Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
Cleveland Pines
Shelby, NC · 120 certified beds · Last Life Safety survey July 18, 2024
CMS Certification Number 345282 · first certified June 1988
Ownership
Operated by ATRIUM HEALTH · For profit - Corporation
- Ownership changed February 1, 2020 (change of ownership)from THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Position within NC
4 citations — more than 9% 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
The latest survey found 3 citations; the earlier surveys in the window averaged 0.5. 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 (September 2025 to November 2025), and past the point by which nine in ten NC facilities have been surveyed. This facility’s last Life Safety survey was July 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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Physical environment (health survey)
2 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 4 Life Safety citations above. The Physical Environment Index
- F-0880 Provide and implement an infection prevention and control program.
How that compares
Compared with the median facility in NC, and nationally. Surveyors differ markedly between states, so the NC figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 4 |
| Median facility in NC | 9 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| June 10, 2021 | 0 |
| March 23, 2023 | 1 |
| July 18, 2024 | 3 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | 1 | 2024-07-18 |
| K-0521 | Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | 1 | 2024-07-18 |
| K-0917 | Ensure electrical receptacles or cover plates have distinctive color or marking. | 1 | 2023-03-23 |
| K-0161 | Use approved construction type or materials. | 1 | 2024-07-18 |
What the citations cover
- Gas, Vacuum, and Electrical Systems Deficiencies 2
- Services Deficiencies 1
- Construction Deficiencies 1
| Category | Citations |
|---|---|
| Gas, Vacuum, and Electrical Systems Deficiencies | 2 |
| Services Deficiencies | 1 |
| Construction Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
July 18, 2024 — 3 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0161 | Use approved construction type or materials. | Deficient, Provider has date of correction (September 27, 2024) |
| K-0521 | Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. | Deficient, Provider has date of correction (September 27, 2024) |
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | Deficient, Provider has date of correction (September 27, 2024) |
March 23, 2023 — 1 citation
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0917 | Ensure electrical receptacles or cover plates have distinctive color or marking. | Deficient, Provider has date of correction (May 5, 2023) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.