Peak Resources - Gastonia
Peak Resources - Gastonia in Gastonia, NC — inspection on June 17, 2026.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
residents on 300 Hall. NA #1 reported she was usually assigned to 100 Hall where they had three NAs
provide and was assigned to assist residents in the dining room during lunch. NA #1 recalled she
Resident #8 mentioning anything about wanting to attend BINGO that afternoon and the only thing Resident #8 had requested was for NA #1 to put Vaseline on her skin after her shower. NA #1 did not recall hearing Resident #8 yelling out for assistance and stated that anytime Resident #8 had used her call bell, she went into the room to let her know that she hadn't forgotten about her and would assist her just as soon as she finished with another resident. NA #1 stated she had asked NA #2 questions about resident care but did not specifically ask her to assist with getting Resident #8 up out of bed.
NA #1 stated she did the best she could and made sure all resident care was provided before she left for the day.During a phone interview on 06/17/26 at 9:53 AM, Nurse #2 confirmed she was assigned to provide Resident #8's care on 06/13/26.
Nurse #2 could not recall the exact time(s) but stated some time before lunch, Resident #8 did state that she wanted to go to BINGO and voiced concerns that no one had assisted her up out of bed.
Nurse #2 stated she explained to Resident #8 that NA #1 got behind due to having several showers to give but NA #1 would assist her out of bed as soon as she could.
Nurse #2 could not recall the exact time when Resident #8 was assisted out of bed but thought it was around 2:00 PM when she was given a shower.
Nurse #2 confirmed Resident #8 was a one-person assist with a stand/pivot transfer and stated she did not offer to assist Resident #8 because she was finishing up her medication pass.
During an interview on 06/17/26 at 10:38 AM, the Nurse Supervisor stated she facilitated the BINGO activity for residents every other Saturday and the NAs helped get residents to the dining room for the activity.
The Nurse Supervisor verified BINGO was scheduled for 2:30 PM on Saturday 06/13/26.
She stated Resident #8 usually attended BINGO and it had crossed her mind to go check on Resident #8 but didn't because she got sidetracked getting everything together for the activity.
The Nurse Supervisor stated no one had mentioned anything to her on 06/13/26 that Resident #8 had not been assisted out of bed and had she known, she would have gone to assist Resident #8 so that she could have attended BINGO.
During an interview on 06/17/26 at 2:27 PM, the Director of Nursing (DON) stated Resident #8 never mentioned any concerns to her about staff not assisting her out of bed on 06/13/26 when requested and she missed attending BINGO.
The DON stated NA #1 reported that the only concern Resident #8 had mentioned on 06/13/26 was that she wanted NA #1 to put Vaseline on her skin after the shower.
The DON was unaware that Nurse #2 knew that Resident #8 requested to get out of bed and stated Nurse #2 should have assisted Resident #8 as requested if NA #1 was unavailable.
During an interview on 06/17/26 at 2:58 PM, the Administrator stated normally with any care concern, it was addressed through the facility's grievance process but Resident #8 never mentioned anything to her or other staff regarding not being assisted out of bed when requested on 06/13/26.
The Administrator stated she felt it was an isolated incident.
She stated if Resident #8 asked for assistance with getting up out of bed, staff should have provided her with assistance when requested.
345494 06/17/2026
Peak Resources - Gastonia 2780 X-Ray Drive Gastonia, NC 28054
Findings included: A review of the facility's Infection Prevention and Control Program for EBP last revised on 10/2025 read in part, EBPs were designed to reduce transmission of multidrug resistant organisms (MDRO) by employing targeted gown use during high-contact resident care activities. EBPs in conjunction with standard precautions to expand the use of PPE to donning (put on) a gown during high-contact resident care activities that provide opportunities for transfer of MDRO's to clothing. PPE - wear a gown for the high-contact care activity of a urinary catheter. An observation of Resident #7's urinary catheter care provided by Nurse #1 was conducted on 06/17/26 from 11:09 AM through 11:27 AM.
Posted on the entry door to Resident #7's room was a sign that read in part, EBP - staff must wear a gown for the following high-contact resident care activities of a urinary catheter. A PPE storage container placed on Resident #7's room entry door contained protective gowns and was available for use.
Nurse #1 entered the room, washed his hands, put on a pair of gloves but did not put on a protective gown.
Nurse #1 cleaned the catheter insert site and tubing using a wound cleanser moistened gauze and flushed 30 milliliters of acetic acid into the catheter tubing.
Nurse #7 removed and discarded his gloves in the trash then cleaned his hands by using sanitizing wipes.
During an interview on 06/17/26 at 11:27 AM, Nurse #1 stated he did not wear a PPE gown when providing catheter care for a resident.
When asked about the EBP sign posted on Resident #7's door with instructions staff must wear a gown for care of a urinary catheter, Nurse #1 stated he wore a PPE gown if a resident was placed on contact precautions.
Nurse #1 further stated he did not wear a gown for a resident on EBP and he was not aware that a PPE gown should be worn when he provided care for a urinary catheter.
During an interview on 06/17/26 at 12:53 PM, the Infection Preventionist stated EBPs were utilized for residents with a urinary catheter.
She revealed EBP signs were used as a reminder and provided instructions on what type of PPE was required when staff provided high-contact resident care.
She revealed an educational in-service on EBP, and other isolation precautions was recently provided to staff and showed Nurse #1 signed the attendance sheet.
She revealed the in-service included review of the EBP sign and the instructions and stated Nurse #1 was expected to wear a protective gown when he provided care for a resident's urinary catheter.
During an interview on 06/17/26 at 1:12 PM, the Director of Nursing (DON) stated she expected Nurse #1 followed EBPs and wore a gown when he provided catheter care for a resident.An interview was conducted on 06/17/26 at 2:18 PM with the Administrator.
The Administrator stated she expected Nurse #1 followed the directions for EBPs and wore a gown when he provided catheter care for Resident #7.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.