Mountain View of Bryson City

Inspectors wroteBased on observations and staff interviews, the facility failed to discard food with signs of spoilage and label and date food items in 1 of 1 walk-in cooler and maintain a clean and sanitary ice machine for 1 of 1 ice machine used to serve beverages to residents. These practices had the potential to affect food served to residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the areas of falls and Preadmission Screening and Resident Review (PASRR) for 7 of 22 residents reviewed for MDS accuracy (Resident #11, #20, #8, #9, #68, #10, and #76).

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a discharge care plan for 1 of 2 sampled residents reviewed for discharge (Resident #83).

Inspectors wroteBased on record review and staff interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) evaluation for residents who were admitted to the facility with serious mental health disorders for 2 of 6 residents reviewed for PASRR (Resident #2 and Resident #75).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to prevent the administration of expired medications for 1 of 5 residents reviewed for Medication Administration (Resident #71).

Inspectors wroteBased on observations, record review and interviews with the Nurse Practitioner (NP), a Family Member and staff, the facility failed to recognize a cognitively impaired resident had left the facility unsupervised. Staff were not aware the resident had exited the facility until a Family Member who was visiting reported a resident was wandering in the parking lot. The deficient practice occurred for 1 of 5 residents reviewed for accidents (Resident #87).

Inspectors wroteBased on observations and staff interviews, the facility failed to remove expired medications and secure an unattended medication cart for 2 of 4 medication carts reviewed for medication storage (A hall cart and C hall cart).

Inspectors wroteBased on observations, test tray and Speech Language Pathologist (SLP), Registered Dietitian (RD) and staff interviews, the facility failed to serve pureed food items with an applesauce or pudding-like consistency. This failure had the potential to affect 2 of 2 residents who had orders for an advanced dysphagia (difficulty swallowing) diet with pureed-texture foods (smooth, moist pudding-like foods that require no chewing).

Inspectors wroteBased on record review and resident and staff interviews, the facility failed to resolve and communicate the facility's efforts to address repeated dietary concerns voiced by residents during Resident Council meetings for 6 of 12 months reviewed (January 2026, February 2026, March 2026, April 2026, May 2026, and July 2026).

Inspectors wroteBased on observations and staff interviews, the facility failed to discard expired food from 1 of 1 walk-in cooler, date food items in 1 of 1 walk-in freezer, cover food items in 1 of 1 walk-in cooler, and remove expired food available for use from 1 of 1 dry storage room. This deficient practice had the potential to affect food served to residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to treat a resident in a dignified and respectful manner when Nurse Aide #1 raised her voice, yelled and argued with a resident causing the resident to become upset for 1 of 3 residents reviewed for dignity (Resident #122). A reasonable person would not want to be yelled at and could feel belittled, scared or threatened when spoken to in such an undignified manner.

Inspectors wroteBased on record review and interviews with staff, the facility failed to protect resident rights to be free from misappropriation of controlled medication for 1 of 7 residents reviewed for misappropriation of resident property (Resident #276).

Inspectors wroteBased on record review and staff interviews, the facility failed to implement their abuse policy and procedure by not maintaining evidence of an investigation into misappropriation of property and not immediately reporting an allegation of abuse to the Administrator/designee and not notifying local law enforcement or Adult Protective Services of allegations of abuse or misappropriation of property for 3 of 5 abuse investigations reviewed (Residents #12, #24, #27, #43, #223, #222).

Inspectors wroteBased on observation and record review, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the area of oxygen use for 1 of 3 residents reviewed for respiratory care (Resident #272).

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a baseline care plan within 48 hours of a resident's admission (Resident #272) and ensure a baseline care plan addressed insulin use for a resident with diabetes (Resident #73) for 2 of 4 residents reviewed for respiratory care and self-administration of medications.

Inspectors wroteBased on observations, record review, and resident and staff interviews, the facility failed to provide showers as scheduled to a resident dependent on staff assistance for bathing for 1 of 4 residents reviewed for activities of daily living (Resident #2).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to post cautionary and safety signage outside a resident's room that indicated the use of oxygen for 1 of 3 residents reviewed for respiratory care (Resident #272).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to secure medications stored at the bedside for 1 of 1 resident reviewed for medication storage (Resident #73).

Inspectors wroteBased on observations, record review, staff interviews, and review of the facility's policies and procedures, the facility staff failed to follow infection control procedures when Nurse #1 did not don a gown while administering Resident #51's tube feeding for 1 of 5 staff members observed for infection control practices.

Inspectors wroteBased on observation, record review and Responsible Party, staff, and Medical Doctor interviews, the facility failed to safely transfer a resident from the bed to the chair when one staff member used a mechanical lift resulting in the resident falling to the floor for 1 of 6 sampled residents reviewed for accidents (Resident #30). On 05/17/23, while being transferred one of the clasps attaching the sling to the mechanical lift malfunctioned resulting in Resident #30 falling out of the sling onto the floor. Upon initial nurse assessment, Resident #30 complained of no pain and had no obvious injuries but later that same day he complained of hip pain, was sent out to the hospital for evaluation, x-rays obtained revealed no hip fracture and he returned to the facility on [DATE]. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code Minimum Data Set (MDS) assessments in the areas of Preadmission Screening and Resident Review (PASRR), falls, pressure ulcer, skin and ulcer treatments, tobacco use, gradual dose reduction, and respiratory treatments for 7 of 24 sampled residents (Residents #8, #42, #39, #1, #19, #26, and #29).

Inspectors wroteBased on observations, record review, interviews with the Medical Doctor and staff the facility failed to set the alternating pressure air mattress at the correct setting based on the resident's weight for 3 of 4 residents reviewed for pressure ulcers (Resident #39, #24, and #1).

Inspectors wroteBased on observation and staff interviews the facility failed to cover and date an open food item in 1 of 1 walk-in freezer; ensure food items were labeled and dated in 2 of 2 nourishment rooms (A/B Hall and C/D Hall); and maintain a clean refrigerator and freezer in 1 of 2 nourishment rooms (C/D Hall). These practices had the potential to affect food served to residents.

Inspectors wroteBased on observations, record review, and staff interviews, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor the interventions that the committee put into place following the recertification and complaint investigation survey completed on 07/15/22. This was for one repeat deficiency originally cited in the area of infection prevention and control that was subsequently recited on the current recertification and complaint investigation survey of 01/26/24. The continued failure of the facility during two federal surveys of record shows a pattern of the facility's inability to sustain an effective Quality Assessment and Assurance Program.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to ensure staff implemented their infection control policy for Personal Protective Equipment (PPE) and hand hygiene when Nurse Aide (NA) #2, the Admissions Director, the Maintenance Director, and Nurse #4 failed to don N-95 facemasks and/or goggles upon entering and/or removing N-95 facemasks and sanitizing goggles upon exiting 3 of 3 resident rooms on special droplet contact precautions for COVID-19 (Rooms 106, 141 and 159); when Nurse #3 failed to perform hand hygiene after removing dirty gloves and before donning clean gloves during wound care for 1 of 3 residents reviewed for pressure ulcers (Resident #29); and when the Nursing Consultant and NA #3 failed to assist 3 of 3 residents with hand hygiene before meals for 2 of 2 dining observations (Residents #21, #46, and #229). [...]

Inspectors wroteBased on record review and staff interview the facility failed to include documentation in the medical record of education on the benefits, and possible side effects of the influenza vaccination and document refusal or acceptance of the influenza vaccination for 3 of 5 residents (Resident #17, Resident #19, Resident #55) reviewed for immunizations.

Inspectors wroteBased on observations, record review, interviews with residents and staff the facility failed to obtain physician orders and assess the ability to safely use medications observed at the bedside for 2 of 3 residents reviewed for self-administered medications (Resident #35 and #46).

Inspectors wrote2. Record review of the undated North Carolina Medicaid Uniform Screening Tool (NC MUST) inquiry document revealed Resident #48 had a Level I PASRR effective 02/22/23. There were no requests for an updated PASRR evaluation submitted or completed since 02/22/23. Resident #48 was admitted to the facility on [DATE] with diagnosis that included bipolar disorder and unspecified dementia mild without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the admission minimum data set (MDS) dated [DATE] revealed Resident #48 had not been evaluated by Level II PASRR and determined to have a serious mental illness, intellectual disability or other related condition. Resident #48 received antipsychotic medication on a routine basis. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to request a Preadmission Screening and Resident Review (PASRR) re-evaluation after a significant change in physical or mental status for 1 of 4 sampled residents reviewed for PASRR (Resident #8).

Inspectors wroteBased on record review and staff interview the facility failed to create a comprehensive care plan related to smoking for 1of 2 residents (Resident #74) reviewed for smoking.

Inspectors wroteBased on observations, record review, and interviews with staff the facility failed to provide nail care for 1 of 1 dependent resident reviewed for activities of daily living (Resident #24).

Inspectors wroteBased on record review and staff, Registered Dietician (RD), and Medical Director (MD) interviews the facility failed to address weight loss for 1 of 3 residents reviewed for nutrition (Resident #29).

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to attempt alternatives, review the risks and benefits, and obtain informed consent from the resident's Responsible Party (RP) prior to use of bed rails; comprehensively assess the risk of entrapment after the placement of an alternating pressure air mattress; and accurately assess the continued need for bed rails for 2 of 6 residents reviewed for bed rail use (Resident #1 and Resident #24).

Inspectors wroteBased on observation, record review, resident and staff interviews, the facility failed to provide drinks consistent with the resident's preference for 1 of 1 sampled resident (Resident #55).

Inspectors wroteBased on observations, record review, interviews with the Registered Dietitian and staff the facility failed to follow the physician's diet order for double portions of protein with meals for 1 of 3 residents reviewed for nutrition (Resident #39).

Inspectors wroteBased on observations of the meal service tray line, record review, and Registered Dietician (RD) and staff interviews the facility failed to provide portions of food from a standardized meal planning guide such as a spreadsheet. This failure had the potential to affect 77 out of 78 residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to document self-administered medications for 1of 3 residents reviewed for self-administration (Resident #55).