Whispering Pines Nursing & Rehab Center

In the surveyor’s words

From the most serious findings on record at Whispering Pines Nursing & Rehab Center, in the surveyor’s own words.

• Actual harm, isolatedF689Feb 16, 2024

  Based on record review, Nurse Practitioner, and staff interviews, the facility failed to provide care safely when Nursing Assistant (NA) #1 and NA #2 transferred a resident who was dependent on staff assistance and unable to bear weight from his bed to chair by holding the resident under his arms. Resident #62 sustained an acute displaced left humeral (long bone in the arm between shoulder and elbow) neck fracture requiring use of a sling, orthopedic follow up, and resulted in pain for 1 of 3 residents reviewed for supervision to prevent accidents (Resident #62). Findings included: Resident #62 was admitted to the facility on [DATE] and his most recent re-admission to the facility was on 1/23/23. His diagnoses included dementia, heart failure, osteoarthritis, and Parkinson's disease. […]

• No harm, potential for more than minimal, patternF791Aug 18, 2022

  Based on observation, record review, resident interview, and staff interview the facility failed to assure one (Resident # 2) of three residents reviewed for dental services received a dental referral for lost dentures. The findings included. Resident # 2 was initially admitted to the facility on [DATE]. The resident had three hospitalization s since initial admission; with his last facility readmitted documented as 6/10/22. Resident # 2's diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident # 2's Minimum Data Set, dated dated [DATE], was coded as a significant change assessment. This assessment coded the resident as cognitively impaired, being edentulous, and as having no significant weight loss issues. […]

• No harm, potential for more than minimal, isolatedF580Jul 30, 2026

  Based on record reviews and interviews with staff and the Physician, the facility failed to notify the physician when a resident with dysphagia (difficulty swallowing) had a choking incident when she was being fed dinner by a facility staff member for 1 of 3 residents reviewed for notification (Resident #42). Findings included:Resident #42 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus type II, hemiplegia (complete or near-complete paralysis of one side of the body) and hemiparesis (partial weakness of one side the body) following cerebral infarction (stroke) affecting right non-dominant side and dysphagia.During an interview on 7/28/26 at 7:04 PM, Medication Aide (MA) #1 reported that on 9/14/25 at approximately 5:45 PM, Resident #42 had a choking… […]

• No harm, potential for more than minimal, isolatedF641Jul 30, 2026

  Based on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) for 2 of 27 residents whose MDS assessments were reviewed (Resident #67 and Resident #28).Findings included:1. Resident #67 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease.Record review revealed Resident #67 had elected hospice care on 6/17/25.Hospice Nurse Practitioner documentation dated 5/30/26 noted Resident #67 likely has less than six months of survival and is appropriate for hospice.Review of Resident #67's most recent annual MDS assessment dated [DATE] was not coded that hospice care had been received. An interview with the MDS Coordinator was conducted on 7/30/26 at 2:00 PM. […]

• No harm, potential for more than minimal, isolatedF645Jul 30, 2026

  Based on record review and staff interviews, the facility failed to submit a request for an updated Preadmission Screening and Resident Review (PASRR) evaluation for a resident who was admitted to the facility with diagnoses including post-traumatic stress disorder (PTSD) and depression for 1 of 3 residents reviewed for PASRR (Resident #2).Findings included:A PASRR Determination Notification letter dated 9/29/25 revealed Resident #2 had a Level I PASRR with no expiration date.A review of a North Carolina PASRR Level I screening form provided by the facility Director of Transitional Services revealed the hospital Social Worker had submitted a PASRR evaluation on 9/29/25 for Resident #2 that did not include the diagnoses of PTSD or depression.Resident #2 was admitted to the facility on… […]