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 Skyline Nursing & Rehabilitation during CMS and state inspections, most recent first.
An LPN administered another resident’s meds to a severely cognitively impaired resident after confusing two similar-looking residents who sat in the same dining area. The resident became unresponsive with low BP, irregular respirations, and decreased O2 sat, and EMS transferred the resident to the ED after the error was discovered.
Failure to Notify Provider of Changes in Condition: Staff failed to notify the MD of changes in condition for three residents. One resident was transferred to the ER after an arrhythmia was noted, but there was no evidence the provider was informed. Another resident with DM had a BG of 56 and insulin and metformin were held without documentation that the provider was notified. A third resident with CHF had ordered weight-monitoring parameters, but weight gains meeting the notification threshold were not reported to the MD.
Facility staff failed to notify the state LTC ombudsman of a resident’s emergency transfer to a higher level of care. The resident had multiple diagnoses, including a fracture, and severe cognitive impairment with a BIMS score of 3/15. A nursing note documented EMS transport to the ED, but the administrator stated the facility did not notify the ombudsman when a resident was sent to the hospital and later returned. The facility policy required evidence that ombudsman notice was sent for emergency transfers.
Facility staff failed to process a provider order for a fluticasone inhaler for one resident with COPD and severe cognitive impairment, delaying the new medication after budesonide was discontinued. Staff also failed to follow ordered diabetes medications for another resident with severe cognitive impairment, including missed Lantus, metformin not given due to poor intake, and Humalog entries coded as not required or held without supporting notes.
Failure to Apply Ordered Knee Brace for Contracture Management: A resident with severe cognitive impairment, quadriplegia/paraplegia, and multiple contractures was observed in bed with a wedge under the hips but without the ordered right knee brace in place. Although the TAR showed the brace as applied, staff told the surveyor the restorative aides had not yet gotten to the room. The care plan directed staff to apply the brace with the wedge for contracture management, and the facility policy required appropriate equipment such as braces or splints to maintain ROM.
A resident with acute and chronic respiratory failure and COPD did not have a provider-ordered fluticasone propionate inhaler available for administration, and the MAR documented the dose as held with nurse notes. Nursing notes showed the facility was awaiting the medication from the pharmacy and later contacted the pharmacy about the unavailability. During meetings with the DON, Administrator, and Nurse Educator, staff acknowledged the medication had not been available, and the facility identified a local pharmacy as a backup pharmacy.
Facility staff failed to follow up on pharmacy recommendations for three residents after MRRs. The records for residents with dementia and other significant diagnoses showed pharmacist notes directing staff to see the report for irregularities and/or recommendations, but the actual pharmacy recommendation reports could not be located. Leadership stated the pharmacy could not access the electronic record at the time, and no resident-specific recommendation documentation was available to surveyors.
Incomplete and inaccurate resident records: One resident’s chart contained another resident’s DNR form, while another resident’s TAR documented a right knee brace as applied even though survey observations did not show the brace in place. The second resident had significant cognitive and physical impairments, including TBI, quadriplegia/paraplegia, and multiple contractures, and the order called for the brace to be placed for contracture management. Staff reported the restorative aides normally apply the brace, but it was not observed during the surveyor’s visits.
Failure to Follow Enhanced Barrier Precautions: The facility failed to maintain its infection prevention and control program by not consistently applying EBP for residents with wounds and indwelling medical devices. A surveyor found that only one resident with a dialysis access port was listed on EBP, while the facility matrix showed residents with catheters, a stage II pressure ulcer, and a feeding tube with a trach; an RN stated long-term catheters, feeding tubes, and trachs were not placed on EBP if they had no adverse effects, despite the facility policy requiring EBP for these devices and for high-contact care activities.
Failure to Document COVID-19 Vaccine Education and Consent for Staff: The facility failed to provide evidence that staff were educated on the risks, benefits, and potential side effects of the COVID-19 vaccine and failed to provide evidence of informed consent for staff vaccination. The administrator stated that employees who wanted the vaccine were ordered it from the pharmacy and administered it, but no evidence was available showing staff education, acceptance, or declination. An LPN and three CNAs later stated they were offered the vaccine and education, and the facility policy required regular staff education and counseling on COVID-19 vaccination.
Medication given to wrong resident caused unresponsiveness and ED transfer
Penalty
Summary
The facility failed to ensure one resident was free from a significant medication error when an LPN administered another resident’s medications to a severely cognitively impaired resident with diagnoses including other encephalopathy, Alzheimer’s disease, vascular dementia, and malignant neoplasm of the sigmoid colon. The resident’s most recent MDS showed a BIMS score of 3 out of 15, indicating severe cognitive impairment. Clinical records documented that the resident was brought to the ED after an episode of unresponsiveness following receipt of another resident’s medications, including 150 mg Klonopin, 100 mg Sertraline, and 1 mg Benztropine, and EMS noted oxygen saturation of 88% on room air at the scene. The nurse’s progress note stated that after administering medications, the nurse realized the medications had been given to the wrong resident. Vital signs were obtained, and the resident was initially alert and at baseline, then became unresponsive with blood pressure of 70/54, oxygen saturation of 90%, irregular respirations, and no response to verbal or tactile stimulation. EMS was called and the resident was transferred to the ER. The LPN stated she was working on a wing that was not her normal assignment and had prepared and administered medications to the resident she thought was another resident because the two were similar in appearance and sat in the same area of the dining room. The facility policy in effect stated to identify the resident by photo in the MAR.
Failure to Notify Provider of Changes in Condition
Penalty
Summary
The facility failed to notify a medical provider of a change in condition for 3 of 24 sampled residents. The report identified Resident #5, Resident #39, and Resident #51 as the affected residents. The facility policy titled Notification of Changes stated that the facility must consult the resident's physician when there is a change requiring notification, including a transfer or discharge of the resident and significant changes in condition. For Resident #5, who had diagnoses including chronic kidney disease stage 4, hypertension, COPD, atherosclerotic heart disease, chronic respiratory failure with hypoxia, and diabetes mellitus type 2, staff documented that the resident was sent to the ER from a cardiology appointment after an arrhythmia was noted. The resident had severe cognitive impairment with a BIMS score of 3. The nursing note stated that the RP was called and notified of the ER transfer, but the facility could not produce evidence that the medical provider was notified of the transfer to the hospital. For Resident #39, who had type 2 diabetes mellitus with hyperglycemia and severe cognitive impairment with a BIMS score of 3, staff documented a blood glucose of 56 and noted that Lantus was not administered. A later note stated that Metformin was not given because the resident did not eat breakfast and had recent low glucose readings. There was no note showing that the medical provider was notified of the low blood glucose or that the medications were held. For Resident #51, who had CHF, CKD, and hypertension and was cognitively intact with a BIMS score of 15, the resident had orders for daily weights and to notify the MD for a 2-pound weight change in 1 day or a 5-pound change in 1 week. The record showed weight increases of 3.2 pounds and 2.2 pounds on separate occasions, but the surveyor found no evidence that the MD was notified of the weight gains.
Failure to Notify Ombudsman of Emergency Transfer
Penalty
Summary
Facility staff failed to provide notification to the representative of the office of the state long-term care ombudsman when Resident #9 was transferred to a higher level of care on 10/22/25. Resident #9 had diagnoses including history of falling, age-related cognitive decline, osteoarthritis, restlessness and agitation, and an unspecified fracture of the upper end of the left humerus. The most recent significant change MDS, with an ARD of 11/14/25, showed a BIMS score of 3 out of 15, indicating severe cognitive impairment. A nursing progress note dated 10/22/25 documented that staff placed a call to EMS for transport to the ED. When the surveyor requested evidence that the ombudsman had been notified of the transfer/discharge, the administrator stated on 12/3/25 that the facility does not notify the ombudsman if a resident is transferred to the hospital and then returns because the resident was not discharged. The facility policy titled Transfer and Discharge stated that the facility will maintain evidence that notice was sent to the Ombudsman and that the Social Services Director, or designee, will provide copies of notices for emergency transfers to the Ombudsman.
Failure to Process Medication Order and Follow Insulin Orders
Penalty
Summary
Facility staff failed to process a provider order for a fluticasone propionate inhaler for a resident with acute and chronic respiratory failure and COPD. The provider discontinued budesonide nebulizers because they were nonformulary and ordered fluticasone HFA 220 mcg, 2 puffs inhaled twice daily with a spacer device. The order was not processed until several days later, and a nursing progress note documented that the nurse processed the physician request to discontinue budesonide and start fluticasone but failed to do so when the order was first written. The resident had severe cognitive impairment, with a BIMS score of 3, and the care plan directed staff to administer medications as ordered. During interview, an LPN stated the facility had a partial box of budesonide and wanted to use it up before starting the new medication, and the omission was discovered during a medication review audit. The facility was able to provide evidence that the order was transcribed later, but the report states the order was not processed when originally ordered. Facility staff also failed to follow physician orders for another resident with type 2 diabetes mellitus with hyperglycemia and severe cognitive impairment. The resident's orders included Humalog before meals, Lantus at bedtime, and metformin daily. The eMAR showed Lantus was not administered on one occasion, metformin was not given on one occasion because the resident did not eat breakfast and had a recent low glucose reading, and Humalog was coded as not required on two occasions when blood glucose readings were 95, and held per parameters on another occasion when blood glucose was 100. The DON stated nursing staff should have administered the insulin per the physician's order and should document anytime insulin is held, and the resident's progress notes contained no notes related to the incidents.
Failure to Apply Ordered Knee Brace for Contracture Management
Penalty
Summary
The facility failed to provide services and treatment to prevent further decrease in range of motion for a resident with multiple diagnoses including diffuse traumatic brain injury, muscle weakness, abnormalities of gait and mobility, quadriplegia, paraplegia, and contractures of both hands, knees, and ankles. The resident’s most recent MDS indicated severe cognitive impairment, with the resident rarely or never understood and having short- and long-term memory problems and severely impaired decision making. During observation, the resident was found lying in bed with bilateral knee contractures and a wedge beneath the hips, but a right knee brace was not in place. A medical provider order dated 11/1/25 directed staff to place a knee brace on the right knee with a wedge at the hip to prevent abduction and external rotation of the hip for contracture management, and the December TAR showed the brace as applied on 12/2/25 and 12/3/25. However, when the resident was observed on both days, staff did not have the brace on the resident, and an RN stated the restorative aides were probably busy and had not yet applied it. The resident’s care plan included impaired physical mobility related to traumatic brain injury with paraplegia/quadriplegia and directed staff to place the knee brace on the right knee with a wedge at the hip as ordered. The facility later provided an orthotic maintenance and wearing schedule signed by a PTA, and on 12/4/25 new orders were issued changing the brace schedule to while in bed only and while in chair. The facility policy stated it would provide interventions to maintain ROM, including appropriate equipment such as braces or splints.
Medication Unavailable for Resident with COPD
Penalty
Summary
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist was not met when facility staff failed to ensure a provider-ordered Fluticasone Propionate inhaler was available for administration for Resident #4 on 12/01/25 and 12/02/25. Resident #4 had diagnoses of acute and chronic respiratory failure and COPD, and the annual MDS dated 11/14/25 showed a BIMS score of 3, indicating severe cognitive impairment for daily decision making. The care plan for COPD included administering medications as ordered, and the provider order for Fluticasone Propionate inhaler was written on 12/01/25 with a start date of 12/01/25 at 9:00 p.m. The MAR for 12/2025 showed a code of 5, meaning Hold/See Nurse Notes, for the inhaler at 9:00 p.m. on 12/01/25 and again at 9:00 a.m. on 12/02/25. Nursing documentation stated on 12/01/25 at 10:34 p.m. that the facility was awaiting arrival from the pharmacy, and on 12/02/25 at 10:31 a.m. that staff had contacted the pharmacy regarding the medication's unavailability. During meetings on 12/03/25 with the Administrator, DON, and Nurse Educator, staff were informed that the medication had not been available for administration on 12/01/25 and 12/02/25, and the Nurse Educator identified the facility as using a local pharmacy for a backup pharmacy. A policy regarding unavailable medications was requested but was not provided before the exit conference.
Failure to Follow Up on Pharmacy Recommendations
Penalty
Summary
Facility staff failed to follow up on pharmacy recommendations for three sampled residents after monthly medication regimen reviews. For Resident #11, who had chronic obstructive pulmonary disease, protein calorie malnutrition, adult failure to thrive, and vascular dementia, the clinical record showed a pharmacist note stating that a medication regimen review had been completed and to see the report for irregularities and/or recommendations, but the surveyor could not locate the report in the record. Facility staff told surveyors there had been an issue with the software system in 07/25 and that the pharmacist was unable to access the system, but no pharmacy recommendation was produced. For Resident #12, who had anxiety disorder, malignant neoplasm of prostate, muscle wasting and atrophy, cognitive communication deficit, and chronic pain, the record contained a medication regimen review stating to see the report for irregularities and/or recommendations, but the pharmacy recommendations report could not be located. The resident’s care plan included consultation with pharmacy and the MD to consider dosage reduction when clinically appropriate at least quarterly. For Resident #23, who had vascular dementia, COPD, type 2 diabetes mellitus, and asthma, the record also contained a medication regimen review stating to see the report for irregularities and/or recommendations, but no pharmacist recommendation was found in the clinical record. In each case, facility leadership stated the pharmacy could not access the electronic clinical record at that time, and no further information was provided to surveyors prior to exit.
Incomplete and inaccurate resident records
Penalty
Summary
The facility failed to ensure an accurate clinical record for Resident #6 by placing another resident’s Durable Do Not Resuscitate form in the resident’s chart. Resident #6’s record identified diagnoses including Alzheimer’s disease, unspecified, and the most recent MDS showed a brief interview for mental status score of 3 out of 15 in section C, indicating significant cognitive impairment. The incorrect DNR form was found during record review, and the concern about another resident’s information being in Resident #6’s record was discussed with the administrator, DON, staff educator, unit managers, and business office manager. The facility also failed to accurately document the application of a right knee brace for Resident #10. Resident #10 had multiple diagnoses including diffuse traumatic brain injury, muscle weakness, gait and mobility abnormalities, quadriplegia, paraplegia, and contractures of both knees and ankles, and the quarterly MDS indicated the resident was rarely/never understood with severe impairment in decision making. The medical provider order directed staff to place a right knee brace with a wedge at the hip for contracture management, but survey observations on two days did not show the brace on the resident’s right knee. Despite this, the December 2025 TAR documented the brace as applied and removed on one day and applied on the next day. RN #1 stated restorative aides apply the brace, and the DON reported one aide was on FMLA and the other was not working that day.
Failure to Follow Enhanced Barrier Precautions
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The deficiency centered on enhanced barrier precautions (EBP), with the facility not following the EBP process for residents with wounds and indwelling medical devices. A surveyor requested and received a list of residents on EBP, which identified one resident with a dialysis access port. A review of the facility matrix showed three residents with indwelling catheters, one resident with a stage II pressure ulcer, and one resident with a feeding tube and a tracheostomy; one resident with a catheter was on Transition Based Precautions related to an infection. During interviews, the infection preventionist/RN stated the facility was using EBP for residents at increased risk such as those with midlines, PICCs, wound vacs, ports, and catheters. Later, the RN stated she did not place long-term catheters, feeding tubes, or tracheostomies on EBP if they had no adverse effects, although she did place new admissions on EBP if warranted and residents with new catheters. The facility policy titled Enhanced Barrier Precautions, revised 11/13/25, stated an order for EBP would be obtained for residents with wounds and/or indwelling medical devices, including urinary catheters, feeding tubes, tracheostomy tubes, and midline catheters, and listed high-contact resident care activities such as dressing, bathing, transferring, hygiene, linen changes, brief changes or toileting assistance, and device care or use.
Failure to Document COVID-19 Vaccine Education and Consent for Staff
Penalty
Summary
The facility failed to provide evidence of education regarding the risks, benefits, and potential side effects of the COVID-19 vaccine for facility employees, and failed to provide evidence of informed consent for the COVID-19 vaccine for facility employees. During the infection prevention review, the surveyor requested evidence of staff screening and eligibility, provision of education, risks versus benefits, and offering and administration of the COVID-19 vaccine. The administrator stated that if an employee wanted the vaccine, the facility ordered it from the pharmacy and administered it, and if an employee did not want the vaccine, the facility did nothing. The administrator could not provide evidence that employees had been educated or that they had refused or accepted the vaccine. Later, the administrator provided a document titled Staying Up to Date with COVID-19 Vaccines, along with a COVID-19 Vaccine Consent Form and an Informed Consent for COVID-19 Vaccine, and stated that starting that day the facility would have employees sign the consents and receive education about the vaccine and declinations. During interviews, an LPN and three CNAs stated they were offered the COVID-19 vaccine and education about the vaccine. The facility policy titled COVID-19 Prevention, Response and Reporting stated the facility should offer resources and counseling to healthcare personnel on the importance of receiving the COVID-19 vaccine and staying up to date with recommended doses, and that staff should be educated regularly.
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 27 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
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 Floyd
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Heritage Hall - Laurel Meadows | 16.1 mi | ★★★★★ | 0 | 0 |
| Blue Ridge Therapy Connection | 19.4 mi | ★★★★★ | 7 | 0 |
| Heritage Hall Blacksburg | 19.5 mi | ★★★★★ | 1 | 0 |
| Radford Health And Rehab Center | 20.4 mi | ★★★★★ | 0 | 0 |
| The Wybe And Marietje Kroontje Health Care Center | 20.6 mi | ★★★★★ | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Skyline Nursing & Rehabilitation.
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.