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 Smoky Mountain Health And Rehabilitation Center during CMS and state inspections, most recent first.
Surveyors found unsanitary conditions and improper food storage in the dietary areas, including a walk-in refrigerator with debris and buildup on the floor and shelving that had not been cleaned for an extended period, as well as a dry storage area containing expired thickened liquids and multiple cases of bottled water stored directly on the floor. The Dietary Manager acknowledged responsibility for stocking food and reported that the expired items were overlooked and the water had been placed on the floor during a prior water line break. The Administrator confirmed that established kitchen cleaning protocols and storage standards, including discarding expired food and keeping water off the floor, were not followed.
A resident with anxiety disorder, who was cognitively intact and receiving antianxiety medications, had a PRN Clonazepam order entered into the EMR without the required 14‑day stop date. The PRN psychotropic order remained active and was administered at least once, while multiple staff, including the nurse who entered the order, the unit manager, the DON, and the Medical Director, were unable to clearly identify how the order was initiated or why it lacked a stop date. Although new medication orders were reportedly reviewed in daily morning meetings, this PRN Clonazepam order without a stop date was not identified or corrected through that process.
The facility failed to clearly explain its binding arbitration agreement and to ensure residents and responsible parties understood that signing was optional and not a condition of admission or services. The arbitration form contained only a single signature line and was routinely stamped "accept" without a distinct option to accept or decline arbitration. A cognitively intact resident reported signing admission documents but not agreeing to binding arbitration. Another resident’s responsible party, who received the form by email in very small font, did not recall any verbal explanation, believed the document simply needed to be signed and returned with other admission papers, and stated there was no way to accept or decline arbitration and no intent to agree to binding arbitration. A third resident with moderate cognitive impairment stated he did not know he did not have to sign, nor that signing placed him into a binding arbitration agreement, and he did not want to agree to it. The Admissions Coordinator stated she was trained to have all residents sign the arbitration form on an electronic tablet and stamp it "accept" to show it had been read and explained, and the form did not clarify that this stamp reflected acknowledgment rather than agreement.
The facility failed to complete comprehensive Care Area Assessments (CAAs) for two residents, leading to deficiencies in addressing triggered care areas. One resident had 10 care areas triggered, but analysis was missing for 9 areas, while another resident had 8 areas triggered with no analysis provided. The MDS Coordinator acknowledged the error, and the Director of Nursing emphasized the need for comprehensive CAAs.
A facility failed to complete a PASRR application for a resident with a new psychiatric diagnosis of hallucinations. The resident, admitted with polyosteoarthritis and generalized anxiety disorder, was later diagnosed with hallucinations, but no new PASRR application was completed. Staff interviews revealed confusion over responsibility for PASRR submissions, with the Social Worker untrained and the Business Office Manager unsure of the process.
A facility failed to post cautionary signage outside a resident's room indicating the use of oxygen, despite the resident having a physician's order for continuous oxygen administration due to acute respiratory failure with hypoxia. Observations confirmed the absence of signage, and staff interviews revealed a lack of awareness and responsibility for ensuring the signage was in place.
A facility failed to manage medications properly, with an opened bottle of Latanoprost eye drops lacking an opening date and an expired bottle of docusate sodium liquid found in a medication cart. The LPN acknowledged the oversight, and both the DON and Administrator expected adherence to medication management protocols, highlighting a gap between policy and practice.
Unsanitary Food Storage and Expired Products in Dietary Areas
Penalty
Summary
Surveyors identified a deficiency in the facility’s food service operations related to storage and sanitation in the walk-in refrigerator and dry food storage area. During an observation of the walk-in refrigerator with the Dietary Manager, the floor under the food storage racks was found to have a buildup of grey-white debris that crumbled when touched, and several areas of the floor were raised, white, and fuzzy in appearance. The food storage racks themselves had a thick, grey, sticky substance on the metal shelving. The Dietary Manager stated that the food storage racks were last cleaned in January of the current year and reported that the walk-in refrigerator floor was scheduled to be replaced and, for that reason, had not been cleaned. In the dry food storage area, surveyors observed two unopened cartons of thickened liquid on a storage rack shelf with a use-by date that had already passed, as well as five cases of bottled water stored directly on the floor beneath the racks. The Dietary Manager stated she was responsible for putting away food stock upon delivery and acknowledged that the expired thickened liquid had been overlooked. She also explained that the bottled water had been placed on the floor approximately three weeks earlier during a facility water line break. The Administrator later stated that kitchen cleaning protocols, including those for the walk-in refrigerator, should have been followed, and that water should not be stored on the floor and expired food should be discarded.
Failure to Apply 14-Day Stop Date to PRN Psychotropic Medication Order
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a PRN psychotropic medication, Clonazepam, had a required 14‑day stop date for a resident with an anxiety disorder. The resident was cognitively intact and had documented use of antianxiety medications. Her care plan identified the use of psychotropic medications with potential adverse effects and included an intervention to administer medications per physician orders. A physician order dated 2/19/26 for PRN Clonazepam, one tablet by mouth every 24 hours as needed for anxiety, was entered into the electronic medical record by a nurse without a stop date. Review of the MAR showed that this PRN Clonazepam order remained active beyond initiation and that the resident received at least one PRN dose on 2/19/26. Interviews revealed uncertainty among staff and the Medical Director about how the PRN Clonazepam order was initiated and why it lacked a 14‑day stop date. The resident reported having both a scheduled bedtime dose and a PRN dose of Clonazepam, which she believed she could receive every 12 hours and stated she had this PRN order for a long time. The nurse who administered the PRN dose could not recall how the order was obtained. The Unit Manager stated she was not present when the order was started and did not remember checking it, but acknowledged that PRN psychotropic medications should only be ordered for 14 days. The Medical Director stated he did not see the resident on the date the order was started, did not know how the order was initiated, and confirmed that PRN psychotropic medications should have a 14‑day stop date. The DON and Administrator both indicated that new medication orders were typically reviewed in morning meetings, but this PRN Clonazepam order without a stop date was missed in that process.
Failure to Clearly Explain and Obtain Informed Choice on Binding Arbitration Agreements
Penalty
Summary
The deficiency involves the facility’s failure to clearly explain its binding arbitration agreement and to ensure residents and their responsible parties understood that signing was optional and not a condition of admission or services. The arbitration document stated that it was not a precondition to admission and could be rescinded within 30 days, but the form only provided a single signature line for the resident or responsible party, with no clear way to indicate acceptance or declination of arbitration. For one cognitively intact resident, the arbitration agreement was signed and stamped “accept,” yet the resident later stated that although he understood the general meaning of arbitration, he did not agree to binding arbitration when he signed the admission documents. Another resident with severe cognitive impairment had an arbitration agreement signed by a responsible party, which was also stamped “accept.” The responsible party reported receiving the agreement by email with very small font, did not recall any person explaining it, and believed there was only an option to sign and return it with other admission documents, with no way to accept or decline arbitration; he stated he did not intend to agree to binding arbitration. A third resident with moderate cognitive impairment signed an arbitration agreement that was stamped “accept” and later reported not knowing that signing was optional or that it placed him into a binding arbitration agreement, and stated he did not want to agree to binding arbitration. The Admissions Coordinator reported that all arbitration agreements were completed electronically on a tablet as part of the admission packet, that she was trained to have all residents sign the arbitration form and stamp it “accept” to show it had been read and explained, and that the form did not specify that the “accept” stamp was only to acknowledge explanation rather than agreement to binding arbitration.
Incomplete Care Area Assessments for Two Residents
Penalty
Summary
The facility failed to complete the Care Area Assessment (CAA) comprehensively for two residents, leading to deficiencies in addressing the underlying causes and contributing factors of triggered care areas. Resident #10, admitted with diagnoses including non-Alzheimer's dementia, anxiety disorder, and osteoarthritis, had 10 care areas triggered in a significant change in status MDS assessment. However, the MDS Coordinator did not provide any analysis for 9 of these areas, which included delirium, cognitive loss/dementia, and psychotropic drug usage, among others. Similarly, Resident #11, with diagnoses such as diabetes mellitus and non-Alzheimer's dementia, had 8 care areas triggered in an annual MDS assessment, but the facility failed to provide analysis for all these areas, which included cognitive loss/dementia and nutritional status. Interviews with the MDS Coordinator and the Director of Nursing revealed that the assessments were submitted without the necessary comprehensive analysis due to an oversight by the former MDS Coordinator. The current MDS Coordinator, who started in November, acknowledged the error and the Director of Nursing emphasized the expectation for individualized and comprehensive completion of CAAs. The Administrator also confirmed the expectation for adherence to MDS guidelines, ensuring that all CAAs include the nature of problems, causative factors, and reasons to proceed to care planning before submission.
Failure to Complete PASRR for New Psychiatric Diagnosis
Penalty
Summary
The facility failed to complete a Preadmission Screening and Resident Review (PASRR) application for a resident who developed a new psychiatric diagnosis. The resident, admitted on September 2, 2023, with diagnoses including polyosteoarthritis and generalized anxiety disorder, was later diagnosed with hallucinations on August 1, 2024. However, there was no record of a new PASRR application being completed following this diagnosis. The resident's care plan, initiated on April 8, 2024, noted an acute confusional state with behaviors and altered thought processes, but the most recent Minimum Data Set assessment did not reflect the hallucinations. Interviews with facility staff revealed a lack of clarity and responsibility regarding the PASRR process. The Social Worker, who joined the facility in November 2024, was not involved with PASRR and indicated that the Business Office Manager was responsible for obtaining PASRR information. The Business Office Manager, however, was unsure who should submit new PASRR applications for residents with new mental health diagnoses, as the previous Social Worker had handled this task. The Administrator confirmed that the Social Worker was supposed to submit new PASRR applications but had not yet been trained, and acknowledged that a vacancy in the Social Worker position might have contributed to the oversight.
Failure to Post Oxygen Use Signage for Resident
Penalty
Summary
The facility failed to post cautionary and safety signage outside a resident's room to indicate the use of oxygen for a resident who required respiratory care. The resident, who was admitted with acute respiratory failure with hypoxia, had a physician's order for continuous oxygen administration via nasal cannula. Observations on two separate occasions revealed that the resident was receiving oxygen, but there was no signage posted outside the room to indicate the use of supplemental oxygen. Interviews with facility staff, including a nurse and the Director of Nursing (DON), revealed that the responsibility for placing oxygen signage on a resident's door fell to the nurse who completed the admission. However, the nurse was unaware that the signage was missing for this resident. The DON confirmed that the signage should have been in place and was unsure why it was not. The facility administrator also stated that nurses should validate physician orders related to oxygen and ensure signage is posted.
Medication Management Deficiency: Expired and Undated Medications Found
Penalty
Summary
The facility failed to adhere to proper medication management protocols, resulting in the presence of expired and improperly labeled medications. During an observation of Medication Cart #1, it was found that an opened bottle of Latanoprost eye drops, used for treating glaucoma, was stored at room temperature without an opening date. The manufacturer's guidelines specify that once opened, Latanoprost should be stored at room temperature for no more than six weeks, and the absence of an opening date made it impossible to determine if this guideline was being followed. Additionally, a bottle of docusate sodium liquid, used to treat constipation, was found to be expired since 01/31/25, yet it remained in the cart with 15 ounces still available for use. Interviews with the nursing staff and administration revealed a lack of compliance with the facility's medication management policies. Nurse #2 acknowledged the oversight, stating that medication carts are supposed to be checked by the third shift nurse every Sunday to ensure proper storage and removal of expired medications. However, the expired docusate solution and the undated Latanoprost eye drops were not identified during these checks. Both the Director of Nursing and the Administrator expressed their expectations that all medications should be dated upon opening and that expired medications should be routinely removed, indicating a gap between policy and practice within the facility.
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 61 citations issued within 25 miles in the last 12 months — including the 2 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
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 Waynesville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Skyland Terrace And Rehabilitation | 3.6 mi | ★★★★★ | 3 | 0 |
| Silver Bluff | 5.9 mi | ★★★★★ | 14 | 0 |
| Autumn Care Of Waynesville | 6.4 mi | ★★★★★ | 1 | 0 |
| Maggie Valley Health And Rehabilitation Center | 8.2 mi | ★★★★★ | 4 | 0 |
| Pisgah Manor Health Care Center | 16 mi | ★★★★★ | 1 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Smoky Mountain Health 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.