North Carolina › Swain County › Cherokee
Tsali Care Center
267 Tsali Care Way, Cherokee, NC 28719
Special Focus Facility candidate
Overall★★★★★
Health inspection★★★★★
Staffing★★★★★
Quality measures★★★★★
Ratings are based on the most recent data available; a facility's ratings may have changed since the last update. The health inspection rating is based on the three most recent standard surveys and complaint investigations. CMS processed this record on 1 Aug 2026. View the Care Compare record.
Certified for 100 beds, Tsali Care Center serves Cherokee in Swain County, North Carolina and has taken Medicare and Medicaid residents since 1996.
CMS gives it 2 of 5 stars overall, below the North Carolina median of 3; the health inspection rating is 1, staffing 5 and quality measures 2.
Inspectors recorded 82 health deficiencies across the three most recent survey cycles (26, 27, 29 by cycle, most recent first), 4 of them at the actual-harm or immediate-jeopardy level. That is 82.0 per 100 beds, more than the state median of 15.6.
CMS lists 5 penalties in the period covered: fines totalling $158K and 1 payment denial.
Reported nurse staffing is 6.1 hours per resident per day (1.3 RN), above the North Carolina median of 3.5; nursing staff turnover is 47.2%.
CMS flags that the facility is a Special Focus Facility candidate.
82health deficiencies, 3 survey cycles4 at actual harm or worse
$158Kfines listed by CMS5 penalties in period
6.1nurse hours per resident per daystate median 3.5
78%occupancy (residents ÷ beds)78 residents a day
Compared with county, state and nation
| Measure | This facility | Swain Co. median | North Carolina median | US average |
|---|---|---|---|---|
| Overall star rating | 2 | 2 | 3 | 3.0 |
| Health citations, 3 cycles | 82 | 82 | 16 | 28.7 |
| Citations per 100 beds | 82.0 | 82.0 | 15.6 | 26.8 |
| Total nurse hours per resident day | 6.1 | 6.1 | 3.5 | 3.9 |
| RN hours per resident day | 1.3 | 1.3 | 0.5 | 0.7 |
| Nursing staff turnover | 47.2% | 47.2% | 48.6% | 45.8% |
| Fines listed | $157,555 | $157,555 | $8,512 | — |
County and state figures are medians across facilities (2 in the county, 419 in the state); the US column is the CMS national average where CMS publishes one.
Citations by survey cycle
Dark bar: this facility. Grey bar: North Carolina average per facility for the same cycle, as published by CMS. Standard health survey dates: 1 Aug 2025, 22 Aug 2024.
Severity mix: G ×4 D ×45 E ×26 F ×7
Health deficiencies
Every health citation in the current CMS record (three survey cycles), most recent first. Tag text is the CMS requirement summary, not the inspection narrative.
Scope and severity letters (A–L)
Isolated
Pattern
Widespread
Immediate jeopardy
J
K
L
Actual harm
G
H
I
Potential for more than minimal harm
D
E
F
Potential for minimal harm
A
B
C
| Survey date | Tag | What the tag requires | Severity | Type | Corrected |
|---|---|---|---|---|---|
| 1 Aug 2025 | F0835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. | F | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | F | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0552 | Ensure that residents are fully informed and understand their health status, care and treatments. | E | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0554 | Allow residents to self-administer drugs if determined clinically appropriate. | E | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0578 | 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. | E | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0583 | Keep residents' personal and medical records private and confidential. | E | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | E | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | E | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0880 | Provide and implement an infection prevention and control program. | E | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | E | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Complaint investigation | 21 Sep 2025 |
| 1 Aug 2025 | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0605 | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0636 | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0644 | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0676 | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | D | Complaint investigation | 8 Sep 2025 |
| 1 Aug 2025 | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | D | Standard survey | 2 Jan 2026 |
| 1 Aug 2025 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0699 | Provide care or services that was trauma informed and/or culturally competent. | D | Standard survey | 8 Sep 2025 |
| 1 Aug 2025 | F0791 | Provide or obtain dental services for each resident. | D | Standard survey | 8 Sep 2025 |
| 10 Apr 2025 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0563 | Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing. | D | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0622 | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | D | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0760 | Ensure that residents are free from significant medication errors. | D | Complaint investigation | 1 May 2025 |
| 10 Apr 2025 | F0880 | Provide and implement an infection prevention and control program. | D | Complaint investigation | 1 May 2025 |
| 18 Oct 2024 | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | F | Complaint investigation | 18 Nov 2024 |
| 18 Oct 2024 | F0698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Complaint investigation | 8 Nov 2024 |
| 22 Aug 2024 | F0697 | Provide safe, appropriate pain management for a resident who requires such services. | G | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | F | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0838 | Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. | F | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0908 | Keep all essential equipment working safely. | F | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0565 | Honor the resident's right to organize and participate in resident/family groups in the facility. | E | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0578 | 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. | E | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0759 | Ensure medication error rates are not 5 percent or greater. | E | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0568 | Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | D | Standard survey | 25 Sep 2024 |
| 22 Aug 2024 | F0880 | Provide and implement an infection prevention and control program. | D | Standard survey | 25 Sep 2024 |
| 31 Jul 2024 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint investigation | 7 Nov 2024 |
| 31 Jul 2024 | F0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | Complaint investigation | 25 Sep 2024 |
| 17 Apr 2024 | F0557 | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | E | Complaint investigation | 4 May 2024 |
| 17 Apr 2024 | F0880 | Provide and implement an infection prevention and control program. | E | Complaint investigation | 4 May 2024 |
| 13 Oct 2023 | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | E | Complaint investigation | 6 Nov 2023 |
| 13 Oct 2023 | F0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | Complaint investigation | 6 Nov 2023 |
| 13 Oct 2023 | F0867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | E | Complaint investigation | 6 Nov 2023 |
| 13 Oct 2023 | F0761 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | D | Complaint investigation | 6 Nov 2023 |
| 21 Sep 2023 | F0570 | Assure the security of all personal funds of residents deposited with the facility. | F | Complaint investigation | 22 Oct 2023 |
| 21 Sep 2023 | F0567 | Honor the resident's right to manage his or her financial affairs. | D | Complaint investigation | 22 Oct 2023 |
| 21 Sep 2023 | F0568 | Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | D | Complaint investigation | 20 Oct 2023 |
| 21 Sep 2023 | F0569 | Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. | D | Complaint investigation | 22 Oct 2023 |
| 13 Jul 2023 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0558 | Reasonably accommodate the needs and preferences of each resident. | E | Standard survey | 6 Nov 2023 |
| 13 Jul 2023 | F0565 | Honor the resident's right to organize and participate in resident/family groups in the facility. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0572 | Give residents a notice of rights, rules, services and charges. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0573 | Let each resident or the resident's legal representative access or purchase copies of all the resident's records. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0574 | The resident has the right to receive notices in a format and a language he or she understands. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0577 | Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0679 | Provide activities to meet all resident's needs. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0680 | Ensure the activities program is directed by a qualified professional. | E | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0578 | 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. | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0695 | Provide safe and appropriate respiratory care for a resident when needed. | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | Standard survey | 15 Aug 2023 |
| 13 Jul 2023 | F0880 | Provide and implement an infection prevention and control program. | D | Standard survey | 15 Aug 2023 |
Penalties
| Date | Type | Amount | Detail |
|---|---|---|---|
| 31 Jul 2025 | Fine | $11,047 | |
| 10 Apr 2025 | Fine | $15,028 | |
| 31 Jul 2024 | Payment denial | — | 81 days |
| 31 Jul 2024 | Fine | $118,938 | |
| 31 Jul 2024 | Fine | $12,542 |
Staffing
Hours per resident per day as reported through the Payroll-Based Journal; grey bars are the North Carolina average. Turnover: nursing staff 47.2%, RNs 31.3%; 1 administrator left in the reporting year.
Quality measures
| Measure | Residents | This facility | North Carolina median | US median |
|---|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 18.1% | 14.4% | 12.6% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 1.6% | 0.4% | 0.3% |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 3.2% | 1.8% | 0.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 6.8% | 3.3% | 2.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 1.6% | 1.1% | 1.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 16.5% | 17.0% | 12.5% |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 12.3% | 5.2% | 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 16.9% | 13.2% | 13.4% |
Four-quarter averages for the measures CMS uses in the quality-measure star rating (2025Q2-2026Q1). Lower is better for every measure listed. Medians are computed across facilities on this site.
Ownership
Ownership type: non-profit, corporation. Legal business name: Cherokee Indian Hospital Authority.
| Organisation | Role in the CMS record | Interest | Since |
|---|---|---|---|
| Cherokee Indian Hospital Authority | Operational/managerial control | NOT APPLICABLE | 10/01/2019 |
Only organisations are shown. CMS also records individual owners, officers and managing employees; this site does not publish people's names.
Other nursing homes in Swain County
| Facility | City | Beds | Overall | Health | Staffing | Citations | Per 100 beds | Fines | Last survey |
|---|---|---|---|---|---|---|---|---|---|
| Mountain View Manor Nursing Center | Bryson City | 120 | 1 | 2 | 1 | 37 | 30.8 | $14K | 9 Jul 2026 |
All 2 facilities in Swain County
Questions and answers
How many deficiencies has Tsali Care Center been cited for?
82 health deficiencies across the three most recent survey cycles, 4 at the actual-harm or immediate-jeopardy level. The North Carolina median is 16 per facility.
Has Tsali Care Center been fined?
Yes. CMS lists fines totalling $158K in the period covered, plus 1 payment denial.
How does staffing at Tsali Care Center compare?
Reported total nurse staffing is 6.1 hours per resident per day against a North Carolina median of 3.5 and a national average of 3.9.
Who operates Tsali Care Center?
Ownership type is non-profit, corporation. Organisations in the CMS ownership record include Cherokee Indian Hospital Authority. Individual owners and managers are not listed on this site.
When was Tsali Care Center last inspected?
The most recent survey or investigation in the CMS record is dated 1 Aug 2025; the most recent standard health survey was 1 Aug 2025.
Where does this data come from?
All figures are from the Centers for Medicare & Medicaid Services Care Compare datasets (provider information, health deficiencies, penalties, ownership and quality measures), processed 1 Aug 2026. Ratings and citations may change; the Care Compare record is authoritative.
Provenance
Source: Centers for Medicare & Medicaid Services, Care Compare nursing home datasets (provider information, health deficiencies, penalties, ownership, MDS quality measures, state and national averages), public domain, processed by CMS on 1 Aug 2026. Facility record: Care Compare. Errors in processing are corrected at the next daily build; see corrections.