Below 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 Asbury Place At Maryville during CMS and state inspections, most recent first.
A resident on hospice with neurocognitive disorder, dementia, anxiety, and adult failure to thrive experienced a rapid decline with labored tachypnea, tachycardia, clammy skin, and non-verbal signs of pain. A hospice nurse assessed the resident, determined the resident was actively dying, obtained urgent physician orders for Morphine, Ativan, and Hyoscyamine, and verbally instructed an LPN to obtain and administer these comfort medications from emergency stock. Although the faxed orders were successfully transmitted and emergency stock was available, the medications were never transcribed to the MAR or administered, and there was no documented ongoing monitoring after the hospice visit. The resident’s daughter and a family friend reported no assessments or medication administration during critical hours, and the DON and hospice nurse confirmed that the failure to provide the ordered comfort medications resulted in actual harm and that the resident died in agony.
Improper Food Storage and Nonfunctional Dietary Equipment: Surveyors found multiple dry storage and refrigerated food items available for resident use that were undated, unlabeled, or past use-by dates, including cereal, tortillas, wafers, cheese, and noodles. The dietary area also had a deep fryer and a reach-in refrigerator that were not operational, and the DON confirmed the foods had been stored improperly and were in violation of facility policy.
Failure to obtain informed consent for psychotropic meds was identified for four residents. Records showed residents with diagnoses including dementia, depression, anxiety, bipolar disorder, and psychosis received antipsychotic or antianxiety meds such as Quetiapine, Olanzapine, and Alprazolam, but no signed consent forms were in the chart. The ADON confirmed the missing psychotropic med consent forms.
Inaccurate MDS assessments were found for two residents. One resident had PASRR Level II findings for intellectual disability and serious mental illness, but the annual MDS did not reflect that status. Another resident had CHF documented in the chart and was receiving diuretics and other cardiac meds, but the admission MDS did not check Heart Failure as an active diagnosis; the RN MDS Coordinator confirmed both assessments were inaccurate.
Incomplete Comprehensive Care Plans for Two Residents: The facility failed to develop comprehensive care plans for two residents. One resident had PTSD, dementia, bipolar disorder, and intellectual disabilities, with a PASRR Level II outcome for intellectual disability and serious mental illness, but the care plan did not address the PASRR status. Another resident had CHF and pulmonary HTN, was receiving Lasix, metolazone, and metoprolol after a recent CHF exacerbation, but the care plan did not address the active HF diagnosis.
Care plan not updated and quarterly conference notices missing. A resident with CKD stage 5 on dialysis had a Perma Cath in the right chest, but the comprehensive care plan was not revised to reflect the device or related interventions after a physician note documented the catheter and AV fistula plan. In a separate case, a resident with CHF, dementia, and anemia had no documented quarterly care plan conference notes or invitations for the resident representative after an earlier IDT meeting, and staff could not locate the required documentation.
Unsecured medications were found in a resident’s room despite no order for self-administration. The resident had dementia and severe cognitive impairment, and surveyors observed eye drops, gas relief tablets, antacid chews, and antifungal powder left unsecured in the room; an RN confirmed the resident did not self-administer medications and that the medications were unsecured.
EBP was not followed for a resident on MDRO precautions. The resident had dementia, type 2 DM, depression, anxiety, moderate cognitive impairment, and was always incontinent of urine and bowel. During observation, a CNA entered the room, applied gloves, did not apply a gown, and provided incontinence care by changing the resident’s brief. The room had an EBP sign posted stating staff must wear gloves and gown for high-contact care activities, and the ADON confirmed the CNA failed to follow the facility’s infection control policy.
Failure to Administer Hospice Comfort Medications to Actively Dying Resident
Penalty
Summary
The deficiency involves the facility’s failure to timely transcribe and administer hospice physician comfort-medication orders for a resident who was actively dying and on hospice services. Facility policies on pain management and medication administration required prompt recognition and assessment of pain, implementation and carrying out of physician orders, and timely administration of medications, with documentation of any reason for not administering medications. The resident had diagnoses including Neurocognitive Disorder with Lewy Bodies, unspecified dementia, anxiety disorder, adult failure to thrive, and was on hospice services with a Do Not Resuscitate status. A quarterly MDS showed the resident was cognitively intact but required moderate to maximal assistance with activities of daily living. On the morning in question, the hospice nurse arrived at approximately 10:30 AM after being contacted by the resident’s daughter about a change in condition. The hospice nurse assessed the resident and documented that the resident had an expected very short life expectancy of days to one week, was near death, used non-verbal indicators of pain, had labored tachypnea at 32 breaths per minute, tachycardic and irregular heart rate at 132 beats per minute, warm and clammy skin, and no oral intake for two days. The hospice nurse determined the resident was actively dying and obtained physician orders for Morphine Sulfate, Ativan (Lorazepam), and Hyoscyamine, with scheduled and PRN dosing for comfort and secretion control. These written orders were faxed to the facility and pharmacy at 11:26 AM, marked urgent. The hospice nurse reported giving verbal orders and specific instructions to the LPN on duty to obtain the medications from the facility’s emergency stock and administer them immediately. Despite these orders and instructions, the medical record and Medication Administration Record showed no evidence that the comfort medications were transcribed into the resident’s MAR or administered at any time before the resident’s death that afternoon. Nurse’s notes by the LPN at 2:02 PM documented elevated heart rate, rapid respirations, lack of eating or drinking, and that the hospice nurse had evaluated the resident and stated the resident was actively dying, but there was no documentation of comfort-medication administration or ongoing monitoring after the hospice visit. The resident’s daughter reported observing her mother with altered mental status, faint moaning, rapid shallow breathing, pale and moist skin, and appearing in distress earlier that morning, and stated that during her absence from approximately midday until about 2:00 PM, a family friend at the bedside did not see staff assess or medicate the resident. Upon her return, the daughter questioned the LPN about the lack of Morphine or other medications and was told the medications were awaiting pharmacy delivery; the hospice nurse later informed the daughter that the medications could have been taken from the facility’s emergency stock. The former DON confirmed that Morphine, Lorazepam, and Hyoscyamine were maintained in emergency stock and could have been used immediately. The DON verified there was no evidence the ordered medications were administered, and the hospice nurse stated that the failure to administer comfort medications caused harm and, in her professional judgment, caused the resident to die in agony.
Improper Food Storage and Nonfunctional Dietary Equipment
Penalty
Summary
The facility failed to maintain safe food storage in the dietary department and failed to maintain fully operational equipment, affecting 115 residents. Review of the facility policy on sanitation and food safety required leftovers and open foods to be clearly labeled with discard dates, and specified that food items prepared in house or opened for later use must be labeled and dated according to the policy. During observation of the dry storage area, surveyors found multiple food items available for resident use that were either undated, past the manufacturer’s use-by date, or not properly labeled, including toasted oats, dry cereal, flour tortilla shells, vanilla wafers, coconut flakes, breading flakes, and dry macaroni noodles. Further observation of the walk-in refrigerator revealed a half pan of shredded Parmesan cheese with an open date but no use-by date, and a freezer bag containing a half block of American cheese with no label or use-by date, both available for resident use. In addition, the dietary department’s deep fryer was not operational and had been out of use since October 2025, and the reach-in refrigerator was also not operational and had been out of service for several months. The Dietary Manager stated she was uncertain when either piece of equipment would be repaired or replaced, and later confirmed the foods observed had been stored improperly and were in violation of facility policy.
Failure to Obtain Consent for Psychotropic Medications
Penalty
Summary
The facility failed to obtain informed consent for psychotropic medications for 4 residents reviewed for unnecessary medications. Facility policy titled, Psychotropic Drugs Usage, stated that any resident receiving a psychotropic medication must have a signed informed consent initiated when the medication starts. Review of the medical record showed Resident #11, who had diagnoses including Alzheimer's Disease, Dementia, Panic Disorder, and Major Depressive Disorder and a BIMS score of 0 indicating severe cognitive impairment, received Quetiapine 25 mg daily and Olanzapine 5 mg daily, but no consent form was found for either medication. Resident #92, with diagnoses including Vascular Dementia, Cognitive Communication Deficit, and Lack of Coordination and a BIMS score of 6 indicating severe cognitive impairment, received Quetiapine 12.5 mg daily with no consent form in the record. Resident #4, diagnosed with Dementia with Behavioral Disturbance and Depression and with a BIMS score of 0 indicating severe cognitive impairment, received Olanzapine 5 mg twice daily without a consent form on file. Resident #77, diagnosed with Anxiety Disorder, Bipolar Disorder, Major Depressive Disorder, Psychosis, and Mood Affective Disorder and with a BIMS score of 13 indicating cognitive intactness, received Alprazolam 0.5 mg twice daily without a consent form in the record. During an interview, the Assistant Director of Nursing confirmed there were no psychotropic medication consent forms in place for Residents #11, #92, #4, and #77.
Inaccurate MDS Assessments for PASRR Status and Heart Failure
Penalty
Summary
The facility failed to ensure accurate MDS assessments for 2 residents reviewed for MDS accuracy. For one resident, the record showed diagnoses including PTSD, dementia, bipolar disorder, and intellectual disabilities, and a Notice of PASRR Level II Outcome stated the resident met criteria for intellectual disability and serious mental illness. However, the annual MDS assessment indicated the resident was not currently considered by the state Level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. A Nurse Practitioner progress note also documented a history of major depressive disorder, bipolar disorder, anxiety disorder, dementia, trauma/stressor related disorder, and intellectual disability, and the MDS Coordinator confirmed the annual MDS was inaccurate. For the second resident, the record showed admission diagnoses of acute on chronic diastolic congestive heart failure and pulmonary hypertension. The MAR documented administration of Furosemide, Metolazone, and Metoprolol Tartrate during the look-back period, and a Nurse Practitioner progress note documented a history of diastolic congestive heart failure and a recent hospitalization. The admission MDS showed a BIMS score of 15 and did not check Heart Failure as an active diagnosis, despite the resident receiving diuretics and having heart failure documented in the medical record. The RN MDS Coordinator reviewed the records and confirmed the admission MDS was inaccurate and did not reflect the resident's active diagnosis of Heart Failure.
Incomplete Comprehensive Care Plans for Two Residents
Penalty
Summary
The facility failed to develop a comprehensive care plan for 2 of 26 residents reviewed for care planning. Facility policy stated that comprehensive care plans must expand on the resident’s risks, goals, and interventions using a person-centered approach, include measurable objectives and timetables, be finalized within 7 days of completion of the full comprehensive MDS assessment, and include any specialized services or specialized rehab services recommended through PASARR. The record for Resident #6 showed diagnoses including PTSD, dementia, bipolar disorder, and intellectual disabilities, and a PASRR Level II outcome dated 3/26/2021 indicated the resident met criteria for intellectual disability and serious mental illness. However, the comprehensive care plan revised 6/17/2025 did not address the resident’s Level II PASRR status, and the MDS Coordinator confirmed this during interview. The record for Resident #84 showed diagnoses including acute on chronic diastolic CHF and pulmonary hypertension. The MAR dated 11/20/2025 through 11/30/2025 showed the resident received Furosemide 80 mg twice daily, metolazone 5 mg daily, and metoprolol tartrate 50 mg twice daily. A Nurse Practitioner progress note dated 11/21/2025 documented recent hospitalization for acute diastolic CHF exacerbation and a plan to continue diuresis with Lasix and metolazone and continue metoprolol. However, the comprehensive care plan revised 12/2/2025 did not outline or address the resident’s active diagnosis of heart failure, and the RN MDS Coordinator confirmed this during interview.
Care Plan Not Updated and Quarterly Conference Notices Missing
Penalty
Summary
The facility failed to revise the care plan for Resident #3 after a physician progress note documented removal of a Perma Cath and placement of an AV fistula, with the Perma Cath scheduled for removal on 1/22/2026. Resident #3 was admitted with chronic kidney disease stage 5, dependence on renal dialysis, and presence of vascular implants and grafts. The quarterly MDS assessment showed the resident had a BIMS score of 15 and was cognitively intact and receiving dialysis. An observation on 1/12/2026 at 1:30 PM showed the resident had a Perma Cath in the right chest, but the comprehensive care plan dated 1/13/2026 had not been revised to include the Perma Cath or related interventions. The LPN MDS Coordinator and the Regional RN both confirmed the care plan had not been updated to reflect the Perma Cath. The facility also failed to provide Resident #105 and the resident representative notice of quarterly care plan conferences. Resident #105 was admitted with diagnoses including congestive heart failure, dementia, and anemia. A care plan meeting progress note dated 3/24/2024 showed the interdisciplinary team reviewed medications, diet, and activities, and the resident representative was invited to attend, but there was no documentation of additional care plan meetings after that date. The resident's daughter stated the family wanted more involvement in care planning, and the Social Services Director and Regional RN both confirmed they could not locate quarterly care plan meeting notes, documentation, or invitations since 3/18/2024.
Unsecured Medications Found in Resident Room
Penalty
Summary
The facility failed to ensure medications were secured in one resident’s room. The facility policy on Medication Self Administration stated residents who request to self-administer drugs must be assessed at admission or later to determine if the practice is safe, based on the Resident Assessment Self-administration Tool, and the assessment results are to be discussed with the attending physician with an order obtained if appropriate. Resident #43 was admitted with diagnoses including dementia, major depressive disorder, and metabolic encephalopathy, and a PPS Part A discharge MDS assessment showed a BIMS score of 6, indicating severe cognitive impairment. The physician’s orders showed no order for the resident to self-administer medications. During observation of the resident’s room, surveyors found unsecured medications in multiple locations: liquid tear eye drops on the bedside table, extra strength gas relief tablets and antacid chews on the bathroom sink, and miconazole nitrate 2% antifungal powder in the window seal. A later observation with RN A confirmed the same medications remained unsecured in the room. RN A stated the resident did not self-administer medications and confirmed the medications were unsecured.
Failure to Follow Enhanced Barrier Precautions During Incontinence Care
Penalty
Summary
The facility failed to follow its infection prevention and control policy for Enhanced Barrier Precautions for one resident. The policy titled "GUIDELINES for ENHANCED BARRIER PRECAUTIONS" stated that EBP is an extension of PPE and that gloves and gowns are to be used for high-contact resident care activities such as changing briefs and for resident care activities involving a resident with a known MDRO. Resident #15 was admitted and later readmitted to the facility with diagnoses including dementia, type 2 diabetes, major depressive disorder, and anxiety disorder. A quarterly MDS assessment showed the resident had moderate cognitive impairment and was always incontinent of urine and bowel, and a physician order dated 12/1/2025 indicated Enhanced Barrier Precautions for MDRO.
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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 Maryville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ocoee Transitional Care Center Llc | 1 mi | ★★★★★ | 4 | 0 |
| Fairpark Health And Rehabilitation | 2.8 mi | ★★★★★ | 0 | 0 |
| Shannondale Of Maryville Health Care Center | 3.4 mi | ★★★★★ | 3 | 0 |
| Foothills Transitional Care And Rehabilitation | 3.9 mi | ★★★★★ | 0 | 0 |
| Life Care Center Of Blount County | 6.6 mi | ★★★★★ | 0 | 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.