01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-05 | 1 | 2024-08-21 | 0 |
| Cycle 2 | 2024-08-21 | 7 | 2023-10-13 | 4 |
| Cycle 3 | 2023-10-13 | 0 | 2022-04-14 | 0 |
CMS CCN 3455352026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Adams Farm Living & Rehabilitation
5100 Mackay Road · Jamestown, NC 27282 · Guilford County
Certified beds120CMS provider file
Recent citation rows12current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
12 rows in the current release
3 rows carry G–L scope/severity codes; 0 carry J–L. 0 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-05 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-12-192025-05-01 · HEALTHF0580Severity G · isolated actual harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Past Non-Compliance · 2025-04-12 · complaint2025-05-01 · HEALTHF0684Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Past Non-Compliance · 2025-04-12 · complaint2025-05-01 · HEALTHF0711Severity G · isolated actual harm
Nursing and Physician Services Deficiencies
Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
Correction field: Deficient, Provider has date of correction · 2025-05-17 · complaint2025-05-01 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2025-05-17 · complaint2025-05-01 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2025-05-17 · complaint2024-08-21 · HEALTHF0761Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2024-09-18 · complaint2024-08-21 · HEALTHF0812Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-09-182023-10-13 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2024-02-142023-10-13 · FIREK0351Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2024-02-142023-10-13 · FIREK0372Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2024-02-142023-10-13 · FIREK0521Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2024-02-1403 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-05-01 | Fine | $24,252 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ADAMS FARM LIVING INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 04/01/2007
- NOAH K DUNCAN MRTL TROrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 04/30/2013
- GILLIAM, ROBERTIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 06/02/2008
- NILES, MARIAIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 05/08/2017
- BOYETTE, BARBARAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2007
- GILLIAM, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/02/2008
- GILLIAM, ROBERTIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/01/2021
- SCHMIDLIN, JAMESIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/01/2021
- CENTURY CARE MANAGEMENT, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2007
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.48per resident day
RN hours0.36per resident day
Weekend nurse hours3.02per resident day
Staff turnover56.8%CMS reported field
06 / LOCAL RECORDS
Open the Jamestown ledger →