White Oak Manor-kings Mountain
White Oak Manor-Kings Mountain in Kings Mountain, NC — inspection on August 12, 2025.
Found 9 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
from under Resident #139's knees and found a soiled brief. NA #6 notified the Unit Manager of the
refused care when she was on my assignment.
Three attempts were made to contact NA #5 and there
Nurse/Unit Manager #7 was conducted on 08/08/25 at 3:00 PM.
Nurse #7 stated Resident #139 was always incontinent of bowel and bladder.
Nurse #7 reported, that several weeks ago around 3:00 PM, NA #6 told her, Resident #139 was laying in urine.
She reported she went to the room and Resident #139's daughter was quite angry because her mother was soaking wet with urine.
Nurse #7 reported that upon entering the room, she noticed a strong urine smell and observed Resident #139 lying in bed with wet clothes, under pad and sheets and a soiled brief lying at the foot of her bed.
There were rings around her body on the sheets and under pad where the urine had begun to dry.
Nurse #7 recalled Resident #139's daughter asked her had Resident #139 been changed at all today.
Nurse #7 reported she told Resident #139's daughter she had to assume Resident #139 had not from the looks of her bed.
Nurse #7 stated no one had reported to her that Resident #139 had refused care during the shift.
Nurse #7 reported that Resident #139 would refuse care sometimes. An interview with the Director of Nursing (DON) was conducted on 08/08/25 at 3:45 PM.
The DON stated Resident #139 was incontinent of bowel and bladder.
The DON indicated Resident #139's daughter made her aware of the incident the day it happened. A grievance was filed and an investigation done which resulted in the termination of NA #5. DON reported that NA #5 reported to her during the investigation that Resident #139 had refused care all day. NA #5 did not report this to any unit manager or supervisor. An interview with the Administrator was conducted on 08/08/25 at 4:00 PM.
The Administrator stated she expected staff to provide care to all residents and if care was being refused then to report that to the Unit Manager or the DON.
The Administrator stated she was made aware of the situation during the investigation process and was in agreement with the decision to terminate NA #5 due to her not making anyone aware of Resident #139 refusing care and allowing her to remain wet all day.
345151 08/12/2025
White Oak Manor-Kings Mountain 716 Sipes Street Kings Mountain, NC 28086
incorrectly included a diagnosis list and physician orders for Resident #153, and a list of all facility
Services.
The Administrator stated that all facility resident representatives were notified of the
information.
The Administrator stated that Resident #43's Representative retained the medical records.
The Administrator reported that the Resident Representative was contacted repeatedly by the Administrator and by Corporate to return the medical records but refused and stated he wanted to prove a point and had not been returned.
345151 08/12/2025
White Oak Manor-Kings Mountain 716 Sipes Street Kings Mountain, NC 28086
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0600 during a standard health inspection conducted on 2025-08-12.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
The facility was found deficient in the following area: Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Scope/Severity Level J: isolated, immediate jeopardy to resident health or safety.
This represents an immediate jeopardy situation, the most serious level of deficiency.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0609 during a standard health inspection conducted on 2025-08-12.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
The facility was found deficient in the following area: Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0610 during a standard health inspection conducted on 2025-08-12.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
The facility was found deficient in the following area: Respond appropriately to all alleged violations.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0627 during a standard health inspection conducted on 2025-08-12.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
room and Resident #139's daughter was quite angry because her mother was soaking wet with urine.
of her bed.
There were rings around her body on the sheets and under pad where the urine had begun
today.
Nurse #7 reported she told Resident #139's daughter she had to assume Resident #139 had not from the looks of her bed.
Nurse #7 stated no one had reported to her that Resident #139 had refused care during the shift.
Nurse #7 reported that Resident #139 would refuse care sometimes. An interview with the Director of Nursing (DON) was conducted on 08/08/25 at 3:45 PM.
The DON stated Resident #139 was incontinent with bowel and bladder.
The DON indicated Resident #139's daughter made her aware of the incident the day it happened. A grievance was filed and an investigation done which resulted in the termination of NA#5. DON reported that NA #5 reported to her during the investigation that Resident #139 had refused care all day. NA #5 did not report this to any unit manager or supervisor. An interview with the Administrator was conducted on 08/08/25 at 4:00 PM.
The Administrator stated she expected staff to provide care to all residents and if care is being refused then to report that to the Unit Manager or the DON.
The Administrator stated she was made aware of the situation during the investigation process and was in agreement with the decision to terminate NA #5 due to her not making anyone aware of Resident #139 refusing care and allowing her to remain wet all day.
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0700 during a standard health inspection conducted on 2025-08-12.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
Federal health inspectors cited White Oak Manor - Kings Mountain in Kings Mountain, NC for a deficiency under regulatory tag F-F0757 during a standard health inspection conducted on 2025-08-12.
Category: Pharmacy Service Deficiencies
The facility was found deficient in the following area: Ensure each resident’s drug regimen must be free from unnecessary drugs.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of White Oak Manor - Kings Mountain.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-10.
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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.