01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-03-11 | 3 | 2025-01-15 | 2 |
| Cycle 2 | 2025-01-15 | 0 | 2023-10-31 | 3 |
| Cycle 3 | 2023-10-31 | 2 | 2022-04-28 | 4 |
CMS CCN 3451522026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Trinity Village
1265 21 Street Ne · Hickory, NC 28601 · Catawba County
Certified beds104CMS provider file
Recent citation rows14current 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
14 rows in the current release
1 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.
2026-03-11 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2026-04-012026-03-11 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
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: Deficient, Provider has date of correction · 2026-04-032026-03-11 · 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 · 2026-04-012025-01-15 · 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 · 2025-03-312025-01-15 · 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 · 2025-03-312024-04-23 · HEALTHF0600Severity G · isolated actual harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Past Non-Compliance · 2024-01-03 · complaint2024-04-23 · 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: Past Non-Compliance · 2024-01-03 · complaint2023-10-31 · FIREK0211Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2023-12-142023-10-31 · FIREK0511Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2023-12-142023-10-31 · 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 · 2023-12-142022-04-28 · FIREK0311Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have an enclosure around a vertical opening shaft.
Correction field: Deficient, Provider has date of correction · 2022-06-222022-04-28 · 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 · 2022-06-222022-04-28 · 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 · 2022-06-222022-04-28 · FIREK0521Severity F · widespread; 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 · 2022-06-2203 / 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 |
|---|---|---|---|
| 2024-04-23 | Fine | $8,512 | 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 06/01/2021
- MADDRY, KARENIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/30/2007
- SMITH, KESHAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2012
- MADDRY, KARENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/30/2007
- NELSON, DOUGLASIndividual · CORPORATE OFFICERNOT APPLICABLE · since 09/01/2022
- NICKERSON, KIRBYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2012
- LSA MANAGEMENT, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2004
- LUTHERAN HOME HICKORY WEST PROPERTY, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2004
- LUTHERAN SERVICES FOR THE AGING, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2004
- DESANTIS, MICHAELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/03/1995
- GOINS, TEDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2004
- HENDREN, KENDRAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2024
- NELSON, DOUGLASIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/01/2022
- NICKERSON, KIRBYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2012
- SMITH, KESHAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2012
- LUTHERAN SERVICES FOR THE AGING, INC.Organization · TRUSTEE OF THE SNFNOT APPLICABLE · since 10/01/2004
- GOINS, TEDIndividual · TRUSTEE 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 hours6.50per resident day
RN hours1.12per resident day
Weekend nurse hours5.86per resident day
Staff turnover28.1%CMS reported field