Home / North Carolina / Mars Hill
Madison Health and Rehabilitation
345 Manor Road, Mars Hill, NC 28754 · Madison County · (828) 689-5200
100 certified beds, about 85 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1981
CMS Care Compare ratings, data as of September 1, 2026 · CCN 345206 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on February 11, 2026, inspectors cited 1 health deficiency (the North Carolina average is 4.7, the national average 9.2).
Of 5 health citations since August 2023, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists 1 fine totaling $9,110 in the last three years; the largest was $9,110, and the latest is dated August 27, 2025.
Nurses and nurse aides worked 3.60 hours per resident per day, against 3.85 across North Carolina and 3.86 nationally. Registered nurses accounted for 0.67 of those hours.
37.9% of nursing staff left within the year CMS measured (North Carolina average 49.0%).
CMS links it to Sanstone Health & Rehabilitation, an affiliated group of 18 nursing homes.
Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 5 health citations on file.
February 11, 2026Standard inspection · 1 citation
- E Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observations and staff interviews, the facility failed to discard food with signs of spoilage and remove expired food items in 1 of 1 walk-in cooler; maintain a clean and sanitary ice machine for 1 of 1 ice machine; date an opened food item in 1 of 1 dry storage room; and label and date opened food items for 1 of 1 kitchen. These practices had the potential to affect food served to residents.
August 27, 2025Complaint inspection · 1 citation
- G Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Inspectors wroteBased on observations, record review and resident, staff and Medical Doctor interviews, the facility failed to protect a resident's (Resident #2) right to be free from physical abuse when a resident (Resident #1) with moderate cognitive impairment and no previous history of behaviors or aggression, hit Resident #2 in the face, head and neck causing injuries. Resident #1 continued to show aggression toward staff members until Nurse Aide (NA) #1 was able to get him redirected back to his bed at which point Resident #1 stated he had injured Resident #2. Resident #2 was immediately removed from the room and sent to the hospital for further evaluation. [...]
November 15, 2024Standard inspection · 1 citation
- E Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observations and staff interviews the facility failed to remove expired food from 1 of 3 kitchen refrigerators (walk-in refrigerator). This practice had the potential to affect food served to residents. Findings Included An observation of the walk-in refrigerator in the kitchen on 11/12/24 at 9:40 AM with the Dietary Manager (DM) found one resealable plastic bag dated 11/3 that contained deli meat. The DM stated during the observation that opened and stored food should be kept for 7 days and then thrown out; she immediately removed the food. The DM stated the morning cook checks the walk-in refrigerator each morning for food out of date and discarded them. She stated the deli meat dated 11/3 was overlooked when the refrigerator was checked for expired food earlier in the day. The Administrator was interviewed on 11/15/24 at 2:09 PM. [...]
August 30, 2023Standard inspection · 2 citations
- D Allow residents to self-administer drugs if determined clinically appropriate.
Inspectors wroteBased on observations, record review, interviews with the resident and staff, the facility failed to assess the capability to apply a topical pain-relieving gel for 1 of 1 resident reviewed for self-administration of medications (Resident #57).
- D Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure an opened bag of tube feeding formula, that was running through a feeding pump, was labeled with the date, time and resident's name for 1 of 2 sampled residents reviewed for tube feeding (Resident #36).
Fire safety inspections
13 fire safety citations on file: 3 on February 11, 2026, 1 on November 15, 2024, 9 on August 30, 2023.
Every fire safety citation13 citations
- E Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- D Have approved installation, maintenance and testing program for fire alarm systems.
- D Have properly installed electrical wiring and gas equipment.
- D Install corridor and hallway doors that block smoke.
- F Have properly installed electrical wiring and gas equipment.
- F Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- D Install emergency lighting that can last at least 1 1/2 hours.
- D Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D Provide properly protected cooking facilities.
- D Install an approved automatic sprinkler system.
- D Inspect, test, and maintain automatic sprinkler systems.
- D Install corridor and hallway doors that block smoke.
- D Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| August 27, 2025 | Fine | $9,110 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Staffing
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | North Carolina | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.60 | 3.85 | 3.86 |
| Registered nurses | 0.67 | 0.62 | 0.69 |
| All nursing staff on weekends | 3.02 | 3.42 | 3.42 |
| Nurse aides | 2.44 | ||
| Licensed practical nurses | 0.50 | ||
| Nursing staff turnover (share who left in a year) | 37.9% | 49.0% | 45.8% |
| Registered nurse turnover | 29.4% | 45.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.73 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.84 on weekdays and 3.02 on weekends, 21% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.1% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.27 in April to June 2025 to 3.60 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.60 | 0.67 | 3.84 | 3.02 | 0.1% | 0 of 90 | 85 |
| Oct to Dec 2025 | 3.54 | 0.75 | 3.81 | 2.84 | 0.1% | 0 of 92 | 89 |
| Jul to Sep 2025 | 3.51 | 0.74 | 3.87 | 2.59 | 0.1% | 0 of 92 | 88 |
| Apr to Jun 2025 | 3.27 | 0.71 | 3.60 | 2.45 | 0.1% | 0 of 91 | 92 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| North Carolina, Jan to Mar 2026 | 3.65 | 0.53 | 3.82 | 3.25 | 8.0% | 0.7% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
Staff pay at this home
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
Official wage estimates for North Carolina
| Job | Median | Middle half | Employed |
|---|---|---|---|
| North Carolina, all employers | |||
| CNAs (nursing assistants) | $18.49 | $17.28 to $21.08 | 64,010 |
| LPNs and LVNs | $30.42 | $28.50 to $33.51 | 18,010 |
| Registered nurses | $40.56 | $37.87 to $49.06 | 111,120 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | North Carolina | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 14.3 | 15.6 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.7 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 1.0 | 2.3 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 3.1 | 3.5 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.4 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 17.0 | 18.3 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.6 | 5.5 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 1.3 | 14.0 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 23.5 | 22.9 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 5.1 | 12.9 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.7 | 1.8 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 0.7 | 1.8 | 1.8 |
Owners and operators
Legal business name: MADISON HEALTH AND REHABILITATION, LLC. CMS links this home to Sanstone Health & Rehabilitation, a group of 18 nursing homes averaging 4.3 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Sprenger, Christopher | 5% or greater direct ownership interest | Individual | 12/14/2010 | |
| Madison Healthcare Properties, LLC | 5% or greater mortgage interest | Organization | 10/22/2013 | |
| Niebes, Haley | W-2 managing employee | Individual | 06/01/2019 | |
| Ardent Health and Rehabilitation Co | Operational/managerial control | Organization | 12/14/2010 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Questions to ask on a visit
Chosen from this home's own inspection record.
- Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 2 problems in this area, most recently on February 11, 2026: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards."
- How are allegations of abuse or neglect reported and investigated, and who tells the family?Inspectors cited 1 problem in this area, most recently on August 27, 2025: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 1 problem in this area, most recently on August 30, 2023: "Allow residents to self-administer drugs if determined clinically appropriate."
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 1 problem in this area, most recently on August 30, 2023: "Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube."
- Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.02 hours per resident per day, below the North Carolina average of 3.42.
Other nursing homes nearby
- Elderberry Health Care Marshall, 7.2 mi · 2 of 5 stars · 18 citations
- The Greens at Weaverville Weaverville, 9.2 mi · 3 of 5 stars · 12 citations
- Bear Mountain Health and Rehabilitation Asheville, 13.2 mi · 3 of 5 stars · 16 citations
- Emerald Ridge Health and Rehabilitation Asheville, 13.2 mi · 1 of 5 stars · 32 citations
- Smoky Ridge Health and Rehabilitation Burnsville, 14.3 mi · 2 of 5 stars · 22 citations
- River Bend Health and Rehabilitation Asheville, 15.5 mi · 1 of 5 stars · 52 citations
- The Laurels of Summit Ridge Asheville, 16.9 mi · 4 of 5 stars · 17 citations
- Nc State Veterans Home - Black Mountain Black Mountain, 17.3 mi · 5 of 5 stars · 13 citations
North Carolina contacts for a concern about a nursing home
These are the official offices in North Carolina. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: NC Division of Health Service Regulation, Nursing Home Licensure and Certification Section, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: North Carolina Long-Term Care Ombudsman Program. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: NC DHSR Regulated Facilities search (Statements of Deficiencies), where North Carolina publishes its own records on licensed homes.
Common questions
- What is Madison Health and Rehabilitation's Medicare star rating?
- CMS rates Madison Health and Rehabilitation 5 out of 5 stars overall, with 4 for health inspections, 4 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Madison Health and Rehabilitation get at its last inspection?
- 1 health deficiency at the standard inspection on February 11, 2026. The North Carolina average is 4.7.
- Has Madison Health and Rehabilitation been fined?
- Yes. CMS lists 1 fine totaling $9,110 in the last three years.
- Does Madison Health and Rehabilitation accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Madison Health and Rehabilitation?
- CMS lists 4 owners and managers, and links the home to Sanstone Health & Rehabilitation. Legal business name: MADISON HEALTH AND REHABILITATION, LLC.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.