2015 10/20/2015 09/17/2015
Dunmore Plantation HAL-086-006 2/20/2015 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide documentation of supervision in accordance with resident's assessed needs, care plan and current symptoms for two residents with multiple falls, including falls with hip fracture and laceration to head 01/19/17 Settlement Agreement for $1,000.00 and Training; Appealed 03/13/2015
Elkin Assisted Living HAL-086-013 8/20/2015 $4,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident who eloped from the facility. Paid in Full; 12/30/2015 Settlement Agreement for $2,000.00; Appealed 10/06/2015 2,000.00 1/19/2016

Swain County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Cornerstone Living Center of Bryson City HAL-087-005 4/16/2015 $4,000.00 Type A2 G.S. 131D-4.4 A(b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were implemented with assisted glucose monitoring for three residents resulting in shared use of glucometers without disinfecting and sharing of residents' lancing devices Paid in Full $4,000.00 6/15/2015
Cornerstone Living Center of Bryson City HAL-087-005 4/16/2015 $4,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications were administered as ordered for five residents Paid in Full $4,325.00 12/18/2015 10/05/2015 06/15/2015
Cornerstone Living Center of Bryson City HAL-087-005 4/16/2015 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow up to meet the acute health care needs for three residents related to medications not available, medication refusals, and mental health referrals for behavior changes Paid in Full $4,325.00 12/18/2015 12/16/2015
Cornerstone Living Center of Bryson City (Change of Ownership) HAL-087-005 5/24/2016 $20,400.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Previous Type B not abated Facility failed to administer medications as ordered by the primary care provider for three residents, which included a resident for Iron, Ascorbic Acid, and Pantoprazole; one for Lasix and Tramadol; one for Keflex, Mobic and Lasix
Cornerstone Living Center of Bryson City (Change of Ownership) HAL-087-005 5/24/2016 $26,600.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Previous Type B not abated Facility failed to contact physician regarding admission orders for two residents after returning to the facility following hospitalizations; failed to coordinate services with home health to administer an anticoagulant for one resident who was at risk for blood clots following surgery, and failed to obtain orders to meet routine health care needs for one resident who returned following rehabilitation with diagnosis of congestive heart failure

Transylvania County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Kingsbridge House HAL-088-015 3/18/2016 $29,600.00 10A NCAC 13F .1004 (a) (1) (2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure Hydrocodone/Acetaminophen and Lorazepam were administered as ordered for three residents Paid in Full; 10/04/2016 Settlement Agreement for $4,000.00; Appealed 04/13/2016 $4,000.00 10/24/2016

Wake County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Above and Beyond Expectations (Penalty #1) FCL-092-165 8/18/2014 $500.00 Type A2 10A NCAC 13G .0601 (b) (1) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was not left alone in the home without a staff member and failed to provide staffing to meet the needs of resident Paid in Full $500.00 10/10/2014
Above and Beyond Expectations (Penalty #2) FCL-092-165 8/18/2014 $1,000.00 Type A2 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure hot water temperatures for four bathroom fixtures were maintained between 100 and 116 degrees farenheit (F) Paid in Full $1,000.00 10/10/2014
Brighton Gardens of Raleigh HAL-092-024 5/13/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for three residents with Alzheimer's disease or dementia and who had elopement incidents Paid in Full $1,000.00 6/19/2014
James Rest Home HAL-092-007 9/18/2014 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for one resident identified as a wanderer, demonstrated exit seeking behaviors, eloped from the facility and was found approximately 20 hours later in a heavily wooded area Paid in Full $4,000.00 11/7/2014
On Track Residential (Closed) FCL-092-048 9/18/2014 $1,000.00 Type A1 10A NCAC 13G .0901 (a) Personal Care & Supervision; 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .0601(a) Management and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure personal care was provided and notification of physican for two residents requiring foot and nail care and unable to attend to for themselves which caused residents to exhibit pain with feet and affect ambulation; the administrator failed to assure compliance to rules related to personal care and supervision, health care, resident rights, residents' personal funds, medication administration and medication storage Paid in Full; 09/23/2015 OAH Decision Upheld (penalty reduced to $1,000.00); Appealed 09/26/2014 $1,000.00 12/7/2015
Phoenix Assisted Care HAL-092-131 9/17/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to respond immediately with Cardiopulmonary Resuscitation (CPR) for one resident who was found to be unresponsive, not breathing, and did not have a palpable pulse Paid in Full; 09/24/2015 Settlement Agreement for $1,000.00; Appealed 09/24/2014 $1,000.00 5/6/2015
Elmcroft of Northridge HAL-092-124 10/16/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for three residents with multiple falls and two residents who exhibited aggressive behaviors Paid in Full $2,000.00 10/29/2014
Heartfield at Cary HAL-092-156 12/17/2014 $3,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure one resident who was non-ambulatory, total care and identifed with reddened skin areas was free of neglect Paid in Full $3,000.00 1/8/2015
James Rest Home HAL-092-007 11/19/2014 $12,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for one resident who exhibited inappropriate sexual behaviors towards other residents and for two residents who demonstrated wandering behaviors Paid in Full; 04/14/2015 Settlement Agreement for $10,000.00 Appealed 12/152014 $10,000.00 4/14/2015
Seagraves Family Care FCL-092-031 11/19/2014 $350.00 & Staff Training Type A2 10A NCAC 13G .0901 (a) Personal Care & Supervision; 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for one resident for mental health evaluation and treatment resulting in elopement behavior placing resident at risk for danger and harm 12/30/2015 Training Completed; Paid in Full $401.04
Oliver House HAL-092-182 1/13/2015 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervison for two residents who were identified as wanderers, recommended for secured unit and with exit seeking behaviors Paid in Full; 12/15/2016 Settlement Agreement for $800.00; Appealed 02/09/2015 $800.00 1/11/2017
Sunrise of Cary HAL-092-152 2/20/2015 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervison for one resident who was diagnosed with dementia and intermittently disoriented and left facility without knowledge Paid in Full $4,000.00 3/19/2015
Wrenette's Place FCL-092-140 2/20/2015 $8,000.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free of neglect where staff failed to initiate the Heimlich or cardio-pulmonary resuscitation (CPR) in an emergency situation 01/11/2017 Training Completed; Paid in Full; 12/31/2015 Settlement Agreement for $500.00 and Training: 03/18/2015 Appealed $500.00 4/1/2016
Falls River Court Memory Care Community HAL-092-141 9/17/2015 $1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to provide interventions in accordance with resident assessments and plan of care for one resident who exited the special care unit on two separate occasions. Paid in Full $1,000.00 10/16/2015
Sunrise Assisted Living at North Hills HAL-092-108 9/17/2015 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision of one resident with exit-seeking behaviors and disorientation, resulting in the resident exiting the facility unsupervised and without staff knowledge. Paid in Full $2,000.00 12/29/2015
Sunrise of Raleigh HAL-092-096 9/17/2015 $1,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to ensure an external medication was administered as ordered to a resident and that only staff meeting the requirements administered medications. Paid in Full $1,000.00 10/9/2015
Elmcroft of Norhtridge HAL-092-124 2/23/2016 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet routine and acute health care needs for one resident Paid in Full $2,000.00 3/15/2016
Sunrise of Cary HAL-092-152 2/22/2016 $12,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident who exhibited exit seeking behaviors and exited the Special Care Unit, went down three flights of stars, and out building without staff knowledge Paid in Full; 05/26/2016 Settlement Agreement for $8,000.00; Appealed 03/07/2016 $8,000.00 6/24/2016
Sunrise Assisted Living at North Hills HAL-092-108 2/22/2016 $6,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision for one residents residing in the Special Care Unit who had a history of elopement and eloped from the facility without staff knowledge 10/3/2016 Training Completed; 08/08/2016 Training Approved; 06/24/2016 Paid in Full; 05/26/2016 Settlement Agreement for $3,000.00 and Training; Appealed 03/07/2016 $3,000.00 6/24/2016
Chatham Commons HAL-092-203 6/2/2016 $2,000.00 & Training Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that residents were free of abuse for two residents as related to physical abuse by two staff 01/24/2017 Settlement Agreement for $1,000.00 and Training; Appealed 06/30/2016 $1,000.00 2/10/2017
Elmcroft of Norhtridge HAL-092-124 6/27/2016 $1,000.00 & Training Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement a physician's order to treat all residents and staff for possible scabies infection resulting in two residents having confirmed diagnoses for scabies Training Completed 11/18/2016; Paid in Full (training due) $1,000.00 7/25/2016
Nana Touch (Change of Ownership) FCL-092-205 5/24/2016 2,000.00 Type A2 10A NCAC 13G .0601 (a) (d) Management of Facilities; 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure additional staff were employed as needed for housekeeping and the supervision and care of five residents 01/19/2017 Settlement Agreement for Penalty Elimination
Lynn's Home at Saybrooke FCL-092-147 10/5/2016 $500.00 Type A2 10A NCAC 13G .0901(b) Personal Care and Supervision Facility failed to ensure supervision for four residents with dementia diagnoses who eloped and were found at three different homes located in same neighborhood. Appealed 11/11/2016
Agape FCH #1 FCL-092-208 9/21/2016 $500.00 Type A2 10A NCAC 13G .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for a resident who had dementia, eloped from the facility and was found approximately 10 hours later at a downtown bus station. Paid in Full $552.08 12/20/2016 12/12/2016
Sunrise Assisted Living at North Hills HAL-092-108 9/20/2016 $15,800.00 Unabated A2 G.S. 131D-21 Declaration of Residents' Rights Failure to ensure supervision based on on assessed needs resuting in fall with injury and elopement of residents; therefore, previously cited A2 violation not abated for 82 days. Paid in Full $15,800.00 10/24/2016
Sunrise Assisted Living at North Hills HAL-092-108 9/20/2016 $61,500.00 Unabated A2 10A NCAC 13F .0311 Other Requirements G.S. 131D-21 Declaration of Residents' Rights Failure to ensure locking mechanism for 1 of 2 exit doors in special care unit was maintained in a safe and operating condition resulting in resident exiting without staff knowledge; therefore, previously cited Type B violation not abated for 79 days. Paid in Full $61,500.00 12/6/2016
Morningside of Raleigh HAL-092-088 12/22/2016 4,000.00 Type A1 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to assure every resident had the right to be free of physical abuse resulting in a resident exhibiting inappropriate sexual behaviors toward females and sexually assaulting a resident. Paid in Full $4,000.00 1/20/2017
North Pointe Assisted Living of Garner HAL-092-186 1/12/2017 1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision for a resident who was identified as a wanderer, exited the facility and was found approximately 2 hours later in a hole behind the facility, 53 yards from the exit door Appealed 02/16/2017
North Pointe Assisted Living of Garner HAL-092-186 1/12/2017 2,000.00 Type A2 10A NCAC 13F .0909 (4) Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility neglected to ensure 1 resident, who was non-ambulatory and constantly disoriented, received are and services for stage IV infected, open wounds on sacrum and back. Appealed 02/16/2017
The Covington HAL-092-181 12/22/2016 2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure supervision for a special care unit resident who eloped from the facility and was found approx. 528 ft. from the facility in a neighbor's backyard in 28 degree weather for approx. one and one-half hours. Appealed 01/20/2017

Warren County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Magnolia Gardens of Warrenton HAL-093-005 8/21/2014 $12,000.00 Type A1 10A NCAC 13F .0305 (h) (4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide an activated sounding device on an exit door that was accessed by one demented, wandering resident in a wheelchair, when the exit door was inactivated, resulting in a fall and sustained injuries that led to the resident's death Paid in Full; 02/12/2015 Settlement Agreement for $9,000.00; Appealed 09/11/2014 $9,000.00 06/25/2015 06/02/2015 05/13/2015 03/31/2015 03/09/2015

Wayne County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Brookdale Country Day Road HAL-096-026 2/22/2016 $2,000.00 & Training Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the administration of prescription medication was in accordance with orders by a licensed prescribing practionioner for one resident 04/22/2016 Training Completed; Paid in Full $2,000.00 3/8/2016

Wilkes County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Wilkes County Adult Care HAL-097-014 8/19/2014 $9,200.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to meet the routine and acute health care needs for five residents related to: notification of physician regarding non-compliance with oxygen administration and medications, increased anxiety attacks and obtaining diagnostic tests and lab tests as ordered for one resident; notification of physician regarding falls, lab reports and obtaining labs and follow up appointment with a cardiologist for one resident; notification of physician regarding resident's cardiac symptoms, blood pressures, falls and failure to schedule a physician appointment ordered for one resident; notification of physician regarding insomnia and unavailability of medication for one resident; and notification of physician regarding pain medication for one resident 04/17/2015 OAH Final Decision Upheld Respondent's Order for Dismissal - Total Due; Appealed 10/15/2014
Wilkes County Adult Care HAL-097-014 12/17/2014 $13,400.00 Unabated Type B G.S. 131D-4.4 A (b) ACH Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate infection control procedures were inplemented for blood glucose monitoring by sharing glucometers designated for individual use without adequate disinfection of meters when used on multiple residents in the facility
Wilkes County Adult Care Hal-097-014 10/14/2015 $20,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure that every resident was free from mental and physical abuse and neglect as related to four residents being assaulted by another resident $11,000.00 12/30/2016 12/31/2015

Yadkin County

FacilityLicense NumberPenalty Issued DatePenalty AmountPenalty TypeReason for IssuanceCurrent StatusAmount PaidDate of Payment
Rule CitedNature of Violation
Piedmont Village of Yadkinville HAL-099-014 3/18/2015 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure physician notification for one resident when a medication was not available for administration as ordered Paid in Full; Payment Plan $2,229.37 12/01/2015 11/02/2015 10/30/2015 09/28/2015 08/31/2015 08/04/2015 07/07/2015