Skyland Care Center — nursing home in Sylva, NC

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 94 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 90.3 CMS, MDS-derived
CMS Certification Number: 345400
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Sep 3, 1991
Ownership type: For profit - Corporation
Operator (legal business name): Bt2, Inc
CMS chain: Not part of a CMS-reported chain
Phone: (828) 586-8935
Resident & family council: Both
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

7

latest Jan 23, 2026

Citations

18

10 health · 8 fire

Harm or worse

2

2 immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J2	K·	L·
Actual harm	G·	H·	I·
Potential harm	D15	E·	F1
Minimal	A·	B·	C·

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

0

$0

Payment denials

0

Latest

—

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 345400
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 94
First approved: Sep 3, 1991
Located in a hospital: No
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for North Carolina.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
Jan 23, 2026	Fire safety	Fire Safety Standard	4	Potential harm	—	Open →
Jan 23, 2026	Health	Health Standard	0	No citations	—	Open →
Nov 21, 2024	Fire safety	Fire Safety Standard	1	Potential harm	—	Open →
Nov 21, 2024	Health	Health Complaint, Health Standard	3	Potential harm	—	Open →
Oct 4, 2023	Health	Infection Control	0	No citations	—	Open →
Jun 30, 2023	Fire safety	Fire Safety Standard	3	Potential harm	—	Open →
Jun 30, 2023	Health	Health Standard	7	Immediate jeopardy	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J2	K·	L·
Actual harm	G·	H·	I·
Potential harm	D15	E·	F1
Minimal	A·	B·	C·

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
Jan 23, 2026	K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 8, 2026
Jan 23, 2026	K-0324	Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 8, 2026
Jan 23, 2026	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 8, 2026
Jan 23, 2026	K-0372	Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 8, 2026
Nov 21, 2024	K-0352	Properly install and monitor supervisory attachments on automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jan 27, 2025
Nov 21, 2024	F-0602	Protect each resident from the wrongful use of the resident's belongings or money. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Past non-compliance Mar 31, 2024	Complaint
Nov 21, 2024	F-0644	Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Dec 4, 2024	Complaint
Nov 21, 2024	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	F · Potential harm Widespread	Corrected Dec 6, 2024	Complaint
Jun 30, 2023	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	J · Immediate jeopardy Isolated	Corrected Jul 18, 2023
Jun 30, 2023	F-0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care	J · Immediate jeopardy Isolated	Corrected Jul 18, 2023
Jun 30, 2023	K-0351	Install an approved automatic sprinkler system. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 21, 2023
Jun 30, 2023	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 21, 2023
Jun 30, 2023	K-0372	Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 21, 2023
Jun 30, 2023	F-0554	Allow residents to self-administer drugs if determined clinically appropriate. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jul 18, 2023
Jun 30, 2023	F-0655	Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jul 18, 2023
Jun 30, 2023	F-0658	Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jul 18, 2023
Jun 30, 2023	F-0808	Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	D · Potential harm Isolated	Corrected Jul 18, 2023
Jun 30, 2023	F-0867	Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Administration Deficiencies · Administration & records	D · Potential harm Isolated	Corrected Jul 18, 2023

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3

Health inspectionsstate 2.9

Staffingstate 2.7

Quality measuresstate 3.5

Long-stay QM

Short-stay QM

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing3.62

State avg 3.87US avg 3.90

Registered nurse (RN)0.57

State avg 0.62US avg 0.69

Licensed practical nurse0.73

State avg 0.88US avg 0.86

Nurse aide2.31

State avg 2.37US avg 2.35

Weekend total nurse3.23

State avg 3.40US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 3.61 (case-mix index 1.40).

Staff turnover

Total nursing staff turnover41.3%

State avg 48.7%US avg 45.3%

Registered nurse turnover14.3%

State avg 45.7%US avg 42.5%

Administrators who left0

State avg 1US avg 1

Health survey score

Cycle 1 standard survey: Jan 23, 2026
Cycle 1 health score: 0
Total weighted score: 6
Infection-control citations: 0

Operating entity

Bt2, Inc

CMS legal business name of the certified provider. Operates this facility only.

VerifiedLinked by exact legal name

CMS chain

Not part of a CMS-reported chain.

Ownership disclosures

Disclosures

11

Organizations

0

Individuals

11

Direct & indirect ownership

Owners of record

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Thomas Gatewood	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	51%	Oct 1, 2016
Mistie Cooley	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	49%	Oct 1, 2013

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Thomas Gatewood	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	51%	Oct 1, 2016
Mistie Cooley	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	49%	Oct 1, 2013
Mistie Cooley	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Oct 1, 2013
Thomas Gatewood	Individual	Operational / managerial control	MANAGING CONTROL - GOVERNING BODY	not provided	Oct 1, 2003
Mistie Cooley	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Oct 1, 2013
Melissa Dills	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Dec 16, 2022
Carlos Vargas	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Aug 1, 2012
Mistie Cooley	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Oct 1, 2013
Thomas Gatewood	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Oct 1, 2003
Melissa Dills	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Dec 16, 2022
Carlos Vargas	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Aug 1, 2012

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS.

Address: 193 Asheville Highway, Sylva, NC 28779
ZIP: 28779
County: Jackson County FIPS 37099
State: North Carolina
Urban / rural (CMS): Rural

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	CMS overall	Last inspection	Citations (window)	Fines
Vero Health & Rehab of Sylva 417 Cloverdale Road, Sylva, NC 28779 CCN 345302SFF Candidate	0.1 km	106		Aug 14, 2025	717 IJ6 harm2 open	$360k
Tsali Care Center 267 Tsali Care Way, Cherokee, NC 28719 CCN 345475SFF Candidate	15.9 km	100		Aug 6, 2026	804 harm1 open	$158k

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	345400	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	345400	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 345400

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction