Below average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Graham Healthcare And Rehabilitation Center during CMS and state inspections, most recent first.
An agency nurse verbally and physically abused a cognitively impaired resident during shift change, yelling vulgar and demeaning remarks in a common area, aggressively moving the resident in her wheelchair, pushing her back down when she tried to stand, and striking her in the back with a closed fist. Witnesses, including another nurse, a nurse aide, and a visitor, reported the resident was crying and afraid afterward, and staff later noted a neck scratch and bruising to the wrist, forearm, fingers, and elbow. The police sergeant confirmed the accounts and charged the nurse with assault on a handicapped person.
Failure to Immediately Protect and Report Resident Abuse: Agency staff were observed verbally abusing a resident, aggressively pushing the resident's wheelchair, and striking the resident in the back with a closed fist. Witnesses did not immediately intervene or report the incident to the DON/Administrator as required, and the allegation was not reported until the next morning. The resident had dementia and depression, and the investigation later found skin alterations and generalized pain.
A resident with atrial fibrillation, CHF, and HTN received digoxin and losartan with physician-ordered hold parameters requiring pulse and BP checks, but staff failed to ensure these parameters were correctly transcribed and flagged in the electronic MAR. Digoxin was administered over several months without the hold parameter appearing on the MAR and with many days lacking documented pulse readings in the electronic record. Losartan was given daily without the hold parameter on the MAR and with only two BP readings documented for the month. Several nurses acknowledged that supplemental documentation to prompt vital sign monitoring was not set up, that they often did not document pulse or BP despite administering the medications, and that order entry and confirmation processes were inconsistently and inaccurately completed. The physician expected adherence to hold parameters, while the DON and Administrator were unaware that monitoring and documentation were not occurring.
A resident with dementia and severely impaired decision-making had a MOST form completed by an NP indicating DNR status, comfort measures, conditional use of antibiotics and IV fluids, and no feeding tube, but the form lacked the required signature of the resident or Resident Representative and did not document the name of the individual with whom the orders were discussed. Medical Records, the DON, the Medical Director, and the Administrator all acknowledged that a resident/representative signature is required for the MOST to be valid, yet the form was still processed and filed without this signature, and the SW’s audits focused only on whether a MOST existed rather than whether it was fully executed.
A resident admitted with diabetes and a history of Guillain-Barre Syndrome later had a diagnosis of intellectual disability added by the Medical Director based on family report and prior records, but no Level II PASRR request was submitted. The diagnosis was documented in the medical record and reflected in the facility’s processes, yet the Social Worker lacked a clear system to track PASRR needs or new diagnoses, and the DON acknowledged that the MDS nurse’s communication of new diagnoses should have triggered a PASRR referral. The Medical Director and Administrator both recognized that an intellectual disability diagnosis requires a Level II PASRR, but the evaluation was never initiated.
A consultant pharmacist failed to identify and report missing monitoring documentation for a resident receiving digoxin with a pulse-based hold parameter and losartan with a systolic BP-based hold parameter. Over several months, the MAR showed these medications were administered as ordered, but the electronic record contained many days without documented pulse and only two documented BPs for the month after losartan was started. Monthly drug regimen reviews by the consultant pharmacist did not include any recommendations regarding these omissions. During interviews, pharmacy staff acknowledged that supplementary orders prompting nurses to document pulse and BP had not been entered and that the consultant pharmacist, who was new, did not know how to verify this in the system, while the physician stated she expected notification when hold parameters were not monitored.
The facility failed to update PASARR evaluations for two residents after new mental health diagnoses were made. One resident, initially admitted with PTSD, was later diagnosed with Major Depressive Disorder, but a Level II PASARR was not completed due to a lack of communication between the NP and nursing staff. Another resident, admitted with dementia, was diagnosed with Major Depressive Disorder and anxiety, but a referral for a Level II PASARR was not made. The Social Worker was not informed of these diagnoses, and the NPs responsible had left the facility.
The facility failed to manage expired medications in both medication rooms and the South medication cart. In the North room, expired Normal Saline with Gentamicin and other medications were found. In the South room, an expired bottle of Multi-Vite was discovered. On the South cart, expired Hemorrhoidal suppositories and undated Latanoprost eye drops were noted. Staff interviews revealed a lack of awareness and oversight in checking for expired medications.
The facility failed to implement its infection control policy during meal service and catheter care. Three nurse aides did not perform hand hygiene between resident contacts, and a nurse did not use PPE or sanitize hands during catheter care for a resident with Enhanced Barrier Precautions. The staff acknowledged awareness of the policies but did not consistently follow them.
The facility failed to document education on the benefits and side effects of the COVID-19 vaccine for three residents, two of whom refused the vaccine. The residents, with varying levels of cognitive impairment, either received or refused the vaccine without documented evidence of being informed. The DON and Interim ADON were unable to provide the necessary documentation, and the Interim Administrator expected staff to educate and document the education provided.
A nurse in an LTC facility was observed by two nursing assistants misappropriating a resident's morphine medication. The nurse was seen taking medication from the cart and later drinking a blue liquid, identified as morphine. The incident was reported to the DON, who conducted a drug test on the nurse, resulting in termination after a positive result for morphine. The resident's medication was replaced, and the facility reported the incident to relevant authorities.
Failure to Protect Resident from Staff Abuse
Penalty
Summary
The facility failed to protect a cognitively impaired resident from staff-to-resident physical and verbal abuse. The resident had diagnoses including dementia, major depressive disorder, glaucoma, cataracts with severe vision loss, and severe cognitive impairment on the quarterly MDS. She required substantial to maximum assistance with sit-to-stand and transfers and used a wheelchair independently. During the incident, an agency nurse yelled at the resident in a common area using vulgar and demeaning language loud enough for a visitor nearby to hear. According to witness statements and the police report, the resident had gone behind the nurses' station asking for water during shift change. After being redirected out of the area, she returned and the interaction escalated. The agency nurse removed the resident from the nurses' station in an aggressive manner, shook the wheelchair violently, and propelled her down the hall. Witnesses reported the nurse continued cursing at the resident, pushed her back into the wheelchair when she tried to stand, and struck her in the back multiple times with a closed fist. One witness also reported the nurse grabbed the resident by the shirt and placed a hand around the resident's throat. A visitor heard the commotion and reported hearing the resident being spoken to in a very bad manner. After the incident, the resident was crying and stated she was afraid to return inside the facility. Staff later observed a scratch on the neck and bruising to the wrist, forearm, fingers, and elbow, and the resident complained of pain all over. The police sergeant confirmed the witness accounts were consistent enough to charge the agency nurse with assault on a handicapped person. The agency nurse denied the allegation and claimed she was preventing the resident from falling, but the facility later confirmed there had been no fight between residents as she had stated.
Failure to Immediately Protect and Report Resident Abuse
Penalty
Summary
The facility failed to ensure staff followed its abuse policy for protecting and reporting a resident who was abused by agency staff. Based on record review and staff interviews, Agency Nurse #1 was observed by Agency Nurse #2 and Agency Nurse Aide #1 using inappropriate language toward a resident, aggressively pushing the resident in a wheelchair down the hall in an erratic manner, and striking the resident in the back with a closed fist multiple times. The witnesses did not immediately and effectively intervene and did not promptly report the incident to the Administrator as required by facility policy. The resident involved was admitted with diagnoses including dementia and major depressive disorder. The report states the resident was behind the nurses' station asking for water when the interaction began. Agency Nurse #1 became upset, used profanity toward the resident, pulled the resident and wheelchair into the hallway, and continued the aggressive behavior. One witness reported the resident nearly fell out of the wheelchair, tried to stand, and was pushed back down into the chair while being struck in the back. Another witness reported hearing yelling and cursing and seeing the nurse shake the wheelchair and hit the resident with a closed fist. The facility became aware of the incident later, when Agency Nurse #2 reported it to the DON the next morning. The Administrator's investigation found the resident had a skin alteration to the neck, discoloration to the right forearm and fingers, and complaints of generalized pain. The allegation of staff-to-resident abuse was substantiated, and the report states the delay in reporting prevented immediate protection, reporting to the State Agency, law enforcement, and APS, and delayed the facility's investigation of the allegation.
Failure to Monitor and Document Vital Signs for Medications With Hold Parameters
Penalty
Summary
The deficiency involves the facility’s failure to monitor and document required vital signs for a resident receiving medications with physician-ordered hold parameters, resulting in a drug regimen that was not shown to be free from unnecessary drugs. The resident had paroxysmal atrial fibrillation, congestive heart failure, and hypertension, and was prescribed digoxin 125 mcg with instructions to hold the dose if the pulse was below 60. Over multiple months, the MAR showed daily administration of digoxin except on days the resident was out of the facility, but the hold parameter was not transcribed onto the MAR and there was no pulse documentation on the MAR. Review of the electronic health record revealed numerous dates across several months with no recorded pulse, despite ongoing administration of digoxin. The resident was also prescribed losartan 100 mg daily with a physician order to hold the medication if systolic blood pressure was less than 110. The MAR documented daily administration of losartan beginning in February, but again, the hold parameter was not transcribed on the MAR and there was no blood pressure documentation on the MAR. The electronic record contained only two blood pressure entries for that month, and the facility could not produce additional blood pressure documentation. Multiple nurses reported that parameters should have been entered into supplemental documentation to flag the need for pulse and blood pressure checks, acknowledged that this was not done, and could not explain why monitoring and documentation were missed. The nurse responsible for entering and confirming orders stated that orders with parameters were not always entered correctly due to lack of staff knowledge and that sometimes the same nurse both entered and confirmed orders. The physician stated she expected her hold-parameter orders to be followed and identified potential adverse effects, while the DON and Administrator both reported they were unaware that the parameter monitoring and documentation were not being carried out.
Failure to Obtain Required Signature on MOST Form for Cognitively Impaired Resident
Penalty
Summary
Facility staff failed to ensure a Medical Orders for Scope of Treatment (MOST) form was properly completed and validated for one resident reviewed for advance directives. The resident, who had dementia and severely impaired cognitive skills for daily decision-making, was rarely or never understood and had both short- and long-term memory problems, and had a designated Resident Representative. A MOST form dated 10/6/25 documented DNR status, comfort measures, antibiotics if indicated, IV fluids for a defined trial period, and no feeding tube. The form stated it had been discussed with and agreed to by an individual with an established relationship with the patient who could reliably convey the patient’s wishes, and it was signed by an NP. However, the form did not identify the name of the individual with whom it was discussed, and the patient or representative signature section at the bottom of the form was blank. Interviews revealed multiple staff were aware that a MOST form must be signed by the resident and/or Resident Representative to be valid, including Medical Records, the Medical Director, the DON, and the Administrator, all of whom confirmed that this resident’s MOST form was not valid due to the missing representative signature. Medical Records staff stated she was responsible for reviewing completed MOST forms for all required dates and signatures before scanning them into the electronic record and placing the hard copy in the code book, and acknowledged she missed that this resident’s form lacked the Resident Representative’s signature. The Social Worker reported she audited MOST forms mainly to see who had a form, and was unsure if an unsigned form was valid. The NP who completed the form stated she was not aware that the resident/representative signature was required, misinterpreting the language above the signature box as making the signature optional, and did not document the name of the person with whom the form was discussed or obtain a witness signature for a telephone review. The Administrator and Medical Director both indicated that, given the resident’s cognitive status, the Resident Representative’s signature was required and that, if completed by phone, the form should document the representative’s name, indicate telephone review, and include two witness signatures.
Failure to Initiate Level II PASRR After New Intellectual Disability Diagnosis
Penalty
Summary
The deficiency involves the facility’s failure to submit a Level II Preadmission Screening and Resident Review (PASRR) evaluation after a resident was diagnosed with an intellectual disability. A Level I PASRR completed in the hospital emergency room listed only diabetes and a history of Guillain-Barre Syndrome. The resident was admitted with these diagnoses, and upon admission the Medical Director completed a history and physical on the same day, adding a new diagnosis of intellectual disability based on information from the resident’s family representative and past medical records. This diagnosis was added to the resident’s diagnosis list in the facility’s medical record, and the resident’s subsequent MDS assessment showed the resident to be cognitively intact. However, there was no evidence in the medical record that a Level II PASRR request was ever submitted following the addition of the intellectual disability diagnosis. Interviews with staff revealed gaps in communication and tracking related to PASRR requirements. The Social Worker stated that hospitals typically completed PASRRs for residents admitted from the hospital and that she completed PASRRs for residents admitted from home, but she could not describe how she tracked PASRRs or how she became aware of new diagnoses. She later acknowledged that the resident had been diagnosed with an intellectual disability months earlier and that a Level II PASRR should have been submitted shortly after that diagnosis was added. The DON explained that new diagnoses were entered by the MDS nurse and then communicated at morning meetings so the Social Worker could initiate PASRRs as needed, and acknowledged that a Level II PASRR should have been completed for this resident but could not explain why it was not. The Medical Director confirmed that she added the intellectual disability diagnosis after reviewing family input and prior records, knew that such a diagnosis required a Level II PASRR, and stated she did not handle PASRR submissions. The Administrator also agreed that a Level II PASRR evaluation should have been submitted once the intellectual disability diagnosis was added.
Consultant Pharmacist Failed to Identify Missing Monitoring for Medications With Hold Parameters
Penalty
Summary
A deficiency occurred when the consultant pharmacist failed to identify and report missing monitoring documentation for a resident receiving medications with hold parameters. The resident was admitted with paroxysmal atrial fibrillation, congestive heart failure, and hypertension, and had a physician’s order for digoxin 125 mcg by mouth in the evening with instructions to hold the dose if the pulse was below 60. The MAR showed digoxin was administered daily over several months, except on two days when the resident was absent, while the electronic health record showed numerous days in October, November, December, January, and February with no documented pulse. Despite this pattern, monthly drug regimen reviews dated in November, December, January, and February contained no recommendations related to digoxin or the lack of pulse documentation. The same resident also had a physician’s order for losartan 100 mg by mouth daily with a hold parameter if the systolic blood pressure was less than 110, and the MAR showed daily administration beginning in February. However, documentation of blood pressures for that month was limited to two dates, and the facility could not produce additional blood pressure records. During interviews, the consultant pharmacist and supervisor consultant pharmacist stated that the facility had not entered supplementary orders prompting nurses to document pulse with digoxin or blood pressure with losartan, and the supervisor explained that the consultant pharmacist was new and did not know how to check this in the system. The consultant pharmacist did not identify the lack of monitoring documentation during monthly reviews, while the physician stated she expected the pharmacist to notify the facility when hold parameters were not being monitored, and the administrator reported she was unaware that the consultant pharmacist did not know how to review hold parameter documentation.
Failure to Update PASARR Evaluations for Residents with New Mental Health Diagnoses
Penalty
Summary
The facility failed to submit requests for updated Pre-Admission Screening and Resident Review (PASARR) evaluations for two residents after they were diagnosed with additional mental health conditions. Resident #11, who was admitted with fibromyalgia, osteoarthritis, and PTSD, was later diagnosed with Major Depressive Disorder. Despite this new diagnosis, a Level II PASARR was not completed. The Social Worker, responsible for notifying the State Mental Health Authority, was not informed by nursing of the new diagnosis, and the Nurse Practitioner (NP) who diagnosed the resident did not communicate this to the nursing staff. The NP had since left the facility, and the new Physician Assistant (PA) was unfamiliar with the resident's case. Similarly, Resident #3, admitted with dementia and a history of bipolar disease, was diagnosed with Major Depressive Disorder and anxiety disorder. However, a referral for a Level II PASARR evaluation was not completed. The Social Worker was not notified of these new diagnoses by nursing, and the Psychiatric NP who diagnosed the resident had also left the facility. The new PA was unfamiliar with the resident's case. The Interim Administrator expected that a Level II PASARR would be completed for residents with new mental health diagnoses, but this was not done for either resident.
Expired Medications and Labeling Issues in Medication Rooms and Cart
Penalty
Summary
The facility failed to properly manage and discard expired medications in both the North and South medication rooms, as well as on the South medication cart. In the North medication room, five bags of Normal Saline with Gentamicin, intended for a resident's urinary catheter irrigation, were found with expiration dates ranging from 12/5/24 to 12/17/24, despite being punctured and only viable for 48 hours. Additionally, expired Bisacodyl suppositories and Guaifenesin were found in the same room. Interviews with Nurse #1 and the Consultant Pharmacist revealed a lack of awareness and oversight regarding the expired medications. In the South medication room, an unopened bottle of Multi-Vite with an expiration date of November 2024 was found. Nurse #2 indicated that night shift nurses were responsible for checking for expired medications, but the expired bottle was overlooked. The Nurse Supervisor admitted to checking the medication rooms monthly but failed to notice the expired items. The Director of Nursing (DON) expressed surprise that the expired medications were not identified and removed sooner. On the South medication cart, expired Hemorrhoidal suppositories and an opened bottle of Latanoprost eye drops without an open date were discovered. Nurse #2 acknowledged the oversight, noting that the suppositories were no longer needed and the eye drops were administered only at bedtime. The DON reiterated that supervisors should check stock medications, while nurses were responsible for the medication carts, but was unaware of why the expired medications were still available for use.
Infection Control Deficiencies During Meal Service and Catheter Care
Penalty
Summary
The facility failed to adhere to its infection control policy during meal service in the dining room, as observed with three nurse aides. Nurse Aide #2 was seen touching a resident's hands and hair, then moving to another resident without sanitizing her hands. She also assisted multiple residents with meal setup without changing gloves. Nurse Aide #1 adjusted a resident's clothing protector and served another resident without hand hygiene. Nurse Aide #3 placed gloves in her pocket, washed her hands, then reused the gloves to touch a resident's sandwich. Interviews with the aides revealed they were aware of the hand hygiene policy but failed to consistently follow it. Additionally, the facility's policy for Enhanced Barrier Precautions (EBP) was not implemented correctly by Nurse #1 during urinary catheter care for Resident #4. Despite signage indicating the need for gloves and a gown, Nurse #1 entered the room without a gown, did not perform hand hygiene before donning gloves, and failed to sanitize hands between glove changes. Nurse #1 acknowledged the oversight, attributing it to the resident's agitation and her attempt to expedite care. The Director of Nursing confirmed that the staff should have followed the infection control policies, including hand hygiene and the use of PPE, especially in rooms with EBP signage. The DON stated that Nurse #1 had been educated on these protocols but did not adhere to them during the observed incident.
Lack of Documentation for COVID-19 Vaccine Education
Penalty
Summary
The facility failed to document the education provided to residents regarding the benefits and potential side effects of the COVID-19 vaccine for three residents. Resident #2, who was admitted with severely impaired cognition, received the COVID-19 vaccine, but there was no documentation in the medical record indicating that the resident or their legal representative was informed about the vaccine's benefits and potential side effects. The Interim Assistant Director of Nursing (ADON) and the Director of Nursing (DON) were unable to provide the required documentation when requested. Resident #11, who had moderate cognitive impairment, refused the COVID-19 vaccine, but there was no documented evidence that the resident or their legal representative was educated about the vaccine's benefits and potential side effects. The resident confirmed during an interview that they did not recall receiving such education. The DON acknowledged the lack of documentation regarding the education provided. Similarly, Resident #18, also with moderate cognitive impairment, refused the COVID-19 vaccine without documented evidence of education about the vaccine's benefits and potential side effects. The resident did not recall being educated about the vaccine, and the DON confirmed the absence of documentation. The Interim Administrator stated that staff were expected to educate and document the education provided, but this was not done for these residents.
Misappropriation of Controlled Medications by Nurse
Penalty
Summary
The facility failed to protect a resident's rights to be free from misappropriation of controlled medications. The incident involved a nurse who was observed by two nursing assistants during a night shift. The nurse was seen taking a brown bottle and another bottle of liquid from the medication cart, preparing a syringe with a clear liquid, and claiming he was going to administer it to the resident. The nursing assistants observed suspicious behavior, including the nurse drinking a blue liquid from a medication cup, which was later identified as morphine. The nursing assistants reported their observations to the Director of Nursing (DON) after being unsure of what to do. The DON conducted a urine drug test on the nurse, which returned positive for morphine and other substances. The nurse was subsequently terminated from his position. The resident's missing morphine medication was replaced at the facility's expense, and the physician confirmed that the resident did not suffer adverse effects from missing a dose of pain medication. The facility's policy on abuse, neglect, or misappropriation of resident property was not effectively enforced, leading to the misappropriation of the resident's medication. The incident was reported to the appropriate authorities, including the North Carolina Board of Nursing and the Drug Enforcement Agency. The facility conducted a thorough investigation, which substantiated the allegations against the nurse.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 20 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Robbinsville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Valley View Care And Rehabilitation | 8.1 mi | ★★★★★ | 7 | 0 |
| Clay County Health And Rehabilitation | 18.6 mi | ★★★★★ | 11 | 0 |
| Mountain View Manor Nursing Center | 21 mi | ★★★★★ | 0 | 0 |
| Macon Valley Nursing And Rehabilitation Center | 23.8 mi | ★★★★★ | 0 | 0 |
| Murphy Rehabilitation & Nursing | 24.3 mi | ★★★★★ | 2 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Graham Healthcare And Rehabilitation Center.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.