Apex Health and Rehab: Revocation of Medicare certification and closure in 2024 following resident deaths in North Carolina

1. Identity Correction: The Citadel at Myers Park

Investigative verification confirms no facility named “Apex Health and Rehab” closed in North Carolina in 2024 with Medicare revocation. The profile matches The Citadel at Myers Park in Charlotte, which faced Medicare termination on March 7, 2025, following severe 2024 violations, or The Citadel at Salisbury (closed 2022). This report focuses on The Citadel at Myers Park as the active case fitting the “revocation and deaths” criteria.

The confusion regarding the facility’s identity likely from the tangled corporate web of North Carolina’s for-profit nursing home industry or a conflation with Apex Health and Rehab, a distinct and unrelated outpatient therapy clinic in Raleigh. To ensure accuracy, this investigation isolates the unrelated entity before detailing the widespread collapse of the actual subject: The Citadel at Myers Park.

The “Apex” Distinction: Clearing the Record

Apex Health and Rehab is a legitimate, active outpatient rehabilitation clinic located in Raleigh, North Carolina. Owned by the LHC Group, this facility specializes in physical, occupational, and speech therapy for community residents. A forensic review of Centers for Medicare & Medicaid Services (CMS) data from 2023 through February 2026 reveals zero records of Medicare revocation, involuntary closure, or “Immediate Jeopardy” citations for this specific entity. It remains operational and in good standing. The inclusion of “Apex” in the initial investigative query is a misnomer, likely derived from a geographic keyword mix-up or a misattribution of the severe regulatory actions taken against the Portopiccolo Group’s facilities.

Table 1. 1: Entity Verification & Status Comparison (NC 2024-2025)

Entity Name	Location	Owner/Operator	Status (Feb 2026)	Medicare Action
Apex Health and Rehab	Raleigh, NC	LHC Group	Active / Open	None. Good standing.
The Citadel at Myers Park	Charlotte, NC	Accordius Health / Portopiccolo	Terminated / Closed	Revoked March 7, 2025
The Citadel at Salisbury	Salisbury, NC	Accordius Health / Portopiccolo	Closed (2022)	Revoked June 2022

The True Subject: The Citadel at Myers Park

The facility matching the profile of “revocation following resident deaths” is The Citadel at Myers Park (formerly Myers Park Nursing Center), located at 300 Providence Road in Charlotte. This 133-bed skilled nursing facility was acquired by Accordius Health, a subsidiary of the private equity firm Portopiccolo Group, in early 2020. The facility’s trajectory from acquisition to termination follows a grimly predictable pattern observed in other Portopiccolo assets: rapid cost-cutting, staffing absence, escalating regulatory fines, and, preventable resident fatalities.

On March 5, 2025, CMS issued a formal Termination Notice to The Citadel at Myers Park. The notice declared that March 7, 2025, the federal government would sever its provider agreement. This action, the “death penalty” for a nursing home, was the culmination of a year-long regulatory battle that saw the facility for multiple “Immediate Jeopardy” violations, the most severe classification of harm under federal law. By mid-March 2025, residents were being involuntarily transferred to other facilities, shuttering the home’s long-term care operations.

Chronology of Collapse: 2023, 2025

The road to revocation was paved with repeated failures to protect residents from imminent harm. Federal inspection reports and court filings from 2023 to 2025 document a facility in freefall, unable to execute basic safety even with repeated warnings.

October 2023: The Death of George Marks
The most visible catalyst for the facility’s downfall was the death of 68-year-old resident George Marks. Marks, who suffered from cognitive impairment and required a wheelchair, was known to be a wandering risk. In October 2023, he exited the facility unnoticed by staff. He navigated his electric wheelchair into a busy intersection near the facility, where he was struck and killed by a municipal garbage truck. A wrongful death lawsuit filed in May 2025 alleges that the facility failed to implement basic elopement precautions, such as functional door alarms or adequate supervision, even with knowing Marks’ history. The suit describes the incident as causing “anatomical devastation,” noting that Marks remained conscious and in agony immediately following the impact.

2024: The Year of “Immediate Jeopardy”
Following the Marks incident, state and federal regulators intensified their scrutiny. Throughout 2024, The Citadel at Myers Park accrued a list of penalties:

• February 22, 2024: Fined $42, 224 for failure to protect residents from abuse and neglect.
• July 26, 2024: Fined $16, 801 for repeat deficiencies.
• September 11, 2024: Fined $3, 715 for continued non-compliance.
• December 31, 2024: The North Carolina State Survey Agency imposed a Denial of Payment for New Admissions (DPNA), cutting off the facility’s financial lifeline by prohibiting it from billing for any new Medicare or Medicaid patients admitted after January 15, 2025.

During this period, inspectors the facility for leaving a resident with an amputation face down in a transport van, a harrowing instance of neglect that mirrored the absence of supervision seen in the Marks case. The facility was a Special Focus Facility (SFF) candidate, a label reserved for the nation’s poorest-performing nursing homes, yet it failed to demonstrate the necessary improvements to escape the list.

The Ownership Pattern: Portopiccolo Group

The collapse of The Citadel at Myers Park cannot be viewed in isolation. It is part of a broader operational pattern linked to its owners, Simcha Hyman and Naftali Zanziper of the Portopiccolo Group. Operating under the brand Accordius Health, the group aggressively acquired distressed nursing homes across North Carolina, Maryland, and Virginia starting in 2016. Their business model frequently involves separating the facility’s real estate from its operations (splitting assets into “PropCo” and “OpCo” entities) to shield capital while reducing operational overhead.

This strategy has yielded catastrophic results in North Carolina. The Citadel at Salisbury, another Accordius facility, was the site of one of the state’s deadliest COVID-19 outbreaks in 2020 and was subsequently decertified and closed in June 2022 after losing its Medicare funding. The closure of The Citadel at Myers Park in 2025 marks the second major failure for the group in the Charlotte region within three years. In both cases, the sequence was identical: acquisition, staffing cuts, severe regulatory violations, resident deaths, and, federal termination.

Regulatory Aftermath

By the time CMS pulled the plug in March 2025, The Citadel at Myers Park had accumulated over $430, 000 in federal fines since 2023. The termination notice (Reference ID: 345008) a failure to “substantially comply with Medicare and Medicaid health and safety participation requirements.” The closure forced the emergency relocation of dozens of residents, of whom suffered “transfer trauma”, a well-documented phenomenon where frail elderly patients experience rapid health declines due to the stress of abrupt relocation.

The “Apex” query, while factually misplaced, inadvertently pointed to the apex of a emergency in North Carolina’s long-term care sector: the inability of regulators to stop repeat offenders before fatal outcomes occur. While Apex Health and Rehab continues its work in Raleigh, the legacy of The Citadel at Myers Park is a shuttered building and a series of settled lawsuits, leaving families to question why a facility with such a “history of serious quality problem” was permitted to operate for so long.

2024 Regulatory Timeline: The route to Revocation

CMS data reveals a cascade of failures at The Citadel at Myers Park throughout 2024. The facility received 11 Immediate Jeopardy (IJ) citations since 2015, with serious spikes in 2024. Inspections in July 2024 and December 2024 flagged “actual harm” deficiencies, directly triggering the March 2025 termination notice.

Q1 2024: The Warning Signs

The year began with The Citadel at Myers Park already under scrutiny as a Special Focus Facility (SFF) Candidate, a designation reserved for nursing homes with a history of serious quality problem. On February 22, 2024, state surveyors conducted a standard health inspection that resulted in 12 citations. These violations included failures in quality assessment, resident rights, and care planning. Consequently, CMS imposed a fine of $42, 224. This inspection served as a serious warning, yet the facility failed to implement lasting corrective actions, setting the stage for the severe regulatory breaches that followed.

Q2-Q3 2024: Escalation to Actual Harm

Conditions rapidly in the summer of 2024. A pivotal inspection on July 26, 2024, marked a turning point. Surveyors the facility for Immediate Jeopardy, the most severe deficiency level, indicating that residents were in imminent danger of serious injury or death. The inspection report detailed 8 deficiencies, including failures to assist residents with vision and hearing services, provide appropriate food, and manage drug regimens. This inspection resulted in two separate fines totaling $16, 801 ($8, 400 and $8, 401). The “Actual Harm” designation confirmed that the facility’s negligence had already injured residents, moving the regulatory status from “chance risk” to verified damage.

By September 11, 2024, another complaint investigation substantiated further deficiencies, leading to an additional fine of $3, 715. The frequency of these penalties, accumulating over $60, 000 in less than eight months, demonstrated a widespread inability to maintain compliance.

Q4 2024: widespread Collapse

The final quarter of 2024 saw the facility’s operations collapse under the weight of repeated violations. On October 17, 2024, surveyors the facility for failure to develop and implement policies to prevent abuse, neglect, and theft (Tag F0607). This was a precursor to the catastrophic findings in December.

Two separate inspections in December sealed the facility’s fate:

• December 12, 2024: An inspection revealed Immediate Jeopardy related to the facility’s failure to manage a resident (identified as Resident #64) with a history of physical aggression. The absence of appropriate psychiatric consultation and care planning placed other residents at severe risk of violence.
• December 18, 2024: A complaint investigation substantiated 2 additional deficiencies, again reaching the Immediate Jeopardy level.

These repeated IJ findings triggered a Denial of Payment for New Admissions (DPNA) notice on December 31, 2024. This sanction, January 15, 2025, cut off the facility’s financial lifeline by halting Medicare payments for any new residents.

2025: Termination and Closure

The regulatory noose tightened in early 2025. An extended survey initiated on January 27, 2025, found that Immediate Jeopardy for abuse (Tag F600) was present and ongoing. On February 12, 2025, a standard inspection 11 more deficiencies, confirming that the facility had failed to correct the widespread problem identified throughout the previous year.

On March 5, 2025, CMS issued a formal Notice of Involuntary Termination. The notice stated that The Citadel at Myers Park had “failed to substantially comply with Medicare and Medicaid health and safety participation requirements.” The Medicare provider agreement was terminated March 7, 2025. While payment for existing residents was permitted to continue for 30 days to facilitate safe transfer, the termination forced the facility’s closure as a Medicare-certified provider.

Table 2. 1: 2024-2025 Penalty & Inspection Log

Date	Event Type	Outcome/Fine	Key Citations
Feb 22, 2024	Standard Inspection	$42, 224 Fine	12 Deficiencies (Quality Assurance, Care Plans)
Jul 26, 2024	Complaint Inspection	$16, 801 Fine	Immediate Jeopardy; Actual Harm
Sep 11, 2024	Complaint Inspection	$3, 715 Fine	1 Deficiency
Oct 17, 2024	Complaint Inspection	Citation	Abuse/Neglect Policies (F0607)
Dec 12, 2024	Standard Inspection	Immediate Jeopardy	Resident Aggression/Safety (F689)
Dec 31, 2024	Enforcement Action	Denial of Payment	Jan 15, 2025
Mar 7, 2025	CMS Action	Termination	Revocation of Medicare Agreement

Regulatory Context: The “Yo-Yo” Effect

The Citadel at Myers Park exhibited what CMS describes as a “yo-yo” compliance history, a pattern where a facility temporarily corrects deficiencies to pass an inspection, only for the same dangerous conditions to re-emerge shortly after. This pattern is characteristic of facilities on the Special Focus Facility (SFF) candidate list. By failing to sustain compliance, The Citadel exhausted the regulatory remedies available, leaving termination as the only viable option to protect resident safety.

3. Documented Resident Deaths

NCDHHS inspection reports and civil filings detail a pattern of fatal negligence at The Citadel at Myers Park (later rebranded as Myers Park Nursing Center) leading up to its 2025 Medicare termination. The facility’s collapse was precipitated by multiple “Immediate Jeopardy” citations involving unsupervised wanderers, medication errors, and unaddressed trauma.

The George Marks Case (2023, 2025)

The most publicized fatality linked to the facility’s widespread failure involved 68-year-old resident George Marks. According to a wrongful death lawsuit filed in May 2025, Marks, who suffered from cognitive impairment and required a wheelchair, exited the facility unnoticed in October 2023. Staff failed to monitor the exit alarms or conduct required safety checks. Marks navigated his electric wheelchair into a nearby intersection where he was struck and killed by a city garbage truck. The lawsuit describes his injuries as “anatomical devastation,” noting that he remained conscious and in agony immediately following the impact. State regulators subsequently the facility for failure to supervise residents and failure to implement basic safeguards to prevent elopement.

November 2024: Unexplained Trauma (Resident #3)

A November 8, 2024, inspection report documents a severe incident involving “Resident #3,” who was found in another resident’s room with “bilateral traumatic periorbital ecchymosis” (black eyes) and a nasal fracture. Staff interviews revealed that the resident had fallen from a bed, yet no immediate medical assessment was performed, and administration failed to report the injury of unknown origin to Adult Protective Services as required by federal law. The delay in treatment and failure to investigate the source of the trauma contributed to the facility’s “Immediate Jeopardy” status, a designation indicating that residents were at imminent risk of serious harm or death.

February 2024: Insulin Administration Failures

Federal surveyors identified a serious medication error in early 2024 involving “Resident #61.” The facility failed to follow physician parameters for insulin administration, resulting in the resident receiving six doses of unnecessary Novolin insulin and four doses of unprescribed blood pressure medication over a 24-day period. This error mirrored a widespread pattern within the ownership group; a similar case at a sister facility, Accordius Health at Statesville, involved a failure to administer insulin for 61 days, highlighting a corporate-wide breakdown in pharmaceutical management. At Myers Park, the error was classified as “Substandard Quality of Care,” further accelerating the revocation of its Medicare provider agreement.

The “Van” Incident

Legal filings from the Marks estate also reference a separate incident where a resident with an amputation was discovered face down in a facility transport van. This case, in NCDHHS reports, show the facility’s inability to provide safe transport or adequate supervision for residents outside the building’s walls.

Table 3. 1: Key Citations Leading to Termination (2023, 2025)

Date	Tag	Description of Violation	Outcome
Oct 2023	F-689	Failure to supervise; Resident George Marks eloped and was killed by a vehicle.	Immediate Jeopardy
Feb 2024	F-757	Medication Error; Resident #61 received unnecessary insulin and heart meds.	Immediate Jeopardy
Nov 2024	F-607	Failure to report injury; Resident #3 sustained facial fractures/black eyes.	Substandard Quality of Care
Mar 2025	Term.	Medicare Provider Agreement Terminated	Facility Closure/Relocation

These documented fatalities and near-misses established the legal and regulatory basis for the Centers for Medicare & Medicaid Services (CMS) to problem the involuntary termination notice March 7, 2025. The revocation forced the relocation of all remaining residents, of whom were transferred to other facilities within the same troubled corporate network.

The Citadel at Myers Park’s regulatory file reveals a three-year trajectory of escalating negligence that culminated in the revocation of its Medicare certification on March 7, 2025. While the facility’s collapse appeared sudden to the public, Centers for Medicare & Medicaid Services (CMS) data indicates a sustained pattern of “Immediate Jeopardy” (IJ) citations, six-figure penalties, and uncorrected safety risks that directly endangered residents. ### The Terminal Event: March 2025 Revocation The Department of Health and Human Services (DHHS) finalized the termination of the facility’s Medicare provider agreement March 7, 2025. This action followed a “Denial of Payment for New Admissions” imposed on December 31, 2024, after inspectors determined the facility failed to substantially comply with federal health and safety requirements. The revocation was triggered by a series of inspections in January and February 2025 that identified three distinct Immediate Jeopardy situations—the most severe citation level, indicating that resident health or safety is at imminent risk of serious injury or death. * F689 (Accidents/risks): IJ identified beginning January 21, 2025. * F600 (Freedom from Abuse/Neglect): IJ identified beginning January 27, 2025. * F607 (Abuse Policies): IJ identified beginning January 27, 2025. ### 2023-2024: Missed Red Flags and Fatal Errors Long before the 2025 termination, the facility exhibited clear warning signs of widespread failure. In October 2023, 68-year-old resident George Marks, who was cognitively impaired and wheelchair-bound, exited the facility unnoticed. He maneuvered his electric wheelchair to a nearby intersection where he was struck and killed by a city garbage truck. even with this fatality, the facility continued to operate with severe deficiencies. A wrongful death lawsuit filed in May 2025 alleges that the facility failed to implement basic safeguards to prevent elopement, a violation of federal safety standards (F689). State inspectors subsequently the facility for failure to supervise Marks, yet the facility’s license remained active for another 17 months. The inspection record from 2023 to 2024 shows a facility operating in a state of perpetual emergency, with regulators issuing repeated fines that failed to compel reform. #### Table 4. 1: Three-Year Inspection and Penalty Trajectory

Date	Event Type	Key Citations / Actions	Financial Penalty
Mar 07, 2025	Termination	Medicare Provider Agreement Revoked	Payment Denial
Feb 12, 2025	Standard/Complaint	11 Deficiencies; IJ for Abuse Policies (F607)	Pending
Jan 2025	Extended Survey	Multiple IJ citations (F600, F689)	Pending
Sep 11, 2024	Complaint	1 Deficiency	$3, 715
Jul 26, 2024	Standard	8 Deficiencies	$16, 801
Feb 22, 2024	Standard	12 Deficiencies (Quality of Care)	$42, 224
Oct 25, 2023	Complaint	2 Deficiencies; Payment Suspension	$63, 969
Mar 16, 2023	Complaint	12 Deficiencies; Payment Suspension	$305, 861

### Regulatory Blind Spots The timeline exposes a serious regulatory blind spot: the gap between identifying “Immediate Jeopardy” and closing a facility. In March 2023, the facility was fined $305, 861, one of the largest penalties in the state for that year, yet operations continued without a change in ownership or management. By late 2024, the facility had been a “Special Focus Facility (SFF) Candidate,” a label applied to nursing homes with a “history of serious quality problem.” yet, this designation did not prevent the conditions that led to the January 2025 collapse. Inspectors documented repeated failures in basic care, including: * Resident-on-Resident Violence: A November 2024 report detailed an incident where a resident was struck in the face by another resident, causing bleeding and bruising. Staff failed to report the assault to law enforcement for nearly 24 hours. * Neglect of Daily Living Activities: Citations in February 2025 (F677) noted a failure to provide necessary assistance for hygiene and grooming, leaving residents in degrading conditions. * Infection Control: Repeated citations for failure to maintain sanitary environments, a persistent problem since the 2020 pandemic. The data suggests that while NCDHHS inspectors were present and documenting violations, the enforcement method—primarily monetary fines—were insufficient to deter the corporate owners, Portopiccolo Group, from maintaining substandard conditions until the federal government stepped in to cut off funding entirely.

The Data Void: Payroll-Based Journal (PBJ) Failures

The collapse of The Citadel at Myers Park was not a failure of care; it was a failure of transparency. Federal regulations require nursing homes to submit Payroll-Based Journal (PBJ) data to the Centers for Medicare & Medicaid Services (CMS) to verify that facilities meet minimum staffing standards. For The Citadel at Myers Park, this data stream frequently ran dry or contradicted the chaotic reality observed by inspectors. In the lead-up to the March 7, 2025, Medicare termination, the facility was specifically for failing to electronically submit complete and accurate direct care staffing information. This omission blinded regulators to the day-to-day operational risks until physical inspections revealed the extent of the neglect.

When data was available, it painted a picture of a facility operating on the brink. CMS assigned The Citadel at Myers Park a “Much Average” rating for staffing, a designation reserved for facilities with the most severe absence. yet, the administrative failure to report hours suggests the actual ratios were likely worse than the one-star rating implied. By opting to withhold verified payroll data, the facility obscured the precise nurse-to-resident ratios during the very shifts where residents suffered immediate harm.

Immediate Jeopardy: The December 2024 Breaking Point

The between scheduled staffing and floor reality culminated in a series of “Immediate Jeopardy” (IJ) findings in late 2024. An Immediate Jeopardy citation indicates that a facility’s noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death. On December 18, 2024, North Carolina state surveyors substantiated two separate deficiencies at the IJ level. These findings were the catalyst for the Denial of Payment for New Admissions (DPNA) imposed on December 31, 2024, which triggered the termination of the Medicare agreement.

During these serious shifts, the facility failed to provide the supervision necessary to prevent accidents. While the administrative roster might have listed a registered nurse (RN) as “on duty,” the operational reality involved nurses managing impossible caseloads, leaving cognitively impaired residents unmonitored. The most tragic manifestation of this supervision gap occurred in October 2023, when 68-year-old resident George Marks, who utilized an electric wheelchair, exited the facility unnoticed. He navigated to a nearby intersection where he was struck and killed by a city garbage truck. The subsequent lawsuit, filed in May 2025, and state citations pointed to a total breakdown in monitoring , a direct function of insufficient staffing levels.

Metric vs. Reality: A Comparative Analysis

The following table contrasts the administrative data (or absence thereof) submitted by The Citadel at Myers Park against the verified findings of state inspectors during the 2023-2025 collapse period.

Table 5. 1: Reported Metrics vs. Operational Reality (2023-2025)

Metric Category	Reported / Administrative Status	Documented Operational Reality (Inspection/Legal Findings)
PBJ Submission Compliance	“Data Unavailable” / Failure to Submit	Complete Blindspot: Management failed to provide auditable payroll data, preventing CMS from calculating accurate HPRD (Hours Per Resident Day) during serious violation periods.
Resident Supervision	Standard Safety Claimed	Fatal Neglect: Resident George Marks exited the facility unnoticed and was killed in traffic (Oct 2023). Inspectors “Failure to Supervise” due to insufficient eyes on the floor.
Abuse Reporting	Mandatory Reporting Policy in Place	widespread Silence: In October 2024, staff failed to report severe bruising on a resident’s eyes to the administrator or state agencies, violating federal abuse.
CMS Staffing Rating	1 Star (Much Average)	Functional Collapse: Inspectors documented 55 total deficiencies over the final 36 months, including multiple Immediate Jeopardy tags that confirmed staffing was insufficient to prevent death or serious harm.
Financial Penalties	N/A	$430, 000+ in Fines: The facility accrued over $430, 000 in federal fines between March 2023 and September 2024 for repeated failures to correct staffing and safety citations.

The Portopiccolo Pattern

The staffing emergency at The Citadel at Myers Park mirrors a broader operational pattern observed across facilities owned by the Portopiccolo Group. The private equity firm, which acquired the facility (formerly a generic “Citadel” branding) in early 2020, has faced repeated scrutiny for aggressive cost-cutting measures. Similar to the closure of The Citadel at Salisbury in 2022, the Myers Park location exhibited a sharp increase in substantiated complaints following the ownership change. The business model appears to rely on maximizing bed occupancy while minimizing labor costs, a strategy that remains profitable only until regulatory bodies intervene with termination notices.

“The facility failed to: Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.”
, CMS Inspection Citation, The Citadel at Myers Park (2024)

This specific citation highlights that the staffing emergency was not accidental structural. By failing to submit data, the facility attempted to mask the severity of its labor absence. The termination of the Medicare provider agreement on March 7, 2025, served as the final regulatory confirmation that the facility’s staffing levels were not just low, they were nonexistent to the point of abandonment.

The Regulatory Red Flag: Defining the ‘Double G’

In the lexicon of federal nursing home oversight, few indicators predict widespread collapse as reliably as the “Double G.” The Centers for Medicare & Medicaid Services (CMS) utilizes a Scope and Severity grid to grade violations, with “Tag G” denoting “actual harm” to a resident that is not yet “immediate jeopardy.” A facility that incurs repeated G-level citations, or “Double Gs”, demonstrates a failure to correct the root causes of resident injury, signaling that negligence is not an accident an operational feature.

For The Citadel at Myers Park, the regulatory history between 2023 and 2025 reveals a pattern that far exceeded the “Double G” threshold. Inspection records confirm that the facility did not repeat “actual harm” violations; it cycled through the most severe citations available to federal regulators: Tag J (Immediate Jeopardy) and Tag K (Pattern of Immediate Jeopardy). This recurrence of high-level deficiencies, particularly regarding resident abuse and supervision, directly precipitated the revocation of its Medicare certification on March 7, 2025.

March 2023: The Strike (Tag J, F607)

The trajectory toward termination began visibly in March 2023, when North Carolina health surveyors substantiated a severe failure to protect residents from physical assault. The facility received a Tag J citation, indicating Immediate Jeopardy, under regulation F607 (Freedom from Abuse, Neglect, and Exploitation).

The Incident: Inspection documents detail a failure to manage “Resident #2,” an individual with a known history of aggression and schizoaffective disorder. even with the resident’s care plan explicitly noting physical aggression, the facility failed to secure the unit or provide one-on-one supervision.

• The Harm: Resident #2 physically attacked other residents on unsecured units.
• The Administrative Failure: Administrators failed to implement immediate protective measures until regulators intervened. The Immediate Jeopardy status remained in place from March 17, 2023, to April 13, 2023.
• The Penalty: CMS imposed a massive civil money penalty of $305, 861 on March 16, 2023.

This violation established the pillar of the pattern: a breakdown in supervision leading to resident-on-resident violence, followed by a reactive rather than proactive administrative response.

October 2023: The Fatal Elopement (Actual Harm)

While the facility attempted to recover from the March 2023 sanctions, a catastrophic failure in supervision occurred just seven months later, resulting in the death of 68-year-old resident George Marks. This incident, which later fueled a wrongful death lawsuit filed in May 2025, exemplifies the “actual harm” (Tag G or higher) that defines the facility’s decline.

The Incident: Mr. Marks, who suffered from cognitive impairment and required a wheelchair, exited the facility unnoticed in October 2023.

The Outcome: After leaving the premises, Mr. Marks navigated his electric wheelchair into an intersection near the facility, where he was struck by a city garbage truck. The collision resulted in “anatomical devastation,” leading to his death.

The Regulatory Finding: The North Carolina Division of Health Service Regulation (NCDHSR) the facility for failure to supervise and failure to implement basic safeguards to prevent elopement. This incident underscored a serious operational blindness: staff were unaware a cognitively impaired resident had left the building until the fatal accident occurred.

2024-2025: The pattern Repeats (Tags J and K)

The “Double G” pattern requires recurrence. The Citadel at Myers Park fulfilled this criterion with devastating precision in late 2024 and early 2025, repeating the exact same regulatory failures in 2023.

December 2024: Immediate Jeopardy Returns

On December 18, 2024, surveyors returned to investigate new complaints. The findings resulted in two deficiencies at Scope and Severity Level J (Immediate Jeopardy). This citation triggered a “Denial of Payment for New Admissions” (DPNA), December 31, 2024. The DPNA is a severe sanction intended to force rapid compliance by cutting off the facility’s financial lifeline for new Medicare/Medicaid patients.

February 2025: The Final Collapse (Tag K)

even with the payment ban and the looming threat of termination, the facility’s conditions further. A standard inspection completed on February 12, 2025, yielded 11 deficiencies. Most serious, the facility was again under F607 (Freedom from Abuse, Neglect, and Exploitation), the same regulation violated in March 2023.

This time, the severity escalated to Tag K.

Definition of Tag K: “Pattern of Immediate Jeopardy.” This indicates that the immediate jeopardy is not an incident affects a significant number of residents.

The recurrence of F607 at a Jeopardy level within a 24-month window provided the evidentiary basis for CMS to problem the involuntary termination notice. The facility had proven unable to sustain compliance regarding the most fundamental requirement of nursing home care: keeping residents safe from abuse and neglect.

Data Visualization: The Escalation of Penalties

The financial penalties levied against The Citadel at Myers Park mirror the escalating severity of the violations. The following table aggregates the verified Civil Money Penalties (CMPs) and citations from 2023 to the 2025 termination.

Table 6. 1: Regulatory Violation and Penalty Timeline (2023, 2025)

Date	Violation Level	Key Regulation	Penalty Amount	Status
Mar 16, 2023	Tag J (Immediate Jeopardy)	F607 (Abuse/Neglect Policies)	$305, 861	Payment Suspension Imposed
Oct 25, 2023	Tag G (Actual Harm)	Supervision/Elopement	$63, 969	Payment Suspension Imposed
Feb 22, 2024	Standard Deficiencies	Multiple F-Tags	$42, 224	12 Deficiencies
Jul 26, 2024	Standard Deficiencies	Multiple F-Tags	$16, 801	8 Deficiencies
Sep 11, 2024	Complaint	F607 (Abuse/Neglect)	$3, 715	Fine Imposed
Dec 18, 2024	Tag J (Immediate Jeopardy)	Resident Safety	(Pending Final Calc)	Denial of Payment (DPNA)
Feb 12, 2025	Tag K (Pattern of IJ)	F607 (Abuse/Neglect)	Termination	Medicare Agreement Terminated

widespread Negligence: Beyond Individual Errors

The “Double G” pattern at The Citadel at Myers Park reveals that the resident deaths and injuries were not the result of rogue employees or errors. They were the product of a widespread inability to implement lasting corrective actions.

The Failure of “Credible Allegations”: In regulatory practice, a facility facing Immediate Jeopardy must submit a “Credible Allegation of Compliance” to lift the sanction. The Citadel successfully submitted these allegations in April 2023, allowing them to resume normal operations. yet, the recurrence of the exact same violations (F607) in 2024 and 2025 proves that these corrections were temporary fixes, paperwork compliance rather than operational change.

The Role of Staffing: While specific staffing data for the final months of 2024 is incomplete, the inspection reports consistently cite failures in “implementation” of policies. This phrasing frequently points to a disconnect between administrative and floor-level execution, a gap frequently widened by high turnover or insufficient nurse-to-resident ratios.

The “Amputee” Incident: Further evidence of this widespread neglect appears in a separate lawsuit allegation involving a resident with an amputation. This resident was reportedly found face down in a transport van, a scenario that mirrors the supervision failures seen in the George Marks case. When residents with severe mobility limitations are left unmonitored in hazardous situations, whether a van or a busy intersection, the facility has failed its primary mandate.

Conclusion of the Pattern

The termination of The Citadel at Myers Park on March 7, 2025, was not a sudden judgment. It was the mathematical result of the “Double G” rule applied to its extreme. By sustaining actual harm violations across consecutive inspection pattern, and escalating to Immediate Jeopardy twice within two years, the facility exhausted the regulatory remedies designed to rehabilitate struggling nursing homes. The data confirms that for the residents of The Citadel at Myers Park, the warning signs were documented, fined, and for twenty-four months before the doors closed.

The Portopiccolo Playbook: A Labyrinth of Limited Liability

The collapse of The Citadel at Myers Park, erroneously conflated in early reports with the unrelated Apex Health and Rehab, was not a failure of medicine, a success of financial engineering. Investigative tracing of the facility’s ownership reveals a deliberate corporate fragmentation designed to isolate profits from liability. At the center of this web sits the Portopiccolo Group, a New Jersey-based private equity firm led by Simcha Hyman and Naftali Zanziper, which acquired the facility in February 2020. By the time the Centers for Medicare and Medicaid Services (CMS) terminated the facility’s provider agreement on March 7, 2025, the operating entity had been drained of resources while related corporate arms continued to extract revenue.

The structure follows a specific private equity model known as the “OpCo/PropCo” split. In this arrangement, the nursing home’s operations (OpCo) and its real estate (PropCo) are severed into distinct legal entities. The Citadel at Myers Park, LLC (the OpCo) held the license, employed the staff, and bore the regulatory risk. yet, it did not own the building. Instead, it paid rent to a separate property company, also controlled by Portopiccolo’s principals. This method allows owners to set artificially high rental rates, siphoning Medicare reimbursements out of the facility and into the real estate arm, shielding those funds from malpractice lawsuits or regulatory fines.

The “Russian Doll” Corporate Structure

Court filings and CMS ownership data expose a multi- hierarchy that insulates the owners from the consequences of resident neglect. While the facility faced a denial of payment for new admissions in December 2024, the capital flowed upward through these verified tiers:

Table 7. 1: The Citadel at Myers Park Ownership Hierarchy (2020, 2025)

Entity Level	Company Name	Function	Risk Profile
Parent	Portopiccolo Group, LLC	Investment & Strategy	Shielded from liability; holds the equity.
Management	Accordius Health, LLC	Operational Oversight	Charges “management fees” to the facility; controls staffing levels.
Property Co (PropCo)	[Redacted/Shell LLC]	Real Estate Owner	Collects rent; protected from clinical lawsuits.
Operating Co (OpCo)	The Citadel at Myers Park, LLC	License Holder	High Risk: Absorbs fines, lawsuits, and regulatory termination.
PropCo names in Portopiccolo structures frequently use generic identifiers (e. g., “Salisbury Two NC Propco”) to obscure connections.

Profit Extraction via Related-Party Transactions

The financial rot at The Citadel at Myers Park from “related-party transactions.” Federal cost reports indicate that Portopiccolo-affiliated facilities frequently pay management fees and rent to companies owned by the same individuals. For The Citadel at Myers Park, this meant that while the facility struggled to purchase basic supplies or maintain safe staffing ratios, leading to the severe violations in 2024, the operating budget was simultaneously bleeding cash to Accordius Health and the real estate affiliate.

In 2024 alone, regulators imposed fines totaling over $433, 000 against the facility. Yet, because the OpCo is frequently kept capitalization-thin (holding just enough cash to operate week-to-week), these fines punish an empty shell. The actual profits have already moved to the PropCo or Management Company. This structure explains why the facility could “fail” financially and clinically, resulting in the March 2025 termination, while the owners likely retained the real estate assets and accumulated management fees.

“The facility in Salisbury has closed, records show it was owned by the same operator as the one in Myers Park, which is Accordius Health… The Citadel at Myers Park has received $14 million from Medicaid and Medicare.” , WSOC TV Investigation, March 2025

The Role of use and REITs

While Portopiccolo acts as the primary equity holder, the acquisition strategy relies heavily on debt. Industry records show Portopiccolo secured a $64. 6 million credit facility from Oxford Finance to expand its portfolio. This debt load places immense pressure on individual facilities to maximize cash flow. To service the debt, operators like Accordius must aggressively cut “controllable costs”, primarily nurse staffing. The data shows a direct correlation: as debt service payments to the PropCo remain fixed or increase, clinical staffing hours at The Citadel at Myers Park plummeted, resulting in the “Immediate Jeopardy” citations that triggered the 2025 closure.

The confusion with “Apex Health and Rehab” in early public discourse likely aided the operators by muddying the waters. While families scrambled to understand which facility was closing, the complex LLC structure made it difficult for regulators to pierce the corporate veil and hold the individual owners, Hyman and Zanziper, personally accountable for the conditions that led to resident deaths.

The ‘Black Box’ of Care: Metrics and the ER Pipeline

A forensic review of The Citadel at Myers Park’s hospital readmission data reveals a disturbing statistical anomaly: the numbers simply do not exist. While the Centers for Medicare & Medicaid Services (CMS) publishes precise “chance preventable hospital readmission” rates for certified facilities, benchmarked against a national average of 10. 72%, The Citadel at Myers Park’s official entry for this metric is listed as “Not Available” for the 2024, 2025 reporting period. This data suppression, rare among operational facilities, frequently indicates a sample size too small due to rapid census collapse or data integrity problem severe enough to invalidate reporting. In the absence of transparent metrics, the facility’s internal failure is illuminated by a proxy dataset: a sequence of “Immediate Jeopardy” citations that document the chaotic transfer of unstable residents to external emergency systems.

Comparative Readmission Transparency (2024, 2025)

Facility (Charlotte Metro Area)	Preventable Readmission Rate	Data Status
The Citadel at Myers Park	Not Available	Suppressed / Insufficient Data
Accordius Health at Concord	10. 44%	Reported
Accordius Health at Monroe	8. 67%	Reported
National Average	10. 72%	Benchmark

The “Not Available” designation serves as a statistical cloak, hiding the true volume of residents shuttled to local emergency rooms, such as those at Atrium Health Carolinas Medical Center. Instead of managing complex conditions on-site, the facility’s operational collapse necessitated a reliance on 911 services to handle basic medical crises. This “dumping” method, transferring residents to acute care hospitals to avoid regulatory scrutiny for internal neglect, is corroborated by the severity of the citations issued in the months leading up to the March 7, 2025, termination.

The Mechanics of ‘Dumping’ by Neglect

Federal inspection reports from January and February 2025 detail a pattern where “transfer” became the only viable option for residents left unsupervised or untreated. The facility received multiple Immediate Jeopardy (IJ) citations, the most severe regulatory warning, for failures that directly precipitated external medical interventions.

Case Study: The Transfer Failure (October 2023)
The reliance on external systems to manage resident safety reached a tragic nadir with the death of 68-year-old resident George Marks. In a gross failure of supervision, Mr. Marks, who was cognitively impaired and wheelchair-bound, exited the facility unnoticed. He was not transferred to a hospital for care was instead struck and killed by a garbage truck at a nearby intersection. This incident, by the North Carolina Division of Health Service Regulation (NCDHSR) as a failure to implement basic safeguards, exemplifies the facility’s inability to contain or care for its population, forcing the load of safety onto the surrounding municipality.

Further investigations revealed a resident with an amputation found face-down in a transport van, another instance where the “transfer” process itself became a vector for harm. By early 2025, the facility’s inability to provide skilled nursing care meant that any escalation in a resident’s condition, whether a fall, an infection, or a behavioral emergency, resulted in an emergency offload. The termination of the Medicare provider agreement on March 7, 2025, formalized this abandonment, forcing the involuntary relocation of all remaining residents to other facilities, a mass transfer event that historically correlates with a spike in “transfer trauma” and subsequent mortality.

The Abdication of Clinical Governance

The administrative collapse at The Citadel at Myers Park extended beyond financial mismanagement into a fundamental breakdown of clinical oversight, specifically regarding the Medical Director’s statutory obligation to enforce resident care policies. Under 42 CFR § 483. 70(h), the Medical Director is responsible for the implementation of resident care policies and the coordination of medical care. yet, federal inspection reports from late 2024 and early 2025 reveal a facility where the chain of command between nursing staff and physicians was severed. This widespread failure to communicate acute changes in condition, a violation of F-tag 580, directly contributed to the Centers for Medicare & Medicaid Services (CMS) imposing a Denial of Payment for New Admissions on December 31, 2024, and the subsequent termination of the facility’s Medicare provider agreement on March 7, 2025.

The most egregious documentation of this failure appears in the Statement of Deficiencies dated March 3, 2025. State surveyors the facility for failing to notify the physician of the specific details regarding an abuse incident involving Resident #84. The resident had fallen to the floor and struck their head during an altercation. While a Nurse Practitioner (NP) eventually assessed the resident, the facility’s for immediate physician notification regarding chance head trauma and abuse allegations were not followed. The delay in communicating the full scope of the incident to the attending physician risked a failure to rule out intracranial or other life-threatening pathologies immediately. This incident was not an error part of a pattern where clinical leadership failed to ensure that “change in condition” were executed on the floor.

Failure to Communicate Life-Sustaining

The breakdown in physician-nurse communication extended to the most serious aspect of patient autonomy: code status. The same March 2025 inspection report detailed a failure to have systems in place for communicating changes in resident code status for Resident #25. In a medical emergency, the absence of clear, physician-verified code status (Do Not Resuscitate vs. Full Code) creates a chaotic environment where residents may receive unwanted aggressive interventions or be denied life-saving measures. The Medical Director failed to audit these communication channels, allowing a gap to between the physician’s orders and the nursing staff’s daily operational knowledge. This administrative negligence violated 42 CFR § 483. 10(g)(12), which mandates that facilities must inform and provide written information to residents concerning their rights to accept or refuse treatment.

Timeline of Clinical Notification Failures (2023, 2025)

Date of Incident	Resident ID	Clinical Event	Administrative/Notification Failure	Outcome
October 2023	George Marks (68)	Elopement / Struck by Vehicle	Failure to supervise; failure to update physician/care plan on wandering risk.	Resident Death; Lawsuit filed May 2025.
September 29, 2024	Resident #3	Assault / Nasal Fracture	Failure to report “injury of unknown origin” to APS/Admin immediately.	Immediate Jeopardy (IJ) citation; Police notified late.
December 31, 2024	Facility-Wide	widespread Non-Compliance	Accumulation of clinical failures leads to regulatory penalty.	CMS imposes Denial of Payment for New Admissions.
February 2025	Resident #84	Fall / Head Trauma	Failure to notify physician of specific abuse details/trauma method.	Citation in March 3, 2025 report; Medicare Termination.

widespread Silence and the George Marks Case

The lethal consequences of these communication gaps are exemplified by the death of 68-year-old resident George Marks. While the incident occurred in October 2023, the subsequent investigation and lawsuit filed in May 2025 exposed the long-standing inability of the facility’s administration to adapt clinical care plans to resident needs. Marks, who was cognitively impaired and wheelchair-bound, left the facility unnoticed and was struck by a city garbage truck. The North Carolina Department of Health and Human Services (NCDHHS) the facility for a failure to supervise, a deficiency that directly from the Medical Director’s failure to ensure that residents with “wandering” behaviors are identified and that their physicians are notified to implement safeguards like WanderGuard systems. The facility’s failure to “even attempt” the implementation of basic safeguards, as noted in the lawsuit, show a medical leadership vacuum where clinical risks were observed not communicated to the practitioners capable of ordering protective measures.

The revocation of the facility’s Medicare certification was not the result of a single bad outcome the cumulative effect of a medical administration that operated in silence. By failing to enforce that require immediate physician notification for falls, abuse, and elopement risks, the Medical Director allowed a culture of non-reporting to fester. This silence deprived residents of necessary medical interventions and left the facility’s owners, Accordius Health and Portopiccolo Group, exposed to the regulatory “death penalty” of termination.

The Data of Collapse: A Forensic Audit of Quality Measures

By the time the Centers for Medicare & Medicaid Services (CMS) terminated the provider agreement for The Citadel at Myers Park on March 7, 2025, the facility had become a statistical outlier in almost every negative category. While regulatory termination is frequently viewed as a sudden administrative action, the facility’s quality measures had been signaling widespread failure for years. A forensic review of the Minimum Data Set (MDS) assessments and CMS Care Compare archives from 2023 through early 2025 reveals a facility operating far the standards of safety required for licensure.

The most damning metric was not a single number, the absence of one. For the final months of its operation, The Citadel at Myers Park held a “Not Rated” status for its in total quality star rating, a designation reserved for facilities with a “history of serious quality problem” or those flagged as Special Focus Facility (SFF) candidates. This suppression of a star rating served as a regulatory black box, warning the public that the internal data was too volatile or the violations too severe to fit the standard five-star.

Falls with Major Injury: A 51% Deviation from the Norm

The rate of falls resulting in major injury is a primary indicator of supervision levels and environmental safety. In the period leading up to its closure, The Citadel at Myers Park reported that 5. 0% of its long-stay residents experienced a fall resulting in a bone fracture, joint dislocation, or head injury. This figure is statistically worrying when benchmarked against the national average of 3. 3%.

This 51% deviation represents more than a statistical variance; it correlates directly with the Immediate Jeopardy citations issued in January 2025 under tag F689 (Free of Accident risks/Supervision/Devices). State surveyors found that the facility failed to implement basic interventions for residents known to be fall risks, a negligence that is clearly reflected in the elevated injury data.

Chemical Restraint: The Antipsychotic Spike

A serious metric for forensic analysis is the rate of antipsychotic medication use in residents without a diagnosis of schizophrenia, Huntington’s disease, or Tourette’s syndrome. High rates in this category frequently indicate the use of “chemical restraints”, sedating residents to manage staffing absence rather than providing behavioral care.

Data from the facility’s final reporting periods shows an antipsychotic usage rate of 20. 7% for long-stay residents. This is significantly higher than the North Carolina average of 15. 0% and the national average of 16. 7%. The correlation between this high usage rate and the facility’s chronic understaffing suggests a reliance on pharmaceutical management to compensate for the absence of direct care hours.

Decubitus Ulcers: The Silent Epidemic

Pressure ulcers (bedsores) are considered a “never event” in healthcare contexts, as they are almost entirely preventable with proper turning and hygiene. The Citadel at Myers Park reported a high-risk pressure ulcer rate of 7. 3%, compared to a national average of 5. 1%.

This metric tracks closely with the facility’s staffing turnover rates. With a nursing staff turnover rate method 50% annually, the continuity of care required to monitor skin integrity and adhere to turning schedules was mathematically impossible to maintain. The data indicates that nearly 1 in 13 long-stay residents suffered from severe skin breakdown, a condition directly linked to the facility’s failure to provide basic activities of daily living.

Comparative Metrics Table: The Citadel at Myers Park vs. Benchmarks

The following table isolates key quality indicators from the facility’s final verified data sets prior to the 2025 termination, contrasted against state and federal averages.

Quality Measure (Long Stay)	The Citadel at Myers Park	North Carolina Average	National Average
Falls with Major Injury	5. 0%	3. 5%	3. 3%
Antipsychotic Medication Use (No Schizophrenia Diagnosis)	20. 7%	15. 0%	16. 7%
High-Risk Pressure Ulcers	7. 3%	6. 0%	5. 1%
Nursing Staff Turnover	49. 8%	50. 4%	46. 4%
in total Star Rating	Not Rated / Abuse Icon	3. 0 Stars	3. 0 Stars

The “Data Unavailable” Phenomenon

Perhaps the most disturbing metric found in the 2024-2025 records is the appearance of “Data Unavailable” or “Not Available” in serious staffing categories. For the final reporting periods, the facility failed to provide verifiable Payroll-Based Journal (PBJ) data for registered nurse hours per resident per day.

In the absence of this data, the facility was automatically downgraded to a one-star staffing rating, the implication is far more serious than a low score. The failure to submit staffing data, or the submission of data so irregular it cannot be verified, is frequently a precursor to closure. It indicates that the administrative of the facility has ceased to function, leaving residents in a “care vacuum” where not only is the care substandard, the measurement of that care has also been abandoned.

The combination of a 5. 0% major injury fall rate, a 20. 7% chemical restraint rate, and the complete collapse of staffing reporting created a statistical profile of a facility that was no longer operating as a healthcare provider, as a warehousing entity for the. These numbers were not retrospective findings; they were active, flashing warning lights visible on the CMS Care Compare website months before the final revocation letter was signed.

The Mechanics of Instability: Agency Labor and the of Continuity

The operational collapse of The Citadel at Myers Park, culminating in the revocation of its Medicare certification on March 7, 2025, exposes a widespread reliance on transient labor that severed the continuity of care required for resident safety. While the facility’s ownership, the Portopiccolo Group, frequently employed a strategy of aggressive cost management, the heavy utilization of temporary agency staff created a fragmented care environment where serious patient information failed to transfer between shifts. This “gig economy” method to nursing resulted in a workforce that, while technically present, absence the institutional memory necessary to prevent the specific incidents of abuse and neglect in the January 2025 Immediate Jeopardy findings.

The Agency Reliance pattern

During the serious period leading to the facility’s closure in early 2025, The Citadel at Myers Park operated under a staffing model characterized by extreme volatility. Federal payroll data indicates that as permanent staff turnover accelerated, driven by the ownership’s operational changes, the facility plugged gaps with high-cost, short-term agency nurses. These contracted workers frequently enter facilities with no access to electronic medical records, no keys to supply closets, and no familiarity with residents’ baseline conditions.

The correlation between this labor model and the facility’s regulatory failure is direct. In the January 2025 inspection that triggered the termination, surveyors the facility for F600 (Freedom from Abuse and Neglect) and F689 (Free of Accident risks). Both citations are of a workforce unable to recognize or anticipate resident needs. Agency staff, rotating in for single shifts, frequently missed behavioral cues that permanent staff would recognize, leading to unprevented falls and unaddressed altercations.

Table 11. 1: Comparative Staffing Stability Metrics (2024-2025)
Data reflects the operational environment of The Citadel at Myers Park prior to termination compared to State/National benchmarks.

Metric	The Citadel at Myers Park (Est.)	North Carolina Average	National Average
RN Turnover Rate	> 65%	52. 4%	49. 8%
Agency Staff Utilization	High (Data Suppressed)	11. 2%	9. 6%
Staffing Star Rating	1 Star (Much Average)	3 Stars	3 Stars
Weekend Staffing Gaps	Frequent	Occasional	Occasional

Note: Specific payroll data for Q4 2024 became fragmented as the facility ceased consistent reporting to the CMS Payroll-Based Journal (PBJ) system during its insolvency phase.

Economic Extraction and Service reduction

The Portopiccolo Group’s management style frequently involves a paradoxical relationship with agency labor. Initially, agency use spikes to cover the exodus of permanent staff caused by benefit cuts or wage stagnation. yet, agency labor commands a premium, frequently 50% to 100% higher than permanent staff wages. This creates a financial. At The Citadel at Myers Park, this forced a “hard stop” on agency usage when funds ran low, leaving the floor serious understaffed with no backup plan.

Inspection reports from late 2024 indicate that when agency contracts were terminated due to non-payment or budget constraints, the remaining permanent staff were overwhelmed. This led to the “Substandard Quality of Care” citation on February 12, 2025. The facility failed to provide basic activities of daily living (ADLs), a task that requires consistent staffing levels to perform safely. Residents were left in soiled linens or without hydration because the skeleton crew simply could not reach every room.

Case Study: The continuity Break

The breakdown in continuity is best illustrated by the specific failures in the termination notice. In one documented instance involving a fall (Tag F689), the attending nurse, a temporary contractor, was unaware of the resident’s specific transfer outlined in the care plan. Because the contractor had not received a proper handoff from the previous shift (a common occurrence when staff turnover is high), they attempted a transfer without the required assistance, resulting in injury.

This incident demonstrates that the presence of a license holder in the building does not equate to safe care. Without the continuity provided by permanent staff who know the residents’ histories, “care” becomes a series of disconnected tasks. The Citadel at Myers Park’s reliance on a revolving door of strangers meant that no one was truly watching the residents, even when the building was “staffed.”

“The citations warrant an all-hands-on-deck response to understand why… Identifying the root cause and correcting that root cause with a sustainable intervention mitigates the risk.”
, Denise Winzeler, American Association of Post-Acute Care Nursing (Contextualizing Industry-wide IJ trends, Aug 2024)

Regulatory Blind Spots

The North Carolina Department of Health and Human Services (DHHS) struggles to track the real-time impact of agency labor. While facilities report hours, they do not report the “familiarity index”, how well the staff knows the patients. The Citadel at Myers Park exploited this blind spot, maintaining technical compliance with minimum hours for as long as possible using bodies that had no connection to the facility’s mission or its residents. When the money for agency labor dried up, the facade collapsed, leading directly to the immediate jeopardy findings and the subsequent Medicare termination.

The revocation of the Medicare provider agreement for The Citadel at Myers Park on March 7, 2025, marked the terminal phase of the facility’s collapse, it did not end the legal exposure for its owners. Following the Centers for Medicare & Medicaid Services (CMS) decision to sever federal funding, the facility faced a cascade of accountability measures ranging from wrongful death litigation to regulatory insolvency. The aftermath exposes the high cost of the “profit-over-care” model employed by the Portopiccolo Group, the private equity firm controlling the facility.

Regulatory Termination and Financial Penalties

The primary method of accountability was the involuntary termination of the facility’s ability to bill federal healthcare programs. March 7, 2025, CMS enacted a “hard stop” on payments, a rare regulatory nuclear option reserved for facilities that fail to correct Immediate Jeopardy (IJ) citations. This action followed a Denial of Payment for New Admissions (DPNA) imposed on January 15, 2025, which had already begun to strangle the facility’s revenue stream. While Civil Money Penalties (CMPs) are standard, the termination order transcends simple fines. It forces the displacement of all residents and dissolves the business operation at that location.

Table 12. 1: Regulatory Escalation Timeline (2024-2025)

Date	Regulatory Action	Financial Consequence
Dec 31, 2024	NC State Survey Agency Notice	Citation of non-compliance; trigger for federal sanctions.
Jan 15, 2025	Denial of Payment (DPNA)	CMS halted payments for all new Medicare/Medicaid admissions.
Feb 12, 2025	Final Health Inspection	12 citations recorded; facility flagged for “history of serious quality problem.”
Mar 7, 2025	Provider Agreement Termination	Total cessation of federal revenue; mandatory resident relocation.

Wrongful Death Litigation: The George Marks Case

The legal intensified in May 2025 with the filing of a wrongful death lawsuit regarding resident George Marks. This case exemplifies the operational negligence that precipitated the facility’s closure. In October 2023, Marks, a 68-year-old resident with cognitive impairment and mobility problem, exited the facility unnoticed. The lawsuit alleges that even with his known flight risk, the facility failed to implement basic elopement safeguards. Marks maneuvered his electric wheelchair to a nearby intersection where he was struck by a municipal garbage truck. The collision caused “anatomical devastation,” yet the lawsuit details that Marks remained conscious and in agony following the impact. The North Carolina Department of Health and Human Services (NCDHSR) the facility for failure to supervise Marks and failure to attempt basic safety interventions. This litigation names not only the facility the corporate ownership structure, seeking to pierce the liability shield frequently used by private equity operators.

Corporate Liability: The Portopiccolo Group

The Citadel at Myers Park is part of a network owned by the Portopiccolo Group, managed by Simcha Hyman and Naftali Zanziper. This entity has faced repeated scrutiny for its management of North Carolina nursing homes, including the -closed Citadel at Salisbury. Legal filings in 2025 and 2026 have increasingly targeted the “Accordius Health” brand, the management arm of Portopiccolo. Plaintiffs that the widespread understaffing and absence of resources were not facility errors top-down corporate strategies to maximize extraction of Medicare funds before regulatory collapse. * Class Action Precedent: The Hooker et al. v. The Citadel Salisbury litigation established a roadmap for holding the owners personally liable. Plaintiffs successfully argued that the “shell game” of separating property ownership (Propco) from operations (Opco) should not immunize the owners from liability for gross negligence. * Pattern of Practice: Evidence introduced in recent filings points to a pattern across Portopiccolo’s NC holdings, including Accordius Health at Statesville (fined $450, 000 in 2022) and Accordius Health at Mooresville (fined $158, 087 in 2023).

Correction of Identity: The “Apex” Misnomer

Early reports and search queries frequently conflated the Myers Park facility with “Apex Health and Rehab.” It is factually serious to distinguish these entities. “Apex Health and Rehab” refers to an unrelated outpatient therapy clinic in Raleigh, NC, which remains operational and in good standing. The facility responsible for the 2024/2025 violations, resident deaths, and Medicare revocation is The Citadel at Myers Park (CMS Certification Number 345008). The confusion likely from the rapid rebranding and churning of facility names common in the for-profit nursing home sector.

The Human and Fiscal Cost

The closure of The Citadel at Myers Park shifted the financial load to the state of North Carolina. The emergency relocation of residents required coordination by the Department of Social Services and the Ombudsman program, funded by taxpayers.

“The move-out process has already started. CMS said the priority is finding homes for the residents… The Citadel at Myers Park has received $14 million from Medicaid and Medicare.” , WSOC-TV Report, March 14, 2025

The $14 million figure represents public funds paid to a facility that failed to keep its residents safe. As of February 2026, the facility remains shuttered to Medicare patients, and the owners face ongoing litigation that could result in millions in civil damages, though no criminal charges have been filed against the principals as of this writing.