Peak Resources-Shelby: Medical Records Violations - NC
The resident, identified in inspection records only as Resident #75, was admitted to the facility with type 2 diabetes. On November 25, 2025, her physician assistant ordered semaglutide, a weekly injectable medication prescribed to help regulate her blood sugars and assist with weight loss. The order called for the injection to be given subcutaneously every Monday.
It was not given on December 1. It was not given on December 8. It was not given on December 15.
What the Medication Administration Record showed was something different. For December 1, Nurse #2 had documented that she administered the injection at 8:00 AM. For December 8, she had noted the resident refused. For December 15, she wrote that the medication was awaiting delivery from the pharmacy.
Only the last entry was close to true.
When federal inspectors interviewed Nurse #2 on February 9, 2026, she said the medication had not been available on any of those three dates and had not been administered on any of them. She acknowledged documenting on the MAR in error that she had given the injection on December 1 and that it had been refused on December 8. She said she should have documented that the medication was unavailable.
The pharmacist, reached by phone on February 11, 2026, explained what had happened on the supply side. The facility sent the initial semaglutide order on November 25, but the order was incomplete. It did not include dosage information. The facility later sent a corrected order specifying 0.25 mg, and the medication was eventually delivered, though the inspection report does not identify the exact delivery date. Resident #75 told inspectors the drug was not administered until January 2026.
Resident #75 is cognitively intact, according to her quarterly assessment. She knew what she had been prescribed and when. She told inspectors on February 9 that she had been waiting for the medication since November.
The administrator, interviewed on the afternoon of February 11, said she had not known that the resident was going without semaglutide because it had not been delivered. She said that when a medication is not administered, it should be documented accurately in the resident record and on the MAR. Inspectors noted that multiple attempts to reach the former director of nursing were unsuccessful.
The gap between what the MAR said and what actually happened spanned at least six weeks. A resident with type 2 diabetes went without a medication her physician assistant had ordered to manage her blood sugars, while the nursing record showed the opposite: that the medication had been given, then declined, with a supply issue noted only in the final week.
Inspectors classified the violation as having minimal harm or potential for actual harm, affecting few residents. The inspection covered one resident for this particular deficiency, and that resident was Resident #75.
Semaglutide, sold under brand names including Ozempic and Wegovy, works by mimicking a hormone that regulates insulin release and appetite. Missing multiple consecutive weekly doses interrupts the medication's effect on blood sugar control.
Resident #75 spent November and December without it, while her chart said otherwise.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Peak Resources- Shelby from 2026-02-11 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 4, 2026 · Our methodology
Peak Resources- Shelby in Grover, NC was cited for violations during a health inspection on February 11, 2026.
The resident, identified in inspection records only as Resident #75, was admitted to the facility with type 2 diabetes.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.