The Shannon Gray Rehabilitation & Recovery Center
Inspection Findings
F-Tag F0627
F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
weekly x 4 weeks, bi-monthly x 4 weeks and then monthly x 1 quarter to ensure compliance. Any discharge(s) since the previous meeting will be reviewed at that time for compliance. The team will also
review ongoing in-servicing of new nurses. The DON will be responsible for taking the results of the QA form audits and the team meetings to the Executive Quarterly QA Meeting. The next Executive Quarterly QA meeting is scheduled for 11/6/2025. The facility alleges compliance with this corrective action plan as of 10/24/2025.On 10/30/2025 the facility provided a corrective action plan which included review of Resident #1's emergency department record which stated Resident #1 presented to the emergency department because she received the wrong medications when discharged from the facility. The emergency department
record also stated Resident #1 suffered no major medicine reactions, her labs were normal, her electrocardiogram showed no changes, and she was safe to discharge back home from the emergency room. The facility also provided Resident #1's Transfer/Discharge Report dated 10/17/2025 and signed by
the RP, which included a medication list that stated how and when the medications should be administered.
The facility provided a list of residents that were discharged within the prior two weeks, and each resident or their RP was interviewed to ensure the correct medication was sent home with each resident by the Director of Nursing on 10/23/2025. The facility provided in-service education regarding the discharge process for nurses and specified 2 nurses will be required to sign off on the medication review of any resident who discharges home with medication(s). The in-service education was also included in the facility's orientation process for nurse. A sample of nursing staff were interviewed regarding the in-service education and were able to verbalize understanding of the process for discharge medications. The facility provided documentation of audits beginning 10/24/2025 of discharged resident's medications that occurred
after the initial audit of previous residents that were discharged . The facility also provided a copy of the minutes from a Quality Assurance Performance Improvement meeting held 10/22/2025 to discuss and
review the plan of correction and any residents that have been discharged . The facility's corrective action plan completion date of 10/24/25 was validated.
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If continuation sheet
The Shannon Gray Rehabilitation & Recovery Center in Jamestown, NC inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Jamestown, NC, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from The Shannon Gray Rehabilitation & Recovery Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.