Hayesville, NC

Clay County Health and Rehabilitation

4-star overall rating with 4-star inspections with 3 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

86 Valley Hideaway Drive, Hayesville, NC

(828) 389-9941

Compare this facility

Overall

4 / 5

CMS overall stars

Health inspections

4 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

4 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

90

Certified beds

Average residents

76

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Consulate Health Care/Independence Living Centers/Nspire Healthcare/Raydiant Health Care

Operator or chain grouping

Approved since

1993-03-30

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

36 facilities

Chain averages 2 overall / 2 health / 3 staffing / 3 quality stars

Changed ownership

No

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.56

Registered nurse staffing · state 0.59 · national 0.68

LPN hours / resident day

0.37

Licensed practical nurse staffing · state 0.87 · national 0.87

Aide hours / resident day

2.23

Nurse aide staffing · state 2.33 · national 2.35

Total nurse hours

3.16

All reported nurse hours · state 3.78 · national 3.89

Licensed hours

0.93

RN + LPN hours · state 1.45 · national 1.54

Weekend hours

2.92

Weekend nurse staffing · state 3.34 · national 3.43

Weekend RN hours

0.34

Weekend registered nurse coverage · state 0.38 · national 0.47

Physical therapist

0.01

Reported PT staffing · state 0.09 · national 0.07

Adjusted RN hours

0.69

CMS adjusted RN staffing hours

Adjusted total hours

3.91

CMS adjusted total nurse staffing hours

Case-mix index

1.10

Higher values indicate more complex resident acuity

RN turnover

75%

Annual RN turnover · state 48% · national 45%

Total nurse turnover

45%

Annual nurse turnover · state 50% · national 46%

SNF VBP

Value-based purchasing

Program rank

2,127

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

51.60

Composite VBP score used to determine payment impact.

Payment multiplier

1.0060

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

4.85

Baseline 20.26% · Performance 19.18% · Measure score 4.85 · Achievement 4.85 · Improvement 2.82

Healthcare-associated infections

5.74

Baseline 7.12% · Performance 6.12% · Measure score 5.74 · Achievement 5.74 · Improvement 4.22

Total nurse turnover

7.54

Baseline 30.16% · Performance 32.86% · Measure score 7.54 · Achievement 7.54 · Improvement 0

Adjusted total nurse staffing

2.51

Baseline 3.77 hours · Performance 3.79 hours · Measure score 2.51 · Achievement 2.51 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.53%	10.72% 0.2 pts better	No Different than the National Rate · Eligible stays 79 · Observed rate 8.86% · Lower 95% interval 6.83%
Discharge to community	41.43%	50.57% 9.1 pts worse	No Different than the National Rate · Eligible stays 66 · Observed rate 34.85% · Lower 95% interval 31.07%
Medicare spending per beneficiary	0.97	1.02 0.1 pts better
Drug regimen review with follow-up	98.11%	95.27% 2.8 pts better	Numerator 52 · Denominator 53
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 53
Discharge self-care score	50%	53.69% 3.7 pts worse	Numerator 16 · Denominator 32
Discharge mobility score	59.38%	50.94% 8.4 pts better	Numerator 19 · Denominator 32
Pressure ulcers or injuries, new or worsened	3.77%	2.29% 1.5 pts worse	Numerator 2 · Denominator 53 · Adjusted rate 3.55%
Healthcare-associated infections requiring hospitalization	6.12%	7.12% 1 pts better	No Different than the National Rate · Eligible stays 48 · Observed rate 2.08% · Lower 95% interval 2.94%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 114
Staff flu vaccination coverage	16.67%	42% 25.3 pts worse	Numerator 19 · Denominator 114
Discharge function score	56.25%	56.45% 0.2 pts worse	Numerator 18 · Denominator 32
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 31 · Denominator 31
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	20.69%	25.2% 4.5 pts worse	Numerator 6 · Denominator 29

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.3	1.8 0.5 pts better	1.9 0.6 pts better	Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.0 · Expected 1.5 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	3.3	1.8 1.5 pts worse	1.8 1.5 pts worse	Long Stay · 20240701-20250630 · Adjusted 3.3 · Observed 2.9 · Expected 1.5 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.3%	91.5% 6.8 pts better	93.4% 4.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 98.7% · Q3 100.0% · Q4 94.2% · 4Q avg 98.3%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	97.5%	94.1% 3.4 pts better	95.5% 2 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 97.5%
Percentage of long-stay residents experiencing one or more falls with major injury	4.5%	3.6% 0.9 pts worse	3.3% 1.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 3.8% · Q3 5.7% · Q4 7.2% · 4Q avg 4.5% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	2.9%	4.8% 1.9 pts better	11.4% 8.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.2% · Q2 1.3% · Q3 1.5% · Q4 3.0% · 4Q avg 2.9%
Percentage of long-stay residents who lose too much weight	9.8%	7.2% 2.6 pts worse	5.4% 4.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 10.6% · Q2 7.5% · Q3 10.4% · Q4 10.6% · 4Q avg 9.8%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	7.2%	21.6% 14.4 pts better	19.6% 12.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 5.5% · Q3 8.6% · Q4 10.3% · 4Q avg 7.2%
Percentage of long-stay residents who received an antipsychotic medication	21.1%	15.0% 6.1 pts worse	16.7% 4.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 22.8% · Q2 15.0% · Q3 23.3% · Q4 23.3% · 4Q avg 21.1% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.0% About the same	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	12.9%	21.5% 8.6 pts better	16.3% 3.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 15.7% · Q2 16.6% · Q3 16.6% · Q4 2.0% · 4Q avg 12.9% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	6.6%	16.8% 10.2 pts better	14.9% 8.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 12.1% · Q2 4.2% · Q3 8.7% · Q4 1.5% · 4Q avg 6.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	1.0%	0.9% 0.1 pts worse	1.0% About the same	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.3% · Q3 1.1% · Q4 1.7% · 4Q avg 1.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	1.1%	2.6% 1.5 pts better	1.7% 0.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 1.4% · Q3 1.5% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	24.4%	21.2% 3.2 pts worse	19.8% 4.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 18.6% · Q2 22.2% · Q3 21.0% · Q4 36.1% · 4Q avg 24.4%
Percentage of long-stay residents with pressure ulcers	5.5%	6.0% 0.5 pts better	5.1% 0.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 7.1% · Q3 9.3% · Q4 3.8% · 4Q avg 5.5% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	92.8%	79.9% 12.9 pts better	81.7% 11.1 pts better	Short Stay · 2024Q4-2025Q3 · Q1 91.5% · Q2 94.3% · Q3 92.6% · Q4 92.5% · 4Q avg 92.8%
Percentage of short-stay residents who had an outpatient emergency department visit	13.7%	13.2% 0.5 pts worse	12.0% 1.7 pts worse	Short Stay · 20240701-20250630 · Adjusted 13.7% · Observed 14.5% · Expected 11.9% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.0%	1.5% 1.5 pts better	1.6% 1.6 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	88.9%	78.1% 10.8 pts better	79.7% 9.2 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 88.9%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	16.8%	22.9% 6.1 pts better	23.9% 7.1 pts better	Short Stay · 20240701-20250630 · Adjusted 16.8% · Observed 17.7% · Expected 25.2% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-02-27 · Fire 2025-02-27

3 health deficiencies

Top issue: Resident Assessment and Care Planning (2 deficiencies)

2 fire-safety deficiencies

Top issue: Egress (1 deficiency)

Cycle 2 Health 2023-10-26 · Fire 2023-10-26

3 health deficiencies

Top issue: Pharmacy Service (2 deficiencies)

1 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 3 Health 2022-05-05 · Fire 2022-05-05

0 health deficiencies

No concentrated health issue counts in this cycle.

2 fire-safety deficiencies

Top issue: Services (1 deficiency)

Fire safety

Fire-safety citations

D · Potential for more than minimal harm 2025-02-27

K222 · Egress Deficiencies

Fire Safety

Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

Corrected 2025-05-24

D · Potential for more than minimal harm 2025-02-27

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-05-24

D · Potential for more than minimal harm 2023-10-26

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2023-12-27

D · Potential for more than minimal harm 2022-05-05

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2022-07-22

D · Potential for more than minimal harm 2022-05-05

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Corrected 2022-07-22

Inspection history

Recent health citations

E · Potential for more than minimal harm 2025-02-27

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-03-25

D · Potential for more than minimal harm 2025-02-27

F636 · Resident Assessment and Care Planning Deficiencies

Health

Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

Corrected 2025-03-25

D · Potential for more than minimal harm 2025-02-27

F700 · Quality of Life and Care Deficiencies

Health

Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

Corrected 2025-03-25

E · Potential for more than minimal harm 2023-10-26

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2023-11-21

E · Potential for more than minimal harm 2023-10-26

F760 · Pharmacy Service Deficiencies

Health

Ensure that residents are free from significant medication errors.

Corrected 2023-11-21

E · Potential for more than minimal harm 2023-10-26

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2023-11-21

Penalties and ownership