White Oak Manor-Kings Mountain

In the surveyor’s words

From the most serious findings on record at White Oak Manor-Kings Mountain, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Aug 12, 2025

  Based on record reviews, resident, staff, resident representative, and Nurse Practitioner (NP) interviews, the facility failed to protect the resident's right to be free from abuse for 4 of 30 residents reviewed for abuse (Resident #32, Resident #59, Resident #86, and Resident #125). On 05/09/25, Resident #32 was heard yelling for help when Resident #154 entered Resident #32's room and grabbed her by the neck and pinned her against the wall. Resident #32 was noted to be swatting at Resident #154 to free herself. Resident #154 sustained scratches to left ear. On 04/20/25, Resident #154 balled up his fist and hit Resident #86 in the mouth. Resident #86 sustained a cut to her upper lip with bleeding. […]

• No harm, potential for more than minimal, patternF609Aug 12, 2025

  Based on record reviews and staff interviews, the facility failed to identify abuse and ensure staff implemented facility's abuse policy and procedures for reporting abuse. This occurred when the facility failed to report allegations of resident-to-resident abuse to the State Survey Agency within the specified time frames. The facility also failed to notify the county Adult Protective Services (APS) of allegations of abuse. This deficient practice affected 4 of 30 residents reviewed for abuse (Resident #32, Resident #59, Resident #86, and Resident #125).The findings included: A review of undated facility policy titled Protocol for Reporting Abuse revealed if a reasonable person suspected that abuse had occurred, staff would immediately notify the administrator or designee, person in… […]

• No harm, potential for more than minimal, patternF610Aug 12, 2025

  Based on record review and staff interviews, the facility failed to complete a thorough investigation after allegations of resident-to-resident abuse occurred. This deficient practice affected 4 of 30 residents reviewed for abuse (Resident #32, Resident #59, Resident #86, and Resident #125).Findings included: The undated facility abuse policy titled [NAME] Oak Management, Inc. Plan for the Prevention of Elder Abuse was reviewed. A section of policy titled Resident to Resident Abuse stated all forms of abuse, including resident-to-resident abuse, must be reported immediately to the Director of Nursing and the facility administrator. […]

• No harm, potential for more than minimal, patternF700Aug 12, 2025

  Based on observations, record reviews, and Nurse Practitioner and staff interviews, the facility failed to accurately assess 3 of 3 severely cognitively impaired residents for bilateral half side rails on their beds (Resident #2, Resident #64, and Resident #77). The findings included:1. Resident #2 was admitted to the facility on [DATE] with diagnoses which included dementia with psychotic disturbance, gastrostomy tube, and atrial fibrillation.Review of Resident #2's consent for use of bed rails dated 08/07/22 revealed the facility received telephone consent from the resident's responsible party (RP) but the consent was not signed by the RP or the nurses receiving consent.Review of Resident #2's care plan dated 07/15/25 revealed a focus area for activities of daily living (ADL) deficits… […]

• No harm, potential for more than minimal, patternF641Jan 6, 2022

  Based on observations, resident and staff interviews and record review the facility failed to ensure the Minimum Data Set (MDS) was accurate for 2 of 3 residents reviewed for wandering (Resident # 38 and Resident #13), 1 of 2 residents reviewed for pacing (Resident #38), 1 of 1 resident reviewed for range of motion (Resident #79) and 1 of 1 resident reviewed for Hospice (Resident #110). The findings included: 1.a. Resident #38 was admitted to the facility on [DATE] with multiple diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . A nursing progress note dated 07/31/21 revealed Resident #38 was noted to be wandering in the corridor and into other residents' rooms. […]