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

White Oak Manor-Shelby

Shelby, NC · 160 certified beds · Last Life Safety survey May 23, 2024

CMS Certification Number 345171 · first certified October 1977

Ownership

Operated by NATIONAL HEALTHCARE CORPORATION · For profit - Corporation

  • Ownership changed August 1, 2024 (change of ownership)from WHITE OAK MANOR SHELBY INC
11
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
0
Tags cited more than once
Across separate surveys
5
Inspection & testing records
Of the citations on file

Position within NC

11 citations — more than 56% 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 5 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 (July 2025 to September 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

Physical environment (health survey)

4 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 11 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.
  • 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 facility11NC median9National median11
Citations on file over three years, compared
MeasureCitations
This facility11
Median facility in NC9
Median facility nationally11

Survey history

Citations at each Life Safety survey
12021-0752023-0252024-05
Citations at each Life Safety survey
Survey dateCitations
July 2, 20211
February 28, 20235
May 23, 20245

Most-cited tags

Most-cited tags at this facility
K-09231K-03211K-09141K-03531K-03451K-09181K-02221K-01611
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0923Have proper medical gas storage and administration areas.12023-02-28
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.12023-02-28
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.12024-05-23
K-0353Inspect, test, and maintain automatic sprinkler systems.12024-05-23
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12024-05-23
K-0918Have generator or other power source capable of supplying service within 10 seconds.12024-05-23
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.12023-02-28
K-0161Use approved construction type or materials.12024-05-23

What the citations cover

Citations by CMS category
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Egress Deficiencies 3
  • Smoke Deficiencies 3
  • Construction Deficiencies 1
Citations by CMS category
CategoryCitations
Gas, Vacuum, and Electrical Systems Deficiencies4
Egress Deficiencies3
Smoke Deficiencies3
Construction Deficiencies1

Every citation on file

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

May 23, 2024 — 5 citations

Citations issued on May 23, 2024
TagWhat the surveyor checksStatus
K-0161Use approved construction type or materials.Deficient, Provider has date of correction (September 5, 2024)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (September 5, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (September 5, 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 (September 5, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (September 5, 2024)

February 28, 2023 — 5 citations

Citations issued on February 28, 2023
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 (May 19, 2023)
K-0225Have stairways and smokeproof enclosures used as exits that meet safety requirements.Deficient, Provider has date of correction (May 19, 2023)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (May 19, 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 19, 2023)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (May 19, 2023)

July 2, 2021 — 1 citation

Citations issued on July 2, 2021
TagWhat the surveyor checksStatus
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (August 28, 2021)

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