Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

Carolina Rivers Nursing and Rehabilitation Center

Jacksonville, NC · 120 certified beds · Last Life Safety survey August 16, 2024

CMS Certification Number 345072 · first certified February 1971

Ownership

Operated by PRINCIPLE LONG TERM CARE · For profit - Limited Liability company

No change of ownership on CMS record since January 1, 2016, when the records begin.

8
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
0
Tags cited more than once
Across separate surveys
6
Inspection & testing records
Of the citations on file

Position within NC

8 citations — more than 34% of the 419 certified nursing homes in NC. Compared within NC rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 6 citations; the earlier surveys in the window averaged 1. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (October 2025 to December 2025), and past the point by which nine in ten NC facilities have been surveyed. This facility’s last Life Safety survey was August 2024. Facilities in NC are typically surveyed 14–16 months after the last one (median 15), measured over 412 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Physical environment (health survey)

1 physical-environment citation on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 8 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in NC, and nationally. Surveyors differ markedly between states, so the NC figure is the meaningful one.

This facility8NC median9National median11
Citations on file over three years, compared
MeasureCitations
This facility8
Median facility in NC9
Median facility nationally11

Survey history

Citations at each Life Safety survey
02022-0122023-0562024-08
Citations at each Life Safety survey
Survey dateCitations
January 14, 20220
May 15, 20232
August 16, 20246

Most-cited tags

Most-cited tags at this facility
K-05111K-05211K-03241K-02221K-09181K-03451K-02811K-03721
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0511Have properly installed electrical wiring and gas equipment.12024-08-16
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.12023-05-15
K-0324Provide properly protected cooking facilities.12024-08-16
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.12024-08-16
K-0918Have generator or other power source capable of supplying service within 10 seconds.12024-08-16
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12023-05-15
K-0281Install proper backup exit lighting.12024-08-16
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12024-08-16

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 3
  • Egress Deficiencies 2
  • Services Deficiencies 2
  • Gas, Vacuum, and Electrical Systems Deficiencies 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies3
Egress Deficiencies2
Services Deficiencies2
Gas, Vacuum, and Electrical Systems Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

August 16, 2024 — 6 citations

Citations issued on August 16, 2024
TagWhat the surveyor checksStatus
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.Deficient, Provider has date of correction (January 5, 2025)
K-0281Install proper backup exit lighting.Deficient, Provider has date of correction (January 5, 2025)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (January 5, 2025)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (January 5, 2025)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (January 5, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (January 5, 2025)

May 15, 2023 — 2 citations

Citations issued on May 15, 2023
TagWhat the surveyor checksStatus
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (July 30, 2023)
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.Deficient, Provider has date of correction (July 30, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.