01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-11-18 | 6 | 2024-07-18 | 3 |
| Cycle 2 | 2024-07-18 | 4 | 2023-03-23 | 1 |
| Cycle 3 | 2023-03-23 | 3 | 2021-06-10 | 0 |
CMS CCN 3452822026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Cleveland Pines
1404 N Lafayette Street · Shelby, NC 28150 · Cleveland County
Certified beds120CMS provider file
Recent citation rows17current 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
17 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-11-18 · HEALTHF0607Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has date of correction · 2025-12-162025-11-18 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2025-12-162025-11-18 · HEALTHF0687Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate foot care.
Correction field: Deficient, Provider has date of correction · 2025-12-162025-11-18 · 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 · 2025-12-162025-11-18 · HEALTHF0700Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-12-162025-11-18 · 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 date of correction · 2025-12-162024-07-18 · 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 · 2024-08-152024-07-18 · HEALTHF0679Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Correction field: Deficient, Provider has date of correction · 2024-08-302024-07-18 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2024-08-152024-07-18 · 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 · 2024-08-152024-07-18 · FIREK0161Severity D · isolated; potential for more than minimal harm
Construction Deficiencies
Use approved construction type or materials.
Correction field: Deficient, Provider has date of correction · 2024-09-272024-07-18 · FIREK0521Severity D · isolated; 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 · 2024-09-272024-07-18 · 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 · 2024-09-272023-03-23 · 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 · 2023-04-302023-03-23 · 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 · 2023-04-302023-03-23 · 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 · 2023-04-302023-03-23 · FIREK0917Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure electrical receptacles or cover plates have distinctive color or marking.
Correction field: Deficient, Provider has date of correction · 2023-05-0503 / 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
- BALL, RODNEYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 08/30/2023
- HAYNES, KENNETHIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/21/2019
- RISSMILLER, SCOTTIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/21/2019
- BALL, RODNEYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2023
- HAYNES, KENNETHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/20/2019
- ADVOCATE HEALTH INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/02/2022
- ATRIUM HEALTH INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/09/2020
- BROAD RIVER REHABILITATIONOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2023
- OPTIMED HOSPITALISTSOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/22/2017
- PRO DIVERSITY PARTNERS, LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/01/2021
- THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITYOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2020
- DOTSON, KATHRYNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2020
- MURRAY, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/16/2024
- BALL, RODNEYIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 08/30/2023
- HAYNES, KENNETHIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 06/21/2019
- RISSMILLER, SCOTTIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 06/21/2019
- ADVOCATE HEALTH INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 07/29/2025
- ATRIUM HEALTH INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 07/29/2025
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 hours2.96per resident day
RN hours0.31per resident day
Weekend nurse hours2.01per resident day
Staff turnover43.3%CMS reported field
06 / LOCAL RECORDS
Open the Shelby ledger →