White Oak Manor-Kings Mountain

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and staff interviews, the facility failed to identify abuse and ensure staff implemented facility's abuse policy and procedures for reporting abuse. This occurred when the facility failed to report allegations of resident-to-resident abuse to the State Survey Agency within the specified time frames. The facility also failed to notify the county Adult Protective Services (APS) of allegations of abuse. This deficient practice affected 4 of 30 residents reviewed for abuse (Resident #32, Resident #59, Resident #86, and Resident #125).The findings included: A review of undated facility policy titled Protocol for Reporting Abuse revealed if a reasonable person suspected that abuse had occurred, staff would immediately notify the administrator or designee, person in charge, and officials including the State Survey Agency and APS no later than 2 hours after the allegation was made if the events of allegation involved abuse or resulted in serious bodily injury. 1. Resident #154 was initially…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility failed to complete a thorough investigation after allegations of resident-to-resident abuse occurred. This deficient practice affected 4 of 30 residents reviewed for abuse (Resident #32, Resident #59, Resident #86, and Resident #125).Findings included: The undated facility abuse policy titled [NAME] Oak Management, Inc. Plan for the Prevention of Elder Abuse was reviewed. A section of policy titled Resident to Resident Abuse stated all forms of abuse, including resident-to-resident abuse, must be reported immediately to the Director of Nursing and the facility administrator. Section 6 titled Investigation stated all reports of resident abuse, neglect, and injuries of unknown source shall be promptly and thoroughly investigated by facility management. The administrator or designee shall investigate the allegation by completing the following: Review the completed documentation forms or any other pertinent documentation related to the allegation. Review the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, and Nurse Practitioner and staff interviews, the facility failed to accurately assess 3 of 3 severely cognitively impaired residents for bilateral half side rails on their beds (Resident #2, Resident #64, and Resident #77). The findings included:1. Resident #2 was admitted to the facility on [DATE] with diagnoses which included dementia with psychotic disturbance, gastrostomy tube, and atrial fibrillation.Review of Resident #2's consent for use of bed rails dated 08/07/22 revealed the facility received telephone consent from the resident's responsible party (RP) but the consent was not signed by the RP or the nurses receiving consent.Review of Resident #2's care plan dated 07/15/25 revealed a focus area for activities of daily living (ADL) deficits related to generalized weakness and cognitive loss secondary to dementia, congestive heart failure (CHF), atrial fibrillation, and stroke with hemiplegia (paralysis on one side of body). The goal was for the resident to be able…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, resident and staff interviews, the facility failed to maintain a resident's dignity when incontinence care was not provided as needed for 1 of 3 residents reviewed for dignity (Resident #139).Findings included: Resident #139 was admitted on [DATE] with diagnoses which included cerebrovascular accident (stroke) and hypertension (high blood pressure). A quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #139 was cognitively intact, received a diuretic (a drug that causes the kidneys to make more urine) daily, was always incontinent of bowel and bladder, and was dependent with incontinence care and toileting. An interview with Resident #139 was conducted on 08/05/25 at 11:32 AM. Resident #139 stated that a few weeks ago she had an incontinent episode early in the morning. She asked to be changed, and no one came back to change her. She reported that she laid in wet briefs all day until her daughter arrived sometime after lunch. Resident reported she couldn't…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews, staff, and family interviews, the facility failed to protect private health information for residents when they provided Resident #153's medical records and a list of resident names, room numbers, medical record numbers, and allergies to Resident #43's Representative at a medical appointment. This deficient practice affected 1 of 2 residents reviewed for privacy (Resident #153). The findings included: Resident #153 was admitted to the facility on [DATE] and was discharged on 03/23/25. Resident #43 was admitted to the facility on [DATE]. A review of Resident 43's neurology consultation form dated 08/15/24 revealed that the provider documented sent wrong medical records on Resident #153, as well as allergies for every resident in the facility. A telephone interview was conducted with Resident #43's Representative on 08/07/25 at 8:41 AM. Resident #43's Representative reported he attended a medical appointment for Resident #43 on 08/15/24. The Representative stated that the facility…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and Hospital Case Manager, Resident's Representative, and staff interviews, the facility failed to allow a resident to return to the first available bed at the facility after being sent to the hospital for a medical and psychiatric (psych) evaluation. The resident remained in the hospital despite being medically cleared to return to the nursing home after 5 days. This deficient practice was evidenced for 1 of 3 residents reviewed for transfer and discharge (Resident #154).Findings included: Resident #154 was admitted to the facility on [DATE] and discharged to the hospital on 5/9/2025. Resident #154 was admitted with diagnoses that included spinal stenosis, muscle weakness, dementia with other behavioral disturbance, depression, generalized anxiety disorder, unspecified glaucoma and resided in the locked unit. Review of Resident #154's face sheet indicated a family member was Resident #154's emergency contact, Resident Representative (RR), and responsible party. A review of progress notes…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, resident and staff interviews, the facility failed to provide incontinence care to a resident when needed and was alerted by a family member that Resident #139 had laid in a urine soaked brief, clothes, under pad and sheets for several hours. This deficient practice was for 1 of 3 residents reviewed for providing activities of daily living care (Resident #139). Findings included:Resident #139 was admitted on [DATE] with diagnoses which included cerebrovascular accident (stroke), hypertension (high blood pressure). A quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #139 was cognitively intact, received a diuretic (a drug that causes the kidneys to make more urine) daily, was always incontinent of bowel and bladder, and was dependent with incontinence care and toileting. An interview with Resident #139 was conducted on 08/05/25 at 11:32 AM. Resident #139 stated that a few weeks ago she had an incontinent episode early in the morning. She asked to be changed,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and resident, staff, pharmacy and Nurse Practitioner (NP) interviews, the facility failed to prevent a drug regimen free from unnecessary drugs for 1 of 17 residents reviewed for unnecessary medications. Resident #142 was administered a tuberculosis skin test using tubersol. Record Review indicated to only perform a screening as Resident #142 had an allergy to tubersol. The findings included: 1. Resident #142 was admitted to the facility on [DATE] with diagnosis that included vascular dementia, hypertension, and unspecified respiratory tuberculosis. Record review of admission paperwork dated 03/04/21 revealed Resident #142 had listed an allergy to tubersol (an intradermal solution used to perform a Mantoux test which test for dormant or active tuberculosis (TB)). No origin of allergy or reaction was noted on paperwork. Review of physician order dated 08/01/21 revealed Resident #142 was to receive TB screening sheet annually on March 1. Review of Resident #142 March 2025 Medical…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation, resident, and staff interviews, the facility failed to develop an individualized person-centered comprehensive care plan in the areas of urinary catheter use and opioid (pain medication) use (Resident #89). This deficient practice was for 1 of 5 residents whose comprehensive care plans were reviewed. Findings included: Resident #89 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus (DM), chronic pain, peripheral vascular disease, and obstructive uropathy. a. A review of Resident #89's physician orders revealed an order dated 11/29/2023 for the placement of a urinary catheter due to urinary retention. b. A review of Resident #89's medication orders revealed: 1. Tramadol (an opioid) 50 milligrams (mg) twice a day for pain; start date: 11/27/2023. 2. Tramadol 50 mg three times a day for pain; start date: 12/21/2023 3. Tramadol 100 mg every 8 hours for pain; start date: 04/29/2024 A review of Resident #89's quarterly Minimum Data Set (MDS) dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, and staff interviews, the facility failed to follow their Hand Hygiene policy and procedure when Nurse #1 failed to sanitize her hands after doffing gloves used to clean stool smears from a resident's rectum and before donning clean gloves to apply treatment to the resident's rectum and then failed to doff her gloves, sanitize her hands and don clean gloves before refastening the resident's brief for 1 of 3 residents (Resident #21) reviewed for incontinence care. The findings included: Review of the facility's Hand Hygiene Policy and Procedure with no date revealed the following statement: Hand hygiene continues to be the primary means of preventing the transmission of infection. The following is a list of some situations that require hand hygiene: Before and after assisting a resident with toileting; After contact with a resident's mucous membranes and body fluids or excretions; After removing gloves or aprons; An observation on 04/30/24 at 12:40 PM revealed Nurse #1 came into Resident #21's room to apply hemorrhoid cream to the resident. The…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, resident, and staff interviews, the facility failed to provide a privacy curtain for 1 of 14 rooms on the memory care unit reviewed for privacy (room [ROOM NUMBER]). The findings included: Resident #48 was admitted to the facility on [DATE]. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #48 was severely cognitively impaired. An observation of room [ROOM NUMBER] was conducted on 04/29/24 at 10:00 AM and revealed a semi-private room with and the bed next to the door had no privacy curtain hanging. An observation and interview were conducted with Nurse #3 on 04/30/24 at 10:15 AM revealed room [ROOM NUMBER] did not have a privacy curtain hanging. Nurse #3 further revealed housekeeping was responsible for cleaning and changing out curtains in residents' rooms. Nurse #3 indicated she was unable to recall how long room [ROOM NUMBER] had gone without a privacy curtain. An observation and interview conducted with Nurse Aide (NA) #3 on 04/30/24 at 10:20 AM revealed the privacy…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and interviews with staff, responsible party and Nurse Practitioner the facility failed to notify the physician when a resident (Resident #142) experienced a second change in condition when the resident's wrist started to swell following an unwitnessed fall. This failure was for 1 of 3 residents reviewed for notification of changes (Resident #142). The findings included: Resident #142 was admitted to the facility on [DATE] with diagnosis which included fracture of the carpal bone in the left wrist. An initial nursing assessment dated [DATE] at 8:33 PM revealed Resident #142 was alert and oriented. A nursing progress note dated 10/15/22 at 3:40 PM written by Nurse #1 revealed Resident #142 was noted to be on the floor at 8:32 AM. Nurse #1 completed an assessment and contacted Nurse Practitioner #1 at 8:47 AM and obtained orders for a 2-view x-ray of right wrist STAT (urgent, right away). The note revealed due to the resident having pain the orders were put in right away. The note revealed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.