Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Accordius Health At Gastonia during CMS and state inspections, most recent first.
A cognitively intact resident with COPD, coronary heart disease, hypertension, and heart failure had two albuterol inhalers and two oxymetazoline nasal sprays kept in a basket on the overbed table within reach, without any documented assessment of the resident’s ability to safely self-administer medications and without an active order for the nasal spray. The resident reported using the inhalers for dyspnea and the nasal spray for congestion, while the assigned nurse stated she had not noticed these medications at bedside and was unaware of any residents self-administering medications. The DON and Administrator later acknowledged that a self-administration assessment and appropriate physician orders, along with secure storage of the medications, were required but had not been completed at the time of the surveyors’ observations.
A resident with a PICC line for extended IV antibiotic therapy had a provider order and care plan directing that the PICC dressing be changed every seven days on the day shift. The MAR reflected this order, but the scheduled dressing change was not completed or signed off, and no nursing note documented a reason. Subsequent observation showed the PICC dressing still dated from a prior week with curled corners, confirming it had not been changed as ordered. The assigned nurse admitted not performing the dressing change, and leadership, including the DON and Nurse Practitioner, confirmed that PICC dressings are expected to be changed at least every seven days to prevent infection.
The facility failed to provide SNF ABNs to three residents before the end of their Medicare Part A skilled services. Although NOMNCs were issued, there was no evidence of SNF ABNs being provided, leaving residents uninformed about potential financial liabilities. Staff interviews revealed a lack of awareness and communication regarding the issuance of SNF ABNs.
The facility failed to provide RN coverage for at least 8 consecutive hours on four days within a 91-day period. The Administrator attempted to show coverage by adding clock-in times for salaried staff, but interviews with the former DON and ADON contradicted these records, as they stated they did not work on the weekends in question.
The facility failed to maintain cleanliness and proper food handling procedures, with unclean floors in the kitchen and storage areas, undated and spoiled food items in the walk-in cooler, and unlabeled items in nourishment rooms. A staff member was also observed preparing food without a facial hair restraint, contrary to policy.
The facility failed to ensure the cleanliness and proper closure of dumpster lids, potentially attracting pests. Observations revealed open dumpster doors and scattered debris. Staff interviews showed confusion over responsibility, with maintenance and housekeeping departments sharing duties but failing to perform daily checks.
The facility failed to maintain a safe and clean environment, with deficiencies including missing knobs on wardrobe closets, unsanitary wheelchairs, and unsecured call light covers. Exposed screws in multiple rooms posed a risk of injury, while a wheelchair was found with dried debris. The Maintenance Director and Environmental Services Director acknowledged these issues, which were not identified during daily rounds.
A facility failed to follow a pharmacy recommendation to update a medication order for a resident to include the indication for use. The resident, with diagnoses including dementia and mood disorders, had an order for Lamotrigine without a specified diagnosis. The Consultant Pharmacist's recommendation to update the order was not addressed due to a lack of follow-up during her absence, and the responsibility for addressing the recommendation was unclear among staff.
The facility did not post accurate daily nurse staffing information for 19 out of 20 days reviewed. The Scheduler was unaware of the requirement to update staffing sheets to reflect actual staff present, completing them ahead of time based on schedules. The Administrator was aware of the requirement but did not know updates were not being made.
Failure to Assess and Authorize Resident Self-Administration of Bedside Medications
Penalty
Summary
Failure to assess and authorize a resident for self-administration of medications occurred when a cognitively intact resident with COPD, coronary heart disease, hypertension, and heart failure had multiple medications stored at bedside without a documented self-administration assessment. The resident’s active physician orders included albuterol sulfate inhaler to be used as needed for dyspnea, but there was no active order for oxymetazoline hydrochloride nasal spray. Review of the medical record showed no documentation that the resident had been evaluated for the ability to safely self-administer medications, despite having these medications in his room. Surveyor observations on multiple days revealed two albuterol inhalers and two oxymetazoline nasal spray bottles in a basket on the overbed table within the resident’s reach while he was in bed. The resident reported using the inhalers about twice a week for shortness of breath and using the nasal spray for congestion. The assigned nurse stated she had administered the resident’s medications but had not noticed the inhalers or nasal sprays at bedside and was unaware of any residents self-administering medications. The DON later confirmed that a self-administration assessment and appropriate physician orders were required if the resident wished to self-administer these medications and that the medications should be stored securely, but at the time of the observations, these steps had not been taken.
Failure to Follow PICC Line Dressing Change Orders
Penalty
Summary
The deficiency involves the facility’s failure to follow a Nurse Practitioner’s order for PICC line dressing changes for a resident receiving IV antibiotic therapy. The resident was cognitively intact, had a PICC line for a 38‑day course of IV antibiotics, and had an order dated 03/20/26 for the PICC dressing to be changed every seven days on Fridays. The care plan and MDS reflected the presence of the PICC and the need for dressing changes per order. The MAR included an order to change the PICC dressing every Friday on dayshift starting 03/27/26, but the entry for 03/27/26 was left blank and not signed, and there was no progress note explaining why the dressing change was not completed. On 03/29/26, observation of the resident’s PICC site showed an intact dressing with curled corners, no redness or drainage, and a date of 03/18/26, indicating the dressing had not been changed as ordered on 03/27/26. The nurse assigned to the resident on 03/27/26 acknowledged he was supposed to change the PICC dressing per the order but did not complete the task. The ADON later confirmed that when she changed the dressing on 03/30/26, the old dressing was still dated 03/18/26 and stated she expected it to have been changed on 03/27/26. The DON stated that IV access dressings must be changed at least every seven days, with daily flushes and daily monitoring for signs of infection, and that the assigned nurse should have recognized the dressing was overdue. The Nurse Practitioner also stated she expected dressing changes every seven days and that exceeding this timeframe increases the risk of infection.
Failure to Provide SNF ABNs to Residents
Penalty
Summary
The facility failed to provide Skilled Nursing Facility Advanced Beneficiary Notices (SNF ABN) to residents prior to the end of their Medicare Part A skilled services. This deficiency was identified for three residents who remained in the facility after their Medicare Part A coverage ended. For each resident, a Notice of Medicare Non-Coverage (NOMNC) was issued, indicating the end of their Medicare Part A coverage, but there was no evidence that a SNF ABN was provided to inform them of their potential financial liability for services not covered by Medicare. Interviews with facility staff revealed a lack of understanding and communication regarding the issuance of SNF ABNs. The Social Worker, responsible for issuing NOMNCs and SNF ABNs for residents under Medicare Part A, was unaware of the requirement to issue a SNF ABN when residents had skilled days left and remained in the facility. The Administrator assumed the Social Worker was aware of this responsibility, but the oversight resulted in the failure to provide necessary notifications to the residents or their responsible parties.
Failure to Ensure RN Coverage for 8 Consecutive Hours
Penalty
Summary
The facility failed to ensure Registered Nurse (RN) coverage for at least 8 consecutive hours per day on four specific days within a 91-day period. The Payroll Based Journal (PBJ) report for the third quarter of 2024 indicated that the facility lacked RN coverage on 5/04/24, 5/18/24, 5/25/24, and 6/08/24. On these dates, the facility either did not have an RN assigned or failed to provide documentation to support RN presence. Interviews with the Scheduler and Administrator revealed awareness of the requirement for RN coverage, but discrepancies were noted in the timecard records and staffing assignment sheets. The Administrator attempted to rectify the situation by manually adding clock-in and clock-out times for salaried employees, such as the Director of Nursing (DON) and Assistant Director of Nursing (ADON), to indicate RN coverage. However, interviews with the former DON and ADON contradicted these records, as they both stated they did not work on the weekends in question. The Administrator attributed the discrepancies to potential disgruntlement among former staff, but no concrete evidence was provided to confirm RN coverage on the specified dates.
Deficiencies in Food Safety and Cleanliness
Penalty
Summary
The facility failed to maintain cleanliness and proper food handling procedures in its kitchen and nourishment rooms. Observations revealed that the floors of the walk-in cooler, walk-in freezer, and kitchen were not clean, with various stains and debris present. Despite the Dietary Manager's expectation that these areas be mopped daily, the issues persisted over multiple days. Additionally, food items in the walk-in cooler were found to be undated, with some showing signs of spoilage, such as a bag of shredded lettuce with brown discoloration and a metal pan of tomato soup that should have been discarded. The Dietary Manager acknowledged that all food items should be dated when opened and discarded if spoiled, but this was not consistently done. Further deficiencies were noted in the nourishment rooms on both the first and second floors, where multiple food items were found unlabeled and undated. The Dietary Manager stated that the dietary department was responsible for ensuring all items were labeled and dated, but nursing staff sometimes placed unlabeled items in the refrigerators and freezers. Additionally, a staff member preparing food was observed without a restraint for his facial hair, which the Dietary Manager confirmed was against policy, as beard guards had been ordered but not yet received. The Administrator expected all dietary staff with facial hair to wear beard guards when preparing and serving food.
Improper Disposal and Maintenance of Dumpster Area
Penalty
Summary
The facility failed to maintain the cleanliness and proper closure of dumpster lids in the area surrounding the dumpsters, which had the potential to attract pests and rodents. During an observation, it was noted that the side doors of all three dumpsters were open, and the top door of the middle dumpster was also open, with multiple cardboard boxes protruding from it. Additionally, various items such as gloves, a plastic drinking cup, pieces of tape, a straw, and condiment packets were scattered on the ground around the dumpster area. Interviews with staff revealed a lack of clarity regarding responsibility for maintaining the cleanliness of the dumpster area. One staff member was unsure who was responsible, while the Dietary Manager indicated that the maintenance department was in charge. The Housekeeping Director stated that both floor technicians and the maintenance department shared the responsibility, with daily checks required to ensure cleanliness and closed lids. However, both the Maintenance Director and a floor technician admitted they had not checked the area on the morning of the observation. The Administrator confirmed that the housekeeping department was responsible for ensuring the area was clean and that dumpster lids were closed.
Facility Fails to Maintain Safe and Clean Environment
Penalty
Summary
The facility failed to maintain a safe and homelike environment for its residents, as evidenced by several deficiencies observed during a survey. In multiple rooms, wardrobe closets had missing knobs, leaving exposed screws that posed a risk of injury to residents. These issues were noted in rooms 202, 208, 212, 215, 223, and 225, with some drawers also being off track and not functioning properly. The Maintenance Director acknowledged these safety concerns and admitted that the issues should have been identified during daily rounds by department managers and reported for repair. Additionally, the facility did not ensure that resident wheelchairs were kept clean and sanitary. A wheelchair in room 227-A was found with dried, crusty debris on and under the seat cushion and on the brake. The Environmental Services Director, who was new to the facility, confirmed the lack of a cleaning schedule and acknowledged the need for the wheelchair to be cleaned. The Administrator was aware of the issue and had discussed the need for regular cleaning with the Environmental Services Director. Furthermore, the call light cover in a resident's bathroom was not secured to the wall, which could cause it to come loose when the cord was pulled. This issue was observed in room 227, and the Maintenance Director was unaware of the unsecured face plate cover. The Administrator stated that department heads conducted daily rounds to check for environmental issues, but this particular problem had not been identified or reported.
Failure to Update Medication Order with Indication for Use
Penalty
Summary
The facility failed to follow the pharmacy recommendation to update a medication order to include the indication for use for a resident. The resident, who was admitted with diagnoses including dementia, mood disturbance, anxiety disorder, and major depressive disorder, had an active physician's order for Lamotrigine without a specified diagnosis indicating the reason for use. The Consultant Pharmacist had submitted a recommendation to the facility to update the order with the indication for use, but this recommendation was not addressed. The Consultant Pharmacist confirmed that the recommendation was made as part of her monthly medication reviews, but due to her absence in November and December, the follow-up was not conducted. The Director of Nursing, who returned to the facility in December, stated that the Unit Manager was responsible for reviewing and following up on pharmacy recommendations. However, the recommendation for the resident's medication order was not completed. The Administrator believed the former Director of Nursing was responsible for ensuring pharmacy recommendations were addressed, but this was not done, resulting in the deficiency.
Failure to Post Accurate Daily Nurse Staffing Information
Penalty
Summary
The facility failed to post complete and accurate daily licensed nurse staffing information for 19 out of 20 days reviewed. Specifically, the staffing information was not updated to reflect the actual staff present on 5/04/24, 5/18/24, 5/25/24, 6/08/24, and from 1/01/25 through 1/16/25, with only 1/16/25 being accurately updated. Additionally, the facility was unable to provide a staffing sheet for 5/25/24. During an interview, the Scheduler admitted to being unaware of the requirement to adjust the posted staffing information to reflect the actual staff present, as she completed the sheets ahead of time based on the staff work schedule and did not update them when she was off on weekends or vacation. The Administrator acknowledged awareness of the requirement but was unaware that the updates were not being made.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Gastonia
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Gastonia Health & Rehab Center | 2.4 mi | ★★★★★ | 4 | 0 |
| Belaire Health Care Center | 2.6 mi | ★★★★★ | 1 | 0 |
| Courtland Terrace | 3.1 mi | ★★★★★ | 4 | 0 |
| Peak Resources - Gastonia | 3.1 mi | ★★★★★ | 2 | 0 |
| The Greens At Gastonia | 3.4 mi | ★★★★★ | 2 | 0 |
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