Below average — CMS composite of the measures below.
The next survey window likely opens around November 2026
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 Ridge Valley Center For Nursing And Rehabilitation during CMS and state inspections, most recent first.
Surveyors found expired Bisacodyl suppositories and Omeprazole tablets, as well as unidentifiable loose pills, in multiple medication carts. Opened insulin Glargine pens were also discovered without required dating. Staff interviews revealed inconsistent practices for checking and removing expired or loose medications, and unclear responsibility for dating insulin pens. The DON and Administrator confirmed expectations for proper medication storage and labeling.
The facility did not establish or maintain an infection prevention and control program as required, resulting in a deficiency identified by surveyors.
A resident with diabetes and bilateral below knee amputations had multiple days where wound care treatments were not documented in the TAR as completed, despite physician orders for daily care. Nursing staff reported completing the treatments but failed to sign off due to being busy, unfamiliar with the electronic medical record, or forgetting. The DON confirmed that staff were expected to document treatments as they were performed.
A resident's zinc oxide ointments were found unattended in their room, contrary to facility protocols requiring medications to be stored in a locked cart. Staff interviews revealed a lack of awareness regarding proper storage procedures, with both the DON and Administrator confirming expectations for secure medication storage.
A facility failed to treat two residents with respect and dignity. One resident, experiencing chest pain and shortness of breath, was dismissed by a nurse and had to call 911 for help. Another resident, embarrassed by facial hair, was not shaved due to a lack of razors, despite requesting assistance. These incidents highlight deficiencies in the facility's operations and staff interactions with residents.
A resident requiring assistance with ADLs did not receive a shave during her scheduled bed bath due to a shortage of razors in the facility. Despite being cognitively intact and requesting the shave, the resident's facial hair was not addressed because razors were unavailable over the weekend. The central supply clerk confirmed a delay in delivery due to a holiday, and the administrator later obtained razors from a local store.
A resident with a terminal prognosis was found on the floor by a nurse aide, who moved him back to bed without a nurse's assessment, contrary to protocol. The resident was later assessed by nurses and found to have no injuries. The Director of Nursing confirmed that residents should be assessed by a nurse before being moved after a fall.
A resident with multiple injuries from a motorcycle accident was admitted to an LTC facility without a documented pain assessment. Despite having orders for pain medication, the resident did not receive any on the day of admission. Miscommunication among staff led to the resident experiencing significant pain, which escalated to chest pain and high blood pressure, resulting in a hospital transfer. The facility failed to assess the resident's pain upon admission and during a change in condition.
The facility failed to ensure accurate documentation of code status for a resident and did not obtain a necessary signature on an advanced directive form for two residents. One resident's care plan inaccurately reflected a full code status despite a DNR order, while another resident's MOST form lacked a signature, rendering it invalid. Staff interviews revealed a lack of awareness and oversight in updating records to match residents' wishes.
A resident receiving hospice care was physically restrained by a nurse aide during an episode of terminal agitation. The aide used her hand to push the resident's head back onto the pillow to prevent him from sitting up. Witnesses reported the actions as rough, leading to an investigation with differing perceptions among staff about the severity of the actions.
A resident with dementia and behavioral issues was placed on one-on-one supervision, but the facility failed to update the care plan to reflect this intervention. Despite staff acknowledging the need for care plan updates, the supervision was not documented, resulting in a deficiency.
A resident with dysphagia and a gastrostomy tube was not receiving the recommended fluid intake, leading to signs of dehydration. Despite the RD's assessment indicating a need for 1982-2379 ml of fluid per day, the resident was only receiving 180 ml of free water daily. Observations showed dry, cracked lips, and interviews revealed a lack of awareness and oversight regarding the resident's hydration needs. The NP had reduced water flushes due to intolerance, and the RD was unaware of the current flush rate. The MD and DON also failed to ensure proper monitoring and adjustment of the resident's hydration needs.
A facility failed to document side effect monitoring for a resident on psychotropic medications, despite the resident exhibiting behaviors such as aggression and hallucinations. The oversight occurred after the resident returned from the hospital, and the facility lacked active personnel to review medical records for accuracy.
The facility staff failed to follow infection control protocols, specifically in the use of PPE and hand hygiene. Two NAs did not wear gowns and one did not sanitize hands between glove changes while caring for a resident under Enhanced Barrier Precautions. Additionally, a nurse aide entered a COVID-19 positive resident's room without eye protection, despite signage indicating its necessity. The DON acknowledged the lapses, noting the recent departure of the infection control educator.
Expired Medications, Unlabeled Insulin Pens, and Loose Pills Found in Medication Carts
Penalty
Summary
Surveyors observed multiple deficiencies in medication storage and labeling practices across four medication carts. Expired Bisacodyl suppositories and Omeprazole tablets were found in medication carts and available for use, indicating that staff failed to remove expired medications in accordance with manufacturer expiration dates. Additionally, unidentifiable loose pills of various shapes and colors were discovered in the drawers of two medication carts, with staff unable to identify or provide expiration information for these medications. Interviews with Certified Medication Aides (CMAs) and nurses revealed inconsistent practices regarding checking for expired or loose medications, with some staff stating they typically checked at the end of their shift or had not yet had time to inspect the carts. Supervising nurses confirmed the presence of expired and loose medications and acknowledged that these should have been discarded. Further deficiencies were noted in the handling of insulin pens. Two opened insulin Glargine pens stored at room temperature were found without any opened date, contrary to manufacturer specifications that require dating upon opening and discarding after 28 days. Staff interviews indicated a lack of clarity regarding responsibility for dating insulin pens, with CMAs stating that nurses were responsible for this task. The Director of Nursing (DON) and the Administrator confirmed their expectation that all nursing staff follow medication storage guidelines, including dating insulin pens and timely removal of expired and loose medications.
Failure to Implement Infection Prevention and Control Program
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program. This deficiency was identified during the survey process, indicating that the required measures to prevent and control infections were not established or maintained as per regulatory standards. The report does not specify particular actions, inactions, or events involving individual residents or staff, nor does it detail specific observations or incidents that led to the deficiency.
Failure to Accurately Document Wound Care Treatments in TAR
Penalty
Summary
The facility failed to maintain accurate Treatment Administration Records (TAR) for a resident with diabetes mellitus and bilateral below knee amputations. Physician orders were in place for daily wound care to both amputation sites, including cleansing, application of petrolatum dressing, and securing with gauze and ACE bandage. Record review revealed multiple dates in June and July where there was no documentation on the TAR to indicate that the ordered treatments were completed. Specifically, there were missing entries for several days, despite physician orders specifying daily and as-needed wound care. Interviews with nursing staff who worked on the dates in question revealed that while they assured the treatments were completed, they failed to document them in the TAR. Reasons provided included being busy, unfamiliarity with the electronic medical record system, and simply forgetting to sign off after completing the treatments. The Director of Nursing confirmed that nurses were educated to sign off treatments as they were completed and that this was the facility's expectation.
Failure to Secure Medications in Resident's Room
Penalty
Summary
The facility failed to secure medications properly, as evidenced by the observation of two opened containers of zinc oxide ointment left unattended in a resident's room. The resident, who was admitted to the facility with intact cognition, was dependent on staff for the application of the ointment to treat or prevent diaper rash. During an observation, it was noted that an opened tube and container of zinc oxide ointment were left on the over-bed and bedside tables, respectively, in the resident's room. The resident confirmed that the ointments had been left unattended for at least two weeks. Interviews with staff revealed a lack of awareness and adherence to proper medication storage protocols. Nurse #1 acknowledged that the ointments were intended for the resident and should have been stored in the wound care medication cart. NA #1, who provided care to the resident earlier that day, was unaware that the ointment should not be left unattended and did not report its presence to the hall nurse. The Director of Nursing and the Administrator both confirmed that it was the facility's expectation for all medications to be stored securely in the medication cart or storage room, and not left unattended in resident rooms.
Deficiencies in Resident Care and Dignity
Penalty
Summary
The facility failed to treat a resident with respect and dignity when a nurse dismissed a resident's request for medical assistance. Resident #48, who was cognitively intact and had no history of behaviors, experienced worsening chest pain and shortness of breath. Despite expressing his discomfort and fear, Nurse #3 reportedly told him he would not be sent to the hospital and left the room. The resident, feeling neglected, called 911 for help, and EMS eventually transported him to the hospital. Interviews with staff and the Director of Nursing confirmed that the resident should have been treated with respect and understanding, regardless of his agitation. Another deficiency involved the facility's failure to address unwanted facial hair on Resident #20, who was also cognitively intact and required assistance with personal hygiene. The resident expressed embarrassment over her facial hair, which had not been shaved since her last bed bath. Despite her request to be shaved, the staff was unable to fulfill this due to a lack of razors, which were not available over the weekend. The Central Supply Clerk confirmed the delay in supply delivery, and the Administrator had to obtain razors from a local store. These incidents highlight the facility's failure to uphold residents' rights to dignity and respect. The lack of immediate response to Resident #48's medical needs and the inability to provide personal hygiene care for Resident #20 due to supply issues demonstrate deficiencies in the facility's operations and staff interactions with residents.
Failure to Provide Personal Hygiene Care Due to Supply Shortage
Penalty
Summary
The facility failed to provide adequate personal hygiene care for a dependent female resident who required assistance with activities of daily living (ADL), specifically shaving. The resident, who was cognitively intact and had a self-care ADL deficit due to decreased mobility and disease processes, did not receive a shave during her scheduled bed bath on Sunday, despite requesting it. The resident's care plan indicated she needed extensive assistance with personal hygiene, including shaving, but this was not provided, leading to the resident having noticeable facial hair on her chin and neck. The deficiency was attributed to the unavailability of razors in the facility over the weekend. A nurse aide assigned to the resident confirmed that razors were not available in the central supply room on the days he was responsible for the resident's care. The central supply clerk acknowledged the delay in the delivery of supplies due to a holiday, which resulted in the facility running out of razors. The administrator confirmed that razors were obtained from a local store only after being notified of the shortage, which was deemed unacceptable.
Failure to Assess Resident Before Transfer After Fall
Penalty
Summary
The facility failed to properly assess a resident, identified as Resident #125, before transferring him back to bed after he was found on the floor. Resident #125, who was admitted with diagnoses including malignant neoplasm of the lung and skin, and anxiety, was cognitively intact and required supervision with transfers. On the night of the incident, Nurse Aide (NA) #2 found Resident #125 lying on the floor with urine around him. Despite requesting assistance from a nurse, NA #2 proceeded to move the resident back to bed without a nurse's assessment, as no nurse arrived promptly. NA #3 and NA #4 later assisted in changing the bed sheets, but the resident had already been moved by NA #2. Interviews with the nursing staff revealed that neither Nurse #2 nor Nurse #3 were aware of the fall until after the resident had been moved. Nurse #2, who was on the phone with hospice at the time, was informed of the incident only after the resident was back in bed. Both nurses later assessed the resident and found no injuries. The Director of Nursing confirmed that protocol requires a nurse to assess any resident who has fallen before they are moved, which was not followed in this case.
Failure to Assess and Manage Resident's Pain
Penalty
Summary
The facility failed to assess a resident for pain upon admission and during a change in condition, leading to a deficiency in pain management. The resident, who had multiple fractures and injuries from a motorcycle accident, was admitted to the facility without a documented pain assessment. Despite having physician orders for pain medications, the resident did not receive any medication on the day of admission. Interviews with staff revealed a lack of communication and misunderstanding regarding the resident's pain management needs. Nurse #3, who admitted the resident, was unsure if a pain assessment was conducted. Nurse #5, who was assigned to the resident later, did not assess for pain, believing there were no issues based on Nurse #3's report. Nurse Aide #6 reported the resident's pain to Nurse #5, but Nurse #5 did not recall this communication. The resident expressed significant pain and frustration, which escalated to chest pain and high blood pressure, prompting a transfer to the hospital. The resident reported to the hospital staff that he had not received pain medication at the facility and was admitted for malignant hypertension. Interviews with the Medical Director and the Director of Nursing confirmed that a pain assessment should have been conducted upon admission and when the resident expressed pain.
Inaccurate Code Status and Unsigned Advanced Directive Forms
Penalty
Summary
The facility failed to ensure the accuracy of a resident's code status election throughout the medical record for Resident #25. Upon admission, Resident #25 was documented as a Do Not Resuscitate (DNR) according to the physician's order and the Medical Orders for Scope of Treatment (MOST) form. However, the care plan inaccurately reflected Resident #25 as a full code, despite the resident's moderate cognitive impairment and the expressed wish to be a DNR. Interviews with the nursing staff, including Nurse #1, the Nurse Practitioner (NP), and the MDS Nurse, revealed a lack of clarity on why the care plan did not match the MOST form and physician's order, indicating an oversight in updating the care plan to reflect the resident's wishes. The facility also failed to ensure that an advanced directive form was signed by the resident or Responsible Party (RP) for Resident #60. The MOST form for Resident #60 indicated a DNR status with limited additional interventions, but it lacked the necessary signature from the resident or RP, rendering it invalid. Despite the resident's moderate cognitive impairment, the care plan correctly documented the DNR status, but the absence of a signature on the MOST form meant that Resident #60 was considered a full code until the form was properly signed. Interviews with Nurse #1 and the NP confirmed the oversight, as they were unaware that the MOST form had not been signed by the resident or RP. The Director of Nursing (DON) acknowledged the discrepancies in both cases, stating that the MOST form, care plan, and physician's order should all match and be signed by the resident or RP. The DON assumed the care plan entry for Resident #25 was an oversight and was unaware of the missing signature on Resident #60's MOST form. These deficiencies highlight a failure in the facility's process to ensure that residents' code status and advanced directives are accurately documented and signed, reflecting their wishes throughout their medical records.
Resident Restrained by Nurse Aide During Terminal Agitation
Penalty
Summary
The facility failed to protect a resident from being physically restrained by a nurse aide during an episode of terminal agitation. The resident, who was receiving hospice care and had a prognosis of less than six months to live, was found on the floor by Nurse Aide #2. Despite requesting assistance, Nurse Aide #2 proceeded to lift the resident back into bed and attempted to clean him up. During this process, the resident repeatedly tried to sit up, prompting Nurse Aide #2 to use her hand to push the resident's head back onto the pillow to keep him in bed. Witnesses, including Nurse Aide #3 and Nurse Aide #4, observed Nurse Aide #2's actions and reported them as rough and forceful. Nurse Aide #3 felt that the actions were harsh and reported the incident to the nursing staff. Nurse #2, upon being informed, assessed the resident for injuries and found no signs of a head injury. However, the incident was reported to the facility's administration, leading to Nurse Aide #2 being asked to leave the facility. The investigation into the incident revealed differing perceptions among staff members about the severity of the actions taken by Nurse Aide #2. While some staff members felt the actions were inappropriate, others, including Former Administrator #2, believed the actions were not forceful and were intended to calm the resident. The Director of Nursing expressed concern that the actions were not appropriate, as holding or pushing a resident's head back is not acceptable, despite the intention to prevent the resident from getting up.
Failure to Implement Person-Centered Care Plan for Resident Requiring Supervision
Penalty
Summary
The facility failed to develop and implement a person-centered care plan for a resident who required one-on-one supervision. The resident, who was admitted with diagnoses including dementia, disorientation, and hallucinations, was identified as being at risk for elopement and wandering. Although interventions such as a wander guard were included in the care plan, there was no intervention related to one-on-one supervision, despite the resident being placed on such supervision due to behaviors and to protect her dignity. Interviews with facility staff, including the NP, NA, DON, Regional Consultant, and MDS Nurse, revealed that the resident was placed on one-on-one supervision due to behaviors related to her dementia and to protect her dignity. However, this intervention was not documented in the care plan. The MDS Nurse and other staff acknowledged that the care plan should have been updated to include the one-on-one supervision, but it was not, leading to the deficiency.
Failure to Meet Resident's Fluid Needs
Penalty
Summary
The facility failed to meet the recommended fluid needs for a resident with dysphagia, who required a gastrostomy tube and tracheostomy. The resident was admitted with a physician order to flush the tube with 30-60 ml of water before and after medications twice a day. However, the Registered Dietitian's (RD) assessment indicated the resident required 1982-2379 ml of fluid per day. Despite this, the resident was only receiving 180 ml of free water per day, as per the physician's orders, which was significantly below the recommended amount. Observations revealed that the resident had dry, cracked lips with a tan crust-like substance, indicating potential dehydration. Interviews with the Nurse Practitioner (NP) and RD highlighted a lack of awareness and oversight regarding the resident's hydration needs. The NP had previously reduced the free water flushes due to high residuals and intolerance, but the RD was unaware of the current flush rate and the resident's dry lips. The RD admitted to overlooking the discrepancy in the free water flushes and acknowledged the resident should have been receiving 30 ml every hour instead of every four hours. Further interviews with the Medical Director (MD) and Director of Nursing (DON) revealed a lack of consistent monitoring and adjustment of the resident's hydration needs. The MD was new to the facility and had not yet familiarized herself with the resident's case, while the DON could not explain why the resident was not receiving the required amount of free water. Laboratory results showed an elevated blood urea nitrogen to creatinine ratio, further indicating dehydration. The NP later increased the free water flushes to 30 ml per hour, which the resident tolerated well.
Failure to Monitor Side Effects of Psychotropic Medications
Penalty
Summary
The facility failed to document monitoring for side effects of psychotropic medications for a resident diagnosed with Parkinson Disease, unspecified dementia without behavioral disturbance, psychosis, mood disorder, and neurogenic disturbance with Lewy body dementia. The resident was prescribed Seroquel and Nuplazid, both antipsychotic medications, but the Medication Administration Record (MAR) for July, August, and September 2024 showed no documentation of side effect monitoring after July 11, 2024. Interviews with staff revealed that the resident exhibited behaviors such as physical aggression, hollering, and visual hallucinations, which were reportedly managed better with medication. The oversight in documenting side effect monitoring was acknowledged by the Director of Nursing (DON), who explained that it was missed when the resident returned from the hospital. The responsibility for reviewing medical records post-admission to ensure accuracy was assigned to the Unit Manager or Assistant Director of Nursing, but the facility did not have active personnel in these roles at the time. This lack of documentation and oversight led to the deficiency identified by the surveyors.
Infection Control Deficiencies in PPE and Hand Hygiene
Penalty
Summary
The facility staff failed to adhere to the infection prevention and control program, specifically in the use of Personal Protective Equipment (PPE) and hand hygiene practices. During an observation, two nurse aides (NAs) were seen transferring a resident under Enhanced Barrier Precautions (EBP) without donning the appropriate PPE. Although the NAs sanitized their hands and applied gloves before entering the resident's room, they did not wear gowns as required. Additionally, one of the NAs failed to sanitize her hands between glove changes, which is a violation of the facility's hand hygiene policy. In another instance, a resident diagnosed with COVID-19 was placed under special droplet contact precautions. The signage on the resident's door clearly indicated the need for healthcare personnel to wear eye protection, among other PPE. However, a nurse aide entered the resident's room without wearing the required eye protection. Upon inquiry, the nurse aide admitted to not checking the PPE cart thoroughly, which contained the necessary face shields. Interviews with the Director of Nursing (DON) revealed that the facility's infection control education was previously overseen by a former Assistant Director of Nursing who had recently left. Despite this, the DON stated that all staff were aware of the precautions and PPE requirements. The deficiencies observed indicate lapses in following established infection control protocols, particularly in the use of PPE and hand hygiene practices.
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What surveyors actually found near you
We read the 26 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
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Nursing homes near Wilkesboro
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Westwood Hills Nursing And Rehabilitation Center | 0.4 mi | ★★★★★ | 3 | 0 |
| Wilkesboro Health And Rehabilitation | 1.1 mi | ★★★★★ | 3 | 0 |
| Wilkes Regional Medical Ctr Sn | 1.2 mi | ★★★★★ | 0 | 0 |
| Valley Nursing And Rehabilitation Center | 18.8 mi | ★★★★★ | 6 | 0 |
| Pruitthealth-elkin | 20.3 mi | ★★★★★ | 0 | 0 |
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