Above average — CMS composite of the measures below.
A standard survey is most likely before 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 Miletree Center during CMS and state inspections, most recent first.
A dietary aide was observed handling food trays, pushing a cart, and using a telephone without changing gloves or performing hand hygiene before returning to the tray line. This breach in infection control procedures was confirmed by the regional dietary manager and had the potential to impact multiple residents.
A resident with worsening incontinence-associated dermatitis (IAD) on the buttocks was not reported to the physician, legal representative, or dietician as required. Documentation showed the wound was deteriorating, but notification sections were left blank and there was no evidence in the medical record that appropriate parties were informed. The DON confirmed the lack of notification.
A resident's quarterly MDS assessment did not accurately reflect the use of an antianxiety medication, Buspar, as required in the medication section. This omission was confirmed by the DON during a review of unnecessary medications.
A resident's pre-admission screening did not reflect their current diagnosis of Major Depressive Disorder, as the PASARR form indicated no major mental illness while other documentation showed the diagnosis. The Administrator confirmed the screening was not updated to match the resident's current condition.
Two residents did not have all of their medical diagnoses included in their care plans, with missing conditions such as paraplegia, acute embolism, panic disorder, chronic hepatitis C, MRSA history, and others. The DON confirmed that the care plans were incomplete after record review.
A resident's care plan was not revised after an antidepressant (Celexa) was discontinued, and the care plan also incorrectly listed a diagnosis of Parkinson's Disease, which the resident did not have. These issues were confirmed by the DON during a record review.
A resident with depression and schizophrenia was prescribed Prozac 40mg daily, but staff did not document required behavior or side effect monitoring for this psychotropic medication. The DON confirmed the absence of such monitoring during the survey.
A resident with a physician order for a puree diet was served crackers by a kitchen aide, which the resident then crumbled into her soup before surveyor intervention. Documentation confirmed that only residents on a Dysphagia Advanced diet may have crackers, not those on a puree diet. The facility did not ensure food was served in the correct consistency as ordered.
Surveyors identified that the facility did not maintain accurate and complete medical records for two residents. One resident's POST form was incomplete, lacking a documented choice for medically assisted nutrition, while another resident's hospital transfer forms contained incorrect transfer dates due to a system issue. These deficiencies were confirmed by facility leadership during the survey.
A resident was not provided with breakfast or lunch trays on a specific day, as confirmed by both a nurse aide and an LPN. The facility's posted meal times were not adhered to for this resident, and the incident was substantiated by staff during a follow-up investigation.
The facility failed to accurately assess three residents, leading to deficiencies in documenting dental status and restraint use. A resident reported dental issues not reflected in their MDS, while two residents had physician's orders for seatbelt restraints that were not documented. The DON confirmed these inaccuracies, indicating lapses in record-keeping and assessment practices.
The facility failed to develop and implement comprehensive care plans for residents, leading to deficiencies in addressing specific health needs. A resident's care plan did not include a diabetes diagnosis, another lacked information on restraint use, and a third had unimplemented fall interventions and meal intake monitoring. Additionally, a resident's dental care needs were not addressed, with the DON admitting to not arranging a dental consult. These issues highlight significant gaps in care planning and implementation.
The facility failed to maintain nutritional standards for two residents, resulting in significant weight loss and inadequate documentation of meal intake. One resident experienced a 10.91% weight loss over four months, with recommendations for snacks and appetite stimulants not implemented. Another resident's meal percentages were inconsistently documented, complicating weight loss monitoring. The DON acknowledged the documentation gap.
The facility failed to document medication refrigerator temperatures on several dates in June and July 2024. A tour revealed missing records for specific PM shifts, contrary to the facility's policy requiring twice-daily checks. The DON confirmed the oversight.
A resident reported significant dental issues, including broken teeth and discomfort, but the facility failed to assist in obtaining dental care. Despite a care plan addressing oral health risks, there was no documentation of dental consultations. The DON acknowledged awareness of the issue but did not document or arrange for care, leading to the deficiency.
The facility failed to maintain proper infection control practices, as evidenced by improper storage of a used bath basin and bed pan in a resident's room, and uncovered transport of clean personal items on a linen cart. The DON confirmed these deficiencies, which were attributed to staff oversight.
The facility failed to ensure dignified meal service by delaying assistance to dependent residents and allowing staff to stand while feeding a resident. The DON confirmed these practices were inappropriate.
A facility failed to notify the ombudsman of a resident's multiple hospital transfers. The resident was transferred to an acute care facility three times, but the DON revealed that the staff responsible for notifications mistakenly thought the requirement only applied to discharges, not transfers.
A facility failed to provide bed hold notices for a resident transferred to an acute care facility on three occasions. The resident was transferred on specific dates, and upon review, it was found that no bed hold notices were documented. The DON confirmed that these notices were not completed.
A facility failed to transmit a Minimum Data Set (MDS) upon the discharge of a resident. The MDS Discharge Return Not Anticipated was completed but not transmitted within the required timeframe, exceeding 120 days. The Clinical Reimbursement Coordinator acknowledged the oversight and was unsure why the MDS was not transmitted.
A facility failed to provide adequate ADL care for a resident, who was observed to be unkempt with oily hair and facial hair. Despite not rejecting care, the resident received only two showers in the last 30 days. The DON confirmed the resident did not receive all scheduled showers, indicating a deficiency in maintaining personal hygiene.
A resident expressed a lack of participation in activities, despite their care plan indicating the importance of group activities. The resident participated in only eight activities during a 48-day stay. The Activity Director acknowledged the resident's infrequent attendance and lack of one-to-one visits, with no further documentation provided.
The facility failed to follow physician's orders for two residents regarding the release of seatbelt restraints every two hours for repositioning. Documentation was missing from the Treatment Administration Record for specific dates and times, as confirmed by the DON. This indicates a failure to adhere to the prescribed care plan.
A resident reported constant severe pain, but the facility failed to provide adequate pain management. Despite having prescriptions for pain medications, the resident's pain was not consistently addressed, and there were no defined parameters for PRN medication use. Staff interviews revealed that medication administration was based on subjective assessments rather than structured guidelines.
A facility failed to maintain an accurate medical record for a resident's transfer to an acute care facility. The transfer form incorrectly stated the transfer date, which was confirmed by the DON during an interview.
Failure to Maintain Infection Control During Food Service
Penalty
Summary
A deficiency was identified when a dietary aide failed to follow proper infection control procedures while serving food from the tray line in the resident dining room. The aide was observed wearing the same gloves while pushing a tray cart, using the telephone, and then returning to handle food items on the tray line without changing gloves or performing hand hygiene. This lapse in infection control was confirmed by the regional dietary manager, who acknowledged that gloves should have been removed and hand hygiene performed before resuming food service tasks. The incident was observed during a random opportunity and had the potential to affect more than an isolated number of residents, given the facility's census of 56 at the time.
Failure to Notify Physician, Responsible Party, and Dietician of Worsening MASD
Penalty
Summary
The facility failed to notify a resident's legal representative, attending physician, and dietician regarding a worsening Moisture-Associated Skin Damage (MASD) area, specifically Incontinence Associated Dermatitis (IAD), located on the resident's intergluteal cleft. Documentation from a Skin and Wound Evaluation indicated the wound was in-house acquired, measured 39.5 cm2, and was deteriorating, with denuded skin due to exposure to bodily fluids. Notification sections for the physician, responsible party, and dietician were left blank, and there was no evidence in the electronic medical record or progress notes that these parties were informed. The Director of Nursing confirmed that the facility could not provide documentation of the required notifications.
Inaccurate MDS Assessment for Medication Use
Penalty
Summary
A review of records for one resident revealed that the facility failed to provide an accurate Minimum Data Set (MDS) assessment. Specifically, the quarterly MDS assessment did not indicate the use of an antianxiety medication, Buspar, in the section related to medications. This omission was confirmed by the Director of Nursing (DON) during an interview after being notified of the discrepancy. The deficiency was identified during a review of five residents under unnecessary medications, with the facility census at 56 residents at the time.
Failure to Update PASARR with Current Mental Health Diagnosis
Penalty
Summary
The facility failed to ensure that a resident's Pre-admission Screening and Resident Review (PASARR) accurately reflected the resident's current mental health diagnosis. Documentation review showed that the pre-admission screening form indicated no major mental illness or suspected mental illness, while a separate diagnosis report listed Major Depressive Disorder, Single Episode, Unspecified. Staff interview with the Administrator confirmed that the pre-admission screening had not been updated to reflect the resident's current diagnosis at the time of admission. This deficiency was identified for one resident out of a facility census of 56, based on both documentation review and staff interview.
Care Plans Incomplete for Residents with Multiple Diagnoses
Penalty
Summary
The facility failed to develop and implement comprehensive care plans that included all current diagnoses for two residents. For one resident, the care plan did not address diagnoses such as non-Alzheimer's disease, paraplegia, transient paralysis, acute embolism and thrombosis of the lower extremity, obstructive and reflux uropathy, and retention of urine. For another resident, the care plan omitted multiple diagnoses, including panic disorder, dizziness, generalized muscle weakness, inflammatory liver disease, chronic viral hepatitis C, a history of MRSA, vestibular disorder, benign prostatic hyperplasia, urinary retention, obstructive sleep apnea, hypertension, hyperlipidemia, bilateral age-related nuclear cataract, dry eye syndrome, GERD, and constipation. These omissions were confirmed by the DON following record reviews.
Care Plan Not Updated After Medication Change and Incorrect Diagnosis Listed
Penalty
Summary
The facility failed to revise a resident's care plan after the discontinuation of a psychotropic medication and also listed an incorrect diagnosis in the care plan. Specifically, the care plan for a resident was not updated when Celexa, an antidepressant prescribed for depression, was discontinued. Additionally, the care plan incorrectly documented a diagnosis of Parkinson's Disease, despite the resident never having been diagnosed with this condition. These deficiencies were identified during a record review and confirmed by the Director of Nursing.
Failure to Monitor Side Effects and Behaviors for Antidepressant Medication
Penalty
Summary
The facility failed to follow a physician's order for a resident who had diagnoses of depression and schizophrenia. The resident was prescribed Prozac 40mg daily for depression, but there was no documentation of behavior or side effect monitoring for this antidepressant as required. This deficiency was identified during a record review, and the DON confirmed that such monitoring was not being conducted or documented for the resident receiving Prozac. This lapse was noted for one out of four residents reviewed in the care area of hospitalizations, with the facility census at 56 at the time of the survey.
Resident on Puree Diet Served Incorrect Food Consistency
Penalty
Summary
A resident with a physician order for a puree diet was served crackers on her plate during a meal service. The incident occurred when a kitchen aide placed crackers on the resident's plate, which was verified by the Regional Dietary Manager. The resident then crumbled the crackers and added them to her soup, preparing to eat the mixture before a surveyor intervened. Documentation from speech therapy indicated that only residents on a Dysphagia Advanced diet may have crackers with soups, but this resident was on a puree diet, which does not permit crackers. The facility failed to ensure that food was prepared and served in the correct consistency as ordered by the physician.
Incomplete Medical Records and Documentation Errors
Penalty
Summary
The facility failed to maintain accurate and complete medical records for two residents. For one resident, the Physician's Order for Scope of Treatment (POST) form dated 01/31/25 was found to be incomplete, specifically missing a documented choice in Section D regarding medically assisted nutrition options. This omission was confirmed by both the Administrator and the DON. For another resident, a review of transfer documentation revealed that the date on the second hospital transfer form was incorrect, listing an earlier year instead of the actual transfer date. The Administrator confirmed that the incorrect dates were due to a system issue. These findings were based on record reviews and staff interviews conducted during the survey process, affecting two of the 22 residents reviewed.
Failure to Provide Scheduled Meals to Resident
Penalty
Summary
The facility failed to provide at least three meals daily at regular times in accordance with resident needs, preferences, requests, and plan of care. Specifically, one resident did not receive a breakfast or lunch tray on a specified date, as confirmed by a facility-conducted Five-Day Follow-Up investigation. Both a nurse aide and an LPN acknowledged that the resident was not given a breakfast or lunch tray on that day. The posted meal times for residents were 7:15 AM for breakfast, 12:00 PM for lunch, and 5:15 PM for dinner. The administrator confirmed that the incident was substantiated by staff during the investigation.
Inaccurate Assessments for Dental Status and Restraint Use
Penalty
Summary
The facility failed to ensure accurate assessments for three residents, leading to deficiencies in the documentation of dental status and the use of restraints. Resident #47 reported significant dental issues, including broken teeth, which were not accurately reflected in their Minimum Data Set (MDS) assessment. The MDS inaccurately indicated that the resident had no natural teeth or tooth fragments and no obvious dental issues, despite the resident's visible dental problems and their own report of discomfort. The Director of Nursing (DON) acknowledged the oversight and the absence of any notes or dental consultations in the resident's chart. Additionally, the facility failed to document the use of restraints for Residents #42 and #20 in their MDS assessments. Both residents had physician's orders for seatbelt restraints while in wheelchairs due to their inability to maintain an upright sitting position independently. However, the MDS for both residents did not reflect the use of these restraints. The DON confirmed that the MDS for both residents was incorrect and should have indicated the use of restraints, highlighting a lapse in accurate record-keeping and assessment practices.
Deficiencies in Care Planning and Implementation
Penalty
Summary
The facility failed to develop and implement comprehensive care plans for several residents, leading to deficiencies in addressing their specific health needs. Resident #10's care plan did not include a diagnosis of diabetes mellitus, which was confirmed by the Director of Nursing (DON). Similarly, Resident #20's care plan lacked information regarding the use of restraints, which was also acknowledged by the DON. These omissions indicate a lack of thoroughness in the care planning process for these residents. Additionally, Resident #52's care plan was not properly implemented concerning fall interventions and meal intake monitoring. A fall mat, which was supposed to be placed on the left side of the bed, was missing, and meal intakes were not documented as required, hindering the dietician and physician's ability to monitor weight loss. Resident #47's dental care needs were not adequately addressed, as the resident reported significant dental issues, and the DON admitted to not having documented or arranged for a dental consult. These failures highlight significant gaps in the facility's care planning and implementation processes.
Failure to Maintain Nutritional Standards for Residents
Penalty
Summary
The facility failed to maintain acceptable nutritional parameters for two residents, as observed during the Long-Term Care Survey Process. Resident #9 experienced a significant weight loss of 10.91% over four months and 6% in one month. Despite a recommendation from the Registered Dietician to add snacks and consider an appetite stimulant, the facility did not implement these measures. The resident's meal intake records showed numerous days with no intake recorded or only 25% intake, and the physician's notes did not address the weight loss. The administrator acknowledged the lack of documentation regarding the resident's eating habits. Resident #52 also faced issues with nutritional management, as evidenced by significant weight fluctuations and inconsistent meal intake documentation. The care plan noted nutritional risk due to dementia, but meal percentages were frequently undocumented, making it difficult for the dietician and physician to monitor the resident's weight loss. The Director of Nursing admitted to not knowing why meal percentages were not documented, highlighting a gap in the facility's monitoring and documentation processes.
Failure to Document Medication Refrigerator Temperatures
Penalty
Summary
The facility failed to record temperatures for the medication refrigerator, which was identified during a tour of the medication room. On July 10, 2024, at 9:25 AM, it was observed that the medication refrigerator temperatures were not documented for several dates in June and July 2024, specifically on June 26, 27, 28, and July 8, 2024, during the PM shifts. The facility's policy, revised on July 1, 2024, requires that refrigerators and freezers used to store medications and vaccines operate within an acceptable temperature range and be checked twice daily. The Director of Nursing confirmed the lack of documentation for the refrigerator temperatures.
Failure to Provide Dental Care for Resident
Penalty
Summary
The facility failed to assist residents in obtaining routine and emergency dental care, as evidenced by the case of a resident who reported significant dental issues. During an interview, the resident expressed that their teeth were in poor condition, with some broken off at the gums, and they were experiencing discomfort. The resident mentioned financial constraints as a barrier to accessing dental care, stating they could not afford it. An observation confirmed the resident's poor dental condition, and a review of their care plan revealed a focus on oral health risks due to being edentulous, with goals and interventions aimed at maintaining oral health. Despite the care plan, there was no documentation of dental consultations or notes addressing the resident's dental issues. The DON acknowledged the resident's dental condition and admitted to being aware of the problem but failed to document or arrange for a dental consultation. This lack of action and documentation contributed to the deficiency, as the resident continued to experience dental pain and discomfort without receiving the necessary dental care.
Infection Control Deficiencies in Storage and Transport
Penalty
Summary
The facility failed to maintain an appropriate infection control program, as observed in two separate incidents. In room [ROOM NUMBER]A, a used bath basin and bed pan were found improperly stored in the bathtub, along with soiled washcloths on the side of the bathtub and hanging on the window seal. Nurse Aide #58 was informed and removed the items, acknowledging the oversight. The Director of Nursing confirmed the improper storage and disposal, attributing the oversight to a recent hospice visit for the resident's bath. Additionally, a linen cart containing clean personal items was observed being transported uncovered by Laundry Aide #38. The linen cart flaps were not secured, leaving the items exposed. Upon notification, the Laundry Aide admitted forgetting to cover the cart, and the Director of Nursing confirmed the requirement for the cart to be covered during transport.
Failure to Ensure Dignified Meal Service
Penalty
Summary
The facility failed to treat residents with respect and dignity during meal service in the main dining room and for a specific resident. In the main dining room, dependent residents had their trays placed in front of them simultaneously with other residents without dining limitations, but were not assisted until all trays were served and a staff member was available. This delay in assistance was confirmed by the Director of Nursing, who acknowledged that dependent residents should be assisted immediately when their tray is placed in front of them. Additionally, an observation of a resident during the noon meal revealed that an Occupational Therapist Aide was standing while feeding the resident. The Director of Nursing confirmed that staff should not stand while feeding residents, indicating a failure to adhere to proper feeding protocols.
Failure to Notify Ombudsman of Resident Transfers
Penalty
Summary
The facility failed to notify the ombudsman of multiple hospital transfers for a resident. The resident was transferred to an acute care facility on three occasions: September 30, 2023, October 1, 2023, and October 9, 2023. Upon review of the notifications to the ombudsman, the Director of Nursing (DON) admitted that there were no records of such notifications. The DON explained that the staff responsible for notifications misunderstood the requirement, believing it applied only to discharges and not to transfers.
Failure to Provide Bed Hold Notices for Hospital Transfers
Penalty
Summary
The facility failed to provide bed hold notices for a resident who was transferred to an acute care facility on three separate occasions. The resident was transferred on 09/30/23, 10/01/23, and 10/09/23. Upon review of the records on 07/10/24, it was found that the facility did not have any documentation of bed hold notices for these transfers. The Director of Nursing confirmed on 07/11/24 that the bed hold notices were not completed.
Failure to Transmit MDS Upon Resident Discharge
Penalty
Summary
The facility failed to transmit a Minimum Data Set (MDS) upon the discharge of a resident. The record review for the resident revealed that the MDS Discharge Return Not Anticipated was completed on March 1, 2024, but was not transmitted within the required timeframe, exceeding 120 days. During an interview, the Clinical Reimbursement Coordinator acknowledged the oversight and expressed uncertainty about the reason for the failure to transmit the MDS.
Deficiency in ADL Care for Resident
Penalty
Summary
The facility failed to provide adequate activities of daily living (ADL) care to maintain good personal hygiene for a dependent resident. During an observation, a resident appeared unkempt, with oily hair and facial hair, indicating a lack of proper grooming. A review of the resident's records showed that they did not reject care, yet only two showers were documented in the last 30 days. The Director of Nursing confirmed that the resident did not receive all scheduled showers, highlighting a deficiency in the facility's provision of ADL care.
Failure to Provide Adequate Activity Program for Resident
Penalty
Summary
The facility failed to provide an ongoing activity program that meets the physical, mental, and psychosocial well-being of each resident, as evidenced by the case of a resident who expressed a lack of participation in activities. During an interview, the resident mentioned that they used to attend activities but no longer do so and were unsure of the reasons. A review of the resident's medical records showed that they had participated in only eight out-of-room group activities during their 48-day stay at the facility. The Minimum Data Set (MDS) indicated that attending group activities was very important to the resident. The resident's activity care plan highlighted their preferences for engaging in meaningful daily routines, such as memory games, sensory activities, and group settings. Despite these preferences, the Activity Director acknowledged that the resident no longer attended group activities frequently and was not on a one-to-one visit schedule. The Activity Director admitted to seeing all residents daily, although this was not always documented. No further documentation regarding the resident's participation was provided by the end of the survey.
Failure to Document Restraint Release as Ordered
Penalty
Summary
The facility failed to adhere to physician's orders regarding the release of restraints for two residents. For Resident #42, a physician's order dated 05/31/24 required the release of a seatbelt restraint every two hours for repositioning. However, documentation was missing from the Treatment Administration Record (TAR) for specific times on 06/18/24 and 06/30/24. The Director of Nursing confirmed the absence of documentation for these dates and times. Similarly, for Resident #20, the same physician's order was in place, but the TAR lacked documentation for several dates and times in June and July 2024. The Director of Nursing also confirmed the missing documentation for these instances. This indicates a failure to follow the prescribed care plan for both residents, as the required actions were not documented as completed.
Inadequate Pain Management for Resident
Penalty
Summary
The facility failed to provide adequate pain management for a resident, identified as Resident #43, during the Long-Term Care Survey Process. The resident reported experiencing constant pain at a level of 8 or above and expressed dissatisfaction with the current pain management plan, stating that no effective pain medications were provided. The resident's medical records indicated prescriptions for Acetaminophen, Naprosyn, and Gabapentin, but there were no defined parameters for the administration of PRN pain medications. Despite the resident frequently reporting pain levels of 4 or 5, the Medication Administration Record showed that pain medications were not consistently administered or offered. Interviews with facility staff revealed a lack of clarity and consistency in administering PRN pain medications. The administrator acknowledged that the resident did not receive PRN medications unless requested, and there was no documentation to justify the decision not to administer pain relief. An LPN admitted that the decision to give medication was based on the resident's mood rather than a structured assessment of pain levels. The facility's policy required defined parameters for PRN medications, which were not in place, contributing to the deficiency in pain management for the resident.
Inaccurate Transfer Record for Resident
Penalty
Summary
The facility failed to maintain an accurate and complete medical record for a resident regarding their transfer to an acute care facility. The record review revealed that the transfer form for the resident indicated an incorrect transfer date. The resident was actually transferred on October 9, 2023, but the form incorrectly stated the transfer date as October 1, 2023. This discrepancy was confirmed by the Director of Nursing during a staff interview, who acknowledged the incorrect date on the transfer form.
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Illustrative
What surveyors actually found near you
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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.
Illustrative
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Spencer
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Roane General Hospital | 0.3 mi | ★★★★★ | 14 | 0 |
| Minnie Hamilton Health Care | 16.8 mi | ★★★★★ | 23 | 0 |
| Elizabeth Care Center | 17 mi | ★★★★★ | 11 | 0 |
| Mountain View Care Center | 19.2 mi | ★★★★★ | 7 | 0 |
| Clay Healthcare Center | 22.2 mi | ★★★★★ | 0 | 0 |
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