The nursing home failed to keep the area free of hazards and provide enough supervision to prevent accidents. Cited April 2025 — isolated incident, actual harm.
View the original federal record
F-Tag 689 — 42 CFR §483.25(d) — S/S: G
Nursing home report
Tsali Care Center
Cherokee, NC · Medicare-certified · 100 beds
Needs attention
Special Focus candidateNon-profit
2 of 5 overall
2-star Tsali Care Center has weak health inspection results (1 star) and quality measures (2 stars), but strong staffing (5 stars) at 5.75 hours per resident per day versus the 4.1 federal benchmark. It is an SFF Candidate/special focus facility and had $157,555 in fines over the last 24 months, with recent citations involving accident hazards, pain management, and pressure ulcer care.
Facility ratings
Health inspections
Staffing
5.7532 hrs/resident/day
Quality measures
Last inspection: August 1, 2025Penalties, last 24 months: $157,555special focus facility
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 5.7532.
Staffing detail
- Registered nurses
- 1.26
- Licensed practical nurses
- 0.56
- Nurse aides
- 3.94
- Weekend nursing
- 5.20
Hours per resident per day.
Total staff turnover: 45%
Registered nurse turnover: 47%
Resident outcomes
How often residents experience these outcomes, with the direction over the past year.
Long-stay residents on antipsychotic medication
19.1%Improving
Residents with a fall causing major injury
6%Worsening
Residents with pressure ulcers (bedsores)
11.4%Worsening
Residents with a urinary tract infection
3.4%Worsening
Residents who lost too much weight
8.2%Worsening
Residents who were physically restrained
0%Steady
Residents needing more help with daily activities
18.3%Worsening
Residents whose ability to walk got worse
17.8%Steady
Show all measures
Long-stay residents on antianxiety or sleep medication
19.9%Worsening
Short-stay residents newly given an antipsychotic
1.5%Worsening
Residents with a long-term catheter
1.5%Worsening
Residents with new or worsening incontinence
24.3%Worsening
Residents with depressive symptoms
7.5%Steady
Long-stay residents given the seasonal flu vaccine
74.6%Steady
Long-stay residents given the pneumonia vaccine
91.2%Improving
Short-stay residents given the seasonal flu vaccine
38.5%Steady
Short-stay residents given the pneumonia vaccine
64.4%Improving
What the inspectors found
The home failed to provide safe, appropriate pain management for a resident who needed it. Cited August 2024 — isolated incident, actual harm.
View the original federal record
F-Tag 697 — 42 CFR §483.25(k) — S/S: G
The nursing home failed to provide proper pressure ulcer care and failed to prevent new pressure sores from developing. Cited July 2023 — isolated incident, actual harm.
View the original federal record
F-Tag 686 — 42 CFR §483.25(b) — S/S: G
The home failed to run its operations effectively and efficiently using its available resources. Cited August 2025 — widespread issue, potential for harm.
View the original federal record
F-Tag 835 — 42 CFR §483.70 — S/S: F
The home failed to have an ongoing quality review group that finds problems and makes corrective plans. Cited August 2025 — widespread issue, potential for harm.
View the original federal record
F-Tag 867 — 42 CFR §483.75 — S/S: F
Recent history
- STAFFING
Reported nurse staffing met or exceeded the federal recommendation.
- INSPECTION
Health inspection found 26 health deficiencies.
See what inspectors found
- PENALTY
A federal fine of $11,047 was recorded.
- PENALTY
A federal fine of $15,028 was recorded.
- INSPECTION
Health inspection found 7 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 2 health deficiencies.
See what inspectors found
- PENALTY
A federal payment denial was recorded.
- PENALTY
A federal fine of $118,938 was recorded.
- PENALTY
A federal fine of $12,542 was recorded.
Penalties & enforcement
On record with Medicare: 9 fines · $199,217 in total fines · 2 payment denials.
- $11,047
Federal fine
Jul 31, 2025
- $15,028
Federal fine
Apr 10, 2025
- 81 days
Medicare/Medicaid payment denial
Jul 31, 2024
- $118,938
Federal fine
Jul 31, 2024
- $12,542
Federal fine
Jul 31, 2024
- 83 days
Medicare/Medicaid payment denial
Jul 13, 2023
- $17,999
Federal fine
Jul 13, 2023
- $8,137
Federal fine
Jul 13, 2023
Operator & ownership
- Ownership
- Non profit - Corporation
- Occupancy
- 71.1 residents on an average day (71% of 100 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 30 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.