With a score of 39/100, Trinity Elms ranks in the bottom tier of North Carolina nursing facilities, earning an F grade. CMS data highlights significant concerns that prospective residents and families should thoroughly evaluate.
Staffing levels at Trinity Elms exceed national averages, with 4.28 total nursing hours per resident per day — compared to the national average of 3.8 hours. RN coverage of 0.63 hours per resident per day is near the national average of 0.7 hours.
Recent CMS inspections identified 11 deficiencies at Trinity Elms, including 2 classified as serious — among the most concerning citation levels. The most notable finding involved: ensure that residents are free from significant medication errors..
Score Breakdown
🏥 Staffing Details
| Staff Type | Hours/Resident/Day | National Avg | Comparison |
|---|---|---|---|
| Total Nursing | 4.28 | 3.8 | Above Average |
| Registered Nurses (RN) | 0.63 | 0.7 | Below Average |
| Licensed Practical Nurses (LPN) | 0.80 | 0.7 | Above Average |
| Certified Nursing Assistants (CNA) | 2.85 | 2.4 | Above Average |
| Weekend Total Nursing | 4.00 | 3.8 | Average |
| Weekend RN Hours | 0.54 | 0.7 | Below Average |
🔍 Inspection & Deficiency History
View recent deficiencies (5 shown)
- Tag 0760 Severity DEnsure that residents are free from significant medication errors.Apr 29, 2025 · Pharmacy Service Deficiencies
- Tag 0851 Severity FElectronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.Jan 16, 2025 · Administration Deficiencies
- Tag 0578 Severity DHonor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, andJan 16, 2025 · Resident Rights Deficiencies
- Tag 0695 Severity DProvide safe and appropriate respiratory care for a resident when needed.Jan 16, 2025 · Quality of Life and Care Deficiencies
- Tag 0761 Severity DEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologiJan 16, 2025 · Pharmacy Service Deficiencies
📊 Resident Outcome Measures
Based on CMS quality measure data. Lower percentages are better for most metrics.
| Measure | This Facility | Nat'l Avg | |
|---|---|---|---|
| Residents with pressure ulcers | 7.7% | 4.5% | Worse |
| Falls with major injury | 3.7% | 3.0% | Worse |
| On antipsychotic medication | 15.3% | 14.5% | Average |
| Urinary tract infections | 3.0% | 2.5% | Worse |
| ADL decline (daily activities) | 23.2% | 14.0% | Worse |
| Excessive weight loss | 12.8% | 7.5% | Worse |
| New/worsened incontinence | 31.4% | 45.0% | Better |
⚠️ Penalties & Fines
2 penalties recorded by CMS
Total fines: $15,646
How This Grade Was Calculated
This facility's grade of F is based on a score of 39 out of 100, calculated from official CMS Nursing Home Compare data:
- Overall CMS Rating: 2★ → 16 pts (max 40)
- Health Inspection Rating: 3★ → 15 pts (max 25)
- Staffing Rating: 4★ → 16 pts (max 20)
- Quality Measures Rating: 1★ → 3 pts (max 15)
- Penalty deductions: -10 pts
- Fine deductions: -1 pts
Grades: A=85+, B=70–84, C=55–69, D=40–54, F=below 40
Facility Details
Other Facilities in North Carolina
- CAutumn Care Of BiscoeBiscoe
- A
- ACypress Pointe Rehabilitation CenterWilmington
- ASilas Creek Rehabilitation CenterWinston Salem
- FPERSON MEMORIAL HOSPITALROXBORO