Trinity Elms

7449 Fair Oaks Drive
Clemmons, NC, 27012
3367471153
CCN: 345565
2
Overall
3
Health
4
Staffing
1
Quality
ChainLUTHERAN SERVICES CAROLINAS
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
NameRole%
SMITH, KESHACORPORATE DIRECTORNOT APPLICABLE
MADDRY, KARENCORPORATE OFFICERNOT APPLICABLE
NICKERSON, KIRBYCORPORATE OFFICERNOT APPLICABLE
MCCOY, CYNTHIAOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
LSA MANAGEMENT, INC.OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SMITH, KESHAOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
OWENS-WATTERSON, DAWNOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
LUTHERAN SERVICES FOR THE AGING, INC.OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
GOINS, TEDOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Penalties (1)
DateTypeAmount
2024-08-20Fine$8K
Health Deficiencies (11)
2025-04-30 · Health
D
F760 · Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
2025-01-17 · Health
F
F851 · Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
D
F761 · 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.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
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.
2024-08-20 · Health
J
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.
J
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.
2023-08-30 · Health
D
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
B
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
2022-03-31 · Health
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
F690 · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
4.28
3.68
RN Hrs/Resident/Day
0.63
0.54
LPN Hrs/Resident/Day
0.80
0.81
CNA Hrs/Resident/Day
2.85
2.33
PT Hrs/Resident/Day
0.06
0.12
Data as of 2026-03-01