01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-07-01 | 2 | 2025-04-16 | 3 |
| Cycle 2 | 2025-04-16 | 3 | 2024-02-08 | 3 |
| Cycle 3 | 2024-02-08 | 3 | 2022-08-25 | 1 |
CMS CCN 3455112026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Autumn Care Of Statesville
2001 Vanhaven Drive · Statesville, NC 28625 · Iredell County
Certified beds103CMS provider file
Recent citation rows15current CMS citation release
Penalty rows0current 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
15 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 2 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-07-01 · HEALTHF0602Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from the wrongful use of the resident's belongings or money.
Correction field: Past Non-Compliance · 2026-04-02 · complaint2026-07-01 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has plan of correction · 2026-07-212025-04-16 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2025-05-092025-04-16 · HEALTHF0578Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2025-05-092025-04-16 · 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 · 2025-05-092025-04-16 · FIREK0741Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2025-05-302025-04-16 · FIREK0911Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the installation and maintenance of electrical systems.
Correction field: Deficient, Provider has date of correction · 2025-05-302025-04-16 · FIREK0918Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-05-302024-02-08 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2024-02-272024-02-08 · HEALTHF0867Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Correction field: Deficient, Provider has date of correction · 2024-02-272024-02-08 · 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 · 2024-02-272024-02-08 · FIREK0223Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Correction field: Deficient, Provider has date of correction · 2024-03-182024-02-08 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2024-03-182024-02-08 · FIREK0918Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-03-182022-08-25 · FIREK0352Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Properly install and monitor supervisory attachments on automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2022-10-0803 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- WILLIAM I WEISBERG FAMILY DYNASTY TRUST (DATED JUNE 1, 2011)Organization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST67% · since 01/01/2023
- VOLPE, BENJAMINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/31/2019
- WEISBERG, WILLIAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/31/2019
- NICOLUZAKIS, GREGORYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/31/2019
- VOLPE, BENJAMINIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/31/2019
- WEISBERG, WILLIAMIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/31/2019
- SABER GOVERNANCE LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/31/2019
- SHG MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/31/2019
- HOPPING, DARINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/21/2021
- RABUCK, TAMBRIAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/16/2022
- WEISBERG, WILLIAMIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 01/15/2026
- BENJAMIN N. VOLPE FAMILY DYNASTY TRUST (DATED DECEMBER 29, 2020)Organization · ADP OF THE SNFNOT APPLICABLE · since 01/01/2023
- BNV DYNASTY LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 01/01/2023
- CITRIN COOPERMAN ADVISORS LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/31/2019
- DECANTED WILLIAM I. WEISBERG FAMILY DYNASTY TRUST (DATED SEPT 30, 2020Organization · ADP OF THE SNFNOT APPLICABLE · since 01/01/2023
- SABER GOVERNANCE LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/31/2019
- SABER HEALTHCARE GROUP LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 12/31/2019
- SHG 4 MT, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 01/15/2026
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 hours3.54per resident day
RN hours0.37per resident day
Weekend nurse hours3.03per resident day
Staff turnover55.2%CMS reported field
06 / LOCAL RECORDS
Open the Statesville ledger →