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

Penick Village

Southern Pines, NC · 32 certified beds · Last Life Safety survey January 23, 2025

CMS Certification Number 345111 · first certified January 1974

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Other

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
2
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

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

The latest survey found 2 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 (March 2026 to May 2026), and past the point by which nine in ten NC facilities have been surveyed. This facility’s last Life Safety survey was January 2025. 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)

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 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
32022-0832023-1022025-01
Citations at each Life Safety survey
Survey dateCitations
August 10, 20223
October 24, 20233
January 23, 20252

Most-cited tags

Most-cited tags at this facility
K-09181K-03411K-03211K-09111K-02811K-07121K-09141K-03251
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0918Have generator or other power source capable of supplying service within 10 seconds.12022-08-10
K-0341Install a fire alarm system that can be heard throughout the facility.12023-10-24
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.12025-01-23
K-0911Meet requirements for the installation and maintenance of electrical systems.12023-10-24
K-0281Install proper backup exit lighting.12022-08-10
K-0712Have simulated fire drills held at unexpected times.12023-10-24
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.12025-01-23
K-0325Have properly installed hallway dispensers for alcohol-based hand rub.12022-08-10

What the citations cover

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

Every citation on file

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

January 23, 2025 — 2 citations

Citations issued on January 23, 2025
TagWhat the surveyor checksStatus
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 (March 12, 2025)
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 (March 12, 2025)

October 24, 2023 — 3 citations

Citations issued on October 24, 2023
TagWhat the surveyor checksStatus
K-0341Install a fire alarm system that can be heard throughout the facility.Deficient, Provider has date of correction (February 27, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (February 27, 2024)
K-0911Meet requirements for the installation and maintenance of electrical systems.Deficient, Provider has date of correction (February 27, 2024)

August 10, 2022 — 3 citations

Citations issued on August 10, 2022
TagWhat the surveyor checksStatus
K-0281Install proper backup exit lighting.Deficient, Provider has date of correction (October 13, 2022)
K-0325Have properly installed hallway dispensers for alcohol-based hand rub.Deficient, Provider has date of correction (October 13, 2022)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (October 13, 2022)

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