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

Brook Stone Living Center

Pollocksville, NC · 80 certified beds · Last Life Safety survey May 1, 2024

CMS Certification Number 345394 · first certified August 1991

Ownership

Independently operated (no chain recorded by CMS) · For profit - Corporation

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

13
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
6
Inspection & testing records
Of the citations on file

Position within NC

13 citations — more than 65% 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 7 citations; the earlier surveys in the window averaged 3. 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 (June 2025 to August 2025), and past the point by which nine in ten NC facilities have been surveyed. This facility’s last Life Safety survey was May 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

1 inspection-and-testing tag has been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Physical environment (health survey)

5 physical-environment citations 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 13 Life Safety citations above. The Physical Environment Index

  • F-0584 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.

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 facility13NC median9National median11
Citations on file over three years, compared
MeasureCitations
This facility13
Median facility in NC9
Median facility nationally11

Survey history

Citations at each Life Safety survey
02021-1062023-0172024-05
Citations at each Life Safety survey
Survey dateCitations
October 6, 20210
January 20, 20236
May 1, 20247

Most-cited tags

Most-cited tags at this facility
K-03212K-03242K-09141K-03531K-09011K-09211K-01111K-02111
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.22024-05-01
K-0324Provide properly protected cooking facilities.22024-05-01
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.12024-05-01
K-0353Inspect, test, and maintain automatic sprinkler systems.12023-01-20
K-0901Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.12023-01-20
K-0921Ensure that testing and maintenance of electrical equipment is performed.12024-05-01
K-0111Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.12023-01-20
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.12024-05-01

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 5
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Egress Deficiencies 1
  • Miscellaneous Deficiencies 1
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies5
Gas, Vacuum, and Electrical Systems Deficiencies4
Egress Deficiencies1
Miscellaneous Deficiencies1
Construction Deficiencies1
Electrical Deficiencies1

Every citation on file

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

May 1, 2024 — 7 citations

Citations issued on May 1, 2024
TagWhat the surveyor checksStatus
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (June 21, 2024)
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.Deficient, Provider has date of correction (June 21, 2024)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (June 21, 2024)
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.Deficient, Provider has date of correction (June 21, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (June 21, 2024)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (June 21, 2024)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (June 21, 2024)

January 20, 2023 — 6 citations

Citations issued on January 20, 2023
TagWhat the surveyor checksStatus
K-0111Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.Deficient, Provider has date of correction (May 6, 2023)
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.Deficient, Provider has date of correction (May 6, 2023)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (May 6, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (May 6, 2023)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (May 6, 2023)
K-0901Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.Deficient, Provider has date of correction (May 6, 2023)

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