Based on observations, record review and interviews with staff, Nurse Practitioner and Responsible Party (RP), the facility failed to protect the residents' right to be free of resident-to-resident physical abuse for 2 of 2 residents (Resident #110 and Resident #14) reviewed for abuse. Resident #110 (a female resident with severe cognitive impairment) had a history of following Resident #14 (a male resident with cognitive impairment) around the facility, getting close to him, and entering his room at night. Staff reported Resident #14 would get irritated and try to get away from Resident #110. On 6/5/26 Resident #110 was observed poking Resident #14 in the face with her finger and yelling. …
F600 citations in North Carolina
Abuse and neglect · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
North Carolina cites F600 more often than its own record predicts
1.18 times the share F600 takes of citations nationally.
Of every deficiency written in North Carolina in 2025, this is the portion that was F600.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What North Carolina surveyors wrote
F600 findings written in North Carolina, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observations, record review, and interviews with staff, resident, Nurse Practitioner #1, and Medical Director, the facility failed to protect a resident's right to be free from neglect when nurse aides did not reposition and provide incontinence care to a dependent resident. One of the nurse aides was made aware on two occasions that Resident #103 reported she had not been repositioned, needed incontinence care and her buttocks was sore. Resident #103 stated being left all day without being changed or repositioned made her feel sick to her stomach when she thought about it and she felt neglected. The deficient practice occurred for 1 of 3 residents reviewed for neglect (Resident #103). …
Based on record reviews and staff interviews, the facility failed to protect a resident's right to be free from neglect when Resident #6's call light was disconnected by a staff member. This caused the resident to be unable to access assistance, and Resident #6 was found on the next shift to be soiled with urine and feces. This failure affected 1 of 2 residents who were reviewed for call system concerns (Resident #6).Findings included:Resident #6 admitted to the facility on [DATE] with diagnoses of chronic kidney disease and hypertension.Resident #6's admission Minimum Data Set (MDS) dated [DATE] indicated he had severe cognitive impairment. Further review of the MDS revealed Resident #6 needed substantial/maximum assistance with toilet hygiene and was incontinent with bowel and bladder. …
The short window
Recent years
| Year | Share of North Carolina citations | vs expected |
|---|---|---|
| 2023 | 1.83% | 1.03× |
| 2024 | 3.06% | 1.30× |
| 2025 | 3.08% | 1.18× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else North Carolina surveyors cite →
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