Listing of Facilities with Penalties

This is the list of facilities, by county names, that have been found in violation of one or more rules since January 2006.

Alamance County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
       Rule Cited Nature of Violation    
Above and Beyond Adult Care Home FCL-001-122 8/9/2013 $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 one resident with exit seeking behaviors who left the facility unsupervised Paid in Full $500.00 10/16/2013
Agape Family Care FCL-001-106 4/4/2007 $1,250.00 Type A 10A NCAC 13G .0601 Management & Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Resident was left unsupervised and locked out of facility Paid in Full $1375.00 6/14/2007
Alvarado's Family Care FCL-001-101 6/27/2007 $2,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Staff allowed Alzheimer resident to walk on facility grounds unsupervised; she was killed when struck by vehicle backing out of driveway Partial pmt.
Paid in Full
$1,000.00
$1,000.00
07/18/2007
07/25/2007
Angel's Family Care Home FCL-001-119 5/14/2008 $9,000.00 Type B Unabated 10A NCAC 13G .0406 (a)(5)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background checks were not conducted for 6 staff and Health Care Personnel registry verification did not occur for 3 staff Referred to Controller's Office    
Angels Family Care Home FCL-001-119 1/18/2008 $2,850.00 Not corrected Type B 10A NCAC 13G .1004 (b) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Both staff administering medications had not completed the clinical skills validation prior to administration of medications Referred to Controller's Office    
Angels Family Care Home II FCL-001-078 11/19/2007 $4,890.00 Not corrected Type B 10A NCAC 13G .1004 Medication Administration, 10A NCAC 13G .0403 (a) Qualifications of Medication Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered to 6 of 6 residents; facility failed to ensure staff administering medications were competency validated to administer medications Referred to Controller's Office    
Burlington Manor HAL-001-024 1/16/2013 $1,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident with wandering behaviors resulting in his elopement from the facility Paid In Full $1,000.00 2/7/2013
Clare Bridge at Burlington Manor dba Discovery Program HAL-001-028 7/20/2011 $60,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision during meals resulting in a resident's choking and subsequent death Training Completed 12/31/2013; Paid in Full: 05/23/2013 Settlement Agreement for $20,000.00 & Training; (training due 11/23/13) Appealed 8/19/2011 $20,000.00 6/20/2013
Clare Bridge at Burlington Manor dba Discovery Program HAL-001-028 11/10/2010 $14,000.00 Type A 10A NCAC 13F .0305 Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident who entered the kitchen and ingested a chemical degreaser product left on a cart in the kitchen. The resident later expired. Paid in Full $14,000.00 11/30/2010
Dogwood Forest / Nicole Building HAL-001-005 11/10/2010 $7,000.00 Type A 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility staff person threw hot water from the coffee maker on a resident in response to the resident's verbal remarks. The resident suffered second and third degree burns. Paid in Full; 3/9/2011 Settlement Agreement $6,500.00; Appealed 12/9/2010 $6,500.00 3/10/2011
Hearts of Gold II (Closed 2/19/2014) FCL-001-124 2/14/2012 $8,500.00 Type A 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to one resident with unsafe eating behavior OAH Decision Rescinded 04/13/2013; Appealed 2/29/2012    
Jeffreys Rest Home FCL-001-016 1/13/2009 $3,100.00 Type B Unabated 10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure at least one staff on duty had cardio-pulmonary resuscitation Referred to Controller's Office    
L M & S Adult Care No 2 FCL-001-063 7/20/2011 $500.00 Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure health care referral and follow-up occurred for two residents related to appointment for lab and medication injection as well as to address bleeding that was noted to be occurring Paid in Full $500.00 12/6/2011
L M & S Adult Care No. 2 FCL-001-063 7/14/2006 $1,350.00 Not corrected Type B 10A NCAC 13G .0406 Other Staff Qualifications Criminal background checks for 4 staff members were not done before hiring Partial pmt.
Partial pmt.
Paid in Full
$500.00
$500.00
$350.00
9/14/2006
10/30/2006
11/07/2006
L M & S Adult Care No. 2 FCL-001-063 3/20/2008 $2,000.00 Type B Unabated 10A NCAC 13G .0406 (a)(5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Healthcare registry verification was not conducted for one staff on first visit and for 3 of 6 staff on revisit Referred to the Controller's Office
Partial pmt. Paid in Full
$500.00 05/29/2008 02/04/2009
McCray Comfort Inn FCL-001-024 12/18/2008 $100.00 Type B Unabated 10A NCAC 13G .0406 (a)(5)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background check and Health Care Personnel registry verification did not occur for one staff person Paid in Full $100.00 1/16/2009
The Oaks of Burlington HAL-001-011 10/30/2007 $6,160.00 Not corrected Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents Rights Residents continued to not receive medications as ordered Paid in Full; Settlement Agreement 3/19/08; Appealed 12/3/07 Training Completed; $2,500.00 05/30/2008 04/02/2008
Rainbow of Love #2 FCL-001-112 1/26/2007 $1,230.00 Not corrected Type B 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background checks were not conducted on two staff Referred to the Controller's Office    
Rainbow of Love #3 FCL-001-111 1/8/2007 Staff Training Not corrected Type B 10A NCAC 13G .0406(a)(7) Other Staff Qualifications Criminal background checks were not conducted on two staff Facility Closed    
Rainbow of Love #3 FCL-001-111 1/8/2007 Staff Training Not corrected Type B 10A NCAC 13G .0403 (a) Qualifications of Medication Staff Staff administering medications had not completed the clinical skills validation prior to administration of medications. Facility Closed    
A Touch of Country Family Care FCL-001-121 3/20/2013 $500.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure one of six residents was free of abuse and neglect from staff Paid in Full $500.00 4/17/2013

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Alexander County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
A New Outlook of Taylorsville HAL-002-007 3/19/2014 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0604 (e) (1) Personal Care and Other Staffing; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure an administrator or supervisor was in the building or within 500 feet and immediately available when only one staff member was assigned on duty from 10pm to 6am based on a census of 28 residents Paid in Full $2,000.00 4/9/2014
A New Outlook of Taylorsville HAL-002-007 10/16/2013 $1,000.00 Type A2 10A NCAC 13F .0906 (f)(4) Other Resident Care and Services; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to immediately notify law enforcement, county social services and responsible party for one resident with diagnosis of dementia whose whereabouts was unknown Paid in Full $1,000.00 10/24/2013

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Alleghany County

None of the facilities in Alleghany County have received a penalty since January 2006.

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Anson County

None of the facilities in Anson County have received a penalty since January 2006.

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Ashe County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Ashe Assisted Living & Memory Care HAL-005-013 2/15/2012 $3,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of residents residing on the Special Care Unit to prevent falls which resulted in injury Paid in Full $3,000.00 3/14/2012

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Avery County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Cranberry House HAL-006-006 12/19/2012 $2,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide personal care and supervision for 8 residents related to bathing, incontinence care, nail care and supervision during dining Appealed 01/18/2013    

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Beaufort County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Wooded Acres #6 FCL-007-017 9/15/2011 $500.00 Type A 10A NCAC 13G .0906 (f)(4) Other Resident Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify appropriate law enforcement agency and county DSS office when one resident left the facility and whereabouts remained unknown Paid in Full $500.00 11/10/2011

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Bertie County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
       Rule Cited Nature of Violation    
Cherry's Family Care Home FCL-008-002 5/14/2008 $1,000.00 Type A 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medication was not administered as ordered; resident did not receive insulin as ordered resulting in ER treatment Paid in Full; Referred to Controller's Office $1,100.00 1/9/2009
Cherry's Family Care Home #2 (Facility Closed) FCL-008-023 5/19/2011 $10,000.00 Type A 10A NCAC 13G .0901(b) Personal Care & Supervision; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to meet the behaviorial needs of two residents and failed to provide referral and follow-up for mental health and medical treatment Referred to Controller's Office    
Cherry's Family Care Home #2 FCL-008-023 3/18/2010 $1,000.00 Type A 10A NCAC 13G .1213 (g) Reporting of Accidents & Incidents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify resident's mental health provider of resident's threatening behavior and physical assaults on a resident and staff Referred to Controllers Office    
Cherry's Family Care #2 FCL-008-023 1/13/2009 $4,500.00 Type A 10A NCAC 13G .0902 Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to refer resident for mental health assessment following multiple threats of suicide; resident ingested gasoline and required emergency medical treatment Paid in Full $5.210.27 1/11/2010
Cherry's Family Care Home #2 FCL-008-002 8/27/2007 $4,500.00 Type A 10A NCAC 13G .0906 Other Resident Services; G.S. 131D-21 (2) Residents' Rights Staff failed to notify family or law enforcement when resident left and failed to return to the facility Paid in Full $5,040.00 1/3/2008
Cherry's Family Care Home #7 FCL-008-018 11/19/2007 $1,000.00 Type A 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect two residents from physical abuse by staff Decision Upheld Appealed 12/21/07 $1,000.00 5/20/2009
Pathways II FCL-008-001 10/15/2012 $3,500.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assure residents were free from physical abuse Paid in Full $3,500.00 11/16/2012
Pathways III FCL-008-019 6/18/2012 $1,000.00 Type A2 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights Facility failed to ensure one resident was free of physical and mental abuse from a staff person Paid in Full $1,000.00 8/8/2012
River's Edge Rest Home HAL-008-017 10/31/2007 $2,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to obtain medical referral and follow-up as needed for two residents Referred to Controller's Office    
United Services Health FCL-008-026 10/16/2013 $2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .0906 (f)(4) Other Resident Care and Services; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to assure the referral and follow-up to meet the routine and acute health care needs of a resident exhibiting aggressive and threatening behaviors      
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 Appealed 06/13/2014    
Windsor House HAL-008-022 7/16/2010 $6,180.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide referral and follow-up with physician to meet needs of two residents Paid in Full; Referred to Controller's Office; Appeal Withdrawn; Appealed 9/8/10 $7,441.75 7/18/2013
Windsor House HAL-008-027 4/17/2012 $1,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision of one resident with disorientation who left the facility unsupervised Paid in Full; 11/06/2013 Settlement Agreement for $250.00; Appealed 05/17/2012 $250.00 1/7/2014
Windsor House HAL-008-027 9/15/2011 $500.00 & $1,500.00 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to two residents with increased needs for supervision and care to prevent falls and injuries Paid in Full; 11/06/2013 Settlement Agreement for $300.00 & Training waived; Appealed 10/10/2011 $300.00 12/4/2013

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Bladen County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
       Rule Cited Nature of Violation    
A & C Family Care, Inc FCL-009-020 5/18/2010 $8,500.00 Type A 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to obtain and administer medication as ordered to address resident diabetic condition resulting in hospitalization Paid In Full; Partial Pmt. 11/8/2010 Settlement Agreement $3,000.00 Appealed 05/24/2010 $300.00 $350.00 $1,000.00 $350.00 $1000.00 3/03/2011 2/2/20011 1/07/2011 1/05/2011 11/10/2010
Bladenboro Assisted Retirement Community HAL-009-019 9/26/2007 Staff Training Type A 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Residents did not receive medications as ordered Change of Ownership    
Bladenboro Assisted Retirement Community HAL-009-019 2/21/2008 $2,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to notify physician of one insulin dependent resident' s blood sugars as ordered Referred to Controller's Office Change of Ownership    
Bladenboro Assisted Retirement Community (Penalty #1) HAL-009-019 5/14/2008 $3,480.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Residents did not receive medications as ordered Referred to Controller's Office Change of Ownership    
Bladenboro Assisted Retirement Community (Penalty #2) HAL-009-019 5/14/2008 $3,480.00 Type B Unabated 10A NCAC 13F. 0901(a) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Residents did not receive personal care assistance with toileting, bathing, grooming and transfers; staff failed to respond to calls during third shift Referred to Controller's Office Change of Ownership    
Cape Fear Manor (Penalty #1) HAL-009-001 2/19/2013 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet surgical consult, podiatry, dental, psychiatric and medical needs of seven residents Paid in Full $2,000.00 4/11/2013
Cape Fear Manor (Penalty #2) HAL-009-001 2/19/2013 $2,000.00 Type A2 10A NCAC 13F .1002 Medication Orders; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to verify and clarify medication orders for two residents returning to facility from hospitalizations Paid in Full $2,000.00 4/11/2013
Cape Fear Manor (Penalty #3) HAL-009-001 2/19/2013 $2,000.00 Type A2 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the administrator managed the facility to be in compliance with regulations Paid in Full $2,000.00 4/11/2013

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Brunswick County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
       Rule Cited Nature of Violation    
Corinthian Place Inc HAL-010-006 1/21/2010 $14,000.00 Type A 10A NCAC 13F. 0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision to address three residents increased need for supervision to address falling, increased aggression and wandering behaviors Referred to Controllers' Office    
Eldo Family Care Home #1 FCL-010-002 04/07/2006 $500.00 Type A 10A NCAC 13G .0601 Management and Other Staff Nine (three that lived in the facility and 6 from another facility) residents were left unattended and unsupervisedby staff Paid in Full $500.00 6/8/2006
Shallotte Assisted Living HAL-010-004 11/21/2013 $64,500.00 Unabated Type A2 10A NCAC 13F .0601 Management of Facilities; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility administrator failed to meet and maintain rules related to controlled substances, personal care and supervison, healthcare and resident rights and failed to assure residents were free from frequent intimidating behaviors which included outbursts of derogatory language, verbal threats and acts of physical harm from one resident      
Shallotte Assisted Living (Penalty # 1 ) HAL-010-004 8/12/2013 $2,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to meet and maintain compliance to rules related to Staffing, Personal Care and Supervision, Health Care, Nutrition and Food Service, Residents' Rights and Medication Administration Appealed 09/13/2013    
Shallotte Assisted Living (Penalty # 2 ) HAL-010-004 8/12/2013 $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 one resident with falls and one resident with poor vision whose smoking resulted in cigarette burns on body and clothing Appealed 09/13/2013    
Shallotte Assisted Living (Penalty # 3 ) HAL-010-004 8/13/2013 $8,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referrals to meet the acute health care needs for six residents related to missing doses of anticoagulant medication, repeated low blood glocuse levels, acute onset illness, multiple falls, recurrent seizures, follow-up on seizure medication, and assuring oxygen is administered to prevent falls Appealed 09/13/2013    
Shallotte Assisted Living (Penalty # 4 ) HAL-010-004 8/12/2013 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facilty failed to provide appropriate care and services for one resident with swallowing difficulties Appealed 09/13/2013    
Shallotte Assisted Living (Penalty # 5 ) HAL-010-004 8/12/2013 $2,000.00 Type A2 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 three residents Appealed 09/13/2013    
Shallotte Assisted Living HAL-010-004 2/14/2012 $7,000.00 Type A 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect two residents from physical and mental abuse by staff 04/16/2013 Settlement Agreement for training; (approved 7/19/13) Appealed 2/17/2012    

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Buncombe County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Alterra Clare Bridge HAL-011-035 5/3/2007 $14,000.00 Type A 10A NCAC 13F .0902 (a)(b)(c) (1)(2)(3)(4) Health Care; G.S. 131D-21 (2) (4) Declaration of Residents' Rights Facility failed to implement order for labwork; resident's decline continued with subsequent admission to hospital and death occurring later that day OAH Decision Rescinded 8/21/2008 Appealed 6/1/07    
Angel House 2 FCL-011-154 11/20/2013 $500.00 Type A2 NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a medication was administered as ordered for one resident Paid in Full $500.00 1/22/2014
Candler Living Center HAL-011-285 5/13/2014 $9,400.00 Type Unabated 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      
Canterbury Hills Adult Care Home HAL-011-031 11/21/2013 $21,200.00 Unabated B 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 three residents related to smoking inside the facility Paid in Full in conjunction with $30,000.00 Settlement Agreement for penalties imposed 6/19/2013; Appealed 12/06/2013   12/31/2013
Canterbury Hills Adult Care Home HAL-011-031 6/19/2013 $6,600.00 Unabated Type B 10A NCAC 13F .0306 (a)(5) Housekeeping and Furnishing; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain a clean, safe and orderly manner hazard free enviornment Paid in full in Conjunction with $30,000.00 Settlement for penalties imposed 6/19/2013 & 11/21/2013   12/31/2013
Canterbury Hills Adult Care Home HAL-011-031 6/19/2013 $20,000.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for one resident with seizure activity, elevated blood presure, medication refusals, and low pulse rates Paid in full in Conjunction with $30,000.00 Settlement for penalties imposed 6/19/2013, & 11/21/2013 $30,000.00 12/31/2013
Canterbury Hills Adult Care Home HAL-011-031 5/17/2012 $13,600.00 Unabated B NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct medication admininstration problems by failing to assure six residents received medications as ordered 10/01/2013 Settlement Agreement for $8,000.00; Appealed 6/15/2012    
Canterbury Hills Adult Care Home HAL-011-031 3/15/2012 $3,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide sufficient supervision of residents with aggressive, threatening and inappropriate behavior to prevent injury 10/01/2013 Settlement Agreement for $1,500.00; Appealed 4/13/2012    
Clare Bridge of Asheville HAL-011-035 12/19/2012 $2,000.00 Type A 10A NCAC 13F .0901(a)(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision for one resident with a history of exit seeking behavior who exited the facility unsupervised Paid in Full $2,000.00 1/17/2013
Clare Bridge of Asheville HAL-011-035 2/15/2012 $12,000.00 Type A 10A NCAC 13F .0901(a)(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and services to prevent falls and resultant fractures for one resident. Resident with resultant fractures died six days after the fall Paid in Full $12,000.00 3/14/2012
Dominion Falls Family Care Home FCL-011-139 4/6/2006 $500.00 Type A 10A NCAC 13G .0909 Resident Rights; 13G .0601 Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Staff left two residents alone and unsupervised Paid in Full $500.00 4/23/2007
Dominion Falls Unit K FCL-011-110 5/3/2007 $1,600.00 Not corrected Type B 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal backgorund check not conducted on staff hired as live-in supervisor Referred to Controller's Office    
Dominion Falls Unit K FCL-011-110 5/3/2007 $1,600.00 Not corrected Type B 10A NCAC 13G .0406 (a)(5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Healthcare registry verification was not conducted for staff hired as live-in supervisor Referred to Controller's Office    
Dominion Falls Family Care Home Unit N (6) Previously known as Sunrise Family Care Home #5 FCL-011-240 11/1/2007 $2,000.00 Type A 10A NCAC 13G .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise incompetent resident who left the facility unattended; law enforcement not notified about absence and guardian not notified until next day Referred to Controller's Office    
Dominion Falls Family Care Home Unit O (6) Previously known as Sunrise Family Care Home #6 FCL-011-239 11/1/2007 $8,500.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise resident; resident left facility without signing self out of facility and facility failed to contact law enforcement when resident did not return Referred to Controller's Office    
Erwin Hills Family Care Home FCL-011-120 9/18/2013 $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 assure referral was made to meet health care needs for two residents related to excessive alcohol consumption, smoking in the facility, aggressive behavior and non-compliance with physician orders.      
Evergreen Living Homes #8 FCL-011-245 10/15/2008 $7,000.00 Type A 10A NCAC 13G. .0901 Personal Care and Supervision; 10A NCAC 13G .0902 Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide personal care services to prevent pressure sores; make timely referral to physician to address resident's congestion and notify md of resident's refusal of prescribed medications. Referred to Controller's Office    
Haywood Heights Family Care Home FCL-011-207 2/21/2008 $2,000.00 Type A 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain hot water temperatures in safe range for resident use in resident bathrooms Paid in Full $2,000.00 4/14/2008
Heather Glen At Ardenwoods HAL-011-151 4/16/2009 Staff Training Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131-D21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents with wandering/elopement behavior. Residents eloped from the facility without staff knowledge Training Completed   6/19/2009
Holly Springs Family Care Home #5 (Ownership Change) FCL-011-303 11/17/2011 $1,000.00 & Staff Training Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide referral and follow-up to meet needs of two residents related to labs and diabetic monitoring Referred to Controller's Office    
Hominy Valley Retirement Center HAL-011-158 3/18/2010 $6,000.00 Type A 10A NCAC 13F .1002 (2) Medication Orders; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to clarify physician orders for 6 of 7 sampled residents including those with orders for coumidin and insulin. Paid in Full Referred to Controllers Office $6,650.00 12/23/2010
Majorie McCune Memorial Center HAL-011-011 5/15/2012 $16,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up to meet the acute and routine needs for three residents Training Completed 5/28/13; 1/31/2013 Settlement Ageement ($3,000.00 for training); Appealed 6/04/2012    
Marjorie McCune Memorial Ctr. HAL-011-011 11/17/2006 $2,800.00 Not corrected Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Insulin not administered as ordered due to blood sugar levels not monitored as ordered for four residents Paid in Full $2,800.00 12/13/2006
Marjorie McCune Memorial Ctr. HAL-011-011 01/23/2006 $3,000.00 Type A 10A NCAC 13F .0909 Resident Rights; 13F .0902 Health Care; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident receiving Coumadin did not have lab work performed as ordered Paid in Full $3,000.00 6/19/2006
Marjorie McCune Memorial Ctr. HAL-011-011 04/10/2006 $900.00 Type A 10A NCAC 13F .0902 Health Care; 13F .0909 Residents Rights; G.S. 131D-21 Declaration of Residents' Rights Resident receiving Coumadin did not have lab work performed as ordered Paid in Full $900.00 6/30/2006
Mountain Valley Retirement Home (penalty # 1) FCL-011-032 7/18/2013 $2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure follow-up with physician to meet the health care needs of one resident with low blood glocuse levels with orders of fingerstick blood test Paid in Full $2,000.00 8/13/2013
Mountain Valley Retirement Home (penalty # 2) FCL-011-032 7/18/2013 $2,000.00 Type A2 10A NCAC 13G .0601 (a) Management of Facilities and Other Staff; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure facility management took responsibility for the total operation of the facility to maintain compliance to rules Paid in Full $2,000.00 9/20/2013
Mountain Valley Retirement Home (penalty #3 ) FCL-011-032 7/18/2013 $3,500.00 Type A1 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; Facility failed to assure two residents were free from mental and/or physical abuse by staff. Paid in Full $3,500.00 8/13/2013
Mountain Valley Retirement Home (penalty #4 ) FCL-011-032 7/18/2013 $3,500.00 Type A2 10A NCAC 13G .0901 (a) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide personal care according to care plan requiring assistance with bathing for one resident resulting in a fall with injuries Paid in Full $3,500.00 9/20/2013
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.      
Plemmons Family Care Home #2 FCL-011-036 6/27/2007 $3,920.00 Not corrected Type B 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background check not conducted on two of two staff employed by facility Partial Payment
Paid in Full
$920.00
$3507.44
8/9/2007
06/13/2008
Richmond Hill Rest Home #1 HAL-011-192 5/19/2010 $7,520.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to to administer medications as ordered Paid in Full $7,520.00 6/22/2010
Richmond Hill Rest Home #2 (Penalty #1) HAL-011-191 1/21/2011 $2,000.00 Type A 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain safe water temperatures at six of six water fixtures utilized by residents Paid in Full Partial Pmt. $1,000.00 $1,000.00 03/17/2011 02/17/2011
Richmond Hill Rest Home #2 (Penalty #2) HAL-011-191 1/21/2011 $2,960.00 Unabated Type B 10A NCAC 13F .0601 Management of Facilities; 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet routine and acute health care needs of four residents and failed to assure medications were administered as ordered Paid in Full Partial Pmt. $1,480.00 $1,480.00 03/17/2011 02/17/2011
Richmond Hill Rest Home #3 HAL-011-190 07/14/2006 Staff Training Type A 10A NCAC 13F .0601 Management of Facilities with a Capacity or Census of Seven to Thirty Residents; 13F .0909 Residents Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Staff left residents alone and unsupervised to attend meeting. Training Completed   2/7/2007
Richmond Hill Rest Home #4 HAL-011-189 06/02/2006 $1,000.00 Type A 10A NCAC 13F .0902 Health Care (a)(b)(c); 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Resident receiving Coumadin did not have lab work performed as ordered Paid in Full $1,000.00 7/21/2006
Richmond Hill Rest Home #5 HAL-011-188 1/21/2011 $3,360.00 Unabated Type B 10A NCAC 13F .0601 Management of Facilities; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to adminster medications as ordered Paid in Full Partial Pmt. $1,680.00 $1,680.00 03/16/2011 02/17/2011
Shadybrook Living Center HAL-011-155 11/22/2006 $6,000.00
$12,000.00
Type A 10A NCAC 13F .1004 (a) Medication Administration; 10A NCAC 13F .1010 Pharmaceutical Services; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident with respiratory congestion did not receive ordered antibiotic timely Settlement Agreement 5/24/07 Appealed 12/19/2006 Paid in Full $6,000.00 3/6/2008
Shadybrook Living Center HAL-011-155 11/22/2006 Training
$7,500.00
Not corrected Type B 10A NCAC 13F .0902(a)(b)(c)(3)(4) Health Care;G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident did not have blood sugar levels monitored as ordered and did not receive ordered amount of insulin Settlement Agreement 5/24/07 Training Appealed 12/19/2006 Training Completed 3/27/08  
Shadybrook Living Center HAL-011-155 2/17/2009 $4,500.00 Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to ensure smoking did not occur in the facility. Residents aware of no smoking policy but residents continued to smoke in their bedrooms. A fire was started by a resident smoking and using oxygen. Paid in Full $5,100.00 9/24/2009
Shangri-La Family Care Home FCL-011-059 7/15/2010 $7,000.00 Type A 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide a safe and secure environment for the residents in the home from owners personal issues and behaviors Facility Closed    
Soundview FCH Unit I FCL-011-236 9/16/2008 $1,000.00 Type A 10A NCAC 13G .0601(b)(3) Management and Other Staff; 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility staff left residents in home unattended for one half hour. Additionally,staff did not ensure smoking did not occur in the presence of one resident using oxygen. Paid in Full $1,123.32 1/14/2009
Westside Assisted Living B (Change of Ownership) FCL-011-305 10/16/2013 $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 referral and follow-up to meet the health care needs of four residents related to self-administration of insulin, sores, physician appointments, labs, Thrombo Embolic Deterrent hose, complaints of chest pains and abnormal blood glucose      
WNC Family Care Home #6 FCL-011-256 7/16/2010 $1,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0601 (a) Management & Other Staff; 10A NCAC 13G .0705 (b) Discharge of Residents; G.S. 131D-4.4 (b)( c) Prohibit Smoking in LTC Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to two residents with noncompliance to policies regarding alcohol, smoking and illegal drug use in the facility Facility Closed    
WNC Family Care Home #10 FCL-011-281 11/18/2009 $7,000.00 Type A 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .1004(a)(1)(2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to monitor resident's condition and administer insulin medications as ordered. Staff failed to communicate and follow-up with referrals to physician. Referred to Controllers' Office    
WNC Family Care Home #13 FCL-011-279 11/18/2009 $1,080.00 Unabated Type B 10A NCAC 13G .1004(j) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maitain medication administration records and failed to accurately document administration of medications Referred to Controllers' Office    

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Burke County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Clara's Cottage #1 FCL-012-038 2/20/2013 $500.00 Type A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure health care referral and follow-up to address a resident's condition Paid in Full $556.25 1/22/2014
Glenda's Plantation FCL-012-021 2/21/2008 $1,000.00 Type A 10A NCAC 13G .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to supervise residents left in vehicle during shopping excursion; one disoriented resident wandered into roadway Paid in Full $1,000.00 4/14/2008
Longview Assisted Living HAL-012-022 01/23/2006 $1,350.00 Not corrected Type B 10A NCAC 13F .1001 Medication Administration Policies and Procedures; 13F .1004(a) Medication Administration;
G.S. 131D-21 (2) Declaration of Residents' Rights
Residents did not receive medications as ordered Paid in Full $1,350.00 1/5/2007
Morganton Long Term Care Facility HAL-012-007 7/21/2011 $10,000.00 & $2,000.00 Staff Training Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for two residents related to acute respiratory distress and lab orders for monitoring therapeutic levels of Coumadin Training Completed Paid in Full $10,000.00 09/26/2011 09/20/2011

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Cabarrus County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Concord House HAL-013-038 6/19/2013 $4,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs of three residents regarding missed medications, behavior changes and ordered laboratory test 4/28/14 Settlement Agreement for $2,750.00; Appealed 7/18/2013    
Concord House HAL-013-038 2/19/2013 $4,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision of a resident who eloped during a community outing Paid in Full $4,450.00 12/31/2013
Concord House (Change of Ownership) HAL-013-031 6/19/2008 $20,000.00 Type A 10A NCAC 13F .0901 (c ) Personal Care and Supervision; 10A NCAC 13F .0909 Resident Rights; G.S.131D-21 (2) Declaration of Residents' Rights Resident found unresponsive; staff failed to initiate their emergency procedures immediately 9/17/2010 Settlement Agreement $5,000.00 ($1,000.00 for training and $4,000.00 payable) Appealed 07/17/2008    
Concord House HAL-013-031 09/14/2006 $6,000.00
$12,000.00
Type A 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Resident did not receive medications as ordered, suffered withdrawal effects requiring hospitalization Settlement Agreement 10/17/07
Appealed 10/13/06
$5,925.49 10/3/2008
Concord House HAL-013-031 06/02/2006 $3,420.00 Not corrected Type B 10A NCAC 13F .1004(e) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Residents did not receive medications as ordered Paid in Full $3,420.00 1/8/2007
Concord Place HAL-013-019 3/16/2011 $8,640.00 Unabated Type B 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure resident received medication and obtain lab tests as ordered Paid in Full $8,640.00 3/31/2011
The Country Home HAL-013-012 4/16/2009 $5,500.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131-D21 (2) Declaration of Residents' Rights Facility failed to provide supervision and monitor inappropriate aggressive behavior of 3 residents 11/20/09 Settlement Agreement violation changed to Type B and $2,000.00 for Training; Appealed 5/15/2009 Training Completed 12/14/2010  

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Caldwell County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      

Camelot Manor d/b/a Brockford Inn

HAL-014-014 07/18/2008 $4,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Staff failed to notify physician of resident's blood sugar levels or administer insulin as ordered Paid in Full $4,000.00 8/8/2008
Carolina Oaks Enhanced Care Center HAL-014-002 1/14/2014 $1,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs of two residents related to use of a CPAP machine and weight loss Paid in Full $1,000.00 1/24/2014
Carolina Oaks Enhanced Care Center HAL-014-002 7/16/2009 $16,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0909 / G.S. 131D-21 (4) Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to protect residents from a resident's verbal and physical aggression Paid In Full 3/1/10 Settlement Agreement $6,000.00 & Training; Appealed 08/12/2009 $6,500.00 3/18/2010
The Shaire Center HAL-014-004 7/16/2012 $4,000.00 Type A1 10A NCAC 13F .0901(a)(c) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to transfer one resident using a hoyer lift as care planned resulting in injury Paid in Full $4,000.00 8/29/2012

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Camden County

None of the facilities in Camden County have received a penalty since January 2006.

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Carteret County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
The Heritage of Newport HAL-016-017 7/16/2009 $2,000.00 Type A 10 NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident while smoking and leaving the the premises on foot while impaired from alcohol consumption Paid in Full 11/20/2009 Settlement Agreement & Training; Appealed 8/13/2009 $1,000.00 12/16/2009

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Caswell County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
G. Anthony Rucker Rest Home HAL-017-040 9/15/2011 $14,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide a resident supervision during eating resulting in the resident requiring hospitalization and ventilator care Paid in Full $14,000.00 9/23/2011
Jones Family Care #4 FCL-017-030 01/26/2006 $1,000.00 Type A 10A NCAC 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights Resident locked out of facility and left unsupervised until staff returned. Paid in Full $1,000.00 3/8/2006

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Catawba County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Carillon Assisted Living of Newton HAL-018-017 9/15/2011 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision in accordance with one resident's assessed needs and current symptoms resulting in injury to another resident Paid in Full $4,000.00 9/29/2011
Walden House HAL-018-015 7/15/2010 $20,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to resident who had a history of aggressive and noncompliant behaviors resulting in a resident death 04/17/2012 Settlement Agreement reducing all Type A Violations to Type B Violations and rescinding the penalty Appealed 8/12/10    
Walden House HAL-018-015 11/19/2007 $4,000.00 Type A 10 NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise two residents who were confused and disoriented who would leave the building and cross nearby four-lane highway. Paid in Full $4,000.00 12/12/2007
Wingo Family Care d/b/a Sarah's Place (penalty #1) Facility Closed FCL-018-029 12/19/2012 $4,400.00 Unabated B 10A NCAC 13G .0406 (a)(5) Health Care Personnel Registry; 10A NCAC 13G .0406 (a)(7) Health Care Personnel Registry - Criminal Background Checks; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct noncompliance to assure staff had no findings of abuse or neglect listed on the health care personnel registry and that a criminal background check had been completed prior to staff being left alone to care for residents Referred to Controller's Office    
Wingo Family Care d/b/a Sarah's Place (penalty #2) Facility Closed FCL-018-029 12/19/2012 $4,400.00 Unabated B 10A NCAC 13G .0507 CPR Training; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct noncompliance to assure two of two staff had completed cardio-pulmonary resuscitation and choking training when left as only staff to care for residents Referred to Controller's Office    

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Chatham County

None of the facilities in Chatham County have received a penalty since January 2006.

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Cherokee County

None of the facilities in Cherokee County have received a penalty since January 2006.

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Chowan County

None of the facilities in Chowan County have received a penalty since January 2006.

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Clay County

None of the facilities in Clay County have received a penalty since January 2006.

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Cleveland County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Alterra Sterling House Of Shelby HAL-023-011 10/30/2007 $16,000.00 Type A 10A NCAC 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility staff failed to administer CPR when resident found unresponsive Paid in Full $16,000.00 11/28/2007
Brooks Family Care Home FCL-023-024 09/14/2006 $2,340.00 Not corrected Type B 10A NCAC 13G .1002 Medication Orders; 13G .1004 Medication Administration Medication orders were not clarified and meds administered without orders for one resident Paid in Full $2,340.00 11/2/2006
Helms Family Care Home FCL-023-011 10/16/2013 $2,000.00 Type A2 10A NCAC 13G .0906 (f) Other Resident Care and Services; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to immediately notify law enforcement and county social services when the whereabouts of one resident was unknown Paid in Full $2,000.00 12/31/2013
Openview Retirement Center HAL-023-004 01/23/2006 $2,000.00 Type A 10A NCAC 13F .0307 Fire Alarm System; 13F .0901(b) Personal Care and Supervision; 13F .1212(a) Reporting of Accidents and Incidents; 13F .0407(a) Other Staff Qualifications Staff failed to respond timely to resident in need of emergency medical services. Room was locked and staff did not have key Paid in Full $2,000.00 3/28/2006
Openview Retirement Home HAL-023-004 1/18/2008 Staff Training Type A 10A NCAC 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident with history of leaving previous placements without notice left facility during early morning hours; another resident informed staff of resident's absence Training Completed 3/5/08    
Shelby Manor HAL-023-008 8/9/2013 $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 supervision for three residents whose current symptoms and assessed needs related to falls required increased supervision Paid in Full $4,000.00 8/19/2013
Somerset Court of Shelby HAL-023-012 3/14/2012 $2,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident with dementia with a history of falls and who exhibited exit seeking behavior Paid in Full $2,000.00 4/16/2012
Unique Living (penalty #1) HAL-023-034 3/19/2009 $20,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Confused resident wandered from facility without staff's knowledge and has not been located Facility Closed
Referred to Controller's Office
   
Unique Living (penalty #2) HAL-023-034 3/19/2009 $20,000.00 Type A 10A NCAC 13F .0305(h)(4) Physical Environment; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure exit door alarms were operable and on with doors left unsupervised. Confused resident wandered from facility and has not been located Facility Closed
Referred to Controller's Office
   
Unique Living (penalty #3) HAL-023-034 3/19/2009 $10,000.00 Type A G.S. 131D-4.4 (b)( c) Prohibit Smoking in LTC Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to enforce no smoking in the facility; residents known to smoke in their rooms at night were told to keep out of sight Facility Closed
Referred to Controller's Office
   
Unique Living HAL-023-034 1/22/2007 $16,000.00 Type A 10A NCAC 13F .0901 Personal Care & Supervision; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident wandered from facility, was returned and left again on same day; later found dead Appealed 02/20/2007 Upheld 07/31/2007
Paid in Full
$18,850.99 2/5/2008

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Columbus County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Lake Pointe Assisted Living HAL-024-011 5/19/2011 Staff Training Type A 10A NCAC 13F .1501(a) Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure restraints were not used for staff convenience and until assessment and care planning had been completed Training Completed   7/26/2011
Lake Waccamaw Senior Living HAL-024-009 1/12/2007 $4,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Residents (two) wandered from facility without staff's knowledge Paid in Full $4,000.00 2/9/2007
Lake Waccamaw Senior Living HAL-024-009 1/9/2007 $4,860.00 Not corrected Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered Paid in Full $4,860.00 1/25/2007
Lake Waccamaw Senior Living (penalty #1) HAL-024-009 11/20/2008 $10,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision (b); G.S. 131D-21 (2) Declaration of Residents' Rights The facility failed to provide supervision for residents displaying aggressive behaviors resulting in one resident being assaulted Paid in Full Partial Pmt(s) - Total paid $5746.56 $957.76 received each date 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009
Lake Waccamaw Senior Living (penalty #2) HAL-024-009 11/20/2008 $2,000.00 Type A G.S.131D-4.4 Prohibit Smoking in LTC Facilities; G.S.131D-21 (2) Declaration of Residents' Rights Facility failed to enforce their smoking policy which resulted in one resident continuing to smoke in his bedroom Paid in Full Partial Pmt(s). - Total paid $1,149.30 $191.55 received each date 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009
Lake Waccamaw Senior Living (penalty #3) HAL-024-009 11/20/2008 $10,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to administer medications including coumidin as ordered for two residents; staff failed to notify physician when medication was not available and not being administered Paid in Full Partial Pmt(s). - Total paid $5746.56 $957.76 received each date 01/04/2010 07/23/2009 07/13/2009 05/22/2009 05/14/2009 03/01/2009 02/01/2009 01/01/2009
Waterbrooke Assisted Living (penalty # 1 ) Change of Ownership HAL-024-010 4/17/2013 $20,000.00 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 five residents who exhibited aggressive behaviors, wandered or were intoxicated Referred to Controller's Office; 5/23/2014 Settlement Agreement in conjunction with all 4 penalties imposed 4/17/2013 for $20,000.00 $6,666.69 11/21/2013 10/28/2013 10/14/2013
Waterbrooke Assisted Living (penalty # 2 ) Change of Ownership HAL-024-010 4/17/2013 $20,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide referral and follow-up for three residents who required follow-up for injury, changes in behavior, or wound care Referred to Controller's Office; 5/23/2014 Settlement Agreement in conjunction with all 4 penalties imposed 4/17/2013 for $20,000.00    
Waterbrooke Assisted Living (penalty # 3 ) Change of Ownership HAL-024-010 4/17/2013 $4,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration; 10A NCAC 13F .0601 Management of Facility; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure Cipro was administered and Coumadin was witheld as ordered for one resident Referred to Controller's Office; 5/23/2014 Settlement Agreement in conjunction with all 4 penalties imposed 4/17/2013 for $20,000.00    
Waterbrooke Assisted Living (penalty # 4 ) Change of Ownership HAL-024-010 4/17/2013 $4,000.00 Type A2 10A NCAC 13F .0306 (a)(5) Housekeeping and Furnishing; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to maintain a clean environment free of hazards related to infestation of bedbugs and roaches Referred to Controller's Office; 5/23/2014 Settlement Agreement in conjunction with all 4 penalties imposed 4/17/2013 for $20,000.00    

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Craven County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Alterra Sterling House of New Bern HAL-025-012 2/23/2007 $2,500.00 Type A 10A NCAC 13F .901 (b) Personal Care & Supervision: G.S. 131D-21 (2) Declaration of Residents' Rights Resident wandered from facility without staff's knowledge Paid in Full $2,500.00 3/22/2007
Carebridge Assisted Living HAL-025-007 5/19/2010 $7,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to obtain timely referral and follow-up for a resident Paid in Full $7,000.00 7/16/2010
Carebridge Assisted Living HAL-025-007 11/20/2008 $7,000.00 Type A 10A NCAC 13F .1002 Medication Orders; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered, one resident received excess insulin resulting in the need for emergency treatment Paid in Full $7,000.00 1/9/2009
Christian Care of New Bern HAL-025-018 1/9/2007 $1,000.00 Type A 10A NCAC 13F .0906 (f)(4) Other Resident Care & Services; G.S. 131D-21 Declaration of Residents' Rights Staff failed to identify resident's failure to return to facility and did not notify family or law enforcement abt. missing status Paid in Full $1.000.00 2/1/2007
Croatan Village HAL-025-020 7/15/2010 $1,000.00 Type A 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to transport resident in a electric wheelchair in a secure manner Paid in Full $1,000.00 8/2/2010
Croatan Village Assisted Living HAL-025-020 1/9/2007 $3,500.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident wandered from the facility without staff's knowledge Paid in Full $3,500.00 2/9/2007
Good Shepherd Home for the Aged HAL-025-023 9/15/2011 $2,000.00 & $2,000.00 Staff Training Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure a resident with skin breakdown was referred to address her acute care needs resulting in hospitalization 12/30/2011 Training Completed; Paid in Full; training due $2,000.00 11/17/2011
Good Shepherd Home for the Aged HAL-025-023 9/13/2010 $4,500.00 Unabated Type B 10A NCAC 13F. 0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision to a resident with a history of elopement who could not safely leave the facility unsupervised Paid in Full Partial pmt. $2,250.00 $2,250.00 1/03/2011 12/09/2010
Homeplace of New Bern HAL-025-014 3/17/2011 $4,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up occurred for a reisdent experiencing a pressure wound Paid in Full $4,000.00 3/25/2011
Homeplace of Newbern HAL-025-014 01/12/2006 $2,000.00 Type A 10A NCAC 13F .0305 Physical Environment; 13F .1304 Special Care Unit Bldg. Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Two residents(confused/disoriented) wandered from the facility without staff's knowledge Paid in Full $2,000.00 2/2/2006
Magnolia Place of New Bern HAL-025-019 3/23/2007 $2,500.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to notify physician when one resident with dementia refused all medications and as result required hospitalization. Paid in Full $2,500.00 5/30/2007
Riverstone HAL-025-026 2/22/2013 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident in accordance to her current symptoms Paid in Full $2,000.00 3/12/2013
Riverstone HAL-025-026 3/17/2011 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise a resident who was known to elope. Facility was unaware resident had left the facility until located by sheriff the following day Staff Training Completed   1/12/2012
Riverstone HAL-025-026 3/20/2008 Staff Training Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered including sliding scale insulin for 3 of 3 residents on two separate inspections Training completed 05/16/ 2008    
The Courtyards at Berne Village HAL-025-024 7/21/2011 $2,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervsion for blind resident known to wander. Resident left the facility without staff knowledge and was found on road having fallen from wheelchair Paid in Full $2,000.00 9/14/2011
The Courtyard at Berne Village HAL-025-024 7/15/2010 $13,980.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered Paid in Full $13,980.00 9/14/2010
The Courtyards at Berne Village Memory Care HAL-025-025 11/17/2011 $8,000.00 & Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to two residents based on assessed needs and known behaviors resulting in a resident with known wandering behaviors being physically assaulted by a resident identified as having aggressive and abusive behaviors Training Completed 1/24/2012; Paid in Full $8,000.00 1/17/2012
The Courtyard at Berne Village Memory Care HAL-025-025 7/15/2010 $7,000.00 Type A 10A NCAC 13F. 0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide supervision to residents who were experiencing falls Paid in Full $7,000.00 9/14/2010
The Courtyards at Berne Village HAL-025-015 5/3/2007 $1,000.00 Type A 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident (confused/disoriented) wandered from facility, was returned and left again on same day without staff knowledge. Referred to Controller's Office    
Water Oak Manor (penalty #1) HAL-025-031 3/20/2013 $2,000.00 Type A2 10A NCAC 13F .0906 (f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify law enforcement when a resident eloped from facility and whereabouts was unknown Paid in Full $2,000.00 5/29/2013
Water Oak Manor (penalty #2) HAL-025-031 3/20/2013 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for one resident who had a history of wandering and elopement behavior Paid in Full $2,000.00 5/29/2013
Water Oak Manor HAL-025-030 11/16/2011 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise a resident to prevent the resident from eloping from the special care unit and failed to provide physician follow-up regarding health care needs for three residents Referred to Controller's Office    

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Cumberland County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Countryside Villa HAL-026-046 5/13/2014 $16,200.00 Type Unabated 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      
Countryside Villa HAL-026-046 5/16/2013 $4,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; Facility failed to ensure resident was free from abuse when reacting to a resident's aggressive behavior towards staff Appealed 06/10/2013    
Cross Creek Manor Assisted Living, LLC HAL-026-050 6/19/2008 $2,940.00 Type B Unabated 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in a safe range for resident use Paid in full $2,940.00 8/13/2008
Eastover Gardens Special Care HAL-026-055 3/21/2013 $2,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure healthcare referral for one resident with a pressure wound 05/29/2013 Settlement Agreement in Conjunction with penalties 1 & 2 imposed 11/15/2012 for $8,000.00 ($6,000.00 & training) payment plan; (total due 06/2014) (training due 11/29/13) Appealed 04/10/2013 $3,000.00 12/18/2013
Eastover Gardens Special Care (penalty #1) HAL-026-055 11/15/2012 $7,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision in accordance to resident's assessed needs, care plan and current symptoms related to falls for two residents with diagnosis of dementia 05/29/2013 Settlement Agreement in Conjunction with penalty imposed 03/21/2013; Referred to Controller's Office    
Eastover Gardens Special Care (penalty #2) HAL-026-055 11/15/2012 $7,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to make referral to healthcare providers relative to conditions including weight changes, wound care, complaints of pain, swelling and falls for four residents 05/29/2013 Settlement Agreement in Conjunction with penalty imposed 03/21/2013; Referred to Controller's Office    
Forest Hills Rest Home HAL-026-003 01/23/2006 $2,700.00 Not corrected Type B 10A NCAC 13F .1004 Medication Administration G.S. 131D-21 (2) Declaration of Residents' Rights Staff administering medications had not completed the clinical skills validation prior to administration of medications. Paid in Full $2,700.00 3/29/2006
Forest Hills Rest Home HAL-026-003 01/23/2006 $3,000.00 Type A 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered. Paid in Full $3,000.00 3/29/2006
Jean's Rest Home FCL-026-029 1/16/2008 $1,720.00 Not corrected Type B 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in a safe range for resident use Paid in Full Settlement Agreement 8/18/2008 Appealed 02/15/2008 $800.00 9/17/2008
Len-Care of Cedar Creek, Inc HAL-026-041 8/27/2007 $4,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Medications were not administered as ordered with significant errors including residents did not receive coumidin as ordered; other resident did not receive medication for seizure disorder; residents' medications not administered based on unavailability Referred to Controller's Office    
Len-Care of Cedar Creek, Inc HAL-026-041 8/27/2007 $1,200.00 Not corrected Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Medications were not administered as ordered with significant errors including failure to adminster residents' coumidin and insulin as ordered and failure to notify physician of when resident's blood sugars were high; residents had documentation of medications not administered based on unavailablity Referred to Controller's Office    

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Currituck County

None of the facilities in Currituck County have received a penalty since January 2006.

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Dare County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Spring Arbor of the Outer Banks HAL-028-001 9/18/2013 $12,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for health care needs for four residents related to coordinating follow-up visits and notifying physician of multiple falls leading to injuries with a sacral spine fracture, a leg fracture, a left hip fracture and head injury requiring sutures Paid in Full; 02/10/2014 Settlement Agreement for $6,000.00; Appealed 10/07/2013 $6,000.00 3/11/2014

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Davidson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Landmark Estates HAL-029-003 4/17/2013 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Faciltiy failed to assure referral and follow-up to meet the routine and acute health care needs of two residents with outburst, agitation, anxiety, and difficulty breathing Paid in Full $2,000.00 7/9/2013
Westanna Family Care FCL-029-001 6/14/2012 $2,600.00 Unabated B 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct infection control practices to ensure infection control measures were used when monitoring fingerstick blood sugars for three of three residents Paid in Full; 2 Partial Payment of $1,300.00 $2,600.00 08/16/2012 07/13/2012

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Davie County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Davie Place HAL-030-003 Amended letter sent 1/2/2008 11/19/2007 $18,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident utilizing oxygen was consistently noncompliant to facility's smoking policy; she continued to smoke in room with oxygen resulting in explosion Paid in Full; Settlement Agreement 4/4/08;
Appealed 12/19/2007
$12,000.00 05/05/2008
Davie Place Residential Care HAL-030-003 3/17/2011 $10,000.00 Type A 10A NCAC 13F .0901 Personal Care & Supervision; 10A NCAC 13F .0504(a) Competency Validation for LHPS Tasks; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure staff were trained and competency validated on use of mechanical lift required for a resident's transfers resulting in one resident experiencing a fracture Paid in Full; Partial pmts of $1,010.00 Total $11,084.56 12/20/2011 09/14/2011 08/12/2011 07/13/2011 06/16/2011 05/11/2011 04/14/2011

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Duplin County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Autumn Village HAL-031-014 4/17/2012 $6,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision of one resident with wandering behaviors and one resident exhibiting aggressive behaviors towards residents Paid in Full $6,000.00 6/1/2012
Autumn Village Inc. HAL-031-014 7/21/2011 $2,000.00 & $2,000.00 Staff Training Type A 10A NCAC 13F .0901(a) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide personal care services in accordance with resident's needs. Resident was routinely provided bed bathe but suffered fracture when gotten up to be showered Paid in Full; Training Completed $2,000.00 09/09/2011 09/26/2011
Golden Care HAL-031-003 5/16/2013 $7,100.00 Unabated Type B 10A NCAC 13F .0309 (b)( c) Plan for Evacuation; G.S. 131D-21 Declaration of Residents' Rights Facility failed to have and document quarterly fire rehearsals on each shift Paid in Full $7,100.00 7/24/2013
Golden Care HAL-031-003 09/14/2006 $2,960.00 Not corrected Type B 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background checks had not been done for 3 staff members before hiring; 10 staff members did not have CPR training; 9 shifts did not have a staff member on duty that was CPR qualified Paid in Full $2,960.00 11/7/2006
Moore's Family Care Home #1 FCL-031-005 5/3/2007 $1,000.00 Type A 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect resident from physical abuse and exploitation by staff and residents Paid in Full $1,000.00 5/11/2007
Moore's Family Care Home #1 FCL-031-005 6/27/2007 $1,000.00 Type A 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Resident's Rights Hot water temperatures were not maintained in safe range in two residents' bathrooms Paid in Full $1,000.00 7/2/2007
Windham Hall HAL-031-006 4/15/2014 $8,000.00 Type Unabated 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 Appealed 4/24/2014    
Windham Hall (penalty # 1 ) HAL-031-006 1/14/2014 $4,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to maintain compliance to Health Care, Medication Orders, Medication Administration, Health Care Personnel Registry and Residents' Rights requirements Appealed 04/25/2014    
Windham Hall (penalty # 2 ) HAL-031-006 1/14/2014 $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 and reporting allegations of physical abuse by two staff, sexual exploitation by one staff and verbal abuse by one staff to North Carolina Health Care Personnel Registry, and not investigating and reporting bruises of unknown origin for two residents Appealed 04/25/2014    
Windham Hall (penalty # 3) HAL-031-006 1/14/2014 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the rights of residents living in facility by not treating each resident with respect and dignity and neglecting to protect residents from abuse and exploitation from staff Appealed 04/25/2014    
Windham Hall HAL-031-006 3/21/2013 $2,000.00 Type A2 10A NCAC 13F .0901 (b)(c) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one disoriented resident who left the facility unsupervised and without staff knowledge Paid in Full; 05/14/2014 Settlement Agreement for $ 1,000.00; Appealed 4/25/13 $1,000.00 6/23/2014

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Durham County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Camellia Gardens HAL-032-071 9/26/2007 Staff Training Type A 10A NCAC 13F .1004 (a)(1) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Resident did not receive medication as ordered Training Completed   06/26/2008
Circle of Daughters FCL-032-085 3/18/2010 $500.00 Type A 10A NCAC 13G .0601(b) Management and Other Staff; 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure resident not left alone and unsupervised in facility Paid in Full $500.00 4/22/2010
Durham Ridge Assisted Living HAL-032-080 5/14/2008 $2,940.00 Type B Unabated 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure follow-ups and referrals occurred to meet health care needs for five residents Paid in Full $2,940.00 07/11/2008
Durham Ridge Assisted Living HAL-032-080 5/14/2008 $6,540.00 Type B Unabated 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Residents did not receive medications or treatments as ordered Paid in Full $6,540.00 07/11/2008
Durham Ridge HAL-032-080 11/19/2007 $1,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident from Special Care Unit was escorted out of secured unit and left unsupervised. Resident found 6 miles from facility Paid in Full $1,000.00 11/28/2007
Elsie-Doris Family Care Home FCL-032-088 10/22/2009 Staff Training Type B Unabated 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to adminster medications as ordered Training Completed   1/9/2010
Friendly Rest Home, Inc HAL-032-003 3/20/2008 $6,160.00 Type B Unabated 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Physicians were not notified for residents' health care needs including pressure sores, psychiatric care, PT and podiatry services Paid in Full Settlement Agreement 6/18/2008; Appealed 03/24/2008 $2,000.00 6/30/2008
Love and Care Family Care Home FCL-032-078 9/16/2008 $1,000.00 Type A 10A NCAC 13G. 0601 (b) Management and Other Staff; 10A NCAC 13G .0901 Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility staff left two residents unattended in the facility for the majority of a weekend.One resident was directed to prepare meals and administer medication for the other. Paid in Full $1,123.32 1/5/2009
Love and Care Family Care Home II (penalty #1) FCL-032-082 4/16/2009 $8,500.00 Type A G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure staff and residents did not smoke in the facility. All five residents and staff smoked in the facility. Paid in Full 5/13/10 Settlement Agreement for $1,000.00 in Conjunction w/penalty #2 imposed 04/16/2009; Appealed 05/14/2009 $1,000.00 6/2/2010
Love and Care Family Care Home II (penalty #2) FCL-032-082 4/16/2009 $4,500.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to provide necessary increased supervision for residents to ensure safe living conditions. Law enforcement was required to respond to conditions in the facility frequently to ensure residents safety. (Paid in full - See penalty #1) 5/13/10 Settlement Agreement for $1,000.00 in Conjunction w/penalty #1 imposed 04/16/2009; Appealed 05/14/2009    
Love and Care Family Care Home II FCL-032-082 3/20/2008 $1,500.00 Type A 10A NCAC 13G .0601 (b) Management and Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Staff left facility leaving two residents unsupervised in facility Paid in Full $1,667.49 6/30/2008
The Meadows of Oak Grove HAL-032-063 2/13/2007 $1,500.00 Type A G.S. 131D-21 (2)(4) Declaration of Residents' Rights Staff reacted to resident aggression by physical "choking of resident" and verbal threat; facility did not remove staff from resident care during investigation of incident Referred to Controller's Office    
South Point Manor HAL-032-072 1/12/2007 $1,000.00 Type A 10A NCAC 13F .0311 Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in safe range in residents' bathrooms Paid in Full $1,000.00 2/14/2007

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Edgecombe County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Britthaven of Tarboro HAL-033-001 9/26/2007 $3,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to supervise smoking of residents whose behaviors demonstrated need for increase supervision Paid in Full $3,000 10/11/2007
The Fountains at The Albemarle NH0352 10/14/2013 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Resident Rights Facility failed to prevent a cognitively impaired resident from exiting the facility. Paid in Full $1,000 10/22/2013
The Fountains at The Albemarle NH0352 3/18/2010 $12,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Resident Rights The facility failed to implement preventative measures for falls after the first fall with injury which resulted in a second fall with injury. Paid in Full $12,000 5/18/2010
Heritage Care of Rocky Mount HAL-033-005 10/15/2008 $1,760.00 Type B Unabated G.S. 131D-4.4 Mininum Safety Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to prohibit smoking inside facility OAH and final agency decision overturned violation on 1/15/2010; Appealed 11/14/08    
Heritage Care of Rocy Mount (penalty #1) HAL-033-005 07/18/2008 $2,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident whose status required supervision was allowed to leave facility unsupervised Settlement Agreement in conjunction with penalty #2. Change to Type B Violation and Rescind Penalty 1/27/2010; Appealed 08/15/2008    
Heritage Care of Rocky Mount (penalty #2) HAL-003-005 07/18/2008 $1,500.00 Type A 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in safe range on one hall serving 29 residents Settlement Agreement in conjunction with penalty #1 $1500.00 1/27/2010; Appealed 08/15/2008 $1,500.00 2/9/2010

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Forsyth County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
The Bradford Village of Kernersville, East HAL-034-068 11/9/2010 $20,000.00 Unabated Type A 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise residents and ensure alarms on doors were engaged. A disoriented resident left the facility during the night without staff knowledge and was found deceased the following morning Paid in Full $20,000.00 1/6/2011
The Bradford Village of Kernersville - West HAL-034-069 12/19/2012 $7,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide health care referrral and follow-up and supervision for four residents who experienced falls Training Completed 09/24/13; Paid in Full; 05/23/2013 Settlement Agreement ($1,000.00 & $2,500.00 for training) training due 8/23/13 (approved 7/19/2013) Appealed 1/18/2013 $1,000.00 6/11/2013
Brighton Gardens of Winston-Salem HAL-034-026 5/20/2010 $4,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide health care referral and follow-up to meet the needs of residents receiving coumidin and insulin Paid in Full $4,000.00 6/14/2010
Brookstone Terrace HAL-034-094 5/16/2013 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide adequate supervision to two residents in accordance with their assessed needs and symptoms who had experienced repetitive falls Paid in Full $2,000.00 6/5/2013
Clemmons Village II HAL-034-062 2/14/2012 $20,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .1501(a) Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to three residents to prevent falls and injury and used physical restraints which residents were unable to extricate themselves resulting in one death Paid in Full; Settlement Agreement for $12,500.00; Appealed 3/1/2012 $12,500.00 6/3/2013
C.R.T. Golden Lamb Rest Home HAL-034-019 9/19/2012 $7,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up to meet one resident's routine and acute healthcare needs Paid in Full; Referred to Controller's Office $7,729.17 1/11/2013
C.R.T. Golden Lamb Rest Home HAL-034-019 5/15/2012 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure resident rights were maintained when infection control measures were not used when monitoring fingerstick blood sugars for five residents Paid in Full $2,000.00 7/6/2012
Dogwood Family Care Home (Facility Closed) FCL-034-076 3/16/2011 $10,000.00 Type A 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident who was constantly disoriented and frequently left the facility premises without supervision Referred to Controller's Office    
Forest Heights Senior Living Community HAL-034-087 6/19/2013 $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 an increase in supervision for two residents assessed with a history of falls Paid in Full $4,000.00 8/5/2013
Forest Heights Senior Living Community HAL-034-087 3/17/2011 $14,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to meet needs of residents resulting in one resident falling from a third floor window and another wandering from the facility at night Paid in full $14,000.00 4/1/2011
Forsyth Village HAL-034-087 7/18/2013 $12,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure contact with physician regarding two residents with low blood glucose episodes, refusal of medication and inabiltiy to obtain fingerstick blood test due to no glucometer. 4/28/2014 Settlement Agreement for $7,000.00; Appealed 08/09/2013    
Heritage Woods HAL-034-003 11/9/2010 $5,280.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered including failing to administer coumidin Paid in Full $5,280.00 $12/6/2010
Hines Good Samaritan Home FCL-034-077 6/27/2007 $1,770.00 Not corrected Type B 10A NCAC 13G .0405 Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Resident's Rights Four of five staff members providing personal care had not been tested for tuberculosis Paid in Full $1,770.00 1/16/2008
The Homestead HAL-034-032 6/19/2008 $9,240.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Resident did not receive insulin medication as ordered; facility continued with medication problem for extended period Paid in Full $9,240.00 6/30/2008
NaRu Family Care Home #1 (6) FCL-034-071 11/1/2007 $1,000.00 Type A 10A NCAC 13G .0317 (d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in safe range for resident use Paid in Full $1,000.00 12/28/2007
Reynolds House (Ownership Change) HAL-034-079 9/15/2011 $16,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision to residents who smoked inside the facility resulting in one resident setting his bed and clothing on fire and resulting in his subsequent death Referred to Controller's Office    
Salem Terrace HAL-034-078 3/14/2012 $9,000.00 & Staff Training Unabated B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct infection control practices to ensure infection control measures were used when obtaining fingerstick blood sugars for six residents Paid in Full Training Completed 5/16/2012; Payment Plan by Controller's Office for Partial pmt. of $1,121.02 $10,089.12 12/14/2012 11/21/2012 10/23/2012 09/25/2012 09/05/2012 07/17/2012 06/15/2012 05/24/2012 04/25/2012
Salem Terrace HAL-034-078 10/22/2009 $8,720.00 Unabated Type B 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to adminster medications and treatments to residents Paid in Full $8,720.00 12/9/2009
Shuler Health Care/Pierce Villa HAL-034-011 9/18/2013 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for health care needs for two residents with low blood glucose levels, medication refusals, and ingestion of a toxic chemical Paid in Full $2,000.00 10/2/2013

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Franklin County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Alston Family Care Home FCL-035-008 07/14/2006 $2,040.00 Not corrected Type B 10A NCAC 13G .0405 Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights Personal care staff (2) had not been tested for tuberculosis Paid in Full $2,040.00 9/18/2006
Carebridge Assisted Living HAL-035-015 11/16/2011 $7,000.00 Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free of mental and physical/sexual abuse Paid in Full $7,000.00 2/6/2012
Louisburg Gardens HAL-035-013 6/27/2007 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to provide supervision in accordance to assessed needs and current symptoms for three residents exhibiting aggressive or sexually inappropriate behaviors Settlement Agreement 09/05/2007 Combined with Type A & Not corrected Type B Penalties Appealed 07/23/2007 Training Completed $3,250.00 12/26/2007
Louisburg Gardens HAL-035-013 5/7/2007 $2,300.00 Not corrected Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure four of four residents received timely referral and follow-up for health care needs due to facility not informing practitioners or providing necessary information to ensure services provided Settlement Agreement 09/05/2007 Combined with Type A & Not corrected Type B Penalties Appealed 05/16/2007 Training Completed $3,250.00 12/26/2007

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Gaston County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Country Time Inn HAL-036-018 5/3/2007 $4,000.00 Rescind
Type A Violation
Type A
10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in a safe range for use by residents Training Completed 3/20/08; Settlement Agreement 1/24/08 Training Appealed 05/25/2007    
Gaston Manor HAL-036-012 9/15/2011 $10,000.00 & $2,000.00 Staff Training Type A 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications to two residents resulting in recurrent gastrointestinal bleeding and hospitalization for one resident Training Completed 11/21/2011; Paid in Full $10,000.00 10/5/2011
Gaston Place HAL-036-015 3/19/2014 $4,000.00 Type A1 & A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure residents were free of neglect by the failure of providing the services necessary to maintain physical health for one resident resulting in the decline of the resident's health and hospitalization Paid in Full $4,000.00 4/24/2014
Gaston Place HAL-036-015 3/18/2009 $2,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility utilized code alert guards on confused residents but failed to ensure they were put on and/or operational Paid in Full $2,000.00 3/31/2009
Gaston Place HAL-036-015 7/16/2009 $4,000.00 Type A 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to document administration of the amount of insulin administered when the resident required sliding scale insulin and notify the physician as ordered Paid in Full $4,000.00 8/4/2009
Morningside of Gastonia HAL-036-019 6/19/2013 $14,000.00 Type A1 10A NCAC 13F .0311 (a) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure windows in the Special Care Unit were maintained in safe and operating condition resulting in the death of one resident Paid in Full $14,000.00 7/9/2013
Moses Manor Inc. HAL-036-001 1/12/2007 $55.00 Not corrected Type B 10A NCAC 13F .0406 Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Resident Rights Personal care staff (5) had not been tested for tuberculosis Referred to Controller's Office    
Rosewood Assisted Living (penalty #1) HAL-036-004 10/22/2009 $4,050.00 Unabated Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents whose behavior put themselves and others at substantial risk for serious physical harm or death Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 $4,500.00 11/19/2010
Rosewood Assisted Living (penalty #2) HAL-036-004 10/22/2009 $2,000.00 Type A G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure smoking did not occur inside facility Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 $4,500.00 11/19/2010
Rosewood Assisted Living (penalty #3) HAL-036-004 10/22/2009 $7,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up to address five residents needs including behavior changes, wound care, antibiotic therapy, refusal of medication and use of anti-embolism hose. Paid in Full; Settlement Agreement 9/1/2010 in conjunction with penalty #2 and #3 for $4,500.00; Appealed 11/25/2009 $4,500.00 11/19/2010
Rosewood Assisted Living HAL-036-004 12/18/2008 $20,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision in accordance to needs and current behaviors for four residents exhibiting behaviors harmful to themselves or others including sexually inappropriate behaviors Paid in Full Settlement Agreement 6/3/09 Appealed 1/16/09 $3,000.00 6/23/2009
Rosewood Assisted Living HAL-036-004 5/14/2008 $3,240.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered; continued problems with ensuring finger stick blood sugars were taken as ordered and as result insulin not administered as ordered Paid in Full $3,240.00 07/11/2008
Somerset Court of Cherryville HAL-036-017 5/20/2010 $12,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide smoking supervision to a resident identified with unsafe smoking behavior. Reident suffered burns requiring hospitalization Paid in Full $12,000.00 6/29/2010
South Haven Long Term HAL-036-005 5/11/2007 $3,060.00 Not corrected Type B 10A NCAC 13F .0407(a)(2) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Resident's Rights Facility unable to effectively execute procedures in response to fire drill Paid in Full $3,060.00 1/3/2008
Trinity Manor (Facility Closed) FCL-036-028 9/15/2011 $4,500.00 Type A 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure three residents were free from verbal and physical abuse and neglect Referred to Controller's Office    
Wellington House HAL-036-031 3/19/2014 $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 a resident received medication as ordered resulting in resident's hospitalization Appealed 4/15/2014    
Woodlawn Haven HAL-036-006 9/18/2013 $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 supervision for two residents whose current symptoms and assessed needs required increased supervision, related to falls to prevent serious injury Paid in Field $4,000.00 1/14/2014

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Gates County

None of the facilities in Gates County have received a penalty since January 2006.

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Graham County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
R&M Family Care Home FCL-038-004 01/12/2006 $1,000.00 Type A 10A NCAC 13G .0801 (c)(d) Resident Assessment; 13G .1002(a) Medication Orders; 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered. Medications orders were not clarified. Resident assessment was not completed when a significant change in condition occurred. Paid in Full $1,000.00 3/24/2006

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Granville County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Heritage Meadows Long Term Care Facility HAL-039-001 5/19/2011 $2,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide monitoring and supervision for three residents who demonstrated the need for increased supervision in the facility with smoking Paid in full $2,000.00 6/16/2011
Toney Rest Home Inc. HAL-039-005 7/21/2011 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to ensure safety of resident known to wander Training Completed   9/26/2011

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Greene County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Cedar Grove Assisted Living FCL-040-005 2/17/2009 $500.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide necessary supervision to prevent one resident with a history of wandering from leaving the facility on two occasions requiring law enforcement to locate the resident Paid in Full Referred to Controllers' Office $609.15 1/14/2011

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Guilford County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Bennett's Family Care Home #2 FCL-041-029 9/13/2010 $10,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility allowed an incompetent resident to regularly leave the facility without supervision. Resident was found dead Paid in Full $11,041.67 1/24/2011
Carriage House Senior Living Community (Penalty #1) HAL-041-065 5/19/2011 $3,480.00 Unabated Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered Paid in Full $3,480.00 6/1/2011
Carriage House Senior Living Community (Penalty #2) HAL-041-065 5/19/2011 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident residing on the Memory Care Unit resulting in burns from prolonged sun exposure with failure to ensure physician notification and emergency medical care; for three residents failed to ensure referral and follow-up regarding lab testing, missed medications or blood sugar values outside parameters as ordered Paid in Full $4,000.00 6/1/2011
Clare Bridge at High Point HAL-041-033 6/19/2008 $3,300.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S.131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered Paid in Full $3,300.00 7/9/2008
Davis Rest Home #2 FCL-041-008 10/22/2009 $1,000.00 Type A 10A NCAC 13G .0317(d) Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to monitor and maintain safe water temperatures. Hot water temperatures were at 140 degrees Paid in Full $1,000.00 1/11/2010
Elm Villa HAL-041-045 1/16/2013 $4,000.00 Type A1 & Type A2 10A NCAC 13F .0902(b) Health Care: 10A NCAC 13F .0702(f) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to protect residents from the physically aggressive behavior of another resident Paid in Full; Payment Plan by Controller's Office $4,452.53 09/10/2013 08/12/2013 07/15/2013 06/18/2013 05/09/2013 04/23/2013
Friendship Care Assisted Living HAL-041-002 1/18/2008 $5,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration Due to lack of payment, ordered medications were not obtained nor administered to 4 residents; physican was not notified of failure to obtain/adminster ordered medications Settlement Agreement 01/17/2008
$5000.00
Paid in Full
$5000.00 2/21/2008
Friendship Care Assisted living HAL-041-002 1/5/2007 $2,640.00 Not corrected Type B 10A NCAC 13F .0403 Qualifications of Medication Staff G.S. 131D-21 (2) Declaration of Residents' Rights Two Staff administering medications had not completed the clinical skills validation prior to administration of medications. Paid in Full $2,899.98 12/4/2007
Friendship Care Assisted Living HAL-041-002 11/17/2006 $12,000.00 Type A 10A NCAC 13F .1004(a) Medication Administration; 13F .0505 Training on Care of Diabetic Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Staff administering insulin were not trained on diabetic care prior to administering insulin. Two residents did not receive insulin as ordered. Paid in Full $12,000.00 1/23/2007
Friendship Care Assisted Living HAL-041-002 10/24/2006 $5,120.00 Not corrected Type B 10A NCAC 13F.1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Resident did not receive medications as ordered. Paid in Full $5,120.00 1/4/2007
Friendship Care Assisted Living HAL-041-002 08/22/2006 $3,920.00 Not corrected Type B 10A NCAC 13F .0703 Tuberculosis Test, Medical Examination and Immunizations; 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Residents were not being tested for tuberculosis; medications were not administered as ordered Paid in Full $3,920.00 1/17/2007
Friendship Care Assisted Living HAL-041-002 07/14/2006 $12,000.00 Type A 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Staff failed to protect residents from physical abuse. Paid in Full $12,000.00 1/4/2007
Greensboro Living Center (penalty #1) (Now Wellington Oaks) HAL-041-072 12/19/2013 $18,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure physician notification for three residents one with head injury resulting in resident's death, inappropriate combative behaviors of one resident towards other residents, and failure to obtain stool culture, bone scan, chest x-ray and EKG as ordered for a resident Appealed 8/27/2013    
Greensboro Living Center (penalty #2) (Now Wellington Oaks) HAL-041-072 12/19/2013 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; Facility failed to assure residents were free from neglect with one resident exhibiting combative and aggressive behaviors towards residents and staff including hitting one resident resulting in a knot on the head and a black eye Appealed 8/27/2013    
Greensboro Living Center (penalty #3) (Now Wellington Oaks) HAL-041-072 12/19/2013 $70,500.00 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 for five residents observed during medication pass including errors with insulin and medications for mood disorders, hypothyroidism and Alzheimer's dementia Appealed 8/27/2013    
Greensboro Living Center (penalty #1) HAL-041-061 7/15/2010 $4,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-4.4 (b)(c) Prohibit Smoking in LTC Facilities; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to supervise resident known to be noncompliant to smoking rules with resident routinely smoking in his room Paid in Full $4,000.00 10/1/2010
Greensboro Living Center (penalty #2) HAL-041-061 7/15/2010 $7,120.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered to five of five sampled residents Paid in Full $7,120.00 10/1/2010
Loyalton of Greensboro (Name Change to Emeritus of Greensboro) HAL-041-049 11/16/2011 $16,000.00 Type A 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision based on assessed needs and behaviors for seven residents with eloping and wandering behaviors, smoking while using oxygen or experiencing falls. Facility failed to assure all exit doors accessible by residents with disorientation, wandering and elopement behaviors were equipped with a sounding device that activated when the door was opened Paid in Full $16,000.00 12/5/2011
Loyalton of Greensboro HAL-041-049 3/18/2010 $3,600.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered. Paid in Full $3,600.00 4/12/2010
Morningview in Greensboro (Name change to Morningview at Irving Park) HAL-041-052 7/21/2011 $7,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the referral and follow-up to meet acute health care needs of residents, one regarding elevated blood sugars and one resident with foot wound and decline in functional status Paid in Full $7,000.00 8/11/2011
Piedmont Christian Home HAL-041-010 9/6/2006 $12,000.00 Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; 13F .0902(b) Health Care; 13F .0909 Residents Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Interventions and safety was not provided for a resident with multiple falls when using a Meri-Walker ambulation device Appealed 10/16/06
Settlement Agreement 6/19/2007
$5,000.00 Training Completed 07/11/2007 6/19/2007
The Shannon Gray Rehabilitation & Recovery Center NH0627 11/12/10 $10,000 Type A 10A NCAC 13D .2305(a) Quality of Care G.S. 131E-117. Declaration of patient's rights. Facility failed to assess, monitor, and implement interventions for an unresponsive resident with low blood. Paid $10,000 12/1/2010
St. Gales Estates, Inc HAL-041-023 2/17/2010 $17,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications including insulin and coumidin as ordered for 6 of 8 residents resulting in one resident being found unresponsive on two occasions requiring hospitalization. Paid in Full $17,000.00 3/31/2010
St. Gales Estates, Inc. HAL-041-023 11/17/2006 $7,500.00 Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .1212(e) Reporting of Accidents and Incidents; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to keep all door alarms on to alert staff of residents' exiting building. Resident wandered from facility and was struck by automobile. Resident suffered fractures Paid in Full $7,500.00 12/20/2006
Wesleyan Arms Retirement Center HAL-041-047 5/20/2010 $16,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide medications and/or implement treatments as ordered and failed to notify physician of acute health care needs Training completed 7/28/2011; Paid in Full; 6/16/2011 Settlement Agreement $12,000.00 ($2,000.00 for training and $10,000.00 payable) Appealed 06/11/2010 $10,000.00 7/12/2011

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Halifax County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
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      

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Harnett County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Core Family Care (Change of Ownership) HAL-043-001 11/16/2011 $14,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident who needed one on one supervision when eating resulting in the resident's death Paid in Full; Partial Payment of $500.00; 3/28/12 Settlement Agreement for $5,000.00; Appealed 12/15/2011 $5,000.00 01/11/2013 12/05/2012 11/15/2012 10/03/2012 09/06/2012 06/28/2012 06/07/2012 05/08/2012
Core Family Care, Inc. HAL-043-001 12/16/2009 $4,410.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered including documenting administration of medications not obtained or available for administration. Paid in Full $4,410.00 2/22/2010
Core Family Care, Inc. HAL-043-001 1/16/2008 $5,700.00 Not corrected Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2)Declaration of Residents' Rights Medications including insulin were not administered as ordered Paid in Full $5,700.00 3/19/2008
Green Leaf Care Center HAL-043-027 10/16/2013 $14,000.00 Type A1 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide immediate referral or contact with physician to meet the acute health care needs of one resident with changes in physical and mental condition subsequently resulting in death Paid in Full $14,000.00 1/6/2014
Oak Hill Living Center HAL-043-015 5/15/2008 $7,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide residents with follow-up and referrals for routine and acute health care needs including high blood sugars, weight loss, and pain Paid in Full $7,000.00 6/25/2008
Oak Hill Living Center HAL-043-015 5/15/2008 $3,350.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered including insulin Paid in Full $3,350.00 6/25/2008
Oak Hill Living Center HAL-043-015 3/20/2008 $4,000.00 Type A 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to serve 5 of 8 residents therapeutic diets and thickened liquids as ordered Paid in Full;
Referred to Controller's Office
$4,446.64 10/21/2008
Pinecrest Gardens HAL-043-022 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 Appealed 4/29/2014    
Pinecrest Gardens (penalty #1) HAL-043-022 5/16/2013 $10,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; Facility failed to assure every resident was free of mental and physical abuse and neglect for three residents who alleged sexual assault by an employee. Paid in Full; Payment Plan Partial pmt. $10,000.00 12/06/2013 10/01/2013 08/19/2013 08/13/2013 08/06/2013
Pinecrest Gardens (penalty #2) HAL-043-022 5/16/2013 $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 sexual assault to the Health Care Personnel Registry (HCPR) within 24 hours when allegations were reported by residents and failed to protect residents by not investigating allegations reported by residents against a staff person Paid in Full $4,000.00 12/6/2013
Pinecrest Gardens HAL-043-022 6/19/2008 $3,500.00 Type B Unabated 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to serve residents ordered therapeutic diets Paid in Full Appealed 07/18/2008 $3,500.00 8/18/2008
Pinecrest Gardens of Lillington HAL-043-012 8/27/2007 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Resident's Rights Facility failed to supervise smoking activities of resident with dementia residing in the facility's locked unit. Resident had previously had a fire in her bathroom. Training Completed   10/10/2007
Primrose Villa Retirement II HAL-043-013 9/13/2010 $1,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervsion to resident to ensure resident with history of elopement did not leave the building unsupervised Paid in Full $1,000.00 12/13/2010
Primrose Villa Retirement III (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      
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      
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      
Primrose Villa Retirement III HAL-043-017 11/20/2013 $2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician regarding non-compliance with fingerstick testing , low and high blood glucose readings, and unavailability of medications for one diabetic resident      
Primrose Villa Retirement III HAL-043-017 4/16/2009 $2,000.00 Type A G.S. 131D-4.4 Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure residents did not smoke in the facility. Residents smoked in their bedrooms. Paid in Full Referred to Controllers' Office $2,000.00 12/13/2010
Primrose Villa Retirement III HAL-043-017 9/13/2010 $1,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to resident with unsafe smoking behavior Paid in Full $1,000.00 12/13/2010
Primrose Villa Retirement IV HAL-043-019 1/27/2010 $18,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and set door alarms to ensure resident with dementia did not leave the facility unsupervised. Resident wandered from building and suffered a fatal fall. Referred to Controllers' Office    
Primrose Villa Retirement IV HAL-043-019 3/20/2008 $1,080.00 Type B Unabated 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in safe range for use in resident and community baths Paid in Full $1,080.00 6/30/2008
United Familly Care 1 FCL-043-023 5/16/2013 $6,000.00 Type A1 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide acute health care for a resident who presented aggressisve/assaultive behavior Appealed 06/11/2013    

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Haywood County

None of the facilities in Haywood County have received a penalty since January 2006.

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Henderson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Cardinal Care Center - Hendersonville (Penalty #1) HAL-045-001 7/21/2011 $4,000.00 Type A 10A NCAC 13F .0406(a) Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure employees were tested for TB prior to employment resulting in one staff working with active TB Paid in Full $4,500.00 5/9/2012
Cardinal Care Center - Hendersonville (Penalty #2) HAL-045-001 7/21/2011 $55,000.00 & $5,000.00 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for 6 of 11 sampled residents assessed at risk for falls resulting in 4 of 6 residents suffering fractures from falls 11/09/2012 Training Completed; Paid in Full; Partial pmt. of $6,000.00; 03/27/2012 Settlement Agreement for $18,000.00 & Training; Appealed 07/29/2011 $18,000.00 09/04/2012 07/02/2012 04/04/2012
Cardinal Care Center- Hendersonville HAL-045-001 9/13/2010 $20,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and implement measures to reduce falls Paid in Full $20,000.00 10/21/2010
Cherry Springs Village HAL-045-099 6/19/2008 $4,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered; resident did not receive coumadin as ordered Paid in Full 10/28/2009 Settlement Agreement $3,000.00 & Training; Appealed 07/18/208 Training Completed & $2000.00 12/7/2009
Druid Hills Living Center #2 HAL-045-071 2/17/2010 $14,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident with mild dementia who utilized a walker and was at risk for falls who left the facility during evening hours during snow and icy weather conditions to travel on foot with a walker to obtain cigarettes. Access to the store required crossing a five lane intersection. She was struck by a vehicle and killed. Paid in Full; 1/18/2012 Settlement Agreement $1,000.00; Appealed 03/18/2010 $1,000.00 1/18/2012
Mountain View Assisted Living HAL-045-015 9/16/2008 $16,000.00 Type A 10A NCAC 13F .0604 Personal Care and Other Sfaffing; 10A NCAC 13F .1005 Self-Administration of Medications Residents were provided medication ahead of scheduled adminstration times and directed to self administer to relieve facility from staffing medication aide. Resident with history of suicide attempts utilized medication to commit suicide. Paid in Full Settlement Agreement 10/14/09 $6,000.00 partial pmts. & Training; Appealed 10/13/2008 Training Completed 11/11/2009 Total paid $5,000.00 - received $1,000.00 each date 01/27/2010 12/17/2009 11/15/2009 10/29/2009 10/05/2009

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Hertford County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Pinewood Manor HAL-046-019 1/15/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident with exit seeking behaviors who eloped from a window in the special care unit Paid in Full $1,000.00 1/21/2014
Twin Oaks Rest Home HAL-046-002 Proposal #1 4/5/2007 $810.00 Not corrected Type B 10A NCAC 13F .0407 (a) (5) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Healthcare registry verifications were not conducted for six staff Paid in Full $810.00 8/30/2007
Twin Oaks Rest Home HAL-046-002 Proposal #2 4/5/2007 $810.00 Not corrected Type B 10A NCAC 13F .0407 (a) (7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background checks were not conducted for five staff Paid in Full $810.00 8/30/2007
Twin Oaks Rest Home HAL-046-002 Proposal #3 4/5/2007 $810.00 Not corrected Type B 10A NCAC 13F .0406 (a) Test for Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights Five of seven staff did not have tuberculois tests Paid in Full $810.00 8/30/2007
Twin Oaks Rest Home HAL-046-002 Proposal #4 4/5/2007 $1,080.00 Not corrected Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered for 7 of 8 residents Paid in Full $1,080.00 8/30/2007

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Hoke County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Open Arms Retirement Center HAL-047-003 1/30/2007 $5,250.00 Not corrected Type B 10A NCAC 13F .0406 (a) Test for Tuberculosis; 10A NCAC 13F .0504 (a) Competency Validation for Licensed Health Professional Support Task; G.S. 131D-21 (2) Declaration of Residents' Rights Three of 13 staff did not have tuberculosis test; ten of 13 staff were not competency validated before providing licensed health professional tasks such as oxygen administration, changing dressings, catheter care, using hoyer lift, and other services Paid in Full; Settlement Agreement 3/13/08; Appealed 3/2/07 $3,000.00 7/28/2009
Raeford Manor (Facility Closed) HAL-047-007 1/3/2011 $2,000.00 Type A 10A NCAC 13F .0702 Discharge of Residents; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents with exit- seeking behaviors and noncompliance to the facility's smoking policy Paid in Full; 09/05/2013 Settlement Agreement; Referred to Controller's Office $2,441.67 10/2/2013
Raeford Manor HAL-047-004 7/16/2009 $2,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide Supervision to a resident known to wander Paid in Full $2,000.00 8/21/2009
Raeford Manor HAL-047-004 9/16/2008 $1,890.00 Not corrected Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Medication (insulin) was not administered as ordered. Four of four staff were not able to calculate correct dose as ordered. Paid in Full $1,890.00 11/19/2008

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Hyde County

None of the facilities in Hyde County have received a penalty since January 2006.

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Iredell County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Aurora of Statesville HAL-049-028 12/19/2013 $10,600.00 Type Unabated B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for two residents related to physical therapy and obtaining labs and chest x-ray Referred to Controller's Office    
Aurora of Statesville HAL-049-028 11/16/2011 $12,000.00 Type A 10A NCAC 13F .0305(h)(4) Physical Environment; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure all exit doors accessible by residents with disorientation, wandering and elopement behaviors were equipped with a sounding device or had an audible alarm resulting in two residents exiting into stairwell and experiencing serious injury. Facility failed to provide supervision based on assessed needs and behaviors for three residents with one experiencing increased falls, one resident who eloped and experienced hypothermia and one resident with suicidal behaviors who experienced physical injury Paid in Full Payment Plan by Controller's Office for Partial pmt. of $1,123.51 $13,482.49 12/14/2012 11/21/2012 10/23/2012 9/25/2012 9/05/2012 7/17/2012 6/15/2012 5/24/2012 4/20/2012 3/26/2012 2/17/2012 2/1/2012
The Churchill Senior Living Community HAL-049-025 10/22/2009 Staff Training Unabated Type B 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service- Therapeautic Diets; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to serve therapeutic diets to four residents on the special care unit ensuing the food form, portions, and food selections were as ordered by the physician. Training Completed   12/18/2009
The Clare Bridge at Statesville Place HAL-049-021 10/16/2013 $7,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and assure referral and follow-up for one resident related to multiple falls, occupational therapy, recommendation for radiology tests, physician visits and increased level of care Paid in Full $7,000.00 11/8/2013
Emertus at Churchill HAL-049-029 12/19/2013 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for three residents with frequent falls in accordance with each resident's assessed needs, care plan and current symptoms Paid in Full $4,000.00 1/7/2014
Olin Village HAL-049-016 8/9/2013 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide appropriate supervision to one resident with a history of elopement Paid in Full $1,000.00 8/19/2013
Summit Place of Mooresville HAL-049-024 5/20/2010 $16,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .1304 (8) Special Care Unit Building Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident residing on the Alzheimer's special care unit when the facility and courtyard doors were left open. Resident wandered outside the secure area and was deceased when found Paid in Full $16,000.00 7/16/2010

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Jackson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
The Hermitage HAL-050-017 9/15/2011 $4,000.00 & $3,000.00 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to 3 of 7 residents assessed at risk for falls resulting in fractures and/or hospital treatment Paid in Full; 11/15/2013 Settlement Agreement for $2,500.00; Appealed 10/10/2011 $2,500.00 12/4/2013

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Johnston County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Cardinal Care Assisted Living HAL-051-030 9/26/2007 Staff Training Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to clarify orders with physician which resulted in resident not receiving insulin as ordered Training Completed   12/23/2007
Cardinal Care Assisted Living Village #2 HAL-051-032 11/19/2007 $3,600.00 Not corrected Type B 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise resident's smoking behavior. Resident smoked in his room Paid in Full $3,600.00 1/17/2008
Clayton House HAL-051-028 6/27/2007 $5,360.00 Not corrected Type B 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Resident's Rights Medications were not administered as ordered for 7 of 16 residents Paid in Full Settlement Agreement 4/4/08;
Appealed 7/27/07
$3,280.00 05/07/2008
Four Oaks Assisted Living HAL-051-026 9/26/2007 $7,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to supervise the smoking activities of residents whose behavior demonstrated the need for increased supervision Paid in Full $7,000.00 11/28/2007
Front Street Family Care Home FCL-051-017 02/14/2006 $2,000.00 Type A 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Medication not administered as ordered for one resident Paid in Full $2,000.00 4/28/2006
Smithfield House West HAL-051-042 3/19/2014 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral was made for four residents to meet their acute health care needs related to notifying physician of missed doses and unavailable medications and failed to assure medications were administered as ordered Paid in Full $2,000.00 5/16/2014
Smithfield House West HAL-051-042 5/16/2013 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights; Facility failed to ensure residents were free of mental and verbal abuse which resulted in personal injury for the resident who exhibited verbally abusive behaviors towards other residents Paid in Full $2,000.00 7/17/2013
Smithfield House West HAL-051-027 12/16/2009 $2,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer sliding scale insulin as ordered to three residents. One resident required hospitalization to address blood sugar levels. Paid in Full; Referred to Controller's Office $2,225.91 9/3/2010

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Jones County

None of the facilities in Jones County have received a penalty since January 2006.

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Lee County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Ashewood Estates Retirement Center (penalty #1) 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      
Ashewood Estates Retirement Center (penalty #2) 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      
Ashewood Estates Retirement Center (penalty #3) 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      
Ashewood Estates Retirement Center (penalty #4) 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      
Ashewood Estates Retirement Center (penalty #5) 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      
Ashewood Estates Retirement Center HAL-053-011 7/18/2013 $2,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision for one resident with a history of falls Paid in Full; 02/10/2014 Settlement Agreement for $1,300.00; Appealed 07/30/2013 $1,300.00 2/27/2014
Ashewood Estates Retirement HAL-053-011 5/14/2008 $16,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement measures to prevent falls; physician notification and medical assessment/treatment was not obtained for resident who fell and those who had acute and routine healthcare needs Paid in Full; Appealed 6/13/08 $17,600.00 12/5/2008
Leaks Family Care FCL-053-013 8/29/2006 Staff Training Not corrected Type B 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents Rights Medications not administered as ordered Training Completed   10/30/2006
Victorian HAL-053-010 1/15/2014 $17,600.00 Unabated B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct and assure medications including medications used for fluid retention, vitamin supplementation, heart disease prevention, anticonvulsant, and depression were administered as ordered for one resident      
Victorian HAL-053-010 7/18/2013 $4,000.00 Type A2 10A NCAC 13F .1008 (a) Controlled Substances; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure an accurate account of controlled drugs for five residents Paid in Full; 02/10/2014 Settlement Agreement for $2,500.00; Appealed 07/30/2013 $2,500.00 2/27/2014
Victorian HAL-053-010 5/20/2010 $10,560.00 Unabated Type B 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G. S. 131D-21 (2) Declaration of Residents' Rights Facility failed to conduct criminal background checks on employees Paid in Full Referred to Controllers' Office; $10,560.00 10/5/2010

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Lenoir County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Trinity Manor of Kinston, Inc. HAL-054-003 11/20/2008 $12,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S 131D-21 (2)(4) Declaration of Residents' Rights Staff failed to refer and seek immediate medical attention for a resident receiving coumidin who was reported to have fallen and presented with an abrasion on his forehead Paid in Full $12,000.00 12/2/2008

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Lincoln County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Boger City Rest Home HAL-055-002 11/15/2012 $12,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for four residents regarding smoking, physical altercations and falls Paid in Full $12,000.00 1/11/2013
Boger City Rest Home HAL-055-002 11/15/2012 $12,000.00 Type A1 10A NCAC 13F .0902(b) Health Care Referral; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet four residents needs regarding burns, falls, refusal of medications and treatments Paid in Full $12,000.00 1/11/2013
Boger City Rest Home HAL-055-002 10/15/2008 $11,440.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications continued to not be administered as ordered including insulin Paid in Full $11,440.00 11/26/2008
Lakewood Care Center HAL-055-003 11/16/2011 $4,000.00 Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure one resident was free of verbal and physical abuse by staff member Paid in Full $4,000.00 1/6/2012

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Macon County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Chestnut Hills of Highland HAL-056-005 11/17/2011 $3,000.00 & Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for residents relative to fire evacuation, exit seeking behaviors, falls and access to hazardous chemicals Training Completed 1/25/2012; Paid in Full $3,000.00 1/17/2012

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Madison County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Hot Springs Family Care Home #1 FCL-057-007 9/19/2012 $5,300.00 Unabated B 10A NCAC 13G .0302(m) Design and Construction; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct and meet sanitation conditions addressing the facility's physical plant, housekeeping, food handling, linen and and furnishings Paid in Full; Referred to Controller's Office $5,852.08 1/3/2013

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Martin County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Vintage Inn (Ownership Change) HAL-058-007 1/21/2011 $16,000.00 Type A 10A NCAC 13F .1501 Use of Physical Restraints & Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physical restraints were not used for convenience, used only after assessment and care planning had been completed, and only after other less restrictive alternatives had been attempted Paid in Full; 5/22/2012 Settlement Agreement $3,000.00; Appealed 2/14/2011 $3,000.00 5/30/2012

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McDowell County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
McDowell House HAL-059-018 12/18/2008 $14,000.00 Type A 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide Supervision to prevent or respond to resident elopement. Resident was found dead having wandered from facility. Settlement Agreement & Training 09/28/2009; Appealed 1/14/09 Training Completed $10,000.00 11/11/2009 11/02/2009

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Mecklenburg County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Charlotte Manor HAL-060-081 3/18/2009 $18,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0702 (b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and provide appropriate discharge to residents involved with illegal substance abuse and physical and verbal violence in the facility Paid in Full 09/23/2011 Settlement Agreement ($18,000.00); Appealed 4/17/09 $18,000.00 10/24/2011
Elliott's Manor #2 FCL-060-092 12/18/2008 $1,720.00 Type B Unabated 10A NCAC 13G .0504 (a) Competency Validation; 10A NCAC 13G .1004 (a) Medication Facility failed to ensure staff were competency validated prior to performing finger stick blood sugars and to administer medication (insulin) as ordered Paid in Full $1,720.00 12/23/2008
Emeritus at Eastover HAL-060-110 3/19/2014 $4,000.00 Type A1 10A NCAC 13F .0902 (b) ( c) (1) Health Care; 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure physician referral and follow-up for one resident requiring medical attention for an unidentified pressure sore Paid in Full $4,000.00 4/2/2014
Helton Manor West Assisted Living (penalty # 1A ) HAL-060-074 4/17/2013 $12,000.00 Unabated Type B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure appropriate care and services were provided for six residents regarding fingerstick blood glocuse testing and infection control procedures Paid in Full $12,000.00 6/12/2013
Helton Manor West Assisted Living (penalty # 1B ) HAL-060-074 4/17/2013 $13,600.00 Unabated Type B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure appropriate care and services were provided for six residents regarding fingerstick blood glocuse testing and infection control procedures Paid in Full $13,600.00 6/12/2013
Helton Manor West Assisted Living (penalty # 2) HAL-060-074 4/17/2013 $9,400.00 Unabated Type B 10A NCAC 13F .0902(b) Health Care: G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure a healthcare referral for four residents related to inappropriate behaviors, x-ray, dermatology consult, refusal of medications, and notification for medication not available for administration. Paid in Full $9,400.00 6/12/2013
Helton Manor West Assisted Living (penalty # 3) HAL-060-074 4/17/2013 $9,400.00 Unabated Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications administered as ordered Paid in Full $9,400.00 6/12/2013
Helton Manor West Assisted Living (penalty # 4) HAL-060-074 4/17/2013 $4,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure a resident was free of physical abuse by a staff member Paid in Full $4,000.00 6/12/2013
Legacy Heights Senior Living Community HAL-060-086 11/19/2007 $12,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medication was not administered as ordered resulting in resident being hospitalized Paid in Full; Referred to Controller's Office $13,499.90 10/21/2008
Oakdale Heights Senior Living HAL-060-062 04/06/2006 $1,000.00 Not corrected Type B 10A NCAC 13F .1004(a) Medication Administration; 13F .0909 Residents Rights; GS 131D-4.4 Adult Care Home Minimum Safety Requirements Rights Medication for one resident not administered as ordered Paid in Full $1,000.00 5/12/2006
The Parc at Sharon Amity HAL-060-103 06/20/2012 $4,000.00 Type A2 10A NCAC 13F .0702 Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to discharge two residents who posed an endangerment to the safety of other residents Penalty Rescinded per Settlement Agreement 09/11/2013; Appealed 07/19/2012    
The Parc at Sharon Amity HAL-060-103 3/17/2011 $10,000.00 Type A 10A NCAC 13F .1004(a)(1)(2) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications administered as ordered. Paid in Full; 09/11/2013 Settlement Agreement for $4,000.00; Appealed 4/8/2011 $4,000.00 10/16/2013
Pray Until Something Happens Assisted Living (Closed) FCL-060-121 10/15/2012 $6,100.00 Unabated B NCAC 13G .1004(j) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct and maintain residents' medication administration records Appealed 12/19/2012    
Pray Until Something Happens Assisted Living (Closed) FCL-060-121 7/16/2012 $1,000.00 Type A2 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain safe water temperatures in all bathrooms utilized by residents      
Regency Retirement Village HAL-060-073 3/18/2009 $7,000.00 Type A 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supevision to confused residents with wandering and elopement behaviors; one resident left the property and was found on state highway Paid in Full $7,000.00 5/14/2009
Regency Retirement Village HAL-060-073 1/23/2008 $6,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medication was not administered as ordered resulting in one resident being hospitalized Paid in Full $6,000.00 3/17/2008
Slay's Rest Home HAL-060-038 8/27/2007 $9,120.00 Not corrected Type B 10A NCAC 13F .0507 Training On Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to to ensure at least one staff on duty at all times who had CPR course. Facility failed to correct noncompliance for 98 days past date given for correction Paid in Full $10,090.00 12/21/2007
Slay's Rest Home HAL-060-038 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
Slay's Rest Home HAL-060-038 8/27/2007 $7,840.00 Not corrected Type B 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Criminal background checks for 4 of 5 staff were not conducted. Facility failed to correct noncompliance for 98 days past date given for correction Paid in Full $8,676/00 12/13/2007
Sunrise On Providence HAL-060-057 6/19/2013 $4,000.00 Type A1 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide care and supervision to one resident with current symptoms of elopement resulting in a fall with injury Paid in Full $4,000.00 7/22/2013
Sunrise On Providence HAL-060-057 3/14/2012 $1,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident with dementia who resided on the secure dementia unit who was found several miles from the facility Paid in Full $1,000.00 3/28/2012
Weddington Park HAL-060-042 7/21/2011 $1,000.00 Type A 10A NCAN 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to follow physician order to reduce Coumadin dosage resulting in resident requiring emergency room treatment Paid in Full $1,000.00 8/17/2011
Willow Ridge Assisted Living HAL-060-070 6/2/2006 $2,500.00 Type A 10A NCAC 13F .0906(f) (3)(4) Other Resident Care and Services; 13F .0901(b)(c) Personal Care and Supervision; 13F .1211(a)(6) Written Policies and Procedures; 13F .0802 (a)(f) Resident Care Plan; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Care not planned and resident not supervised; resident failed to return to facility and law enforcment not notified timely Paid in Full $2,500.00 1/8/2007

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Mitchell County

None of the facilities in Mitchell County have received a penalty since January 2006.

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Montgomery County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Evans Rest Home (name change - Tillery Chase ACH) HAL-062-004 2/21/2008 $16,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Resident Rights Facility failed to enforce no smoking policy when resident noncompliant; fire occurred resulting in evacuation of building and rolcation of 53 residents with two requiring medical treatment Paid In Full Referred to Controller's Office $18,346.24 11/4/2008
Tillery Chase Adult Care Home (penalty #1) Closed 9/2013 HAL-062-004 3/20/2013 $4,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up for three of five residents who experienced pressure sores, skin tears, falls and weight loss      
Tillery Chase Adult Care Home (penalty #2) Closed 9/2013 HAL-062-004 3/20/2013 $30,750.00 Unabated Type A2 10A NCAC 13F .0902(b) Health Care Referral and Follow-up; G.S. 131D-21 (4) Declaration of Residents' Rights-Neglect; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare follow-up and referral for four of five residents who experienced aggressive behaviors, decline in health, need for eye glasses, medication refusal and unreal perceptions      
Tillery Chase Adult Care Home HAL-062-004 7/16/2012 $8,800.00 Unabated B 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 Declaration of Residents' Rights Facility failed to correct infection control practices when they failed to assure staff implemented infection control measures for four of four residents when staff shared and failed to clean blood testing devices Paid in Full $8,800.00 9/12/2012
Tillery Chase Adult Care Home HAL-062-004 11/16/2011 $2,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to obtain a psychiatric consultation as ordered and physician was notified of resident's inappropriate behavior Paid in Full $2,000.00 12/7/2011
Tillery Chase Adult Care Home HAL-062-004 7/15/2010 $3,240.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications including insulin as ordered Paid in Full $3,240.00 9/7/2010

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Moore County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Magnolia Gardens HAL-063-007 7/18/2013 $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 to two residents who exhibited confusion and disorientation Paid in Full $7,000.00 9/3/2013
Magnolia Gardens HAL-063-007 2/17/2010 $2,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications including sliding scale insulin to residents as ordered by their physician Paid in Full $2,000.00 3/26/2010
Magnolia Gardens of Southern Pines, LLC HAL-063-007 9/16/2008 $7,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify md of resident's low blood sugar. Resident became unresponsive, fell and suffered facial fracture Paid in Full Settlement Agreement & Training 6/06/2009 Appealed 10/15/08 Training Completed; $4,000.00 08/28/2009 06/09/2009
Michael Lane Alternative House FCL-063-018 9/16/2008 $1,740.00 Not corrected Type B 10A NCAC 13G .0403 Qualification of Medication Staff; G.S. 131D-21(2) Declaration of Residents' Rights Two of four staff were not clinically validated to administer medications prior to administering medications. Residents experienced medication errors. Paid in Full $1,954.58 1/5/2009
Penick Village NH-0127 11/15/2012 $14,000 Type A1 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 Declaration of Residents' Rights Facility failed to initiate emergency medical services, call 911 immediately and perform cardiopulmonary resuscitation for a resident who was a full code. Invoiced $14,000 $14,000 12/11/2012
Seven Lakes Assisted Living HAL-063-023 3/19/2014 $4,000.00 Type A2 10A NCAC 13F .0904 (e) (4) Nutrition and Food Service; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to serve the appropriate foods for one resident with orders for a pureed diet and nectar-thickened liquids Appealed 04/15/2014    
Seven Lakes Assisted Living HAL-063-023 9/18/2013 $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 physical and mental abuse caused by another resident Appealed 01/13/2014; Paid in Full $4,416.67 12/30/2013
Seven Lakes HAL-063-023 7/16/2012 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision for one resident residing in the special care unit from eloping on several occasions Paid in full; 11/06/2013 Settlement Agreement for $1,000.00; Appealed 08/13/2012 $1,000.00 12/4/2013
Southern Pines Manor HAL-063-012 11/15/2006 $1,000.00 Type A 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Hot water temperatures were not maintained in safe range for use in 3 resident rooms and both community bath areas Appealed 11/27/06 Paid in Full
10/5/07
$1000.00 10/5/2007
Tara Plantation of Carthage HAL-063-011 5/16/2013 $4,000.00 Type A1 & Type A2 10A NCAC 13F .0901 (a)(b) Personal Care & Supervision; 10A NCAC 13F .1305 (5) Special Care Unit Policies and Procedures; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to provide adequate supervision and implement policies and procedures that address safety measures for a resident experiencing multiple falls which resulted in injuries and bruises Appealed 06/18/2013    
Tara Plantation of Carthage HAL-063-011 11/16/2012 $2,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident with dementia while in the facility's courtyard Appealed 12/14/2012    
Tara Plantation of Carthage HAL-063-011 11/20/2008 $14.000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility staff failed to ensure health care referral and follow-up for two residents: one who was administered the wrong medication; the other experiencing skin breakdown Paid in Full 1/12/2010 Settlement Agreement & Training Appealed 12/18/08 $4,000.00 2/4/2010
Zeno Villa at St. Joseph of the Pines FCL-063-025 9/18/2013 $1,000.00 Type A2 10A NCAC 13F .0902(b) Health Care: G.S. 131D-21 (2) Declaration of Residents' Rights Facility did not provide adequate supervision and personal care for two residents who exhibited wandering, aggressive and agitated behaviors Paid in Full $1,000.00 11/12/2013

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Nash County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
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      
Universal Healthcare/ Nashville NH0500 1/25/2011 $2,000 Type A 10A-13D.2208 (e) Safety G.S. 131E-117. Declaration of patient's rights. Facility failed to prevent a cognitively impaired resident who was identified by the facility with exit seeking behavior from leaving the facility unsupervised. The resident was found by a passing driver across the street from the facility unsupervised. Paid $2,000 2/8/2011

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New Hanover County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Champions Assisted Living HAL-065-020 3/20/2008 $2,000.00 Type A 10A NCAC 13F .0306 (a)(5) Housekeeping & Furnishings; G.S. 131D-21 (2) Declaration of Residents' Rights Disoriented resident fell in unsecured, unoccupied room being renovated Paid in Full $2,000.00 4/14/2008
Champions Assisted Living HAL-065-020 2/27/2007 $4,000.00 Type A 10A NCAC 13F .0901 (B) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Two confused residents wandered from facility. System to supervise residents not implemented. Paid in Full Appealed 3/13/07 $4,000.00 4/20/2007
Clare Bridge of Wilmington HAL-065-019 1/15/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to have supervision in place when one resident exited the building when the Special Care units doors locks were disalarmed during routine emergency system testing      
Clare Bridge of Wilmington HAL-065-019 5/19/2011 Staff Training Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to prevent the elopement of two residents residing on the special care unit Training Completed   7/12/2011
The Commons at Brightmore HAL-065-002 1/16/2013 $20,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; 10A NCAC 13F .1501(a)(2) Use of Physical Restraints and Alternatives; G.S. 131D-21 Declaration of Residents' Rights Facility failed to provide supervision to residents at risk for falls and failed to assure physical restraints (bed rails) were used only with physican order following resident assessment and care planning resulting in resident death and injury Paid in Full $20,000.00 2/8/2013
GlenCare of Wilmington (Ownership Change) HAL-065-030 3/17/2011 $7,000.00 Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility neglected to assure the rights of residents were maintained by their failure to investgate causes of residents' bruising in relation to the potential of abuse and the monitoring of weights to address recorded weight losses for accuracy or need for referral Paid in Full Partial pmt. $3,500.00 $3,500.00 05/11/2011 04/07/2011
GlenCare of Wilmington HAL-065-030 12/16/2009 $2,000.00 Type A Reduced to Type B 10A NCAC 13F .0407(a)(5) Other Staff Qualifications; 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision and health care referral and follow-up to meet the needs of residents on the Special Care Unit. Facility failed to ensure that they did not employ staff who had substantiated findings on the NC Health Care Personnel Registry Paid in Full; 6/16/2011 Settlement Agreement resulting in change in noncompliance from a Type A to a Type B violation and $2,000.00 fine; Appealed 1/14/2010 $2,000.00 8/1/2011
Hermitage House HAL-065-034 3/19/2014 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure six residents were free from abuse who were hit or harmed by other residents or an outside provider Appealed 04/16/2014    
Hermitage House HAL-065-034 12/19/2013 $2,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for three residents, two with facial brusing with one experiencing falls and one who removed physical restraints Appealed 01/16/2014    
Hermitage House Rest Home HAL-065-001 5/19/2010 $4,000.00 Type A 10A NCAC 13F .0311 (d) Other Requirements (Hot Water Temperature); G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain hot water temperatures within a safe range for resident use Paid in Full $4,000.00 6/24/2010
Jasmine Cove Assisted Living HAL-065-022 1/9/2007 $4,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to obtain medication order and administer insulin as needed requiring resident to be hospitalized; additionally, failed to administer insulin and other medications as ordered for other residents Referred to Controller's Office    
Jasmine Cove Assisted Living HAL-065-022 08/25/2006 $2,500.00 Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident reported intent to leave, left unsupervised, resident found on busy roadway Paid in Full $2,500.00 1/5/2007
Lowe's Family Care Home #3 FCL-065-011 1/21/2010 $6,680.00 Unabated Type B 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide residents health care referral and follow-up to needs including elevated blood pressures and orders for physical therapy, speech therapy, range-of-motion, and labwork Appealed 2/18/2010    
Lowe's Family Care Home #3 FCL-065-011 10/22/2009 $3,000.00 Unabated Type B 10A NCAC 13G .0318 Outside Premises; 10A NCAC 13G .0901 (a) Personal Care & Supervision; 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure 3 residents received personal care and referral and follow-up regarding physician orders for 2 residents. Outside premises were not maintained due to lack of addressing presence of animal waste Appealed 11/20/2009    
Lowes Family Care Home #3 FCL-065-011 2/21/2008 $2,000.00 Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to send resident for medical assessment after fall; resident later determined to have fractures OAH Decision Rescind 3/30/2009 Appealed 3/21/08;    
Lowes Family Care Home #3 FCL-065-011 08/27/2007 $1,000.00 Type A 10A NCAC 13G .0901 Personal Care and Supervision; 10A NCAC 13G .0312 Outside Entrance and Exits; G.S. 131D-21 (2)Declaration of Resident's Rights Confused resident wandered from facility without staff knowledge of absence. Door alarm was turned down and not audible at time of elopement. Paid in Full $2,500.00 1/5/2007
Oakdale Heights of Wilmington HAL-065-032 7/16/2009 Training Unabated Type B 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to assure supervision of residents who had histories of falls Training Completed   8/27/2009
Oakdale Heights of Wilmington HAL-065-024 07/23/2008 $21,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident experiencing confusion wandered from the facility without staff knowledge Paid in Full; Settlement Agreement 4/1/2009 Appealed 7/28/08 $4,000.00 4/1/2009
Oakdale Heights of Wilmington HAL-065-024 9/26/2007 Staff Training Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff failed to supervise residents on the Alzheimers' Unit to ensure their safety within the Unit Training Completed   11/13/2007
Pacifica Senior Living Wilmington HAL-065-032 7/18/2013 $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 assure adequate supervision of one resident in the Memory Care Unit who fell out of a second story window sustaining multiple injuries Paid in Full $7,000.00 9/30/2013
Pacifica Senior Living Wilmington HAL-065-032 11/15/2012 $1,000.00 Type A2 NCAC 13F .1004(a)(1) Medication Administration; G.S. 131D-21 Declaration of Residents' Rights Facility failed to administer medications as ordered to one resident administering ear drops to the eye on two separate occasions Paid in Full $1,000.00 1/18/2013
Port South Village / Catherine S. Villa HAL-065-026 1/13/2009 $14,000.00 Type A 10A NCAC 13F .1006(b) Medication Storage; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications were stored in a locked and secured manner; controlled medications were obtained resulting in resident death Paid in Full $14,000.00 4/2/2009
Port South Village Lorraine Villa HAL-065-010 01/12/2006 $6,000.00 Type A 10A NCAC 13F .0906 Other Resident Care and Services; 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Authorities not notified when resident failed to return to facility; resident later found dead OAH Decision Rescinded 09/25/2007; Appealed 02/10/06    
Port South Village Teresa C Villa HAL-065-007 01/12/2006 $2,000.00 Not corrected Type B 10A NCAC 13F .0507 Training on Cardio-Pulmonary Resuscitation; G.S. 131D-21 (2) Declaration of Residents' Rights The staff person on duty was not qualified to provide cardio-pulmonary resuscitation or choking intervention OAH Decision rescinded 09/25/2007; Appealed 02/10/06    
Port South Village Teresa C Villa HAL-065-007 01/12/2006 $2,000.00 Type A 10A NCAC 13F .0604 Personal Care and Other Staffing; G.S. 131D-21 (2) Declaration of Residents' Rights Residents left unsupervised in facility OAH Decision rescinded 09/25/2007; Appealed 02/10/06    
Spring Arbor of Wilmington HAL-065-014 5/16/2013 $4,000.00 Type A1 10A NCAC 13F .0906 (f)(4) Other Resident Care and Services; G.S. 131D-21 Declaration of Residents' Rights Facility failed to immediately notify local law enforcement and the resident's responsible party when a resident eloped from the facility Paid in Full; 09/24/2013 Settlement Agreement for $2,500.00; Appealed 06/11/2013 $2,500.00 10/30/2013
Spring Arbor of Wilmington HAL-065-014 1/26/2007 $2,500.00 Type A 10A NCAC 13F .901 (b) Personal Care & Supervision: G.S. 131D-21 (2) Declaration of Residents' Rights Resident wandered from facility without staff's knowledge; found in road intersection Paid in Full $2,500.00 2/15/2007

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Northampton County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Hampton Manor HAL-066-012 7/16/2009 $3,500.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to increase supervision and notify the resident's physician of a resident's inappropriate sexual statements, behaviors and inappropriate dress in the facility Paid in Full 5/21/2010 Settlement Agreement $2,500.00 ($1,000.00 for training and $1,500.00 payable) Appealed 08/14/2009 Training Completed 8/23/2010; Training Due $1,500.00 6/18/2010
Highland Gardens of Pleasant Hill (penalty #1) HAL-066-016 12/19/2013 $4,000.00 Type A2 10A NCAC 13F .0311 (d) Other Requirements; 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)      
Highland Gardens of Pleasant Hill (penalty #2) HAL-066-016 12/19/2013 $4,000.00 Type A2 G.S. 131D-4.4A (b) Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement appropriate infection control procedures during use of glucose meters and lancing devices for two residents requiring blood glucose monitoring      
Highland Gardens of Pleasant Hill HAL-066-016 3/21/2013 $7,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up for three of eight residents who experienced inappropriate behavior and elevated blood sugar levels Paid in Full; 02/14/2014 Settlement Agreement for $3.500.00; Appealed 04/05/2013 $3.500.00 3/11/2014
Pleasant Hill Gardens (penalty # 1) HAL-066-015 3/14/2012 $7,000.00 Type A 10A NCAC 13F .0702(b) Discharge of Residents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to discharge one resident whose medical care needs could not be met and one who's aggressive behavior put others' safety at risk Paid in Full; 10/18/2013 Settlement Agreement in Conjunction with penalties 2 & 3 for $8,000.00; Appealed 1/2/13 $8,000.00 3/19/2014
Pleasant Hill Gardens (penalty # 2) HAL-066-015 3/14/2012 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident who displayed verbally and physically threatening behaviors endangering others Paid in Full; 10/18/2013 Settlement Agreement in Conjunction with penalty #1 & 3; Appealed 1/2/13   3/19/2014
Pleasant Hill Gardens (penalty # 3) HAL-066-015 3/14/2012 $4,000.00 Type A 10A NCAC 13F .0901(c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer emergency intervention ( the heimlich maneuver) for one resident experiencing choking during a meal Paid in Full; 10/18/2013 Settlement Agreement in Conjunction with penalty #1 & 2; Appealed 1/2/13   3/19/2014
Rich Square Manor HAL-066-011 9/19/2012 $4,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up for one resident with weight loss and pressure ulcer Appealed 10/15/2012    
St. Mary's Assisted Living of Pleasant Hill HAL-066-009 5/14/2008 $16,000.00 Type A 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Resident was not served therapeutic pureed diet as ordered resulting in resident choking and suffering full arrest and death

Paid in Full Partial pmt.

$12,000.00 $4,000.00 07/11/2008 5/31/2008

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Onslow County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
The Heritage of Richlands, LLC HAL-067-016 1/13/2009 $2,000.00 Type A 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service- Therapeautic Diets; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure therapeutic diets were served resulting in one resident requiring medical treatment Paid in Full; 8/13/2009 Settlement Agreement $2,000.00 & Training; Appealed 2/11/09 $2,000.00 8/19/2009
Lighthouse Village HAL-067-013 9/15/2010 $3,720.00 Unabated Type B 10A NCAC 13F .0906(f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to respond when resident did not return to facility as scheduled. Paid in Full $3,720.00 10/14/2010
Lighthouse Village HAL-067-013 9/26/2007 $4,000.00 Type A 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2)(4) Residents' Rights Facility failed to ensure residents were protected from staff abuse Paid in Full Settlement Agreement 03/13/08; Appealed 10/17/07 $1,500.00 5/13/2009
Pearl's Family Care Home #4 FCL-067-014 2/21/2008 $1,920.00 Not corrected Type B 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to conduct criminal background checks for 2 of 3 staff on revisit Paid in Full $1,920.00 2/14/2008
Pinewood Harbor (penalty #1) HAL-067-022 10/16/2013 $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 personal care for two residents needing assistance with ambulation, toileting, dressing and eating resulting in falls with injuries and fracture Paid in Full $4,000.00 1/6/2014
Pinewood Harbor (penalty #2) HAL-067-022 10/16/2013 $2,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure facility management took responsibility for the total operation of the facility to maintain compliance to rules Paid in Full $2,000.00 1/6/2014

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Orange County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Carolina House of Chapel Hill HAL-068-008 11/10/2010 $4,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide healthcare referral and follow-up for residents including for a resident with pressure sores Paid in Full $4,000.00 11/30/2010
Carrboro Senior Living HAL-068-022 08/22/2006 $7,500.00 Type A 10A NCAC 13F .0906 (f)(3) Other Resident Care Services G.S. 131D-21 (2) Declaration of Residents' Rights Resident wandered from facility and suffered hypothermia Paid in Full $7,500.00 10/17/2006
The Stratford HAL-068-025 7/15/2010 $4,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medication (insulin) as ordered and failed to ensure follow-up and referral with resident's physician Appealed 9/8/10    

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Pamlico County

None of the facilities in Pamlico County have received a penalty since January 2006.

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Pasquotank County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Carolina House of Elizabeth City HAL-070-005 1/16/2008 $7,000.00 Type A 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21 (2)Declaration of Residents' Rights During fire drill, one staff person unsuccessfully attempted to transfer a resident requiring two person assistance; resident reported pain and was found to have fractures Paid in Full $7,000.00 2/8/2008
Carolina House of Elizabeth City HAL-070-005 08/23/2006 $11,400.00
$12,000.00
Type A 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-21 (2)Declaration of Residents' Rights Resident wandered from facility and was found dead Settlement Agreement 2/6/07
Appealed 09/15/06
$11,400.00 2/28/2007
Waterbrooke of Elizabeth City HAL-070-008 9/14/2010 $42,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision and referral to health care provider relative to five residents' needs including falls, inappropriate behaviors and pressure wound Training Completed 7/12/11 Paid in Full 2/24/2011 Settlement Agreement ($8,000.00 - $7,000.00 payable & $1,000.00 for training) Appealed 10/11/2010 $7,000.00 4/13/2011
Waterbrooke of Elizabeth City HAL-070-008 2/17/2010 $1,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; 10A NCAC 13F .1304 (4) Special Care Unit Building Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain supervision and secure area for residents residing on the special care unit. Three residents wandered several blocks from the facility when the doors were deactivated for service work in the facility Paid In Full $1,000.00 3/18/2010
Waterbrooke of Elizabeth City HAL-070-007 9/16/2008 $1,000.00 Type A 10A NCAC 13F .901 Personal Care and Supervision; G.S.131-D(2) Declaration of Residents' Rights Confused resident at high risk for falls using a rolling walker eloped and was found by EMS staff. Facility not aware of resident's absence from building. Paid in Full $1,000.00 12/10/2008

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Pender County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Ashe Gardens HAL-071-011 1/15/2014 $2,000.00 Past Corrected Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure four residents were free of physical and verbal abuse from a staff person Paid in Full $2,000.00 3/7/2014
DaySpring Assisted Living HAL-071-008 01/12/2006 $3,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights One resident wandered from facility Paid in Full $3,000.00 1/25/2006
Forest Lane Family Care Home #2 FCL-071-003 6/19/2008 $3,000.00 Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(4) Declaration of Residents' Rights Facility failed to notify physician of resident's continued skin breakdown Paid in Full Referred to Controller's Office $3,352.47 12/10/2008

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Perquimans County

None of the facilities in Perquimans County have received a penalty since January 2006.

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Person County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Maple Heights Assisted HAL-073-010 11/20/2013 $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 by not investigating or reporting allegations of verbal and physical abuse by one staff Paid in Full $2,000.00 11/27/2013

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Pitt County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Dixon House HAL-074-033 2/17/2009 Training Type B Unabated 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to notify physician regarding residents' medication refusals, blood pressure values and contraindications for medication Training Completed   4/17/2009
Freeman Family Care Home #2 (penalty #1) FCL-074-010 11/15/2012 $7,600.00 Unabated B NCAC 13G .0904(a)(1) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct conditions to assure kitchen, dining, and food storage areas were clean and orderly and protected from contamination Paid in Full - Penalty #1 and #2; Referred to Controller's Office $16,853.33 5/21/2013
Freeman Family Care Home #2 (penalty #2) FCL-074-010 11/15/2012 $7,600.00 Unabated B NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct medication admininstration problems by failing to assure three residents received medications as ordered (See Penalty #1) PReferred to Controller's Office    
Stafford Glen Assisted Living (chow 1/1/2009) HAL-074-030 5/18/2010 $2,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medication as ordered resulting in one resident requiring hosptialization Paid in Full $2,000.00 6/14/2010
Winterville Manor HAL-074-026 1/9/2007 $4,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Residents did not receive medications as ordered; resident not administered insulin required hospitalization Paid in Full $4,000.00 1/16/2007

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Polk County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Twin Lanes Home HAL-075-002 5/3/2007 $4,000.00 Type A 10A NCAC 13F .0305 Physical Environment; 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Exit alarm did not activate at night. While supervisor slept, resident known to wander left the facility. Resident was found cold and had sustained multiple cuts and bruises Paid in Full $4,000.00 6/1/2007

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Randolph County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Caregivers of Liberty II FCL-076-033 9/15/2011 $500.00 & $500.00 Staff Training Type A 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .0601 Management and Other Staff: G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to address resident's pressure sores and orders for the adminstration of oxygen Training Completed 12/2/11; Training Due; Paid in Full $500.00 11/15/2011
Carol Lee Family Care Home FCL-076-021 1/21/2011 $1,590.00 Unabated Type B 10A NCAC 13G .0904 (e)(4) Nutrition & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide one resident with therapeutic diet as ordered Partial pmt. Facility Closed $1,500.00 3/30/2011
Carolina House of Asheboro HAL-076-007 2/20/2013 $12,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up regarding a resident's aggressive behaviors and another resident's need for a access to continuous oxygen Paid in Full $12,000.00 3/7/2013
Carolina House of Asheboro HAL-076-007 12/19/2012 $2,000.00 Type A2 10A NCAC 13F .0902 (c)(4) Health Care Implementation; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure implementation of physician orders regarding the monitoring of coumidin for one resident Paid in Full 1/4/2013 $2,000.00

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Richmond County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Fisher Adult Care, Inc HAL-077-008 5/18/2010 $6,100.00 Unabated Type B 10A NCAC 13F .0407 (a)(5) Other Staff Qualifications (HCPR); G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide verification with healthcare registry that staff had no findings prohibiting employment in the facility Referred to Controllers' Office    
Fisher Adult Care, Inc HAL-077-008 12/16/2009 $36,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide referral and follow-up for residents exhibiting high blood pressures or low blood sugars Referred to Controllers' Office    
Fisher Adult Care (penalty #1) HAL-077-008 10/15/2008 $2,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; G.S.131D-21(2) Declaration of Residents' Rights Facility failed to supervise resident to prevent elopement and unsupervised access to traffic intersection Paid in Full $2,000.00 2/6/2009
Fisher Adult Care (penalty #2) HAL-077-008 10/15/2008 $4,400.00 Type B Unabated 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to refer residents to physician and dentist as needed and failed to administer medications including insulin as ordered. Paid in Full $4,400.00 2/6/2009
Somerset Court of Hamlet HAL-077-009 10/15/2008 $12,000.00 Type A 10A NCAC 13F .0902(c)(3)(4) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to obtain ordered lab test to monitor effects of resident's use of coumidin with resident requiring hospitaliztion for treatment Paid in Full $12,000.00 10/21/2008

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Robeson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Cromartie Spring Village Rest Home HAL-078-082 4/15/2014 $15,800.00 Type Unabated 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 Appealed 05/12/2014    
Dial's Family Care Home #2 FCL-078-075 10/16/2013 $1,000.00 Type A2 10A NCAC 13G .0504 (b) Competency Validation for Licensed Health Professional Support Tasks; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure four non-licensed personnel were competency validated prior to performing Hoyer Lift transfer for two non-ambulatory residents resulting in an injury to a resident Paid in Full $1,000.00 12/27/2013
Golden Years of Pembroke #4 HAL-078-045 08/25/2006 $4,000.00 Type A 10A NCAC 13F .0305 (h)(4) Physical Environment; 13F .0901(b)(c) Personal Care and Supervision; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Resident was found in facility's yard; door alarm had not been activated; resident suffered hypothermia Referred to Controllers' Office; OAH Decision Upheld 1/24/07 Appealed 09/21/06    
Greenbrier of Fairmont HAL-078-068 2/17/2010 $2,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to follow physician's orders including administration of medication to infected toe and referral to VA hospital for treatment. Amputation of resident's toe was necessary following onset of gangrene by the time of VA visit Paid in Full Referred to Controllers' Office $2,216.67 5/13/2010
Green Manor Rest Home (Change of Ownership) HAL-078-003 1/16/2013 $2,000.00 Type A2 10A NCAC 13F .1212(g) Reporting of Accidents and Incidents; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to respond to protect residents and report behaviors to health and mental health providers when a resident exhibited a change in status and demonstrated physically aggressive behaviors Paid in Full $2,226.75 12/9/2013
Green Manor Rest Home HAL-078-003 6/18/2012 $7,900.00 Unabated B 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications and treatments were adminstered as ordered for two residents and failed to assure referral and follow-up for one resident Paid in Full $7,900.00 8/21/2012
Green Manor Rest Home HAL-078-003 4/17/2012 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure supervision of one resident with exit seeking behavior and another who demonstrated inappropriate sexual behavior to other residents Paid in Full $2,000.00 5/23/2012
Green Manor Rest Home (Penalty #1) HAL-078-003 3/20/2008 $2,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Medications were not administered as ordered for 3 of 9 residents including sliding scale insulin Paid in Full $2,000.00 6/17/2008
Green Manor Rest Home (Penalty #2) HAL-078-003 3/20/2008 $2,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Physicians were not notified for residents' health care needs regarding recent hospitalization, treatment for pressure sores and hyperglycemic conditions Paid in Full $2,000.00 6/17/2008
Green Manor Rest Home HAL-078-003 5/15/2008 $4,000.00 Type A 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Therapeutic diets were not served as ordered to two residents needing enteral feedings via peg tubes Paid in Full Referred to Controller's Office $4,400.00 8/12/2008
Greystone Manor (Ownership Change) HAL-078-040 3/17/2011 $30,000.00 Type A 10A NCAC 13F .0901(b)(c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to protect residents from self initated harmful behavior Paid in Full; 01/11/2012 Settlement Agreeement $15,000.00; Appealed 04/13/2011 $15,000.00 5/1/2012
Greystone Manor (chow 6/1/10 now Red Springs AL) HAL-078-040 2/17/2010 $12,000.00 Type A 10A NCAC 13F .0702 (b) Admission & Discharge 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision to a unsafe smoker and failed to provide supervision or initiate discharge to a resident with history of aggression who subsequently sexually assaulted another resident Paid in Full; Settlement Agreement 8/18/10 for $5,000.00; Appealed 03/11/2010 $5,000.00 9/2/2010
Greystone Manor HAL-078-040 10/15/2008 $4,240.00 Type B Unabated 10A NCAC 13F .0904 (e)(1) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility staff failed to thicken liquids as ordered for two residents Paid in Full $4,240.00 12/4/2008
Greystone Manor HAL-078-040 1/22/2007 $4,000.00 Type A 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident found unresponsive, staff failed to initiate CPR Paid in Full $4,000.00 2/1/2007
Greystone Manor HAL-078-045 10/24/2006 $5,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; 10A NCAC 13F .1501 Use of Physical Restraints and Alternatives; G.S. 131D-21 (1)(2)(4) Declaration of Residents' Rights Restraints not applied to resident as ordered Paid in Full $5,000.00 11/15/2006
L & S Family Care Home - Facility Closed FCL-078-060 1/21/2011 $3,480.00 Unabated Type B 10A NCAC 13G .0403 Qualifications of Medication Staff; 10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; 10A NCAC 13G .0702 Tuberculosis Test & Medical Examination; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure employees who administered medications had passed the written medication test; had an employee working at all times who had completed the cardio-pulmonary resuscitation course; and failed to assure that two of three residents had been tested for TB Referred to Controller's Office    
L & S Family Care Home (penalty #1) FCL-078-060 11/18/2009 $3,100.00 Unabated Type A G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to prohibit resident from smoking inside the facility Referred to Controllers Office    
L & S Family Care Home (penalty #2) FCL-078-060 11/18/2009 $5,670.00 Unabated Type B 10A NCAC 13G .0214 Suspension of Admission; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to stop admitting residents when a suspension of admission was in effect due to noncompliance Referred to Controllers Office    
L & S Family Care Home FCL-078-060 7/16/2009 $3,650.00 Unabated Type A G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure staff and residents did not smoke in the facility Referred to Controllers Office    
L & S Family Care Home FCL-078-060 4/16/2009 $1,500.00 Type A Unabated G.S. 131D-4.4 Minimum Safety; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure that staff and residents did not smoke in the facility. Staff and residents smoked in bedrooms. 05/07/2009 Settlement Agreement for $2,800.00 in Conjunction w/penalty imposed 01/13/2009; Partial pmt(s).    
L & S Family Care Home FCL-078-060 1/13/2009 $2,000.00 Type A G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure that residents did not smoke in the facility. Residents smoked in their bedrooms and common rooms 05/07/2009 Settlement Agreement for $2,800.00 in Conjunction w/penalty imposed 04/16/2009; Partial pmt(s); Appealed 12/16/2008 Partial pmts $400.00 6/23/2009
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      
Red Springs Assisted Living (penalty #1) HAL-078-083 3/19/2014 $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 ensure adequate supervision for one resident who had a history of smoking in the facility, which resulted in a fire at the facility causing the temporary relocation of 65 residents Appealed 03/28/2014    
Red Springs Assisted Living (penalty #2) HAL-078-083 3/19/2014 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure one resident known to be combative received adequate and appropriate care when resident became combative Appealed 03/28/2014    
Sampson Family Care Home (Facility Closed) FCL-078-089 6/19/2013 $2,000.00 Type A2 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to contact physician for acute physical symptoms related to elevated blood glucose levels and assure referral and follow-up of acute health care needs for two residents Paid in Full $2,000.00 8/21/2013
Sampson's Family Care Home FCL-078-028 11/9/2010 $5,450.00 Unabated Type B 10A NCAC 13G .0406 (a)(7) Other Staff Qualifications (Criminal Background); G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to conduct criminal background checks on employees Referred to Controllers' Office    
St. Mary's Assisted Living HAL-078-052 6/27/2007 $7,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to make referral to address resident's pressure sore which had become gangrenous Partial Pmt.
Paid in Full
$2,000.00
$5691.62
7/20/2007
2/4/2008
St. Mary's Assisted Living of Red Springs, Inc. (Penalty #1) HAL-078-071 1/21/2011 $12,000.00 Type A 10A NCAC 13F .0407(a)(2) Other Staff Qualifications (Fire Safety & Emergency Procedures); 10A NCAC 13F .0601(a) Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure staff were able to apply fire and safety emergency procedures assuring all residents were safely evacuated during a fire. Staff were not aware they had left eight residents in the building during a response to a fire started by a resident Paid in Full; 6/22/2011 Settlement Agreement for $12,000.00 in conjunction with penalty #2 imposed 1/21/2011 $12,000.00 7/19/2011
St. Mary's Assisted Living of Red Springs, Inc. (Penalty #2) HAL-078-071 1/21/2011 $2,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide adequate supervision to two residents based on assessed needs; one regarding exit-seeking behaviors and the other due to noncompliance to facility's smoking policy Paid in Full; 6/22/2011 Settlement Agreement for $12,000.00 in conjunction with penalty #1 imposed 1/21/2011    
St. Mary's Assisted Living of Red Springs (Penalty #1) HAL-078-052 12/18/2008 $5,640.00 Type B Unabated 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure residents received medication (insulin) as ordered Paid in Full $5.640.00 1/15/2009
St. Mary's Assisted Living of Red Springs (Penalty #2) HAL-078-052 12/18/2008 $5,040.00 Type B Unabated 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide follow-up and referral to address residents needs including dental needs and physician notification of residents' refusal to take medication Paid in Full $5,040.00 1/15/2009

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Rockingham County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Ashlee Place Adult Care (Change of Ownership) FCL-079-083 12/19/2012 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (1)(4) Declaration of Residents' Rights Facility failed to assure residents were free from mental abuse based on the care and interactions with staff Referred to Controller's Office    
Cornerstone Assisted Living FCL-079-068 9/15/2010 $1,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; 10A NCAC 13G .0902 (b) Health Care Referral & Follow-up; G.S. 131D-21 (2) Declaration of Residents' Rights; 131D-21 (4) Declaration of Residents' Rights to be free of mental, physical abuse, neglect & exploitation Facility failed to provide supervision and referral to health care provider to prevent resident to resident abusive behavior Paid in Full Partial pmt. $552.12 $500.00 12/22/2010 11/16/2010
Faithworks Assisted Living FCL-079-067 3/19/2014 $4,600.00 Type Unabated B 10A NCAC 13G .0902 (b) Health Care; 10A NCAC 13G .1005 (a) Self-Administration of Medication: G.S. 131D-21 (2) Declaration of Residents' Rights Faciity failed to assure referral was made to meet the routine and acute health care needs for two residents related to follow-up for high blood glucose levels and mammogram appointment, failed to ensure physician contact and orders for self-administration were obtained for two residents including medication labels with specific instructions or directions for administration of insulin for one resident Appealed 04/16/2014    
Faithworks Assisted Living FCL-079-067 7/16/2010 Staff Training Type A 10A NCAC 13G .0902 (b) Health Care Referral & Follow-up; 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify physician for follow-up andreferral rgarding medication order failing to administer insulin as ordered Paid in Full $1,116.67 12/30/2011
Highgrove Long Term Care Center HAL-079-002 3/10/2011 $12,000.00 Type A 10A NCAC 13F .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide care and services to prevent the development of pressure sores for two residents 3/8/2012 Training Completed; Paid in Full; 11/30/2011 Settlement Agreement $6,000.00 ($4,000.00 payable & $2,000.00 training; Appealed 5/2/2011 $4,000.00 12/15/2011
Holman-Hampton Sunshine FCH #1 FCL-079-062 11/18/2009 $2,000.00 Type A 10A NCAC 13G .1004 (a) Medication Administration; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered for residents, documented administration of medication and treatments not administered and failed to refer resident suffering from chest pain and chronic foot pain to physician Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #1 FCL-079-062 2/17/2009 $1,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility staff left three residents unattended to purchase cigarettes. During absence of staff, fight ensued between residents resulting in resident injury Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #2 (penalty #1) FCL-079-063 11/18/2009 $7,000.00 Type A 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer insulin to resident as ordered resulting in resident requiring hospitalization Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #2 (penalty #2) FCL-079-063 11/18/2009 $2,000.00 Type A G.S. 131D-4.4 Prohibit Smoking; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to prohibit smoking in the facility by two residents. Three of four residents residing in the facility were nonambulatory Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #2 (penalty #3) FCL-079-063 11/18/2009 $7,000.00 Type A 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident who suffered burns due to being unable to smoke safely without assistance Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #3 (penalty #1) FCL-079-064 11/18/2009 $1,000.00 Type A 10A NCAC 13G .1004(a) Medication Administration; 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered and failed to notify physician of resident's suicidal ideations Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #3 (penalty #2) FCL-079-064 11/18/2009 $2,000.00 Type A 10A NCAC 13G .0705(b) Discharge of Residents; 10A NCAC 13G .0901 (b) Personal Care and Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to discharge a resident known to purposely inflict harm to himself when they failed to provide adequate supervision to protect him Facility Closed
Referred to Controllers Office
   
Holman-Hampton Sunshine FCH #3 (penalty #3) FCL-079-064 11/18/2009 $8,500.00 Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to refer resident to physician when the resident experienced physical symptoms after hitting her head on concrete as a result of a fall Facility Closed
Referred to Controllers Office
   
Home Away From Home FCL-079-051 11/20/2013 $1,000.00 Type A2 G.S. 131D-4.4A (b) Infection Prevention Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement appropriate infection control procedures during fingerstick testing for two residents requiring blood glucose monitoring Paid in Full $1,000.00 1/31/2014
Mark's Family Care Home #1 FCL-079-032 11/10/2010 Staff Training Type A 10A NCAC 13G .0909 Resident Rights; 10A NCAC 13G .1206 Health Care Personnel Registry; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to investigate allegations regarding a physical altercation between a resident and a staff person. The staff person responded to a resident's verbal aggressiveness with physical intervention Training Completed   12/22/2010
Pine Forrest Home for the Aged HAL-079-079 3/15/2012 $3,000.00 Type A2 10A NCAC 13F .0904 (e)(4) Nutriction & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to serve thickened liquids as ordered to two residents Paid in Full $3,000.00 4/25/2012
Pine Forrest Home for the Aged (Ownership Change) HAL-079-072 5/19/2011 $4,000.00 Type A 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0904 (3)(4) Nutrition & Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide feeding assistance to one resident at risk for choking and failed to assure referral and follow-up for seven residents regarding behavioral, fall and medical status issues Referred to Controller's Office    

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Rowan County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
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
China Grove Retirement Center HAL-080-020 5/16/2013 $4,000.00 Type A2 10A NCAC 13F .1004 (a)(1)(2) Medication Administration; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure the resident was administered medications as ordered; resident's physician was contacted and resident sent to hospital in a timely manner when the resident's mental status declined along with elevated blood pressure readings for one resident Paid in Full; 2 - Partial Payment $4,000.00 08/14/2013 07/03/2013
Harris Enterprises of NC d/b/a Deal Care Inn HAL-080-021 1/3/2008 Staff Training Type A 10 NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to make referral to address resident's pressure sores and assure that unlicensed staff did not treat. Training Completed   2/8/2008
Kannon Creek Assisted Living HAL-080-003 2/20/2013 $2,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care and Supervision; G.S. 131D-21 (3) Declaration of Residents' Rights Facility failed to intervene and provide CPR when a resident was found unconscious Paid in Full $2,000.00 3/12/2013
The Meadows of Rockwell Retirement Center HAL-080-008 9/15/2011 $2,000.00 & $2,000.00 Staff Training Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to one resident with history of wandering and elopement resulting in resident found near highway on one of several elopements Training Completed 11/21/2011; Paid in Full $2,000.00 10/13/2011
Salisbury Gardens HAL-080-011 10/30/2007 $16,000.00 Type A 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to set door alarms and supervise resident with history of elopement. Following elopement, resident fell and suffered fatal injury. Paid in Full $16,000.00 11/28/2007

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Rutherford County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Haven-N-Hills Living Center (penalty #1) HAL-081-041 1/21/2010 $7,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident adjudicated incompetent allowing the resident to leave the facility unsupervised Paid in Full Referred to Controllers' Office $7,816.67 1/31/2011
Haven-N-Hills Living Center (penalty #2) HAL-081-041 1/21/2010 $12,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure seven residents were administered medications as ordered and failed to make health care referrals to the physician. Residents did not receive sliding scale insulin, seizure medication, medication for pain management and oxygen as ordered Paid in Full Referred to Controllers' Office $13,753.88 1/31/2011
Haven-N-Hills Living Center HAL-081-041 10/22/2009 $2,000.00 Type A G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure residents did not smoke inside facility Paid in Full $2,000.00 1/5/2010
Haven-N-Hills HAL-081-041 07/18/2008 $7,000.00 Type A 10A NCAC 13F .0305 (h)(4) Physical Environment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Resident with history of elopement was found on highway in wheelchair, door alarms were not functioning and staff had no knowledge of his absence Paid in Full $7,822.22 12/31/2008
Haven-N-Hills HAL-081-041 01/12/2006 $1,000.00 Type A 10A NCAC 13F .0901 Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision to one resident with problematic behaviors that resulted in physical abuse to four residents Paid in Full $1,000.00 3/3/2006
Hillcrest Rest Home HAL-081-046 6/19/2013 $30,000.00 Unabated Type B 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 three residents related to dressings and changes to pressure ulcer, low blood glucose levels and resident hospitalization Paid in Full; 06/06/2014 Settlement Agreement for $15,000.00; Appealed 6/25/2013 $15,000.00 6/17/2014
Hillcrest Rest Home HAL-081-046 12/20/2012 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure heathcare referral and follow-up for two residents to address medication refusal and and pressure sores Paid in Full $2,000.00 1/31/2013
Hillcrest Rest Home (Penalty #1) HAL-081-046 9/19/2012 $7,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure a medication, an antibiotic, was administered as ordered for one resident Paid in Full; 1/29/2013 Settlement Agreement - payment plan $9,292.51 10/15/2013 09/12/2013 08/15/2013 07/17/2013 06/12/2013 05/14/2013 04/16/2013 03/21/2013 02/12/2013 01/18/2013
Hillcrest Rest Home (Penalty #2) HAL-081-046 9/19/2012 $5,000.00 Type A2 10A NCAC 13F .0311(d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain safe water temperatures in multiple resident bathroom sinks and at the resident common bathroom shower and sink. 10/15/2013 Paid in Full; 1/29/2013 Settement Agreement for $2,000.00 - payment plan    
Hillcrest Rest Home (Penalty #1) HAL-081-046 2/15/2012 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for one resident identified with wandering behaviors who wandered from the facility premises Paid in Full; Partial Payment; 5/30/2012 Appeal Dismissed; Appealed 3/1/2012 $2,000.00 12/14/2012 11/14/2012 09/20/2012 08/23/2012
Hillcrest Rest Home (Penalty #2) HAL-081-046 2/15/2012 $4,000.00 Type A1 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure staff implemented infection control measures for eight diabetic residents when staff shared and failed to clean blood testing devices Paid in Full; 5/30/2012 Appeal Dismissed; Appealed 3/1/2012 $4,000.00 12/14/2012
Open Arms Family Care Home FCL-081-045 1/21/2011 $7,000.00 Type A 10A NCAC 13G .0902 Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to ensure a medication resident was noted to be allergic to was not administered 6/25/12 Training Completed, 3/8/12 Settlement Agreement $1,000.00 training; Appealed 2/9/11    
Southern Manor Rest Home HAL-081-008 1/16/2014 $1,000.00 Type A2 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure staff responded immediately to a resident to provide cardiopulmonary resuscitation (CPR) and to immediately call emergency medical services (EMS) according to the facility's policies and procedures Paid in Full $1,000.00 2/24/2014
Southern Manor Rest Home HAL-081-008 7/18/2013 $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 assure adequate supervision for four residents who smoked within the facility Paid in Full $2,000.00 11/25/2013
Tipton's Family Care Home #4 FCL-081-020 9/18/2006 $2,000.00 Type A 10A NCAC 13G .0406(4) Other Staff Qualifications; 13G .0901(b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Staff sent resident to obtain alcohol for staff' personal use during work providing resident with alcohol; resident required treatment for alcohol abuse Paid in Full $2,000.00 11/20/2006
Tipton Retirement Home #4 FCL-081-020 10/22/2009 $2,500.00 Type A 10A NCAC 13G .0317 Building Service Equipment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain stove in working order. Pliers were neded to utilize burners resulting in a fire due to inability to determine their on/off status Paid in Full $2,500.00 11/17/2009
Union Mills Living Center #2 (Facility Closed) FCL-081-034 3/16/2011 $7,000.00 Type A 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed ensure healthcare referral and follow-up for residents experiencing elevated blood sugars or needing ordered labs. Additionally, the facility failed to administer medications as ordered. Referred to Controller's Office    

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Sampson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Clinton House HAL-082-018 6/19/2013 $4,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assess or identify the current needs of four residents with behaviors of wandering and one with aggressive behaviors Paid in Full $4,433.34 12/31/2013
Clinton House HAL-082-018 6/19/2013 $4,000.00 Type A2 10A NCAC 13F .1004 (k) Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to ensure a system of identifying residents prior to medication administration when aware of admissions increase Paid in Full $4,433.33 12/31/2013
Clinton House (penalty #1) HAL-082-015 9/13/2010 $1,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up for residents with physician regarding appointments, medication refusal, and labwork Paid in Full $1,000.00 10/25/2010
Clinton House (penalty #2) HAL-082-015 9/15/2010 $1,000.00 Type A 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications and treatments administered as ordered and documentation was accurate Paid in Full $1,000.00 10/25/2010
Forest Trail Retirement Center HAL-082-014 9/26/2007 $4,440.00 Not corrected Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure medications were administrated as ordered Paid in Full; Settlement Agreement $2,400.00 & Training 7/28/2008; Appealed 10/15/07 $2,400.00 07/14/2009 Training Completed 10/7/2008 10/22/2008
Forest Trail Retirement Center HAL-082-014 07/14/2006 $1,920.00 Not corrected Type B 10A NCAC 13F .0305 (h)(4) Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Door alarms did not function for 2 of 6 doors potentially affecting 18 residents with diagnosis of disoriented or wandering behavior Paid in Full $1,920.00 9/5/2006

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Scotland County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
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 Appealed 4/25/2014    
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 Appealed 4/25/2014    

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Stanly County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Albemarle House HAL-084-006 5/19/2011 Staff Training Type A 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer a medication to one resident with a history of seizures and failed to notify the physician of the missed medication Training Completed; Appealed 6/20/2011 7/13/2011  

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Stokes County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Priddy Manor Assisted Living HAL-085-007 12/16/2009 $4,000.00 Type A 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights The facility failed to provide supervision to residents while off of the Special Care unit resulting in a resident wandering from the facility. Paid in Full $4,000.00 1/27/2010
Walnut Ridge Assisted Living HAL-085-005 2/15/2012 $4,000.00 Type A 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for residents residing on the Special Care Unit resulting in one resident elopement and multiple falls for four residents Paid in Full; Appealed 2/22/2012 $4,000.00 5/1/2012

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Surry County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Central Care HAL-086-001 10/15/2012 $18,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up to the routine and acute needs for two residents addressing respiratory distress and referral appointments Paid in Full $18,000.00 12/28/2012
David's House HAL-086-012 5/15/2012 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up for one resident with continuing low blood pressure Paid in Full $2,000.00 7/6/2012
Heritage Care of Elkin (Penalty #1) - Ownership Change HAL-086-011 11/16/2011 $7,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for five residents relative to health care needs, noted increase in pyschotic behaviors, obtaining lab work and the continued implementation of orders Paid in Full; 9/24/2012 Settlement Agreement $3,250.00; Appealed 12/14/2011 $3,250.00 10/2/2012
Heritage Care of Elkin (Penalty #2) - Ownership Change HAL-086-011 11/16/2011 $7,000.00 Type A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure medications and treatments were administered as ordered to four residents Paid in Full; 9/24/2012 Settlement Agreement $3,250.00; Appealed 12/14/2011 $3,250.00 10/2/2012

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Swain County

None of the facilities in Swain County have received a penalty since January 2006.

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Transylvania County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Transylvania Living Center (Facility Closed) FCL-088-003 5/19/2011 $4,500.00 Type A 10A NCAC 13G .0902(b) Health Care; 10A NCAC 13G .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights; G.S. 131D-21 (4) Declaration of Residents' Rights; Facility failed to ensure administered medications were taken by the resident to prevent the distribution to other resident; failed to respond to resident with referral and follow-up when resident reported sexual encounter which occurred while being transported to community activity Referred to Controller's Office    
Transylvania Living Center FCL-088-003 09/14/2006 $500.00 Type A 10A NCAC 13G .0601 Management and Other Staff; GS 131D-4.3 (a)(5) Adult Care Home Rules; G.S. 131D-21 (1)(2)(4) Declaration of Residents' Rights Four residents left unsupervised in facility Paid in Full $500.00 12/13/2006

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Tyrrell County

None of the facilities in Tyrrell County have received a penalty since January 2006.

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Union County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Clare Bridge at Monroe Square HAL-090-022 9/15/2010 $2,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facilility failed to provide supervision and implement measure to reduce falls Paid in Full $2,000.00 10/5/2010
Union Park HAL-090-007 1/14/2014 $4,000.00 Type A1 10A NCAC 13F .0901 (a) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide personal care for one resident according to care plan requiring a two-person transfer at all time from a mechanical hoyer lift Paid in Full $4,000.00 2/6/2014
White Store Road Family Care Home of Monroe - Penalty #1 (Closed) FCL-090-012 5/17/2012 $3,300.00 Unabated B 10A NCAC 13G .1009(b) Pharmaceutical Care; 10A NCAC 13G .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct medication adminstration problems to assure three residents received medications as ordered Referred to Controller's Office    
White Store Road Family Care Home of Monroe - Penalty #2 (Closed) FCL-090-012 5/17/2012 $18,000.00 Unabated A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to correct healthcare referral and follow-up problems to assure the referral and follow-up of acute and routine needs for one resident was met Referred to Controller's Office    
White Store Road Family Care Home of Monroe - Penalty #3 (Closed) FCL-090-012 5/17/2012 $2,000.00 Type A 10A NCAC 13G .0601(b) Management & Other Staff; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure that management took responsibility for the total operation of the facility to meet residents care and service needs Referred to Controller's Office    
White Store Road Family Care Home of Monroe (Closed) FCL-090-012 3/15/2012 $5,000.00 Type A2 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet the routine and acute health care needs of two residents including access to mental health services, medication and lab work Referred to Controller's Office    

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Vance County

None of the facilities in Vance County have received a penalty since January 2006.

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Wake County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Ann's Family Care Home II FCL-092-110 12/7/2006 Staff Training Not corrected Type B 10A NCAC 13G .0405 (a)(b) Test For Tuberculosis; G.S. 131D-21 (2) Declaration of Residents' Rights Three staff were not tested for tuberculosis Training Completed   2/26/2007
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
Brookridge Assisted Living HAL-092-146 11/21/2013 $4,000.00 Type A1/A2 10A NCAC 13F .0909 Resident Rights; 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to protect residents right to be free from mental and physical abuse and neglect by another resident and failed to assure referral and follow-up to meet the routine and acute health care needs of residents 05/28/2014 Training Completed; 4/24/2014 Settlement Agreement training required; (training due 5/24/14) Appeal 12/18/2013    
Brookridge Assisted Living HAL-092-146 3/20/2013 $1,000.00 Type A2 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer a medication, coumadin, for one of two residents Paid in Full; Partial pmt. $600.00 $400.00 06/26/2013 04/19/2013
Brookridge Assisted Living Inc. HAL-092-146 1/21/2011 $12,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure timely referral and follow-up was made when residents presented with a change in physical condition 01/06/2012 Training Completed; Paid in Full; Partial Payment; 10/26/11 Settlement Agreement $4,000.00 (1,000.00 payable & 3,000.00 for training) Appealed 2/16/2011 $400.00 $600.00 12/19/2011 11/09/2011
Carillon Assisted Living of Knightdale Hal-092-166 9/18/2013 $2,000.00 Type A2 10A NCAC 13F .0311 (a) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure the locking mechanism for one exit door in the special care unit was maintained in a safe and operating condition resulting in one resident exiting the Special Care Unit Paid in Full $2,000.00 10/8/2013
Carolina House of Wake Forest HAL-092-032 8/27/2007 $4,000.00 Type A 10A NCAC 13F .0901 (c) Personal Care & Supervision; G.S. 131D-21 (4) Residents Rights Facility failed to provide timely supervision checks on one resident to ensure needs met after resident experienced a fall Paid in Full $4000.00 11/1/2007
Elmcroft of Northridge HAL-092-124 12/13/2011 $4,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision for three residents relative to their need for physical assistance and failed to ensure referral and follow-up to meet acute and routine needs of 5 residents relative to mental health evaluations, aggressive behaviors and wound care Paid in Full $4,000.00 1/6/2012
The Haven FCL-092-054 9/16/2008 $6,200.00 Not corrected Type B 10A NCAC 13G .0702(a) Tuberculosis Test and Medical Exmination; G.S. 131D 4.4 Adult Care Home Minimum Safety Requirements; G.S.131D-21(2) Declaration of Residents' Rights Facility failed to prohibit smoking in the facility and did not ensure residents had TB tests Facility Closed; Settlement Agreement 03/18/2009; Appealed 10/16/2008    
The Haven FCL-092-054 5/15/2008 $1,000.00 Type A 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21(2) Delcaration of Residents' Rights Resident experiencing seizures did not receive follow-up and referral as ordered to address evaluation of medication dosage Facility Closed; Referred to Controller's Office    
James Rest Home HAL-092-007 5/20/2010 Staff Training Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide referral and follow-up with physician regarding blood sugar readings Training Completed   7/23/2010
Jones Family Care Home FCL-092-016 9/16/2008 $800.00 Not corrected Type B 10A NCAC 13G .0405(a)(b) Test for Tuberculosis;10A NCAC 13G .0507 Training on Cardio-Pulmonary Resuscitation; 10A NCAC 13G .0406(a)(7) Other Staff Qualifications; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to ensure staff had TB tests, training on CPR, and criminal background checks Paid in Full $800.00 12/31/2008
Lawndale Manor HAL-092-017 6/18/2012 $4,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide increased supervision of a resident exhibiting exit seeking behavior who eloped Paid in Full $4,000.00 8/17/2012
Lawndale Manor HAL-092-017 1/21/2011 $18,000.00 Type A 10A NCAC 13F .0902(C) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to implement physician's orders including the use of side rails Paid in Full $18,000.00 3/18/2011
Lee's Long Term Care Facility HAL-092-009 7/18/2013 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervison to one resident according to care plan, assessed needs and current symptoms resulting in resident being sent to Emergency Room multiple times in one week Appealed 08/14/2013    
Oliver House (Change of Ownership) HAL-092-158 11/18/2011 Staff Training Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure adequate and appropriate care and services were provided to residents relative to a resident's fall and addressing reported area of blood soiled carpet 07/08/2014 Training Completed; 10/30/2013 Settlement Agreement training required; (training due 1/30/14) Appealed 12/16/2011    
Parkway Retirement Home HAL-092-118 11/19/2007 $16,000.00 Type A 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (4) Declaration of Residents' Rights Medication was not administered as ordered resulting in resident being admitted to hospital's ICU Paid in Full in Conjunction w/ penalty imposed 10/30/2007   5/18/2009
Parkway Retirement Home HAL-092-118 10/30/2007 $16,000.00 Type A 10A NCAC 13F .1501 (a) Use of Physical Restraints and Alternatives; G.S. 131D-21 (2) Declaration of Residents' Rights Facility continued to utilize side rail on bed after resident needed medical assessment when previously found with head between siderail and mattress. Several weeks later, staff discovered resident dead in same position. Paid in Full Settlement Agreement in Conjunction w/penalty imposed 11/19/07; Appealed 11/28/07; Partial pmt(s). $7,000.00 $5,000.00 $2,000.00 $2,000.00 05/18/2009 05/12/2009 10/17/2008 11/16/2008
Phoenix Assisted Care, LLC HAL-092-131 5/19/2011 $12,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up with physician for resident with severe bruises from unknown origin and for to obtain wound care forone resident needing home health services 1/29/2013 Training Completed; 7/24/2012 Settlement Agreement ($2,000.00 for training) Appealed 6/17/2011    
Pine Tree Villa HAL-092-121 5/11/2007 $7,000.00 Type A 10A NCAC 13F .0901( c) Personal Care and Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide supervision to two residents sharing a room to prevent physical abuse after earlier episodes of physical attacks Paid in Full; Settlement Agreement $1,000.00 & Training 6/22/2009; Appealed 6/6/07 Training Completed; $1000.00 08/31/2009 07/27/2009
Rose Haven HAL-092-015 5/3/2007 $1,860.00 Not corrected Type B 10A NCAC 13F .0407 (a)(5) HCPR; G.S. 131D-21 (2) Residents' Rights Healthcare registry verifications were not conducted for either of the staff currently employed Facility Closed; Referred to Controller's Office    
Summer Manor FCL-092-136 2/14/2012 $7,000.00 Type A 10A NCAC 13G .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up to meet one resident's need for routine and acute care to address pressure sores Appealed 3/26/2012    
Sunrise Assisted Living at North Hills HAL-092-108 6/18/2012 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a disoriented resident who wandered from the facility Paid in Full; Referred to Controller's Office $2,216.67 9/27/2012
Sunrise Assisted Living of North Hills HAL-092-108 8/27/2007 $4,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to provide timely supervision checks on one resident. Resident experienced hypothermia after being found outside in secured courtyard Paid in Full $4,000.00 9/19/2007
Sunrise of Cary HAL-092-152 5/16/2013 $6,000.00 Type A2 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to provide supervision for one resident who had demonstrated inappropriate behaviors against others 02/10/2014 Settlement Agreement for $4,000.00; Appealed 06/14/2013    
Sunrise of Cary (penalty #1) HAL-092-152 1/16/2013 $1,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to a resident with exit seeking behaviors to prevent elopement from the facility Paid in Full $1,000.00 5/7/2013
Sunrise of Cary (penalty #2) HAL-092-152 1/16/2013 $2,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to protect a resident at risk for falls and with exit seeking behaviors from leaving the facility unsupervised Paid in Full $2,000.00 5/7/2013
Wake Assisted Living HAL-092-144 11/10/2010 $2,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision related to elopement/wandering, smoking, and mental health related behaviors for 5 of 8 residents residing on the special care unit Paid in Full Referred to Controllers' Office $2,000.00 2/18/2011
Wake Forest Care Center HAL-092-020 7/16/2012 $4,000.00 Type A2 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered for 4 residents including administering the correct dosage of insulin Paid in Full; Settlement Agreement 8/13/2012 in conjunction with penalties 1 & 2 issued 4/17/2012 for $22,500.00 $22,500.00 8/15/2012
Wake Forest Care Center (penalty #1) HAL-092-020 4/17/2012 $20,000.00 Type A1 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision of a resident with dementia resulting in the resident's death when he left the facility unsupervised Paid in Full see penalty issued 07/16/12; Settlement Agrement 8/13/2012; Appealed 5/01/2012    
Wake Forest Care Center (penalty #2) HAL-092-020 4/17/2012 $14,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure supervision of three residents with aggressive behaviors resulting in physical altercations with residents and staff Paid in Full see penalty issued 07/16/12; Settlement Agreement 8/13/2012; Appealed 5/01/2012    
Wake Forest Care Center (penalty #1) HAL-092-020 5/20/2010 $5,700.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to administer medications as ordered Paid in Full; Settlement Agreement 9/27/10 Penalties 1 & 2 combined for $6,000.00; Appealed 06/17/2010 $6,000.00 12/21/2010
Wake Forest Care Center (penalty #2) HAL-092-020 5/20/2010 $4,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to supervise resident known to be noncompliant to smoking rules resulting in facility fire Paid in Full (see penalty #1) Settlement Agreement 9/27/10 Penalties 1 & 2 combined for $6,000.00; Appealed 06/17/2010    
Wake Forest Care Center, Inc (penalty #1) HAL-092-020 10/22/2009 $16,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure referral and follow-up for two residents with one resident who developed an infected pressure sore and the other resident needing dental services Paid in Full $16,000.00 1/12/2010
Wake Forest Care Center, Inc (penalty #2) HAL-092-020 10/22/2009 $4,000.00 Type A G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensured smoking did not occur inside facility. One resident set clothes and bed covers on fire twice while smoking in bed Paid in Full $4,000.00 1/12/2010
Wake Forest Care Center HAL-092-020 12/15/2006 $12,000.00 Type A 10A NCAC 13F .0901(a) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights One resident wandered from facility and was found dead Paid in Full $12,000.00 1/17/2007

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Warren County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Floyd B McKissick Sr. Assisted Living (penalty #1) HAL-093-009 7/15/2010 $1,400.00 Unabated Type B 10A NCAC 13F .0407 (a)(7) Other Staff Qualifications (Criminal Background); G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to conduct criminal background checks for 14 of 14 staff Referred to Controllers' Office    
Floyd B McKissick Sr. Assisted Living (penalty #2) HAL-093-009 7/15/2010 $1,400.00 Unabated Type B 10A NCAC 13F .0504 (c) Competency Validation for LHPS Task; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide competency validation prior to one staff performing dressing changes and compression wraps Referred to Controllers' Office    
Floyd B McKissick Sr. Assisted Living (penalty #3) HAL-093-009 7/15/2010 $1,400.00 Unabated Type B 10A NCAC 13F .0505 Training on Care of Diabetic Residents; 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure 5 of 5 staff who administered insulin had training prior to adminstering insulin; staff failed to administer medications as ordered Referred to Controllers' Office    
Floyd B McKissick Sr. Assisted Living (penalty #4) HAL-093-009 7/15/2010 $1,400.00 Unabated Type B 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide referral and follow-up for coumidin lab order and physician notification of high blood pressure and skin problems Referred to Controllers' Office    
Floyd B McKissick Sr. Assisted Living (penalty #5) HAL-093-009 7/15/2010 $4,000.00 Type A 10A NCAC 13F .0601 (a) Management of Facilities with Seven to Thirty Residents; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents with wandering behaviors Referred to Controllers' Office    
Sainte's Assisted Independent Living, Inc./Floyd B. McKissick Sr. AL Center HAL-093-003 1/2/2008 $1,000.00 Type A 10A NCAC 13F .0311 (d) Other Requirements; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain hot water temperatures in safe range for resident use in resident rooms and community bathrooms Paid in Full $1,000.00 1/16/2008

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Washington County

None of the facilities in Washington County have received a penalty since January 2006.

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Watauga County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Mountain Care Facilities HAL-095-002 3/14/2012 $2,000.00 Type A2 10A NCAC 13F .0909 Resident Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure infection control measures were used when obtaining fingerstick blood sugars for eight residents Paid in Full with 2 Partial Payments of $1,000.00; Partial Payment $2,000.00 04/25/2012 03/21/2012

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Wayne County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Britthaven of LaGrange HAL-096-001 9/16/2008 $4,100.00 Not corrected Type B 10A NCAC 13F .1004(a) Medication Administration; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to administer medications as ordered including insulin, anti-seizure and antihypertensives Paid in Full $4,100.00 10/6/2008
Faithful Family Care FCL-096-033 12/15/2009 $500.00 Type A 10A NCAC 13G .0901(b) Personal Care & Supervision; G.S. 131D-21(2) Declaration of Residents' Rights Facility failed to provide adequate supervision to a resident known to be an elopement risk Paid in Full $500.00 1/21/2010
Freemont Rest Center HAL-096-024 1/16/2013 $1,000.00 Type A2 10A NCAC 13F .0901(b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision of a resident to ensure his safety from deliberate self infliction of injury 12/18/2013 Training Completed; 07/30/2013 Settlement Agreement ($1,000.00 for Training); (training due 10/30/13) Appealed 1/30/2013    
Glen Care of Mt. Olive HAL-096-028 7/20/2011 $16,000.00 Type A 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure 6 of 6 sampled diabetic residents (including 4 recently deceased residents) requiring fingerstick blood sugar testing received the appropriate care and services in accordance with infection control measures Paid in Full; Partial Payment $8,000.00 $8,000.00 08/19/2011 08/10/2011
Goldsboro Assisted Living & Alzheimer's Care HAL-096-031 9/19/2012 $14,000.00 Type A1 10A NCAC 13F .0906(f)(4) Other Resident Care and Services; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify law enforcement and responsible party when a resident's whereabouts was unknown and there was reason for safety concern. Resident was struck by vehicle on roadway Paid In Full $14,000.00 10/12/2012
Pikeville Assisted Living FCL-096-035 2/17/2010 $2,000.00 Type A 10A NCAC 13G .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to seek health care referral following a resident's fall from bed injuring her eye 3 Partial Payments
Facility Closed Referred to Controllers' Office
$188.33 09/01/2010 08/03/2010 07/02/2010
Renu Life Extended, Inc HAL-096-022 4/16/2009 Staff Training Type A 10A NCAC 13F .0305 (h)(4) Physical Enviornment; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to several residents who had known history of wandering behavior; residents eloped from the premises. Training Completed   6/12/2009
Waylin Life Care Center (Change of Ownership) HAL-096-028 6/18/2012 $2,000.00 Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 Declaration of Residents' Rights Facility failed to assess and notify physician of the condition of a resident with pressure sores Paid in Full $2,000.00 6/25/2012

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Wilkes County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Wilkes County Adult Care HAL-097-014 6/19/2013 $3,400.00 Unabated Type B 10A NCAC 13F .0904 (e)(4) Nutrition and Food Service; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure all therapeutic diets were served as ordered by physician for four residents 4/28/14 Settlement Agreement for $1,700.00; Appealed 7/18/2013    
Wilkes County Adult Care HAL-097-014 6/20/2013 $6,000.00 Type A2 10A NCAC 13F .0902 (b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to notify mental health provider for one resident with aggressive behaviors who refused prescribed medications and was incarcerated for assault Paid in Full $6,700.00 12/31/2013
Wilkes County Adult Care HAL-097-014 12/19/2012 $4,000.00 Type A1 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure healthcare referral and follow-up for two residents relative to obtaining x-rays and orthopedic consult Paid in Full; Referred to Controller's Office $4,471.93 12/31/2013
Wilkesboro Living Center HAL-097-012 10/22/2009 $1,000.00 Type A 10A NCAC 13F .0702(b) Discharge of Residents; 10A NCAC 13F .0901(b) Personal Care and Supervision; G.S. 131D-4.4 (b)(c) Minimum Safety -Prohibit Smoking in Long Term Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure resident was supervised regarding smoking behaviors. Resident continued to smoke inside facility where oxygen was being used. Paid in Full $1,000.00 1/5/2010

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Wilson County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Applewood Assisted Living, LLC HAL-098-019 7/15/2010 $1,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to resident who presented with active symptoms of her mental illness including noncompliance to smoking policy resulting in a facility fire Paid in Full $1,000.00 9/1/2010
Dilda's Home Care, Inc FCL-098-026 12/16/2009 $7,000.00 Type A 10A NCAC 13G .0902 Health Care; 10A NCAC 13G .0901 Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to call a physician or seek immediate medical evaluation of a resident who sustained a fall resulting in injury Referred to Controller's Office    
Elm City Assisted Living (penalty #1) HAL-098-028 12/19/2013 $4,000.00 Type A2 10A NCAC 13F .0601 (a) Management of Facilities; G.S. 131D-21 (4) Declaration of Residents' Rights Facility failed to assure facility management took responsibility for the total operation of the facility to maintain compliance to rules 06/27/2014 Settlement Agreement for $2,000.00; Appealed 01/13/2014    
Elm City Assisted Living (penalty #2) HAL-098-028 12/19/2013 $53,250.00 Unabated Type A2 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure physician notification and mental health referrals were made for three residents who physically assaulted other residents and staff 06/27/2014 Settlement Agreement for $15,000.00; Appealed 01/13/2014    
Friendly Elm City Assisted Living HAL-098-016 01/23/2006 $2,000.00 Type A 10A NCAC 13F .0604 Personal Care and Other Staffing; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Facility failed to provide supervision to residents with problematic behaviors that resulted in injury for one resident Paid in Full $2,000.00 3/29/2006
Friendly Elm City Assisted Living HAL-098-016 01/23/2006 $5,000.00 Type A 10A NCAC 13F .1004 Medication Administration; G.S. 131D-21 (2)(4) Declaration of Residents' Rights Medication not administered as ordered for two residents Paid in Full $5,000.00 3/29/2006
The Meadows of Wilson HAL-098-015 01/26/2006 $8,000.00 Type A 10A NCAC 13F .1004 (a)(g)(j) Medication Administration G.S. 131D-21 (2)(4) Declaration of Residents' Rights; 131D-4.4 Adult Care Home Minimum Safety Requirements Resident's condition not reassessed, medications not administered as ordered, physician visit and labs not obtained as ordered upon return from hospitalization Settlement Agreement 6/19/06 $8,000.00 6/6/2006
Wilson Assisted Living HAL-098-027 9/18/2013 $21,600.00 Unabated Type B 10A NCAC 13F .1004 (a) Medication Administration; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure administration of prescription and non-prescription medications as prescribed for seven residents Paid in Full $21,600.00 11/14/2013
Wilson Assisted Living HAL-098-024 5/3/2007 $2,000.00 Type A 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to one resident (adjudicated incompetent) who left the facility multiple times Paid in Full $2000.00 6/11/2007

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Yadkin County

Facility Name License Number Penalty Issued Date Penalty Amount Penalty Type Reason for Issuance Current Status Amount Paid Date of Payment
          Rule Cited Nature of Violation      
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) HAL-099-013 7/21/2011 $7,000.00 Type A 10A NCAC 13F .0902 (b) Health Care; 10A NCAC 13F .0909 Residents' Rights; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure referral and follow-up for 3 residents related to significant weight loss,obtaining labs for monitoring lithium levels, and obtaining STD screening and treatment Paid in Full; 7/11/2012 Settlement Agreement for $19,000.00 in conjunction with 5 penalties issued 12/14/2011 - payment plan; Appealed 8/17/11 $19,000.00 03/04/2014 01/31/2014 01/07/2014 12/02/2013 10/28/2013 09/27/2013 08/28/2013 07/26/2013 06/27/2013 05/29/2013 04/29/2013 03/28/2013 02/25/2013 12/27/2012 11/26/2012 10/22/2012 09/17/2012 08/20/2012 07/18/2012
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #1 HAL-099-013 12/14/2011 $7,000.00 Type A 10A NCAC 13F .0407(a)(2) Other Staff Qualifications; 10A NCAC 13F .0901 (b) Personal Care & Supervision; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to provide supervision to residents noncomplaint to smoking policies and failed to ensure staff were trained on fire safety and emergency procedures to protect residents 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012    
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #2 HAL-099-013 12/14/2011 $7,000.00 Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to assure mental health referral and follow-up for two residents and physician notification regarding medication refusals for one resident 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012    
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #3 HAL-099-013 12/14/2011 $14,000.00 Type A 10A NCAC 13F .0305 Physical Environment; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to maintain outside grounds in a safe conditon resulting in one resident suffering fractures when stepping into an established hole in the yard 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012    
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #4 HAL-099-013 12/14/2011 $6,200.00 Unabated Type A 10A NCAC 13F .0902(b) Health Care; G.S. 131D-21 (2) Declaration of Residents' Rights Facility continued to fail to ensure health care referral and follow-up occurred for 2 residents 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012    
Johnston Enterprises of Shelby dba Piedmont Village at Yadkinville (Change of ownership) Penalty #5 HAL-099-013 12/14/2011 $2,700.00 Unabated Type B 10A NCAC 13F .0601 Management of Facilities; G.S. 131D-21 (2) Declaration of Residents' Rights Facility failed to ensure management directed care and services to meet needs of residents and maintain compliance to rules 7/11//2012 Settlement Agreement in conjunction with penalty issued 7/21/2011; Appealed 01/12/2012    
Piedmont Village at Yadkinville HAL-099-012 07/18/2008 $4,000.00 Type A 10A NCAC 13F .0702 (b) Discharge of Residents; 10A NCAC 13F .0901 (b) Personal Care and Supervision; G.S.131D-21 (2) Declaration of Resident's Rights Staff failed to address resident's increased aggressive behaviors resulting in resident setting room on fire Paid in Full $4,000.00 9/12/2008

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Yancey County

None of the facilities in Yancey County have received a penalty since January 2006.

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