01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-03-19 | 5 | 2026-03-19 | 2 |
| Cycle 2 | 2025-01-17 | 7 | 2025-01-17 | 4 |
| Cycle 3 | 2023-08-30 | 2 | 2023-08-30 | 3 |
CMS CCN 3455652026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Trinity Elms
7449 Fair Oaks Drive · Clemmons, NC 27012 · Forsyth County
Certified beds100CMS provider file
Recent citation rows23current CMS citation release
Penalty rows2current 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
23 rows in the current release
2 rows carry G–L scope/severity codes; 2 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-03-19 · HEALTHF0580Severity D · isolated; potential for more than minimal 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 · 2026-02-04 · complaint2026-03-19 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2026-03-312026-03-19 · HEALTHF0655Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Correction field: Deficient, Provider has date of correction · 2026-03-312026-03-19 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2026-03-312026-03-19 · HEALTHF0684Severity D · isolated; potential for more than minimal 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 · 2026-02-04 · complaint2026-03-19 · 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 · 2026-06-272026-03-19 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-06-272025-04-30 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-04-30 · complaint2025-01-17 · 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 · 2025-02-062025-01-17 · 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 · 2025-02-062025-01-17 · HEALTHF0761Severity D · isolated; 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 · 2025-01-202025-01-17 · HEALTHF0851Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Correction field: Past Non-Compliance · 2024-11-152025-01-17 · FIREK0222Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-05-022025-01-17 · FIREK0281Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Install proper backup exit lighting.
Correction field: Deficient, Provider has date of correction · 2025-05-022025-01-17 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-05-022025-01-17 · 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 · 2025-05-022024-08-20 · HEALTHF0580Severity J · isolated immediate jeopardy
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 · 2024-08-01 · complaint2024-08-20 · HEALTHF0689Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Past Non-Compliance · 2024-07-24 · complaint2023-08-30 · HEALTHF0609Severity B · pattern; potential for minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has plan of correction · 2023-09-18 · complaint2023-08-30 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2023-09-182023-08-30 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2023-11-112023-08-30 · FIREK0363Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-11-112023-08-30 · 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 · 2023-11-1103 / 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 |
|---|---|---|---|
| 2024-08-20 | Fine | $7,823 | 0 |
| 2024-08-20 | Fine | $7,823 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- GOINS, TEDIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2004
- HERMAN, RICHARDIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/01/2022
- NELSON, DOUGLASIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 09/01/2022
- SMITH, KESHAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 09/08/2003
- MADDRY, KARENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2014
- NICKERSON, KIRBYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2012
- LSA MANAGEMENT, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/28/2008
- LUTHERAN SERVICES FOR THE AGING, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/28/2008
- GOINS, TEDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2004
- MCCOY, CYNTHIAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/26/2023
- OWENS-WATTERSON, DAWNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/03/2023
- SMITH, KESHAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2012
- LUTHERAN SERVICES FOR THE AGING, INC.Organization · TRUSTEE OF THE SNFNOT APPLICABLE · since 08/28/2008
- GOINS, TEDIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 10/01/2004
- NELSON, DOUGLASIndividual · TRUSTEE OF THE SNFNOT APPLICABLE · since 09/01/2022
- LSA ELMS PROPERTY, INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/16/2025
- LSA MANAGEMENT, INC.Organization · ADP OF THE SNFNOT APPLICABLE · since 03/16/2025
- GOINS, TEDIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/01/2004
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 hours4.96per resident day
RN hours0.70per resident day
Weekend nurse hours4.71per resident day
Staff turnover50.5%CMS reported field
06 / LOCAL RECORDS
Open the Clemmons ledger →