Autumn Care of Statesville

2001 Vanhaven Drive
Statesville, NC, 28625
7048839700
CCN: 345511
3
Overall
4
Health
1
Staffing
4
Quality
ChainSABER HEALTHCARE GROUP
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
NameRole%
AUTUMN CORPORATION5% OR GREATER DIRECT OWNERSHIP INTEREST100%
BENJAMIN N. VOLPE FAMILY DYNASTY TRUST (DATED DECEMBER 29, 2020)5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
BNV DYNASTY LLC5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
DECANTED WILLIAM I. WEISBERG FAMILY DYNASTY TRUST (DATED SEPT 30, 20205% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
SABER HEALTHCARE HOLDINGS LLC5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
SHG AUTUMN, LLC5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
WILLIAM I WEISBERG FAMILY DYNASTY TRUST (DATED JUNE 1, 2011)5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
WIW DYNASTY LLC5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED
WEISBERG, WILLIAMCORPORATE DIRECTORNOT APPLICABLE
VOLPE, BENJAMINCORPORATE DIRECTORNOT APPLICABLE
WEISBERG, WILLIAMCORPORATE OFFICERNOT APPLICABLE
NICOLUZAKIS, GREGORYCORPORATE OFFICERNOT APPLICABLE
VOLPE, BENJAMINCORPORATE OFFICERNOT APPLICABLE
SHG MANAGEMENT LLCOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SABER GOVERNANCE LLCOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
RABUCK, TAMBRIAOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
HOPPING, DARINOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Health Deficiencies (18)
2025-04-16 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F578 · 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.
D
F554 · Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
2024-02-08 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F867 · Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
2022-08-25 · Health
D
F919 · Environmental Deficiencies
Make sure that a working call system is available in each resident's bathroom and bathing area.
D
F842 · 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.
E
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F790 · Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for each resident.
G
F697 · Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
G
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F688 · 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.
E
F677 · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
F658 · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
D
F638 · Resident Assessment and Care Planning Deficiencies
Assure that each resident’s assessment is updated at least once every 3 months.
D
F580 · 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.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
3.43
3.68
RN Hrs/Resident/Day
0.40
0.54
LPN Hrs/Resident/Day
0.76
0.81
CNA Hrs/Resident/Day
2.27
2.33
PT Hrs/Resident/Day
0.11
0.12
Data as of 2026-03-01