NC State Veterans Home - Salisbury

Name: NC State Veterans Home - Salisbury
Address: 1601 Brenner Ave., Building #10, Salisbury, NC, 28145, US
Telephone: 7046384200

1601 Brenner Ave., Building #10, Salisbury, NC 28145 · Rowan County · 99 certified beds · avg 83 residents/day · certified since Nov 22, 2004

2/5

Health inspection rating (on-site)

Serious findings on record

$12,444

Fines, last 3 years

4.98

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 4/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

Most serious findings (actual harm or immediate jeopardy)

▲ Immediate jeopardy, one-off · Dec 12, 2025 · F-0880

The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.

Why it matters: Weak infection control lets illnesses like flu, COVID-19, and drug-resistant infections spread quickly among vulnerable residents.

Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.

Corrected: Jan 13, 2026 (Deficient, Provider has date of correction)

All citations in the current public record (17)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Dec 12, 2025	▲ J · Immediate jeopardy, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights.
Dec 12, 2025	D · Potential for harm, one-off	The facility gave residents unnecessary mind-altering (psychotropic) medications, or used drugs in a way that restrained residents by dulling their ability to think, move, or function.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection.
Dec 12, 2025	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Dec 12, 2025	D · Potential for harm, one-off	The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards.
Dec 12, 2025	D · Potential for harm, one-off	The facility did not develop and follow policies and procedures for offering residents flu and pneumonia vaccinations.
Dec 12, 2025	C · Minimal risk, facility-wide	The facility did not post the names, addresses, and phone numbers of state agencies and advocacy groups, along with a notice that residents may file complaints with the state survey agency.
Dec 12, 2025	B · Minimal risk, repeated	The facility did not properly inform residents or their representatives about arbitration agreements — contracts that give up the right to sue in court — including their right to refuse to sign.
Aug 8, 2024	E · Potential for harm, repeated	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Aug 8, 2024	D · Potential for harm, one-off	The facility did not honor residents' right to make their own choices about their daily lives, such as when to wake up, what to eat, or how to spend their time.
Aug 8, 2024	D · Potential for harm, one-off	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Feb 23, 2023	D · Potential for harm, one-off	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Feb 23, 2023	D · Potential for harm, one-off	The facility did not arrange hospice services for a resident who needed them, or help the resident move to a facility that could arrange hospice. Hospice provides comfort-focused care for people nearing the end of life.

Inspection trend by year

Citations from standard inspections increased between the last two inspection cycles (3 → 12).

Year	Citations	Serious (G–L)	Worst severity that year
2023	2	0	D
2024	3	0	E
2025	12	1	J ▲

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

1 fine totaling $12,444.

Date	Type	Amount / length
Dec 12, 2025	Fine	$12,444

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	North Carolina avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	4.98	4.01	3.95	top 13% in North Carolina; top 13% in the U.S.
Registered Nurse hours	1.19	0.64	0.69	top 8% in North Carolina; top 10% in the U.S.
Weekend total nurse staffing	3.96	3.56	3.50	top 19% in North Carolina; top 24% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.53	0.41	0.48	top 21% in North Carolina; top 30% in the U.S.
Total nursing staff turnover (%)	43.9	49.0	45.8	top 38% in North Carolina; top 47% in the U.S.
RN turnover (%)	14.3	45.7	42.9	top 6% in North Carolina; top 7% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.79, RN 1.14, weekend 3.81. Staffing rating: 5/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 5/5 · long-stay residents: 5/5 · short-stay residents: —/5

Who owns this facility

Government - State

Owner / manager	Type	Role	Stake	Since
NC Dept of Military and Veterans Affairs NC Division of Veter Affairs	Organization	5% or Greater Direct Ownership Interest	100%	03/31/2009
NC Dept of Military and Veterans Affairs NC Division of Veter Affairs	Organization	Operational/Managerial Control	NOT APPLICABLE	03/31/2009
Stephens, Nicole	Individual	W-2 Managing Employee	NOT APPLICABLE	02/07/2019
Westbrook, Terry	Individual	W-2 Managing Employee	NOT APPLICABLE	06/26/2019
Westbrook, Terry	Individual	Corporate Officer	NOT APPLICABLE	06/26/2019

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
"Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
"What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
"What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
"Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
"What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
"How do you care for residents with incontinence or catheters, and what do you do to prevent urinary tract infections?"
"Does a pharmacist review every resident's medications and chart monthly, and how are their concerns acted on?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
Autumn Care of Salisbury	0.1 mi	Salisbury, NC	★★★★☆	3/5
Compass Healthcare and Rehab Rowan, LLC	1.5 mi	Spencer, NC	★★★☆☆	3/5
Piedmont Health & Rehab Center	1.8 mi	Salisbury, NC	★★☆☆☆	2/5
Trinity Oaks	2.3 mi	Salisbury, NC	★★★★★	4/5
Meadowbrook Health & Rehabilitation	3.2 mi	Salisbury, NC	★☆☆☆☆	1/5
The Laurels of Salisbury	4.8 mi	Salisbury, NC	★★★☆☆	3/5
Liberty Commons Nsg and Rehab Ctr of Rowan County	5.2 mi	Salisbury, NC	★★★☆☆	3/5
Davidson Health & Rehab Center	11.0 mi	Lexington, NC	★☆☆☆☆	1/5	abuse
Pine Acres Center for Nursing and Rehabilitation	13.1 mi	Lexington, NC	★☆☆☆☆	1/5
Big Elm Retirement and Nursing Centers	14.6 mi	Kannapolis, NC	★★★★☆	4/5
Lexington Health Care Center	15.8 mi	Lexington, NC	★★☆☆☆	2/5	abuse
Kannapolis Health and Rehabilitation	16.1 mi	Kannapolis, NC	★★☆☆☆	2/5

Compare this facility with the 3 closest →

All facilities in Salisbury →

Facility data as of CMS processing date 2026-08-01. CCN 345531.

The Care File

Visit checklist — NC State Veterans Home - Salisbury

1601 Brenner Ave., Building #10, Salisbury, NC 28145 · 7046384200

Health inspection rating 2/5 · CMS overall 4/5· Fines (3y): $12,444

Most serious findings on record:

▲ Dec 12, 2025 (F-0880, Immediate jeopardy, one-off): The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.

Questions for the administrator:

☐ "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
☐ "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
☐ "What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
☐ "What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
☐ "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
☐ "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
☐ "How do you care for residents with incontinence or catheters, and what do you do to prevent urinary tract infections?"
☐ "Does a pharmacist review every resident's medications and chart monthly, and how are their concerns acted on?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 345531 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)