Home / North Carolina / Cherokee
267 Tsali Care Way, Cherokee, NC 28719 · Swain County · (828) 497-5048
100 certified beds, about 78 residents a day · Non profit - Corporation · Medicare and Medicaid since 1996
CMS Care Compare ratings, data as of September 1, 2026 · CCN 345475 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on August 1, 2025, inspectors cited 26 health deficiencies (the North Carolina average is 4.7, the national average 9.2).
Of 82 health citations since July 2023, 4 were rated as actual harm or immediate jeopardy to residents.
CMS lists 4 fines totaling $157,555 in the last three years; the largest was $118,938, and the latest is dated July 31, 2025.
Nurses and nurse aides worked 6.14 hours per resident per day, against 3.85 across North Carolina and 3.86 nationally. Registered nurses accounted for 1.30 of those hours.
47.2% of nursing staff left within the year CMS measured (North Carolina average 49.0%).
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.
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 82 health citations on file.
Inspectors wroteBased on document review, interview, record review, and policy review, the facility's Administrator and Director of Nursing (DON) failed to identify there was no physician order in the electronic medical record (EMR) orders to correctly identify all residents' code status, and failed to provide oversight of staff's audits of residents' EMR Code Status to ensure the audits were accurate and to make corrections to ensure sustained compliance with the citation which had the potential to affect 72 of 72 residents who resided in the facility.
Inspectors wroteBased on observations, interviews, record review, and review of the facility's policy titled Quality Assessment and Assurance Committee, the facility Quality Assurance and Performance Improvement (QAPI) committee failed to 1. ensure the QAPI committee policy addressed data collection and analysis, data and adverse event monitoring, and feedback; 2. track and analyze data and conduct at least one process improvement plan (PIP) this year; and 3. maintain implemented procedures and monitor interventions that the committee put into place following the recertification survey of 08/22/24 and the complaint surveys on 10/18/24 and 04/10/25. This was for deficiencies re-cited during the recertification and complaint survey conducted 07/28/25-08/01/25. The recited deficiencies included F 550, F 578, F645, F689, F698, and F761. [...]
Inspectors wroteBased on interview, record review and review of the facility policy titled Administrative-Residents Rights for Senior Service, the facility failed to ensure residents were informed of the risks of treatment of prescribed medications for four (4) of five (5) residents sampled for unnecessary medications (Resident #'s 1,4, 7 and 8).
Inspectors wroteBased on observations, interviews, record review and the facility's Medication Self-Administration and Storage policy, the facility staff failed to assess residents for safe self-administration and storage of medications/biologicals, i.e., medicated cough drops, Zinc Oxide topical ointment, Anesep antimicrobial skin wound cleanser, and Betadine Gluconate 4% Solution Antiseptic Surgical Scrub, left unsecured at the bedside for four (4) of 23 sampled residents (Resident #s 17, 18, 21, and 45).
Inspectors wroteBased on interview, record review, and review of the facility's policy titled Advance Directives Policy, the facility failed to ensure appropriate Advance Directives were readily available in resident records or appropriate Advance Directives were in place for six (6) of 23 residents (Resident #'s 16, 17, 27, 34, 51, and 66) reviewed for Advance Directives.
Inspectors wroteBased on observation, interview, and review of the facility's policy titled Resident Rights for Senior Services Policy, the facility failed to provide privacy for one (1) of 25 resident residents (Resident #51) during a temperature monitoring. The facility also failed to ensure staff did not leave resident protected health information (PHI) unattended, uncovered and visible on top of the [NAME] neighborhood's diabetic treatment cart for 13 of 23 sampled residents (Residents #s 1, 8, 10, 15, 18, 23, 24, 32, 44, 45, 58, 61, and 71).
Inspectors wroteBased on record review, interview, and review of the facility's policy titled Complaints and Grievances Policy, the facility failed to resolve a grievance timely for one (1) resident of 23 sampled residents (Resident #66).
Inspectors wroteBased on observations, interviews, and review of the facility's Medication Storage policy, the failed to ensure staff secured medication inside a locked medication cart and did not repeatedly leave one (1) of three (3) medication carts unlocked, unattended, and accessible to residents, staff, and the general public. The facility also failed to ensure staff did not leave one (1) of two (2) diabetic treatment carts unlocked and unattended.
Inspectors wroteBased on observations, interviews, and review of the facility's policies titled Personal Protective Equipment Policy, Catheter Drainage Bags and Tubing-Clinical Protocol, and Infection Control- Hand Hygiene, the facility failed to ensure 1. staff appropriately donned and doffed personal protective equipment (PPE) when providing laundry services; 2. staff kept indwelling catheter bags and/or tubing off the floor for one (1) of three (3) residents sampled for indwelling catheters (Resident #21); and 3. that during dining ,the staff performed hand hygiene before and after resident contact and after touching soiled surfaces (i.e. garbage can lid), and avoided touching inside of the residents' plates with while serving food.
Inspectors wroteBased on interviews, record review, facility policy review, and the online resource from the Centers for Disease Control and Prevention (CDC), the facility failed to ensure residents received education and were given the opportunity to accept or decline immunizations according to the CDC Adult Immunization schedule for four (4) residents (Resident #'s 21, 23, 45, and 71) of the five (5) residents reviewed for Immunizations.
Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to treat two (2) residents (Resident #6 and #23) in a dignified manner to promote the residents' quality of care and quality of life in a sample size of 23 residents who were reviewed for resident rights.
Inspectors wroteBased on interview, record review and review of the facility's policy titled (Facility Name) Administrative-Residents Rights for Senior Service, the facility failed to ensure Resident #4 was provided appropriate durable medical equipment (DME) that allowed the use of the bathroom for one (1) of twenty-three (23) sampled residents.
Inspectors wroteBased on record review, observation, interview, and review of the facility's policy titled Medication Regimen Review, the facility failed to ensure an order for an as needed (PRN) antipsychotic had a stop date and a supporting diagnosis for use for one (1) resident of five (5) sampled for unnecessary medications (Resident #7).
Inspectors wroteBased on observations, interviews, record reviews, and a review of the facility's Resident Assessment Instrument policy, facility staff failed to identify and document a skin tear injury on the comprehensive Minimum Data Set (MDS) for one (1) of three (3) residents reviewed for skin integrity (Resident #18).
Inspectors wroteBased on record review, interviews, and review of the facility's policy titled Pre-admission Screening and Resident Review (PASRR), the facility failed to complete the Preadmission Screening and Resident Review (PASRR) Level II upon a new qualifying mental health diagnosis for one (1) out of two (2) residents sampled for PASRR Level II (Resident #4 ).
Inspectors wroteBased on record review, interviews, and review of the facility's policy titled Pre-admission Screening and Resident Review (PASRR), the facility failed to ensure the accurate completion of the Level I PASRR and referral for Level II PASRR for a resident with a mental health diagnosis for one (1) out of two (2) residents sampled for PASRR (Resident #5).
Inspectors wroteBased on record reviews, observations, interviews, and review of the facility's policies Resident Rights for Senior Services, Behavioral Health Services and Trauma-Informed Care, and Care Plans - Nursing Facility, the facility failed to ensure staff developed and/or implemented comprehensive care plans for three (3) of 23 sampled residents reviewed, that included person-centered interventions for behaviors (Resident #7), trauma informed care (Resident #8), and restorative services (Resident #45).
Inspectors wroteBased on record review, interview, policy review, and review of Up To Date medical reference, the facility: 1. failed to ensure arrangements were made for a dermatology consult in accordance with a physician order for one (1) resident (Resident #27); 2. failed to ensure assessment and treatment for potential insect bites for one (1) resident (Resident #66); and 3. failed to ensure arrangements were made for a speech and language evaluation in accordance with an order for one (1) resident (Resident #21) of 23 sampled residents.
Inspectors wroteBased on interviews, record review, and review of the facility's policy titled Restorative Nursing Care, the facility failed to initiate restorative care nursing services for Activities of Daily Living (ADL) for two (2) residents out six (6) residents sampled for ADL decline and rehabilitation and restorative care (Residents' #3 and #5).
Inspectors wroteBased on record review, interview, and review of the facility policies titled Bathing and Dressing Policy and Activities of Daily Living (ADLs) Policy, the facility failed to ensure showers were provided at least twice a week as scheduled for one (1) resident of three (3) sampled residents for ADLs (Resident #66).
Inspectors wroteBased on observations, interviews, and record reviews, and review of the facility's Wound Care and Dressing Change-Clinical Protocol policy, facility staff failed to identify, treat, and/or implement appropriate measures to prevent friction-related skin tear/injuries during showering or personal care, in accordance with professional standards of practice for one (1) of three (3) residents reviewed, with fragile skin susceptible to injury (Resident #18).
Inspectors wroteBased on observations, interviews, and record reviews, and review of the facility's Restorative Nursing Care, policy, facility staff failed to provide or re-evaluate appropriate restorative treatment and services to increase, maintain and/or prevent decrease in range of motion (ROM) and/or mobility for one (1) of three (3) residents reviewed for limited ROM and/or mobility (Resident #s 45).
Inspectors wroteBased on observations, interviews, record reviews, and review of the facility's policy titled Fall Risk Reduction and Management, the facility staff failed to ensure fall prevention interventions were resident-centered, practicable, consistently implemented, and that adequate supervision was provided to prevent falls for two (2) of two (2) residents reviewed with a history of multiple falls (Residents' #18 and #33). Additionally, staff failed to document its assessment and safety education for the use of smokeless (chewing) tobacco and offer nicotine cessation alternatives for one (1) of one (1) resident who used smokeless tobacco (Resident #71).
Inspectors wroteBased on interviews, record review, and review of the facility's policy titled Dialysis Services and the Nursing Home Dialysis Transfer Agreement, the facility failed to ensure one (1) of one (1) sampled residents reviewed for dialysis services had coordinated care with the dialysis center to include communication between both facilities regarding the assessment of the resident pre and post dialysis for any changes in condition and/or for any complications and providing updates to the health care provider and dialysis center regarding missed dialysis visits to ensure appropriate interventions were developed and followed (Resident #3) .
Inspectors wroteBased on interview, record review and review of the facility's policy titled Social Services-Behavioral Health Services and Trauma-Informed Care, the facility failed to assess the needs of a resident with a history of post-traumatic stress disorder (PTSD) for one (1) of twenty-three (23) sampled residents (Resident# 8).
Inspectors wroteBased on observations, interviews, record reviews, and a review of the facility's Referrals to Outside Agencies policy, facility staff failed to assess residents' dental care needs and did not assist with coordinating, scheduling, or rescheduling routine or emergency dental evaluations for two (2) of three (3) residents reviewed. This included one resident with a missing upper denture (Resident #45) and another with broken and decayed teeth (Resident #70).
Inspectors wroteBased on interviews, record review, and review of facility documents, the facility failed to ensure one (1) of three (3) residents (Resident #1) was safely transferred from the facility van.
Inspectors wroteBased on interviews, and review of facility documents, the facility failed to ensure one (1) of three (3) residents were provided their visitation rights.
Inspectors wroteBased on interview, review of facility documents, and review of the facility policy entitled Transfers and Discharges Policy, the facility failed to ensure one (1) of three (3) residents (Resident #1) was provided a discharge notice giving at least a 30-day notice of discharge and contained the necessary information required in the notice. Resident #1 was given a 48- hour discharge notice.
Inspectors wroteBased on interview, record review, review of facility documents, and review of the facility policy entitled TCC Nursing Services - Care Plans - Nursing Facility Policy, the facility failed to ensure one (1) of three (3) residents (Resident #1) or the resident's representative received notification of care plan meetings.
Inspectors wroteBased on medical record review, interview, and review of the facility's policy titled Wound Care and Dressing Changes - Clinical Protocol Policy, the failed to ensure one (1) of three (3) sampled residents (Resident #6) received wound care daily as ordered by the physician.
Inspectors wroteBased on medical record review, interview, and review of the facility policy titled General Guidelines for Medication Administration Policy, the facility failed to ensure a resident received three (3) doses of an ordered medication that was required to prevent an allergic reaction during a procedure for one (1) resident of 10 residents reviewed (Resident #6).
Inspectors wroteBased on observation, interview, and review of the facility policy entitled Cleaning and Disinfection Policies and Practices Policy, the facility failed to ensure a blood glucose monitor was properly cleaned and disinfected for one (1) of one (1) resident (Resident #2) observed after a blood glucose monitoring.
Inspectors wroteBased on observation and test tray evaluation, the facility failed to ensure food and beverages were served at an appetizing temperature for residents who ate breakfast in their rooms and had the potential to affect 55 of 55 residents in the facility.
Inspectors wroteBased on record review, confidential interviews, staff interview, and review of the Nursing Home Dialysis Transfer Agreement and Nursing Services-Dialysis Services Policy, the facility failed to ensure one (1) of two (2) sampled residents (Resident A) reviewed for dialysis services had coordinated care with the dialysis center and communication between both facilities was established to ensure any changes in condition, complications and/or changes in the plan of care were monitored to ensure appropriate interventions were developed and followed.
Inspectors wroteBased on observations, medical record review, staff, resident and physician interviews, and facility policy titled Pain Management Protocol Policy, the facility failed to manage pain for one (1) of five (5) residents (Resident #159).
Inspectors wroteBased on interview, review of facility documents, and review of a facility policy entitled TCC Administrative - Advance Beneficiary Notices, Beneficiary Appeal Rights, and Expedited Review Policy, the facility failed to ensure residents were issued a Notice of Medicare Non-Coverage form for 12 of 12 residents (Resident #s 15, 20, 29, 32, 46, 51, 112, 259, 260, 261, 262, 263) who no longer qualified for Medicare part A and had days remaining.
Inspectors wroteBased on staff interview and review of the Facility Assessment the facility failed to ensure the required parties were involved in developing the Facility Assessment, failed to ensure the staffing plan was provided per unit as required, failed to address resources necessary to grandfather residents who smoke, and did not clearly state staff competencies and required training, which had the potential to affect 56 of 56 residents.
Inspectors wroteBased on observations, interview, review of the dish machine operation manual, review of dish machine temperature logs, review of work orders, and review of the facility's policy TCC Dining Services - Warewashing - Dish Machine Policy, the facility failed to ensure the dish machine in the dietary department had a functioning wash temperature gauge which affected 56 of 56 residents in the facility.
Inspectors wroteBased on the resident group interview, review of resident council meeting minutes, and staff interview, the facility failed to ensure grievances voiced in the group meeting were promptly acted upon and responded back to the resident group to address issues regarding cold food for six (6) of nine (9) residents who attended and participated in the group interview.
Inspectors wroteBased on record review and interview, the facility failed to provide residents an opportunity to formulate advanced directives for four (4) residents of 18 sample residents (Residents #33, #31, #112 and #9).
Inspectors wroteBased on observation, staff interview and review of facility policy the facility failed to ensure the medication error rate was below 5%. There were five (5) medication errors out of 31 opportunities for a medication error rate of 16.13%.
Inspectors wroteBased on observations, interview, record review, and review of the facility's Resident Rights, the facility failed to promote dignity by ensuring a resident was dressed for one (1) resident of 19 sample residents (Resident #112).
Inspectors wroteBased on medical record review, resident and staff interviews, and facility policy titled, Resident Funds Policy, the facility failed to ensure a quarterly statement was provided to one (1) of three (3) residents reviewed for personal funds (Resident #9).
Inspectors wroteBased on observation and staff interview the facility failed to ensure a worn and soiled mattress was replaced and failed to ensure a soiled slipper pan was cleaned or replaced for one (1) of 22 sampled residents (Resident #14).
Inspectors wroteBased on record review, interview, review of the facility's procedure entitled Instructions for Residents to Transfer to Hospital, and review of the facility's policy TCC Social Services - Transfers and Discharges Policy, the facility failed to ensure a resident received notification of the reason for transfer to the hospital for one (1) resident of three (3) sample residents (Resident #112).
Inspectors wroteBased on record review, interview, and review of the facility's procedure entitled Instructions for Residents to Transfer to Hospital, the facility failed to ensure a resident received notification of the facility's bed hold policy on transfer to the hospital for one (1) resident of three (3) sample residents (Resident #112).
Inspectors wroteBased on staff interview and record review the facility failed to submit a referral for Level 2 PASSAR (Pre-admission Screening and Resident Review) Evaluation for one (1) of one (1) resident (Resident #42) with an expired Level 2 PASSAR who remained in the facility.
Inspectors wroteBased on record review, interview, observations, and review of the facility policy TCC Nursing Services - Safe Lifting and Moving of Residents Policy, the facility failed to revise the care plan for 1. falls interventions, and 2. after a change in condition for two (2) residents of 19 sample residents (Residents #51 and #112).
Inspectors wroteBased on record review, interview, observations, and review of staff training, the facility failed to ensure Certified Nurse Aides were competent to report changes in condition to the nurse for one (1) resident of 19 sample residents (Resident #112).
Inspectors wroteBased on staff and Medical Director interview, record review, and review of facility policy the facility failed to 1) ensure medication was available as ordered for two (2) of five (5) residents (Resident #s 14 and 9) reviewed for unnecessary medications and failed to 2) ensure a staff member followed facility policy to sign off the controlled count sheet immediately after dispensing a controlled medication for one (1) of two (2) staff observed dispensing controlled medication.
Inspectors wroteBased on observation, staff interview, and review of the manufacturer's Prescribing Information the facility failed to ensure in-use insulin was dated when opened and dated with an accurate Do Not Use After date, and failed to ensure an inhaler medication was dated when opened for one (1) of three (3) medication carts (Hall D).
Inspectors wroteBased on observation, medical record review, staff interviews, and facility policy titled Enhanced Barrier Precautions, the facility failed to 1) implement Enhanced Barrier Precautions (EBP) for one (1) of one (1) resident admitted with a pressure ulcer (Resident #31); and failed to 2) ensure a single resident use glucometer was cleaned and disinfected according to facility policy and the sanitizing wipes manufacturers instructions for one (1) of two (2) residents (Resident #49).
Inspectors wroteBased on record review and staff interview the facility failed to complete a thorough fall investigation to identify root cause(s) and appropriate interventions to prevent future falls for one (1) of three (3) residents (Resident #3). This failure resulted in the resident sustaining a right femoral neck fracture, a type 4 fracture of the sacrum and a rib fracture.
Inspectors wroteBased on observation, record review, resident, family and staff interview and review of the Facility Assessment, the facility failed to have sufficient nurse staffing to meet activities of daily living needs and preferences of residents for five (5) of seven (7) sample residents (Resident #'s 1, 2, 3, 4, and 5) and failed to meet the facility's planned Certified Nursing Assistant (CNA) staffing ratio of 1:13 on the night shift (7:00 PM - 7:00 AM) on seven (7) of 56 nights. In addition, on the A and D halls the ratio was consistently over 1:13. The facility also failed to meet the planned number of Nurses on night shift for 16 of 56 nights during the period 5/18/24 - 7/20/24.
Inspectors wroteBased on observations, interviews, and review of facility Resident's Rights document, the facility failed to ensure the resident's dignity was maintained during medication administration for one (1) of two (2) residents reviewed (Resident #8). Additionally, the facility failed to ensure staff did not call out from across the room to prompt/encourage residents to eat for four (4) of nine (9) sampled residents (Resident #s 2, 3, 4, and 8); and did not engage in personal conversation or discuss another resident, while assisting Resident #5 with her meal.
Inspectors wroteBased on observations, interviews and review of the facility's policies, titled Handwashing and Hand Hygiene and Cleaning of Glucometer, the facility failed to ensure staff cleaned and disinfected the glucometers prior to use for two (2) of two (2) residents observed (Resident #s 3 and 8). The facility also failed to ensure staff washed/sanitized their hands between direct contact with four (4) of nine (9) sampled residents (Resident #s 2, 3, 4, and 5), and assisted residents with hand hygiene before and after the meal for nine (9) of nine (9) residents in the Memory Care Unit's dining room, (Resident #s 2, 3, 4, 5, 6, 7, 8, 9 and 11).
Inspectors wroteBased on record review, interview, review of facility policy, and review of the IDF (International Diabetes Federation) Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care - 2017, the facility failed to ensure medications were administered according to facility policy and standard of practice for 21 of 25 residents reviewed (Residents #1, #2, #3, #4, #7, #8, #9, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24 and #25).
Inspectors wroteBased on record review, interview, review of staffing schedules, and review of facility policy, the facility failed to ensure adequate staff were available to administer medications within the 2-hour medication administration time for 21 of 25 residents reviewed (Residents #1, #2, #3, #4, #7, #8, #9, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24 and #25). Cross reference to F-658 all examples.
Inspectors wroteBased on record review, interview, and review of facility policy, the facility failed to ensure the Quality Assessment and Performance Improvement committee implemented a plan to correct repeated occurrences of nursing staff failing to administer medications within the established 2-hour medication administration time for 21 of 25 residents reviewed (Residents #1, #2, #3, #4, #7, #8, #9, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24 and #25). Cross reference to F-658 and F-725 all examples.
Inspectors wroteBased on observations, interviews, and review of the facility policy entitled Medication Storge, the facility failed to ensure unattended medications were secure on two (2) of three (3) hallways.
Inspectors wroteBased on interviews, record review and review of the facility's surety bond, the facility failed to ensure to balances for the resident trust account did not exceed insured amount for 12 of 13 months reviewed.
Inspectors wroteBased on interviews, record review, review of the facility documents, and review of the facility policy entitled Resident Funds Accounting, the facility failed to ensure funds in excess of $50 were in an interest-bearing account for one (1) of three (3) residents (Resident #6) reviewed.
Inspectors wroteBased on interviews, record reviews, review of the facility documents, and review of the facility policy entitled Resident Funds Accounting, the facility failed to maintain a system that assured a full and complete accounting, according to generally accepted accounting principles for resident's personal funds entrusted to the facility on the resident's behalf for one (1) of three (3) residents (Resident #6) reviewed for personal funds accounting.
Inspectors wroteBased on interviews, record reviews, and review of the facility policy entitled Resident Funds Accounting, the facility failed to ensure residents were notified when resident accounts reached $200 less than the Social Security Income (SSI) resource limit for one person for one (1) of three (3) residents (Resident #6) reviewed for resident trust accounts.
Inspectors wroteBased on observation, record review, and resident and staff interview, the facility failed to prevent an avoidable pressure ulcer for one (1) of one (1) sampled residents for pressure ulcers, Resident #23, who was at risk for skin impairment, developed a pressure ulcer to the penis due to the facility's failure to promptly identify that the catheter tubing was causing pressure injury to the resident's penis resulting in harm to the resident.
Inspectors wroteBased on observation, interview and policy review, the facility failed to allow six (6) of sixteen (16) residents to choose where to eat their evening meal (Resident #'s 2, 13, 22, 32, 43, and 47).
Inspectors wroteBased on the resident group interview, review of resident council meeting minutes, and staff interview, the facility failed to ensure grievances voiced in the group meeting were promptly acted upon and responded back to the resident group to address issues regarding missing items, menus, wander guards, and mail delivery for twelve (12) of fifty (50) residents who attended the group interview.
Inspectors wroteBased on record review and resident group and staff interview, the facility failed to ensure twelve (12) of twelve (12) residents that attended the group interview out of the fifty (50) residents that resided in the facility, were aware of resident's rights (Resident #s' 4, 5, 15, 16, 17, 22, 25, 28, 32, 34, 36, and 43).
Inspectors wroteBased on record review and resident group and staff interview, the facility failed to ensure ten (10) of twelve (12) residents in the group interview were aware they had the right to review their medical record.
Inspectors wroteBased on record review and resident group and staff interview, the facility failed to ensure twelve (12) of twelve (12) residents that attended the group interview out of the fifty (50) residents that resided in the facility, were aware of how to contact pertinent regulatory agencies to file a complaint, were aware of the Ombudsman program and how to contact the Ombudsman, and were unaware of any posting in the facility on how to contact regulatory agencies.
Inspectors wroteBased on record review and resident group and staff interview, the facility failed to ensure twelve (12) of twelve (12) residents that attended the group interview out of the fifty (50) residents that resided in the facility, were aware of their right to review the facility's inspection results and were aware of the location of the inspection results.
Inspectors wroteBased on interview and review of the facility's policy titled Advance Beneficiary Notices, Beneficiary Appeal Rights, and Expedited Review, the facility failed to provide a Notice of Medicare Non Coverage for three (3) of three (3) residents (Resident #'s 5, 34, and 53) reviewed for Notice of Medicare Non-Coverage.
Inspectors wroteBased on the group interview, record review, and staff interview, the facility failed to ensure an ongoing program to support residents in their choice for evening and weekend activities for ten (10) of twelve (12) residents in the group interview.
Inspectors wroteBased on staff interview, the facility failed to ensure a qualified activities professional, to direct the provision of activities to residents, was employed by the facility which had the potential to affect forty-three (43) of fifty (50) residents who regularly attended activities in the facility.
Inspectors wroteBased on observation, record review, and staff interview, the facility failed to promote quality of life and promote dignity for two (2) of eighteen (18) sampled residents. Resident #43 was not given an explanation when a wander guard was placed on her ankle which embarrassed her and made her feel like she didn't want to leave her room at the facility. Resident #12 was not provided dignity in dining when staff stood over the resident during meal observations.
Inspectors wroteBased on record review, staff interview, and review of the facility's policy titled Advance Directive, the facility failed to formulate or provide an opportunity to formulate an advance directive for two (2) of seven (7) residents reviewed for advanced directives (Resident's #11 and 13).
Inspectors wroteBased on medical record review and staff interview, the facility failed to refer residents for a Level II Preadmission Screening and Resident Review (PASARR) evaluation and determination for specialized services, for two (2) of two (2) residents admitted with serious mental disorder(s) (Resident's #16 and 28).
Inspectors wroteBased on observation, record review, and staff interview, the facility failed to develop a person-centered care plan with realistic interventions for one (1) of eighteen (18) sampled residents (Resident #43) related to elopement risk and use of a wander guard.
Inspectors wroteBased on observation, record review, staff interview, and review of the facility's policy titled Oxygen Administration, the facility failed to ensure Oxygen in Use signs were posted for two (2) out of five (5) residents observed who received Oxygen (Resident's #13 and #254).
Inspectors wroteBased on record review, staff interview, and review of facility policy, the facility failed to ensure administrative staff and the provider on-call were notified to address a possible change in emotional well-being and difficulty adjusting to living in a skilled nursing facility for (1) of eighteen (18) sampled residents (Resident #34).
Inspectors wroteBased on observation, record review, staff interview, and review of the facility's policies, the facility failed to ensure that the indwelling catheter tubing was not on the floor for one (1) of three (3) residents sampled for indwelling catheters (Resident #34) and that staff performed hand hygiene and changed gloves during wound care for one (1) of one (1) resident sampled for pressure ulcers (Resident #23).
1 fire safety citation on file: 1 on August 1, 2025.
| Date | Penalty | Amount or length |
|---|---|---|
| July 31, 2025 | Fine | $11,047 |
| April 10, 2025 | Fine | $15,028 |
| July 31, 2024 | Fine | $12,542 |
| July 31, 2024 | Fine | $118,938 |
| July 31, 2024 | Payment Denial | 81 days from August 29, 2024 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
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) | 6.14 | 3.85 | 3.86 |
| Registered nurses | 1.30 | 0.62 | 0.69 |
| All nursing staff on weekends | 5.55 | 3.42 | 3.42 |
| Nurse aides | 4.23 | ||
| Licensed practical nurses | 0.61 | ||
| Nursing staff turnover (share who left in a year) | 47.2% | 49.0% | 45.8% |
| Registered nurse turnover | 31.3% | 45.6% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.08 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
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 6.37 on weekdays and 5.55 on weekends, 13% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 30.8% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 5.76 in April to June 2025 to 6.14 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 | 6.14 | 1.30 | 6.37 | 5.55 | 30.8% | 0 of 90 | 78 |
| Oct to Dec 2025 | 5.75 | 1.26 | 5.97 | 5.20 | 20.4% | 0 of 92 | 71 |
| Jul to Sep 2025 | 6.03 | 1.17 | 6.19 | 5.61 | 26.5% | 0 of 92 | 70 |
| Apr to Jun 2025 | 5.76 | 0.88 | 6.08 | 4.94 | 28.1% | 0 of 91 | 67 |
| 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
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. If you work here, your report helps start one.
| 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.
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 | 18.1 | 15.6 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 1.6 | 0.7 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 3.2 | 2.3 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 6.8 | 3.5 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 1.6 | 1.4 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 16.5 | 18.3 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 12.3 | 5.5 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 16.9 | 14.0 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 30.5 | 22.9 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 7.5 | 12.9 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.6 | 1.8 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.8 | 1.8 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Tsali Care Center's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (37.9% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
37.9% this home
No different from the national rate
US median of homes 51.5% · North Carolina: 93 better, 25 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 47 eligible stays.
11.1% this home
No different from the national rate
US median of homes 10.7% · North Carolina: 1 better, 4 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 55 eligible stays.
7.1% this home
No different from the national rate
US median of homes 7.1% · North Carolina: 1 better, 3 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 33 eligible stays.
43.2% this home
Median of homes: North Carolina54.0% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 37 residents counted.
3.9% this home
Median of homes: North Carolina0.6% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 51 residents counted.
2.4% this home
Median of homes: North Carolina2.5% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 51 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: North Carolina97.5% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 9 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: CHEROKEE INDIAN HOSPITAL AUTHORITY.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Brady, Pamela | Managing control - governing body | Individual | 01/01/2025 | |
| Bunio, Richard | Managing control - governing body | Individual | 01/01/2025 | |
| Hollifield, Marcia | Managing control - governing body | Individual | 01/01/2025 | |
| Madden, Adele | Managing control - governing body | Individual | 01/01/2025 | |
| Monteith, Carmaleta | Managing control - governing body | Individual | 01/01/2025 | |
| Parker, Barbara | Managing control - governing body | Individual | 01/01/2025 | |
| Stephens, Ahll-Sha | Managing control - governing body | Individual | 01/01/2025 | |
| Wachacha, Sonya | Managing control - governing body | Individual | 01/01/2025 | |
| Cooper, Casey | Corporate officer | Individual | 09/09/2002 | |
| Dando, Jonathan | Corporate officer | Individual | 09/09/2002 | |
| Cherokee Indian Hospital Authority | Operational/managerial control | Organization | 01/01/2002 | |
| Brady, Pamela | Operational/managerial control | Individual | 01/01/2025 | |
| Bunio, Richard | Operational/managerial control | Individual | 01/01/2025 | |
| Dorgan, Mary Beth | Operational/managerial control | Individual | 01/01/2025 | |
| Hollifield, Marcia | Operational/managerial control | Individual | 01/01/2025 | |
| Houston, Michele | Operational/managerial control | Individual | 01/01/2025 | |
| Lambert, Barbara | Operational/managerial control | Individual | 01/01/2025 | |
| Madden, Adele | Operational/managerial control | Individual | 01/01/2025 | |
| Monteith, Carmaleta | Operational/managerial control | Individual | 01/01/2025 | |
| Parker, Barbara | Operational/managerial control | Individual | 01/01/2025 | |
| Reed, Jacob | Operational/managerial control | Individual | 01/01/2025 | |
| Stephens, Ahll-Sha | Operational/managerial control | Individual | 01/01/2025 | |
| Tenhengel-Deville, Michelle | Operational/managerial control | Individual | 01/01/2025 | |
| Wachacha, Sonya | Operational/managerial control | Individual | 01/01/2025 | |
| Cherokee Indian Hospital Authority | Adp of the SNF | Organization | 01/01/2002 | |
| Bunio, Richard | Adp of the SNF | Individual | 07/21/2026 | |
| Tenhengel-Deville, Michelle | Adp of the SNF | Individual | 07/21/2026 |
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.
Chosen from this home's own inspection record.
These are the official offices in North Carolina. NursingHomeClear cannot take or act on complaints.