Trinity Grove
631 Junction Creek Drive, Wilmington, NC 28412
Trinity Grove is a nursing home in Wilmington, North Carolina. This page lists the citations, fines and star ratings that CMS publishes for it. Each one has a date and a link to CMS.
CMS abuse icon
CMS adds this icon when it cites a home for abuse that hurt a resident in the past year. It also adds it when it cites a home for abuse that could have hurt someone, in each of the past two years.
CMS star ratings
- 3 of 5CMS overall star rating
- 2 of 5CMS health inspection star rating
- 5 of 5CMS staffing star rating
- 4 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (910) 442-3000
- Last standard health inspection
- September 18, 2025 (1 year ago)
- Certified beds
- 100
- Residents per day, on average
- 93.9
- Ownership type
- Non profit - Church related
- Legal business name
- Lutheran Home - Wilmington, INC.
- Chain
- Lutheran Services Carolinas
- Takes part in
- Medicare and Medicaid
Fewer health citations than the North Carolina average (15 vs 18).
Inspections, fines and changes
This list shows every citation and fine in CMS's current data, which covers about the last three years. It also shows changes CMS made to this home's ratings and records.
CMS update of October 28, 2026
Star rating
The CMS quality measures star rating changed from 3 of 5 to 4 of 5.
CMS update of April 29, 2026
Fine
CMS changed the fine from September 18, 2025 from $99,600 to $64,740.
CMS update of February 25, 2026
Star rating
The CMS quality measures star rating changed from 4 of 5 to 3 of 5.
CMS update of November 20, 2025
Star rating
The CMS quality measures star rating changed from 3 of 5 to 4 of 5.
Fine
CMS changed the fine from August 5, 2024 from $17,086 to $8,542.
5 citations
Health inspection on September 18, 2025
CMS lists this as a standard inspection and a complaint inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
69 of 419 North Carolina homes (16%) got a citation at the actual harm level in 2025.
Citation F0600. Severity G: actual harm, isolated.
The rule CMS cited:
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS lists it as corrected on September 26, 2025.
CMS has cited this home for F0600 3 times since 2024.
Citation F0565. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Honor the resident's right to organize and participate in resident/family groups in the facility.
CMS lists it as corrected on October 8, 2025.
Citation F0880. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on October 8, 2025.
Citation F0732. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Post nurse staffing information every day.
CMS lists it as corrected on October 8, 2025.
Citation F0585. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
CMS lists it as corrected on October 8, 2025.
Fine
September 18, 2025 (1 year ago)
CMS fine of $64,740 on September 18, 2025.
CMS update of July 30, 2025
Fine
CMS changed the fine from October 10, 2024 from $20,781 to $21,085.
CMS update of May 28, 2025
Fine
CMS changed the fine from October 10, 2024 from $31,970 to $20,781.
CMS update of April 30, 2025
Fine
CMS changed the fine from August 5, 2024 from $16,801 to $17,086.
CMS update of February 26, 2025
Fine
CMS changed the fine from August 5, 2024 from $25,847 to $16,801.
CMS update of October 30, 2024
Star rating
The CMS overall star rating changed from 4 of 5 to 3 of 5.
Star rating
The CMS health inspection star rating changed from 3 of 5 to 2 of 5.
CMS abuse icon
CMS added its abuse icon to this home.
3 citations
Health inspection on October 10, 2024
CMS lists this as a standard inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
76 of 419 North Carolina homes (18%) got a citation at the actual harm level in 2024.
Citation F0600. Severity G: actual harm, isolated.
The rule CMS cited:
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS lists it as corrected on October 30, 2024.
Citation F0607. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS lists it as corrected on October 30, 2024.
CMS has cited this home for F0607 2 times since 2024.
Citation F0810. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
CMS lists it as corrected on October 30, 2024.
6 citations
Fire safety inspection on October 10, 2024
CMS lists this as a standard inspection.
Citation K0914. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
CMS lists it as corrected on December 3, 2024.
Citation K0321. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
CMS lists it as corrected on December 3, 2024.
Citation K0353. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Inspect, test, and maintain automatic sprinkler systems.
CMS lists it as corrected on December 3, 2024.
Citation K0521. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on December 3, 2024.
Citation K0916. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have a battery powered remote alarm panel in a location accessible by operating personnel.
CMS lists it as corrected on December 3, 2024.
Citation K0918. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have generator or other power source capable of supplying service within 10 seconds.
CMS lists it as corrected on December 3, 2024.
CMS has cited this home for K0918 2 times since 2023.
Fine
October 10, 2024 (2 years ago)
CMS fine of $21,085 on October 10, 2024.
3 citations
Health inspection on August 5, 2024
CMS lists this as a complaint inspection.
Severity K is the highest of CMS's four levels. CMS uses it when residents' health or safety is at serious risk right away.
88 of 419 North Carolina homes (21%) got a citation at the immediate jeopardy level in 2024.
Citation F0600. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS lists it as corrected on November 21, 2023.
Citation F0607. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS lists it as corrected on November 21, 2023.
Citation F0684. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on August 25, 2024.
Fine
August 5, 2024 (2 years ago)
CMS fine of $8,542 on August 5, 2024.
Fine
August 5, 2024 (2 years ago)
CMS fine of $8,543 on August 5, 2024.
CMS update of July 31, 2024
Star rating
The CMS overall star rating changed from 3 of 5 to 4 of 5.
Star rating
The CMS staffing star rating changed from 4 of 5 to 5 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
CMS update of March 28, 2024
Ownership
CMS lists this home under a new chain.
CMS update of January 31, 2024
Star rating
The CMS staffing star rating changed from 3 of 5 to 4 of 5.
4 citations
Health inspection on July 13, 2023
CMS lists this as a standard inspection.
Citation F0761. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on August 15, 2023.
Citation F0812. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS lists it as corrected on August 15, 2023.
Citation F0550. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
CMS lists it as corrected on August 15, 2023.
Citation F0811. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that residents are assessed for appropriateness for a feeding assistant program, receive services as per their plan of care, and feeding assistants are trained and supervised.
CMS lists it as corrected on August 15, 2023.
2 citations
Fire safety inspection on July 13, 2023
CMS lists this as a standard inspection.
Citation K0761. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
CMS lists it as corrected on September 20, 2023.
Citation K0918. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have generator or other power source capable of supplying service within 10 seconds.
CMS lists it as corrected on September 20, 2023.
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- LSA MANAGEMENT, INC.Operational/managerial control · not applicable · since 04/30/2007
- LUTHERAN HOME WILMINGTON PROPERTY, INCOperational/managerial control · not applicable · since 04/05/1988
- LUTHERAN SERVICES FOR THE AGING, INC.Operational/managerial control · not applicable · since 04/30/2007
- GOINS, TEDOperational/managerial control · not applicable · since 11/04/2004
- PARRISH, JAMESOperational/managerial control · not applicable · since 02/25/2022
- SMITH, KESHAOperational/managerial control · not applicable · since 10/01/2012
- SUTTON-SURAK, AUDREYOperational/managerial control · not applicable · since 02/25/2022
Questions
When was Trinity Grove last inspected?
CMS lists September 18, 2025 as the date of its most recent standard health inspection.
How many citations (violations) does Trinity Grove have?
CMS lists 15 health citations since July 13, 2023. CMS also calls these deficiencies.
Has Trinity Grove been fined?
CMS lists 4 fines in the past three years, $102,910 in total.
What is the CMS star rating of Trinity Grove?
Its CMS overall star rating is 3 of 5.
Is Trinity Grove a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.
Other nursing homes in Wilmington
- August Healthcare at Wilmington
- Autumn Care of Myrtle Grove
- Azalea Health & Rehab Center
- Bradley Creek Health Center
- Cypress Pointe Rehabilitation Center
- Davis Health and Wellness Center at Cambridge Vill
- Davis Health Care Center
- Liberty Commons Rehabilitation Center
- Northchase Nursing and Rehabilitation Center
- Peak Resources-Wilmington, Inc