Home / North Carolina / Waynesville
Skyland Terrace and Rehabilitation
516 Wall Street, Waynesville, NC 28786 · Haywood County · (828) 452-3154
90 certified beds, about 83 residents a day · For profit - Corporation · Medicare and Medicaid since 1992
Certified for Medicaid Certified for Medicare
Overall
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
3 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 345411 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on February 19, 2026, inspectors cited 3 health deficiencies (the North Carolina average is 4.7, the national average 9.2).
Of 13 health citations since July 2023, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists 1 fine totaling $8,512 in the last three years; the largest was $8,512, and the latest is dated December 6, 2024.
Nurses and nurse aides worked 3.39 hours per resident per day, against 3.85 across North Carolina and 3.86 nationally. Registered nurses accounted for 0.65 of those hours.
53.3% of nursing staff left within the year CMS measured (North Carolina average 49.0%).
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.
507/23
412/24
104/25
302/26
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
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 13 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
1G
0H
0I
Potential for more than minimal harm
9D
3E
0F
Potential for minimal harm
0A
0B
0C
February 19, 2026Standard inspection · 3 citations
- D Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Inspectors wroteBased on record review and staff interviews, the facility failed to update a care plan to reflect a change of code status for 1 of 18 residents reviewed for care plans (Resident #40).
- D Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on a record review and staff interviews, the facility failed to have a nurse assess a resident who had fallen prior to moving the resident for 1 of 2 residents reviewed for falls (Resident #34).
- D Develop and implement policies and procedures for flu and pneumonia vaccinations.
Inspectors wroteBased on record review and staff interviews, the facility failed to administer a pneumococcal vaccine to a resident who had consented to receive the vaccine for 1 of 5 residents reviewed for pneumococcal vaccines (Resident #72).
April 30, 2025Complaint inspection · 1 citation
- D 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, family, and staff interviews, the facility failed to protect a resident's right to be free from abuse when a family member (Family Member #1) hit Resident #1 on the leg, covered her mouth with her hand, and told her to shut up. This affected 1 of 3 residents reviewed for abuse (Resident #1).
December 6, 2024Standard inspection, Complaint inspection · 4 citations
- G Provide medically-related social services to help each resident achieve the highest possible quality of life.
Inspectors wroteBased on record review, observations, and resident, staff, Physician, Nurse Practitioner (NP), Physician Assistant (PA) and neurology office Scheduler interviews the facility failed to ensure a neurology appointment was scheduled for a resident (Resident #14). The Physician ordered a neurology referral for Resident #14 first on 8/23/24 for evaluation of her tremors. A second neurology consult was ordered by the NP on 11/5/24 again for evaluation of her tremors. Resident #14 had tremors to her upper and lower extremities, including her hands and feet. Resident #14 reported her tremors had worsened, were unmanageable, made her feel awful, and like she could not do anything. Resident #14 reported the tremors made her not want to leave her room because she did not want people to see her in that state. [...]
- D Protect each resident from the wrongful use of the resident's belongings or money.
Inspectors wroteBased on record review, and resident, staff, and Senior Police Officer interviews, the facility failed to protect the resident's right to be free from misappropriation of resident property. This deficient practice was for 1 of 1 resident reviewed for misappropriation of resident property (Resident #78).
- D Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Inspectors wroteBased on observations, record review, resident, staff, and wound care center Nurse Practitioner (NP) interviews the facility failed to follow physician orders from the wound care center for the treatment of a stage II pressure ulcer (partial thickness open wound) for 1 of 2 residents reviewed for services to prevent and treat pressure ulcers (Resident #233).
- D 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 nutritional supplement from 1 of 2 nourishment room refrigerators. This practice had the potential to affect residents who received nutritional supplements.
July 14, 2023Standard inspection · 5 citations
- E Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Inspectors wroteBased on record review and interviews with the resident, staff, Consultant Pharmacist, and Medical Director (MD), the Consultant Pharmacist failed to identify drug irregularities and provide recommendations for 2 of 7 residents reviewed for unnecessary medications (Residents #24 and Resident #38).
- E Ensure that residents are free from significant medication errors.
Inspectors wroteBased on record review and interviews with the resident, staff, Consultant Pharmacist, and the Medical Director (MD), the facility failed to prevent a significant medication error when nurses failed to follow physician's perimeter setting as ordered during insulin administration. As a result, Resident #24 received 2 doses of unnecessary Novolog insulin within 1 day, and Resident #38 had received 34 doses of unnecessary Novolog insulin in June 2023, 13 doses of unnecessary Novolog insulin in July 2023. This affected 2 of 7 residents reviewed for significant medication errors (Resident #24 and Resident #38).
- 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 maintain a walk-in refrigerator from an accumulation of thick, clumpy grayish matter on the circulatory fan cover and thick, clumpy darkish buildup on the floor of 1 of 2 walk-in refrigerators. In addition, the facility failed to discard 2 opened loaves of expired bread. This practice had the potential to affect foods served to residents.
- D Ensure each resident receives an accurate assessment.
Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) regarding smoking for 1 of 1 resident reviewed for smoking (Resident #58).
- D Ensure each resident’s drug regimen must be free from unnecessary drugs.
Inspectors wroteBased on record reviews and interviews with Resident, staff, Consultant Pharmacist, and Medical Director (MD), the facility failed to monitor cholesterol level for 1 of 7 residents reviewed for unnecessary medications (Resident #24).
Fire safety inspections
6 fire safety citations on file: 4 on February 19, 2026, 2 on July 14, 2023.
Every fire safety citation6 citations
- F Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- E Have properly installed electrical wiring and gas equipment.
- D Install emergency lighting that can last at least 1 1/2 hours.
- D Have approved installation, maintenance and testing program for fire alarm systems.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| December 6, 2024 | Fine | $8,512 |
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) | 3.39 | 3.85 | 3.86 |
| Registered nurses | 0.65 | 0.62 | 0.69 |
| All nursing staff on weekends | 3.00 | 3.42 | 3.42 |
| Nurse aides | 1.98 | ||
| Licensed practical nurses | 0.77 | ||
| Nursing staff turnover (share who left in a year) | 53.3% | 49.0% | 45.8% |
| Registered nurse turnover | 40.0% | 45.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.60 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 3.55 on weekdays and 3.00 on weekends, 15% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 32.4% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.77 in April to June 2025 to 3.39 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 | 3.39 | 0.65 | 3.55 | 3.00 | 32.4% | 0 of 90 | 83 |
| Oct to Dec 2025 | 3.64 | 0.49 | 3.80 | 3.23 | 36.9% | 0 of 92 | 83 |
| Jul to Sep 2025 | 3.68 | 0.53 | 3.80 | 3.36 | 37.3% | 0 of 92 | 83 |
| Apr to Jun 2025 | 3.77 | 0.58 | 3.91 | 3.41 | 33.2% | 0 of 91 | 81 |
| 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.
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 | 23.9 | 15.6 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 1.8 | 0.7 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 1.3 | 2.3 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 3.4 | 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 | 14.9 | 18.3 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 3.8 | 5.5 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 11.8 | 14.0 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 5.7 | 22.9 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 11.3 | 12.9 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.9 | 1.8 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.6 | 1.8 | 1.8 |
Owners and operators
Legal business name: COOLGATE INC.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Cooley, Mistie | 5% or greater direct ownership interest | Individual | 49% | 10/01/2022 |
| Gatewood, Thomas | 5% or greater direct ownership interest | Individual | 51% | 10/01/2022 |
| Cooley, Mistie | Managing control - governing body | Individual | 10/01/2022 | |
| Cooley, Mistie | Corporate officer | Individual | 10/01/2022 | |
| Gatewood, Thomas | Corporate officer | Individual | 10/01/2022 | |
| Cooley, Mistie | Operational/managerial control | Individual | 01/19/2025 | |
| Gatewood, Thomas | Operational/managerial control | Individual | 01/19/2025 |
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.
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 3 problems in this area, most recently on February 19, 2026: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
- How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 3 problems in this area, most recently on July 14, 2023: "Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures."
- How are allegations of abuse or neglect reported and investigated, and who tells the family?Inspectors cited 2 problems in this area, most recently on April 30, 2025: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody."
- 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 December 6, 2024: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards."
- Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.00 hours per resident per day, below the North Carolina average of 3.42.
Other nursing homes nearby
- Autumn Care of Waynesville Waynesville, 2.9 mi · 1 of 5 stars · 31 citations
- Smoky Mountain Health and Rehabilitation Center Waynesville, 3.6 mi · 3 of 5 stars · 10 citations
- Silver Bluff Canton, 5.8 mi · 3 of 5 stars · 14 citations
- Maggie Valley Health and Rehabilitation Center Maggie Valley, 6.8 mi · 2 of 5 stars · 17 citations
- Vero Health & Rehab of Sylva Sylva, 15.2 mi · 1 of 5 stars · 53 citations
- Skyland Care Center Sylva, 15.3 mi · 4 of 5 stars · 10 citations
- Pisgah Manor Health Care Center Candler, 18.1 mi · 2 of 5 stars · 12 citations
- Tsali Care Center Cherokee, 20.2 mi · 2 of 5 stars · 82 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 Skyland Terrace and Rehabilitation's Medicare star rating?
- CMS rates Skyland Terrace and Rehabilitation 4 out of 5 stars overall, with 4 for health inspections, 3 for staffing and 3 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Skyland Terrace and Rehabilitation get at its last inspection?
- 3 health deficiencies at the standard inspection on February 19, 2026. The North Carolina average is 4.7.
- Has Skyland Terrace and Rehabilitation been fined?
- Yes. CMS lists 1 fine totaling $8,512 in the last three years.
- Does Skyland Terrace 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 Skyland Terrace and Rehabilitation?
- CMS lists 7 owners and managers. Legal business name: COOLGATE INC.
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.