Cycle 1
Health 2025-12-12 · Fire 2024-08-16
0 health deficiencies
No concentrated health issue counts in this cycle.
6 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Jacksonville, NC
Carolina Rivers Nursing and Rehabilitation Center
5-star overall rating with 5-star inspections with $4,271 in total fines with 6 fire-safety deficiencies in the latest cycle
1839 Onslow Drive Extension, Jacksonville, NC
(910) 455-3610
Overall
5 / 5
CMS overall stars
Health inspections
5 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
120
Certified beds
Average residents
101
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Principle Long Term Care
Operator or chain grouping
Approved since
1971-02-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
44 facilities
Chain averages 3 overall / 3 health / 3 staffing / 4 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.53
Registered nurse staffing · state 0.59 · national 0.68
LPN hours / resident day
0.90
Licensed practical nurse staffing · state 0.87 · national 0.87
Aide hours / resident day
2.21
Nurse aide staffing · state 2.33 · national 2.35
Total nurse hours
3.64
All reported nurse hours · state 3.78 · national 3.89
Licensed hours
1.43
RN + LPN hours · state 1.45 · national 1.54
Weekend hours
3.26
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.32
Weekend registered nurse coverage · state 0.38 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.53
CMS adjusted RN staffing hours
Adjusted total hours
3.65
CMS adjusted total nurse staffing hours
Case-mix index
1.36
Higher values indicate more complex resident acuity
RN turnover
67%
Annual RN turnover · state 48% · national 45%
Total nurse turnover
66%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
11,780
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
15.33
Composite VBP score used to determine payment impact.
Payment multiplier
0.9815
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.76
Baseline 24.29% · Performance 22.65% · Measure score 1.76 · Achievement 0 · Improvement 1.76
Healthcare-associated infections
0
Baseline 7.65% · Performance 8.04% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
2.98
Baseline 63.95% · Performance 51.52% · Measure score 2.98 · Achievement 2.98 · Improvement 2.68
Adjusted total nurse staffing
1.39
Baseline 3.73 hours · Performance 3.47 hours · Measure score 1.39 · Achievement 1.39 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.39% |
10.72%
0.7 pts worse
|
No Different than the National Rate · Eligible stays 196 · Observed rate 13.27% · Lower 95% interval 8.79% |
| Discharge to community | 48.34% |
50.57%
2.2 pts worse
|
No Different than the National Rate · Eligible stays 171 · Observed rate 41.52% · Lower 95% interval 41.05% |
| Medicare spending per beneficiary | 0.89 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 98.25% |
95.27%
3 pts better
|
Numerator 168 · Denominator 171 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 171 |
| Discharge self-care score | 53.85% |
53.69%
0.2 pts better
|
Numerator 63 · Denominator 117 |
| Discharge mobility score | 52.14% |
50.94%
1.2 pts better
|
Numerator 61 · Denominator 117 |
| Pressure ulcers or injuries, new or worsened | 2.34% |
2.29%
About the same
|
Numerator 4 · Denominator 171 · Adjusted rate 2.05% |
| Healthcare-associated infections requiring hospitalization | 8.04% |
7.12%
0.9 pts worse
|
No Different than the National Rate · Eligible stays 113 · Observed rate 9.73% · Lower 95% interval 5.04% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 147 |
| Staff flu vaccination coverage | 15.48% |
42%
26.5 pts worse
|
Numerator 26 · Denominator 168 |
| Discharge function score | 58.12% |
56.45%
1.7 pts better
|
Numerator 68 · Denominator 117 |
| Transfer of health information to provider | 99.19% |
95.95%
3.2 pts better
|
Numerator 122 · Denominator 123 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 15.29% |
25.2%
9.9 pts worse
|
Numerator 13 · Denominator 85 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.9 |
1.8
0.1 pts worse
|
1.9
About the same
|
Long Stay · 20240701-20250630 · Adjusted 1.9 · Observed 1.7 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 3.0 |
1.8
1.2 pts worse
|
1.8
1.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 3.0 · Observed 2.6 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 95.2% |
91.5%
3.7 pts better
|
93.4%
1.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 97.7% · Q2 97.5% · Q3 95.1% · Q4 90.5% · 4Q avg 95.2% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 98.9% |
94.1%
4.8 pts better
|
95.5%
3.4 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.7% |
3.6%
0.9 pts better
|
3.3%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.3% · Q2 2.5% · Q3 1.2% · Q4 4.8% · 4Q avg 2.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 4.2% |
4.8%
0.6 pts better
|
11.4%
7.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.9% · Q2 4.1% · Q3 1.3% · Q4 6.4% · 4Q avg 4.2% |
| Percentage of long-stay residents who lose too much weight | 6.8% |
7.2%
0.4 pts better
|
5.4%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 10.1% · Q3 6.8% · Q4 4.0% · 4Q avg 6.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.6% |
21.6%
4 pts better
|
19.6%
2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.6% · Q2 12.9% · Q3 18.9% · Q4 22.7% · 4Q avg 17.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 10.8% |
15.0%
4.2 pts better
|
16.7%
5.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 8.2% · Q2 14.0% · Q3 12.9% · Q4 8.3% · 4Q avg 10.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 21.3% |
21.5%
0.2 pts better
|
16.3%
5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 17.3% · Q4 38.8% · 4Q avg 21.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 14.9% |
16.8%
1.9 pts better
|
14.9%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 5.6% · Q2 14.9% · Q3 11.1% · Q4 28.6% · 4Q avg 14.9% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 2.8% |
0.9%
1.9 pts worse
|
1.0%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.1% · Q2 3.8% · Q3 3.9% · Q4 1.5% · 4Q avg 2.8% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 2.4% |
2.6%
0.2 pts better
|
1.7%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.4% · Q2 0.0% · Q3 3.7% · Q4 2.4% · 4Q avg 2.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 6.5% |
21.2%
14.7 pts better
|
19.8%
13.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 12.8% · Q3 5.8% · Q4 5.3% · 4Q avg 6.5% |
| Percentage of long-stay residents with pressure ulcers | 6.2% |
6.0%
0.2 pts worse
|
5.1%
1.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.5% · Q2 6.1% · Q3 3.6% · Q4 7.3% · 4Q avg 6.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 42.4% |
79.9%
37.5 pts worse
|
81.7%
39.3 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 62.3% · Q2 39.0% · Q3 30.3% · Q4 40.6% · 4Q avg 42.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 17.9% |
13.2%
4.7 pts worse
|
12.0%
5.9 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 17.9% · Observed 17.6% · Expected 11.0% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.8% |
1.5%
0.3 pts worse
|
1.6%
0.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 2.2% · Q3 2.2% · Q4 1.3% · 4Q avg 1.8% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 41.0% |
78.1%
37.1 pts worse
|
79.7%
38.7 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 41.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 30.1% |
22.9%
7.2 pts worse
|
23.9%
6.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 30.1% · Observed 31.2% · Expected 24.7% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-08-16 · Fire 2023-05-15
4 health deficiencies
Top issue: Resident Assessment and Care Planning (2 deficiencies)
2 fire-safety deficiencies
Top issue: Services (1 deficiency)
Cycle 3
Health 2023-05-15 · Fire 2022-01-14
3 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-08-16
K281 · Egress Deficiencies
Fire Safety
Install proper backup exit lighting.
Corrected 2025-01-05
F · Potential for more than minimal harm
2024-08-16
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-01-05
D · Potential for more than minimal harm
2024-08-16
K222 · Egress Deficiencies
Fire Safety
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.
Corrected 2025-01-05
D · Potential for more than minimal harm
2024-08-16
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2025-01-05
D · Potential for more than minimal harm
2024-08-16
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-01-05
D · Potential for more than minimal harm
2024-08-16
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-01-05
D · Potential for more than minimal harm
2023-05-15
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-07-30
D · Potential for more than minimal harm
2023-05-15
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2023-07-30
Inspection history
Recent health citations
D · Potential for more than minimal harm
2024-10-01
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-10-16
D · Potential for more than minimal harm
2024-08-16
F644 · Resident Assessment and Care Planning Deficiencies
Health
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected 2024-10-01
D · Potential for more than minimal harm
2024-08-16
F758 · Pharmacy Service Deficiencies
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2024-10-01
B · Minimal harm
2024-08-16
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-09-04
E · Potential for more than minimal harm
2023-05-15
F578 · Resident Rights Deficiencies
Health
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.
Corrected 2023-06-10
D · Potential for more than minimal harm
2023-05-15
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2023-06-10
D · Potential for more than minimal harm
2023-05-15
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2023-06-12
Penalties and ownership
What sits behind the stars
$4,271
2024-08-16
Fine
Fine · fine $4,271
Fine
Ownership
Principle It Services, Inc.
5% Or Greater Direct Ownership Interest · Organization
Principle Long Term Care, Inc.
5% Or Greater Direct Ownership Interest · Organization
Boice, Gale
Corporate Officer · Individual
Hill, Raymond
5% Or Greater Direct Ownership Interest · Individual
Hill, Robert
5% Or Greater Direct Ownership Interest · Individual
Hill, Stephen
5% Or Greater Direct Ownership Interest · Individual
Johnson, Dianne
Corporate Director · Individual
Karstetter, Brian
Operational/Managerial Control · Individual
Principle It Services, Inc.
Operational/Managerial Control · Organization
Principle Long Term Care, Inc.
Operational/Managerial Control · Organization
Nearby options
Other facilities in reach
#1
Premier Nursing and Rehabilitation Center
Jacksonville, NC
3-star overall rating with 3-star inspections with $51,984 in total fines with 7 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
#2
Brook Stone Living Center
Pollocksville, NC
2-star overall rating with 3-star inspections with $18,600 in total fines with 3 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
#3
Woodbury Wellness Center Inc
Hampstead, NC
3-star overall rating with 3-star inspections with $15,646 in total fines with 1 recent health deficiencies with 10 fire-safety deficiencies in the latest cycle
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