Average — CMS composite of the measures below.
The next survey window likely opens around December 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 Silver Bluff during CMS and state inspections, most recent first.
Surveyors found that kitchen staff failed to follow food safety and sanitation standards, including storing an opened container of soy sauce beyond its usable date in a walk-in refrigerator. During tray line service, a kitchen worker touched their hair with bare hands, did not perform hand hygiene before putting on gloves, and moved between the dining room and kitchen without washing hands while plating hot tray liners and handling covered desserts. An air vent directly above the tray line was also observed to be covered with thick, gray debris, and the Dietary Manager could not state when it was last cleaned.
A resident with severe cognitive impairment, total dependence for ADLs, and multiple pressure injuries had a right hip wound with purulent drainage, odor, and unstable eschar. A wound NP documented that the wound had declined and showed signs of infection and recommended that staff contact the PCP about possible antibiotic treatment, ordering Santyl for debridement. The wound nurse reported verbally mentioning antibiotics to an NP who did not assess the wound, while that NP later stated she was never informed. The EMR contained no documentation that the PCP or any provider was contacted and no antibiotic order, despite the care plan requiring staff to monitor wounds and report declines to the MD and the wound NP’s clear note about suspected infection and need for provider follow-up.
A medication error rate above 5% was identified when a resident with COPD and other chronic conditions received a crushed dose of Oxybutynin XL despite an order specifying it should not be crushed, and ordered doses of Refresh Tears eye drops and a Fluticasone-Salmeterol inhaler were not administered. A medication aide reported crushing the extended-release tablet based on the resident’s preference and not noticing the "do not crush" instruction, and also stated the resident self-administered the eye drops and inhaler from the bedside. The resident denied keeping or self-administering these medications, and the DON confirmed there were no self-administration orders and that facility medication administration protocols were not followed.
Surveyors found multiple medication management failures, including an opened, undated Novolog insulin pen and an expired bottle of Acidophilus tablets left available for use on a medication cart, as well as a partially full heparin lock flush syringe left unsecured on a resident’s bedside shelf after the related order had been discontinued. A nurse acknowledged administering insulin from the undated pen and stated she only checked expiration dates on stock medications she used during her shift, while the DON and Administrator confirmed that medications should not be left in resident rooms or at bedside without a self-administration order.
A resident with heart disease, severe protein-calorie deficiency, and significant dental problems had a standing, year-long consent and order to hold aspirin prior to dental extractions. Aspirin was correctly held for an earlier visit, allowing extraction of several teeth, but for a subsequent scheduled extraction visit, staff did not obtain or act on the existing order to hold the blood thinner, and the medication was administered as usual. The dentist documented that the resident could not be treated because the blood thinner had not been held, and the resident reported ongoing tooth pain and that the appointment was canceled due to the medication not being stopped.
The facility failed to secure medications properly, leaving an unopened vial and an opened ointment unattended in a resident's room. Additionally, opened medications, including eye drops and insulin pens, were not dated across multiple medication carts, and a medication cart was left unlocked and unattended. Staff interviews revealed a lack of awareness and responsibility for medication management, highlighting significant gaps in the facility's practices.
A resident with dementia and severe cognitive impairment was subjected to physical restraint during incontinence care when a nurse aide held her wrists and later smacked her wrist. The incident was witnessed by other staff, who reported feeling uncomfortable with the actions, which they did not perceive as defensive. Despite this, the facility's investigation concluded the actions were defensive and unsubstantiated the abuse allegation.
The facility failed to serve food at an appetizing temperature for three residents, with reports of cold meals at lunch and dinner. Observations confirmed the food was cold and unappealing, attributed to inadequate steam table temperatures and lack of plate warmers. The Administrator was unaware of these issues until informed by the Corporate Dietary Manager.
Expired Food Storage, Poor Hand Hygiene, and Dirty Air Vents in Kitchen Tray Line Area
Penalty
Summary
Surveyors identified deficiencies in food storage and kitchen sanitation practices. In the walk-in refrigerator, an opened 1-gallon container of soy sauce was observed on a top shelf with a written date range of 6/11–12/11. The Dietary Manager stated that the soy sauce had been opened on 6/11/25 and that its useful date range was 6 months after opening, meaning it should have been disposed of after 12/11/25. The Administrator later confirmed that food stored past its usable date should have been discarded. During tray line service, surveyors observed a kitchen staff member remove his hat and rub his hair with bare hands, then fail to wash his hands before donning gloves. The same staff member left the kitchen wearing gloves, entered the dining room, and returned to the kitchen without handwashing, then proceeded to plate hot tray liners into plate covers and onto trays, and handle covered dessert containers. Additionally, an air vent located directly above the tray line was observed to be covered in thick, clumpy, grayish debris. The Dietary Manager acknowledged that the staff member should have washed his hands after touching his hair and each time he entered the kitchen and changed gloves, and stated that kitchen air vents were supposed to be cleaned every 3 to 4 months but did not know when they were last cleaned.
Failure to Follow Up on Wound NP Recommendation for Possible Antibiotics for Infected Pressure Wound
Penalty
Summary
The deficiency involves the facility’s failure to follow up on a wound care nurse practitioner’s recommendation to contact the primary care provider regarding possible antibiotic treatment for a resident’s pressure-related hip wound that showed signs of infection. The resident had severe cognitive impairment, required extensive to total assistance with all ADLs and mobility, and was identified as at risk for pressure ulcers, with existing unhealed stage 3 and unstageable pressure ulcers and a pressure-reducing device in use. A care plan directed staff to administer treatments as ordered, monitor wound healing weekly, and report improvements or declines to the MD. On 12/31/25, Wound Care NP #2 evaluated the resident’s right hip wound, which had declined, and documented that there were positive signs and symptoms of infection, recommending that staff contact the primary care physician for possible antibiotic treatment. NP #2 ordered Santyl for debridement because the wound was covered with unstable eschar and reported that the wound was bad, with moderate purulent drainage and odor, leading her to believe there was likely infection present. She stated that her process was to notify the primary care provider and defer to them for the antibiotic decision, and she discussed with the facility’s wound care nurse that the resident had symptoms of infection and needed follow-up with the primary care provider, which she also documented in her note. Despite this recommendation and documentation, review of the electronic medical record showed no antibiotic orders and no progress note indicating that the primary care provider had been contacted. The facility’s wound care nurse (Nurse #2) stated she was aware of NP #2’s note and said she mentioned the possible need for antibiotics to NP #1 when NP #1 was at the facility, but NP #1 allegedly did not think the resident needed an antibiotic and did not examine the wound; NP #1, however, reported she had not been informed and did not recall being contacted about the wound or need for antibiotics. On observation by the surveyor, the right hip wound had copious purulent brown drainage saturating the dressing and under-pad, a malodorous smell, a visible cavity, and remaining eschar, and was measured at 4 cm by 5 cm by 5.5 cm. The Medical Director later stated he had not been contacted about the wound or antibiotics and that someone should have followed up on the wound NP’s recommendation. The DON and Regional Nurse acknowledged that information about the possible need for antibiotics should have been communicated to the primary care provider and that outside provider notes were expected to be reviewed and addressed by the clinical team, but the DON did not recall reviewing the 12/31/25 wound note, and there was no evidence that the recommendation for possible antibiotics was acted upon prior to the surveyor’s involvement. The deficiency therefore centers on the facility’s failure to implement and act upon the wound care NP’s documented recommendation to contact the primary care provider regarding possible antibiotic therapy for a wound with documented signs and symptoms of infection, and the lack of documented communication or follow-up with any provider despite the resident’s high-risk status, existing pressure injuries, and care plan requirements to monitor and report wound changes to the MD.
Medication Error Rate Exceeded Due to Improper Crushing and Omitted Doses
Penalty
Summary
A medication error rate of 8.82% was identified during a medication pass observation involving one resident with COPD, benign prostatic hyperplasia, and age-related bilateral cataracts. The resident had an active order for Oxybutynin Chloride XL 5 mg, an extended-release tablet to be given once daily with instructions not to crush. During the observed medication pass, the medication aide crushed the Oxybutynin along with other medications, stating the resident preferred medications crushed. She administered the crushed medications, including the extended-release Oxybutynin, with water. In a subsequent interview, the medication aide acknowledged she had not noticed the "do not crush" instruction in the electronic order and stated she did not know why Oxybutynin could not be crushed. The nurse practitioner and pharmacist both confirmed that extended-release Oxybutynin should not be crushed because it is designed to release medication over 24 hours and crushing would release the dose at one time. The same resident also had active orders for Refresh Tears ophthalmic solution to be instilled in both eyes three times daily and for Fluticasone-Salmeterol inhalation aerosol to be administered twice daily for COPD. During the same medication pass observation, the medication aide did not administer the ordered eye drops or inhaler. She later stated she did not give these medications because she believed the resident kept them at the bedside and self-administered them. However, when the resident was interviewed, he reported that he did not keep these medications at the bedside and denied self-administering them. The interim DON confirmed there were no physician orders authorizing the resident to self-administer medications and stated he did not know why the medication aide believed the medications were at the bedside. He also stated that the medication aide should have followed the medication administration protocol, including not crushing medications that were ordered not to be crushed.
Improper Medication Labeling and Unsecured Heparin Syringe
Penalty
Summary
The facility failed to ensure proper labeling and storage of medications on a medication cart and in a resident room. During an observation of the 500 hall long-side medication cart with a nurse, surveyors found an opened and undated Novolog insulin flex pen in the top drawer, with a pharmacy label showing it was filled on 11/10/25. Manufacturer instructions indicated the pen was usable for 28 days after first use, but the nurse stated she did not know whether the expiration was 28 or 30 days after opening and confirmed it should have been dated. She reported she had administered insulin from this pen that morning and had not noticed it was undated. The same cart also contained an open bottle of Acidophilus tablets with a manufacturer’s expiration date of 11/25 and approximately 40 tablets remaining, indicating the stock medication was expired but still available for use. The nurse stated she had not administered any of the Acidophilus and that she only checked expiration dates on stock medications she used during her shift, rather than all stock medications in the cart. In a separate incident, the facility failed to secure a heparin flush syringe, leaving it accessible in a resident’s room. A resident with a prior physician’s order for heparin lock flush solution 10 units/mL, 5 mL IV every shift for PICC line patency, had that order discontinued on 12/15/25. On observation of the resident’s room, surveyors found a syringe in a sealed bag on a shelf next to the resident’s chair, labeled as heparin lock flush solution 5 mL and partially full. A nurse confirmed the syringe contained medication and removed it from the room, stating he had given the resident medications earlier that day but had not seen the syringe on the shelf and did not know who had left it there. The DON later stated that medications should never be left in a resident’s room and the Administrator stated that medications should not be kept at bedside unless there was an order for self-administration of medication.
Failure to Hold Antiplatelet Medication Resulting in Missed Dental Extractions
Penalty
Summary
The deficiency involves the facility’s failure to hold an ordered antiplatelet medication (aspirin) prior to a scheduled dental extraction, resulting in a resident being unable to receive planned dental services. The resident was admitted with severe protein-calorie deficiency and heart disease and had an active order for aspirin 81 mg at bedtime. He was care planned for dental health problems, including broken teeth, poor repair, tooth pain, and abscesses, and his MDS documented mouth or facial pain and discomfort with chewing. A dental extraction consent form, signed by the resident and the Medical Director, specified that because the resident was on a blood thinner, the medication needed to be held 24–48 hours prior to dental procedures, and that this order was valid for one year. Following this, the dentist documented that no remaining teeth were restorable and that a full mouth extraction was planned. A physician’s order was written and implemented in October to hold the aspirin for several days, and the resident successfully had four teeth extracted at that time. The social worker reported that after the October visit, the dentist scheduled the resident for additional extractions at the next clinic visit in November and that she informed the former DON of this upcoming extraction. However, there were no physician’s orders to hold aspirin in November, and the MAR showed the aspirin was not held on the days preceding or on the date of the scheduled November dental visit. On that date, the dentist documented that the resident could not be seen because the blood thinner had not been held and that he would be seen at the next visit if the medication was held. The resident reported ongoing intermittent tooth pain, especially with tougher foods, and confirmed that the November appointment was canceled because his medication had not been stopped beforehand. The former DON acknowledged that the consent form, which included the standing order to hold blood thinners for one year, had been scanned into the chart but was missed by nursing staff, who were looking for a new order and were not aware of the dentist’s return date.
Medication Management Deficiencies
Penalty
Summary
The facility failed to properly secure and manage medications, leading to several deficiencies. During a medication storage audit, an unopened vial of DuoNeb solution and an opened tube of zinc oxide ointment were found unattended in a resident's room. The Unit Manager and Staff Development Coordinator acknowledged that these medications should not have been left in the room, especially since the resident had not been assessed for self-administration of medication. This oversight indicates a lapse in medication management and security protocols. Additionally, the facility did not date opened medications, including a bottle of latanoprost eye drops and several insulin pens, across multiple medication carts. These medications were found without opening dates, making it impossible to determine their usability according to manufacturer guidelines. Interviews with nursing staff revealed a lack of awareness and responsibility for ensuring medications were dated, with some staff not authorized to administer insulin and therefore not checking the medications properly. Furthermore, a medication cart was left unlocked and unattended in a hallway, with keys left on the countertop. Nurse #1 admitted to being distracted by nursing students, which led to the oversight. The Director of Nursing and the Administrator both expressed that it was their expectation for staff to follow proper procedures for medication management, including dating medications and securing them appropriately. These incidents highlight significant gaps in the facility's medication management practices.
Resident's Right to Be Free from Physical Restraint Violated
Penalty
Summary
The facility failed to protect a resident's right to be free from physical restraint during incontinence care. A nurse aide (NA #2) held the resident's wrists/hands in front of her chest when the resident began swinging her arms and kicking her legs. This incident involved a resident with severe cognitive impairment and dementia with behavioral disturbances, who was known to exhibit physical and verbal behaviors directed toward others. The resident was dependent on staff for toileting hygiene and personal care. During the incident, NA #2, along with NA #1 and a student nurse aide, were providing incontinence care to the resident. The resident became combative, swinging her arms and kicking, prompting NA #2 to hold her hands. After the care was completed, NA #2 was observed smacking the resident on the wrist. NA #1 and the student nurse aide witnessed the incident and reported feeling uncomfortable with NA #2's actions, which they did not perceive as defensive. The facility conducted an investigation, including interviews with the involved staff and a reenactment of the event. Despite the witnesses' accounts, the facility concluded that the abuse allegation was unsubstantiated, determining that NA #2's actions were defensive. However, the report highlights discrepancies in the staff's accounts and the facility's conclusion, as NA #1 and the student nurse aide did not agree with the facility's assessment that the actions were defensive.
Facility Fails to Serve Food at Appropriate Temperature
Penalty
Summary
The facility failed to provide palatable food at an appetizing temperature for three residents who had food concerns. Resident #59, with severely impaired cognition, required assistance with eating and reported through a representative that the food was often cold at lunch and dinner. Resident #103, who was cognitively intact, also required setup assistance and reported that the food was cold about half the time. Resident #42, also cognitively intact and requiring setup assistance, mentioned that the food was cold sometimes. An observation of the lunch tray line revealed that the test tray, which was the last to be plated and delivered, contained food that was not at the appropriate temperature. The pork chop and beets were cold, while the stuffing was warm, and the overall appearance of the plate was mostly brown. The Corporate Dietary Manager and facility Dietary Manager confirmed the food was cold and unappealing, attributing the issue to the steam table temperature not being set high enough, lack of plate warmers, and absence of insulated meal tray carts. The Administrator was unaware of these concerns until informed by the Corporate Dietary Manager.
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Illustrative
What surveyors actually found near you
We read the 74 citations issued within 25 miles in the last 12 months — including the 4 immediate-jeopardy cases — 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
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Illustrative
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Nursing homes near Canton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Skyland Terrace And Rehabilitation | 5.8 mi | ★★★★★ | 3 | 0 |
| Smoky Mountain Health And Rehabilitation Center | 5.9 mi | ★★★★★ | 3 | 0 |
| Autumn Care Of Waynesville | 7.6 mi | ★★★★★ | 1 | 0 |
| Maggie Valley Health And Rehabilitation Center | 12.6 mi | ★★★★★ | 4 | 0 |
| Pisgah Manor Health Care Center | 13 mi | ★★★★★ | 1 | 0 |
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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.