All citations for Chapel Hill Community

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Chapel Hill Community

Last standard health inspection on record

April 24, 2025

Showing 1 to 25 of 45 citations

  1. No harm, with potential for more than minimal harm

    Install emergency lighting that can last at least 1 1/2 hours.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0291, Egress Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  2. No harm, with potential for more than minimal harm

    Have approved installation, maintenance and testing program for fire alarm systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0345, Smoke Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  3. No harm, with potential for more than minimal harm

    Install an approved automatic sprinkler system.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0351, Smoke Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  4. No harm, with potential for more than minimal harm

    Have generator or other power source capable of supplying service within 10 seconds.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  5. No harm, with potential for more than minimal harm

    Have proper medical gas storage and administration areas.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0923, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  6. No harm, with potential for more than minimal harm

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Widespread (many residents). CMS level F.

    Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  7. No harm, with potential for more than minimal harm

    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

    Widespread (many residents). CMS level F.

    Health citation F-0761, Pharmacy Service Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  8. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  9. No harm, with potential for more than minimal harm

    Have simulated fire drills held at unexpected times.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0712, Miscellaneous Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  10. No harm, with potential for more than minimal harm

    Provide activities to meet all resident's needs.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0679, Quality of Life and Care Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  11. No harm, with potential for more than minimal harm

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0725, Nursing and Physician Services Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  12. No harm, with potential for more than minimal harm

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0803, Nutrition and Dietary Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  13. No harm, with potential for more than minimal harm

    Inspect, test, and maintain automatic sprinkler systems.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  14. No harm, with potential for more than minimal harm

    Ensure proper usage of power strips and extension cords.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  15. No harm, with potential for more than minimal harm

    Have an enclosure around a vertical opening shaft.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0311, Smoke Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  16. No harm, with potential for more than minimal harm

    Have power receptacles that are properly grounded.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0912, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  17. No harm, with potential for more than minimal harm

    Ensure proper usage of power strips and extension cords.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of December 12, 2019. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 13, 2020).

  18. No harm, with potential for more than minimal harm

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of April 24, 2025. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  19. No harm, with potential for more than minimal harm

    Provide safe, appropriate dialysis care/services for a resident who requires such services.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0698, Quality of Life and Care Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  20. No harm, with potential for more than minimal harm

    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0758, Pharmacy Service Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  21. No harm, with potential for more than minimal harm

    Provide and implement an infection prevention and control program.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0880, Infection Control Deficiencies. Inspection of April 24, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 12, 2025).

  22. No harm, with potential for more than minimal harm

    Protect each resident from the wrongful use of the resident's belongings or money.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0602, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of May 21, 2024. Found during a complaint inspection.

    Past non-compliance: already corrected by the time of the inspection (April 1, 2024).

  23. No harm, with potential for more than minimal harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0550, Resident Rights Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  24. No harm, with potential for more than minimal harm

    Reasonably accommodate the needs and preferences of each resident.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0558, Resident Rights Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

  25. No harm, with potential for more than minimal harm

    Keep residents' personal and medical records private and confidential.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0583, Resident Rights Deficiencies. Inspection of November 7, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2022).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.