Above average — CMS composite of the measures below.
The next survey window likely opens around January 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 Skyland Terrace And Rehabilitation during CMS and state inspections, most recent first.
A resident with dementia and epilepsy had a documented death with dignity care plan indicating a wish for CPR, but later the family requested a change to DNR, and a physician wrote a corresponding DNR order. The social worker documented the change and followed the process for obtaining the physician’s signature but did not recall notifying the MDS nurses or discussing the change in the morning meeting. The MDS nurses, who are responsible for updating care plans and rely on morning meeting reports for changes, were unaware of the new DNR status, and the care plan continued to list the resident as Full Code. The Administrator confirmed the resident’s current code status should have been reflected in the care plan.
A resident with dementia, severe cognitive impairment, heart failure, a history of falls, and physical aggression was being assisted with morning care and a transfer when she became combative, leading a nurse aide to lower her onto a fall mat beside the bed. Two other NAs responded, found the resident on the floor/mat, and transferred her into a wheelchair without first notifying a nurse or obtaining a nursing assessment, as they did not consider the incident a fall. After the transfer, they removed the resident’s nightgown and discovered a large skin tear on her right forearm, at which point a nurse was called and later documented the injury and the resident’s report of right arm pain. The administrator stated that being lowered to the floor is considered a fall and that a nurse should have assessed the resident before she was moved.
A resident with severe cognitive impairment had a prior history of receiving PCV13 and later had a signed consent form from the responsible party requesting a pneumonia vaccine. Record review showed no documentation that a pneumococcal vaccine was administered despite this consent. The DON/Infection Preventionist stated she uses CDC guidelines and an algorithm to determine when residents need PCV20 to be up to date and confirmed this resident should have received PCV20 but could not explain the omission. The Administrator reported an expectation that vaccines be kept current and was unable to state why the PCV20 was not given.
A resident with hemiplegia and hemiparesis was subjected to abuse by a family member, who was witnessed by a nurse aide hitting the resident on the leg, covering her mouth and nose, and telling her to shut up. The incident was directly observed and reported by staff, and the resident, though minimizing the event, was unable to recall key details. The facility failed to protect the resident's right to be free from abuse during this incident.
A resident with significant tremors and a history of depression and anxiety did not have a neurology appointment scheduled despite multiple referrals. The resident's condition worsened, affecting her quality of life and mental health. Facility staff interviews revealed a breakdown in the appointment scheduling process, with the scheduler failing to follow up on the neurology referral. The neurology office confirmed multiple attempts to contact the facility to schedule the appointment, which went unanswered.
A resident reported missing valuable rings, which were replaced with cheap costume jewelry after being placed on her bedside table. The facility's investigation confirmed the loss of five rings, including a diamond cluster and a mother's ring, valued between $4,000 and $5,000. Despite staff interviews and a police report, no individuals were identified as responsible for the misappropriation.
A resident with peripheral vascular disease and chronic wounds developed a stage II pressure ulcer on the left lower back, which was not treated according to wound care center orders. The facility's treatment records lacked the necessary orders, and staff interviews revealed unawareness of the ulcer. The DON and Administrator admitted that appointment notes were not reviewed for new orders, leading to the oversight.
The facility failed to remove an expired nutritional supplement from a nourishment room refrigerator, potentially affecting residents receiving supplements. An observation with the Dietary Manager revealed a container of supplement with a received and open date, approximately 25% full. The Dietary Manager stated items should be discarded after 7 days and discarded the expired supplement. The refrigerator is checked twice daily, but the manager was unsure when the supplement was placed there by a nurse. The Administrator confirmed expired items should be disposed of.
Failure to Update Care Plan After Change in Code Status
Penalty
Summary
The facility failed to update a resident’s care plan to reflect a change in code status from Full Code to Do Not Resuscitate (DNR). The resident was admitted with dementia and epilepsy and had a death with dignity care plan that documented a wish for cardiopulmonary resuscitation (CPR) to be attempted. A social worker’s progress note documented that the resident’s family changed the code status to DNR, and a physician subsequently wrote a DNR order. The resident’s comprehensive MDS indicated he was rarely or never understood, underscoring reliance on documented directives rather than resident self-report. Despite these documented changes, the care plan continued to list the resident as Full Code. During interviews, the social worker confirmed the code status change and described the process of placing new or updated code status forms in the physician’s notebook for review and signature, with the physician then writing an order in the chart. The social worker did not recall informing the MDS nurses of the code status change or whether it was discussed in the morning meeting. The two MDS nurses, who stated they were responsible for updating care plans including code status changes, reported they relied on information from the morning meeting for changes in orders or resident condition and did not recall the code status change being reported. The Administrator stated that the resident’s current code status should be reflected on the care plan and acknowledged that the care plan should have been updated when the code status changed.
Failure to Obtain Nursing Assessment Before Moving a Resident After a Fall
Penalty
Summary
The deficiency involves the facility’s failure to ensure a nurse assessed a resident after a fall before the resident was moved. The resident had dementia, heart failure, severe cognitive impairment, a history of falls, and required moderate assistance for transfers. She was care planned for restorative care due to fall risk and poor safety awareness, and also for a history of physical aggression, with interventions to anticipate needs and remove her from escalating situations. On the morning in question, a nurse aide (NA #1) was providing incontinence care and dressing the resident at the end of the night shift. After moving the resident to the edge of the bed and positioning the wheelchair, NA #1 attempted a “bear hug” transfer without holding the resident’s arms. During the lift, the resident became combative, hitting and yelling, and NA #1 lowered her onto the fall mat beside the bed. NA #1 called for help, and two other aides (NA #2 and NA #3) entered the room and found the resident sitting on the fall mat/floor with her back against the bed. Without first notifying a nurse or obtaining a nursing assessment, NA #2 and NA #3 lifted the resident from the floor/mat into her wheelchair. NA #2 later stated she did not consider the incident a fall based on NA #1’s description and therefore did not notify the nurse before moving the resident. Once the resident was in the wheelchair, the aides removed her nightgown and discovered a large skin tear on her right forearm, and only then did NA #2 seek out the nurse (Nurse #3). Nurse #3 subsequently documented a skin tear to the right forearm, resident-reported pain in the right arm, and that vital signs were within normal limits. The administrator later confirmed that being lowered to the floor should have been considered a fall and that the NAs should have notified a nurse to assess the resident before moving her.
Failure to Administer Pneumococcal Vaccine After Consent
Penalty
Summary
The deficiency involves the facility’s failure to administer a pneumococcal vaccine to a resident who had consented to receive it. The resident, who had severe cognitive impairment per a quarterly MDS, had a documented history of receiving Prevnar 13 (PCV13) in 2016. A 2025 Vaccine Consent Form in the medical record showed that the pneumonia vaccine option was selected and the resident’s responsible party signed consent for the pneumococcal vaccine. However, review of the medical record revealed no documentation that staff had administered a pneumococcal vaccine following this consent. During an interview, the DON, who also served as the Infection Preventionist, stated she was responsible for assessing and administering immunizations for all new admissions and ensuring residents were up to date per CDC guidelines. She reported that current CDC guidelines recommend PCV20 for residents to be up to date and used a CDC algorithm with prior vaccine history to determine vaccine needs. After entering the resident’s prior vaccines, she confirmed the resident should have received PCV20 but could not explain why it had not been administered. In a separate interview, the Administrator stated she expected resident vaccines to be kept up to date and did not know why staff had not administered the PCV20 vaccine to the resident.
Failure to Protect Resident from Abuse by Family Member
Penalty
Summary
A resident with a history of hemiplegia and hemiparesis following a stroke, who was cognitively intact and dependent on staff for most activities of daily living, was subjected to abuse by a family member during a visit. The incident occurred when the resident was speaking on the phone and the family member became upset, reportedly hitting the resident on the leg, covering her mouth and nose with her hand, and telling her to shut up. This event was directly witnessed by a nurse aide, who intervened immediately. The nurse aide reported hearing the sound of the slap and observed the family member forcefully covering the resident's mouth and nose, pushing her head back. The aide confronted the family member and called for supervisory staff, who arrived and removed the family member from the room. The resident, when interviewed, did not recall being hit or being told to shut up, and minimized the incident, stating that her family member was not trying to hurt her. However, the nurse aide's account was consistent and detailed, and the supervisory staff confirmed the sequence of events as reported by the aide. The family member denied hitting or covering the resident's mouth, though admitted to touching the resident's chin to get her attention. Other family present did not provide additional details. The Director of Nursing and Administrator both confirmed that the incident was substantiated as abuse based on the nurse aide's eyewitness account. The facility's failure to protect the resident from abuse by a family member constituted a deficiency in ensuring the resident's right to be free from all forms of abuse.
Failure to Schedule Neurology Appointment for Resident with Tremors
Penalty
Summary
The facility failed to ensure a neurology appointment was scheduled for a resident who was experiencing significant tremors. The resident, who was admitted with diagnoses including depression, anxiety, mood disorder, essential tremor, and drug-induced secondary Parkinson's disease, had a neurology referral ordered by the physician on two separate occasions. Despite these orders, no neurology appointment was scheduled, and the resident's condition worsened, affecting her quality of life and mental health. The resident's medical records indicated that she had been experiencing worsening tremors, which were interfering with her daily activities and social interactions. Multiple medications were trialed to manage her symptoms, but they were either ineffective or exacerbated her condition. The resident expressed feelings of isolation, depression, and hopelessness due to her unmanageable tremors and the lack of improvement in her condition. Interviews with facility staff revealed a breakdown in the appointment scheduling process. The facility's scheduler admitted to being behind on scheduling and not following up on the neurology referral as required. The neurology office confirmed that they had attempted to contact the facility multiple times to schedule the appointment but received no response. The facility's Director of Nursing and Administrator acknowledged the lack of a proper process for tracking and following up on appointments, which contributed to the oversight in scheduling the resident's neurology consultation.
Resident's Rings Misappropriated
Penalty
Summary
The facility failed to protect a resident's right to be free from misappropriation of property, specifically involving the loss of valuable rings. The resident, who was cognitively intact, reported that her wedding rings and mother's ring were missing after she had taken them off and placed them in a plastic bag on her bedside table. The rings were replaced with cheap costume jewelry, which the resident discovered the following morning. The resident had worn the rings during a family outing and continued to wear them at the facility until she removed them before bed. Staff interviews revealed that some staff members noticed the resident wearing rings, while others did not recall seeing them. The incident was reported to the facility staff, and the police were notified. The facility's investigation confirmed that five rings were missing, including a diamond cluster and a mother's ring with colored stones. Despite the investigation, there were no accused individuals, and the police report was filed with an estimated value of the missing rings between $4,000 and $5,000. The facility's administrator was still investigating the incident at the time of the report. The deficiency was substantiated as the rings were indeed missing, but the investigation did not identify any specific individuals responsible for the misappropriation.
Failure to Follow Wound Care Orders for Pressure Ulcer
Penalty
Summary
The facility failed to follow physician orders from the wound care center for the treatment of a stage II pressure ulcer on a resident's left lower back. The resident, who was admitted with peripheral vascular disease and chronic bilateral lower extremity wounds, was not documented as having an unhealed pressure ulcer on the Minimum Data Set assessment. Despite the wound care center's orders for daily wound care, the facility's treatment administration records for April and May 2024 did not include any orders for the pressure ulcer treatment. The wound care center identified the stage II pressure ulcer during a visit on April 12, 2024, and provided specific instructions for wound care, which were not followed by the facility. The resident reported to the wound care center that the area had not received care until a week later, and the wound care center noted the absence of a dressing during a subsequent visit on May 3, 2024. Interviews with facility staff, including nurses and the Director of Nursing, revealed a lack of awareness of the pressure ulcer and a failure to implement the wound care orders. The Director of Nursing and the Administrator acknowledged that there was an issue with appointment notes being scanned into the electronic records without being reviewed for new or updated orders. This oversight led to the facility missing the wound care orders for the resident's pressure ulcer. The facility's failure to review and implement the wound care center's orders resulted in the deficiency noted in the report.
Expired Nutritional Supplement Found in Refrigerator
Penalty
Summary
The facility failed to remove an expired nutritional supplement from one of the two nourishment room refrigerators, which had the potential to affect residents receiving nutritional supplements. During an observation conducted with the Dietary Manager, a container of nutritional supplement was found in the north nourishment room refrigerator with a received date and an open date, and it was approximately 25% full. The Dietary Manager stated that opened and stored refrigerator items should be discarded after 7 days and immediately discarded the expired supplement. The nourishment room refrigerator is checked twice daily by dietary staff for expired items, but the Dietary Manager was unsure when the supplement was placed in the refrigerator, as it was placed there by a nurse. The Administrator confirmed that open nutritional supplements or food items should be disposed of when expired.
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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.
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Nursing homes near Waynesville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Autumn Care Of Waynesville | 2.9 mi | ★★★★★ | 1 | 0 |
| Smoky Mountain Health And Rehabilitation Center | 3.6 mi | ★★★★★ | 3 | 0 |
| Silver Bluff | 5.8 mi | ★★★★★ | 14 | 0 |
| Maggie Valley Health And Rehabilitation Center | 6.8 mi | ★★★★★ | 4 | 0 |
| Vero Health & Rehab Of Sylva | 15.2 mi | ★★★★★ | 7 | 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.