Cordele Health And Rehabilitation
1106 North 4th Street, Cordele, GA 31015 · Non profit - Corporation · 100 certified beds · (229) 273-1227 Medicare & Medicaid certified
The public record raises real questions here. Weigh the concerns below carefully.
- a middle-of-the-pack inspection score (3/5)
- no federal fines or payment denials on record
- it has a citation for mishandling residents’ money or property (F0570)
- a high number of inspection citations overall (18) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its payroll-based staffing rating is low (1/5)
- its facility-reported quality-measure rating is low (2/5)
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 3 of 5 |
| StaffingFrom payroll records (PBJ) | 1 of 5 |
| Quality measuresSelf-reported by the facility | 2 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 2 of 5 |
| Long-stay residentspeople who live here | 2 of 5 |
| Short-stay residentsrehab / post-hospital | 1 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating fell from 3 to 2 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 14.7% | 15.3% | 15.4% | typical |
| Long-stay residents who lose too much weight | 2.5% | 5.6% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 0.5% | 0.9% | 0.9% | better |
| Long-stay residents with a urinary tract infection | 2.3% | 2.5% | 2.0% | worse |
| Long-stay residents with depressive symptoms | 0.0% | 11.3% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.1% | 0.1% | better |
| Long-stay residents with falls causing major injury | 2.6% | 3.2% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 16.1% | 15.2% | 16.1% | typical |
| Long-stay residents on antianxiety or hypnotic medication | 19.7% | 20.5% | 18.9% | typical |
| Long-stay residents given the seasonal flu vaccine | 98.2% | 95.0% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 12.0% | 5.6% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 16.7% | 15.8% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 12.7% | 19.9% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 2.2% | 2.6% | 1.4% | worse |
| Short-stay residents given the seasonal flu vaccine | 88.6% | 78.4% | 79.4% | better |
| Short-stay residents rehospitalized after admission | 40.5% | 25.0% | 22.6% | worse |
| Short-stay residents with an outpatient ER visit | 22.5% | 11.6% | 12.0% | worse |
| Long-stay hospitalizations per 1,000 resident days | 2.83 | 2.15 | 1.67 | worse |
| Long-stay outpatient ER visits per 1,000 resident days | 2.64 | 1.90 | 1.80 | worse |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
59.7% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 77 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 23.1% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 39 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: this home’s payroll records show 0.42 therapist hours per resident per day in 2026Q1 — more than 72% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 18% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 59.7%CMS range 51.1–69.2 | 51.5% | Oct 2022–Sep 2024 | better than U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 11.8%CMS range 8.3–16.5 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 23.1% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 25.6% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 38.5% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 97.6% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 96.4% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 0.0% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 0.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 7.4%CMS range 3.7–13.2 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.75 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 100 beds and averages 72.9 residents a day — about 73% occupied, or roughly 27 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 2.93 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.27 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.47 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 2.57 hrs/resident/day on weekends vs 3.07 on weekdays — 16% thinner on weekends. RN hours go from 0.33 to 0.12 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 48% is about the same as the national median of 45%. 3 administrators have left in the past year — frequent leadership churn is a warning sign families often miss.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
18 citations, most serious first. The 10 most serious are shown; the remaining 8 are one tap away and print in full.
- Potential for harm · Fcited before2025-04-03 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, staff interviews, and review of the facility policy titled, Dietary Cleaning, the facility failed to ensure that the walk-in refrigerator, the oven, and the fryer were kept clean and sanitary, in a manner that prevents foodborne illness to the residents. This deficient practice had the potential to affect 56 of 62 residents who receive food from the kitchen. Findings include: A review of the facility policy titled Dietary Cleaning revealed: Creating a kitchen cleaning policy for a long-term care facility is essential to maintaining food safety, hygiene, and overall health. Under objective: The objective of this policy is to establish clear guidelines for maintaining a clean, sanitary kitchen environment to prevent food borne illness and ensure the health and safety of residents, staff, and visitors. Under General Guideline: All kitchen surfaces, utensils, equipment, and food storage areas must be kept clean and sanitized. During an initial walk through the kitchen on 4/1/2025 at 9:00 am with the Dietary Manager (DM) the following observations were made: Both…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-04-03 · tag F0584 — failed to keep a safe, clean, comfortable home — isolatedHonor 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.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and staff interviews, the facility failed to maintain a clean, sanitary, and comfortable environment for three of 13 resident rooms (room [ROOM NUMBER], room [ROOM NUMBER], and room [ROOM NUMBER]) reviewed. Specifically, the PTAC (Packaged Terminal Air Conditioner) vents were dirty. This deficient practice had the potential to compromise the health and safety of residents and staff by increasing the risk of respiratory and allergy symptoms due to inadequate air filtration and reduced fresh air circulation. Findings include: Review of the undated facility- provided document titled PTAC Preventative Maintenance Guide under the Three-Monthly PTAC Air Cleaning Tasks section revealed, 1. Air Filter Clean the filter with a vacuum or running water. 2. Vent Screen Clean or replace the vent screen. Remove the front grille and clean it with a dampened cloth Review of the undated facility-provided document titled HVAC (heating, ventilation, and air conditioning): Clean Air Filters details the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-04-03 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interviews, record review, and review of the facility policy titled, (Long Term Care [NAME] Data Set) LTC MDS and Care Plan, the facility failed to follow the care plan for one of eight residents (R) (R168) and failed to include a care plan for O2 use with interventions for one of eight R (R37) who receive (O2) therapy. The deficient practice had the potential for R168 and R37's oxygen needs to go unmet. Findings include: Review of the facility policy titled LTC MDS and Care Plan with a revision date of December 2023 revealed under the Care Plan section: It is the policy of the facility to promote seamless interdisciplinary care for our residents by utilizing the interdisciplinary plan of care based on assessment, planning, treatment services, and interventions. 1. Review of the Care Plan dated 3/17/2025 for R168 revealed a focus diagnoses of emphysema/chronic obstructive pulmonary disease related to smoking. An intervention for oxygen setting revealed oxygen settings as ordered. Review of the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-04-03 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interviews, record review, and review of the facility policy titled, Medical Gas Cylinder Storage, the facility failed to ensure an oxygen (O2) tank was properly secured for one of five residents (R) (R37) reviewed for O2 storage. The deficient practice had the potential to result in harm or injury to the facility's residents. Findings include: Review of the facility policy titled Medical Gas Cylinder Storage dated February 2025 revealed under 2.0 General Requirements: All freestanding oxygen cylinders shall be in a rack, on a cart, in a portable cylinder holder, in a gas cylinder storage cabinet, or secured with a chain to protect them. Review of the electronic medical record (EMR) revealed that R37 was admitted to the facility with diagnoses of, but not limited to dependence on supplemental oxygen, dyspnea (shortness of breath), pneumonia (recurrent), Alzheimer's disease, chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, dementia, unspecified. Review of the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-04-03 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, resident and staff interviews, record review, and review of the facility's policies titled, Oxygen (O2) Concentrator and LTC (long term care)-Oxygen, the facility failed to ensure that residents received O2 as ordered for two of eight residents (R) (R29 and R168) receiving O2 therapy; and failed to ensure that the O2 concentrator (machine that supplies O2) was clean, sanitary, and free of sediment build-up for one of eight R (R33) receiving O2 therapy. The deficient practice had the potential to put the residents at risk for medical complications such as hypoxia, respiratory depression, and infection. Findings include: Review of the facility's policy titled Oxygen Concentrator last revised 3/5/2024 documented under Policy Explanation and Compliance Guidelines: Oxygen is administered under orders of the attending physician. Care of the Concentrator: Follow manufacturer recommendations for the frequency of cleaning filters and servicing the device, external filters will be cleaned weekly.…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-04-03 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, staff interviews, and review of the facility's policy titled, Hand Hygiene and Policy Procedure, the facility failed to ensure the infection control process was followed for two residents (R) (R48 and R168) during medication observation. The deficient practice had the potential to spread infection to other residents, staff and visitors. Findings include: Review of the facility policy titled Hand Hygiene dated 8/4/2011 revealed under Purpose: To decrease the risk of transmission of infection by appropriate hand hygiene. Section 2: Waterless Handwashing Products: If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all clinical situations other than those listed under Handwashing. Review of the facility policy titled Policy Procedure dated 3/2023 revealed under Procedure: . 3. The facility will provide personal protective equipment (PPE) to support compliance with standard and transmission-based precautions and ensure that it is readily available for staff use. Staff are required to adhere to standard precautions…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-02-20 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on resident and staff interviews, record review, and review of the facility's policies titled, Non-Pressure Ulcers, and Treatment Administration Record (TAR), the facility failed to ensure that wound care was provided as ordered by the physician, for one of three residents (R) (RA) with venous ulcers. The deficit practice caused RA not to receive medical treatments as needed, and placed RA at risk for adverse consequences. Findings included: Review of the facility's policy titled, Non-Pressure Ulcers, dated 6/21/2021, revealed under Procedures: 3. Treatment and Management: Wound Care: A structured wound care protocol should be followed, including cleaning . dressing changes 4. Documentation: All non-pressure ulcers must be documented in the resident's medical record including the . treatments provided Review of the facility's policy titled, Treatment Administration Record (TAR), dated 6/21/2021 revealed under, 2. Recording and Documentation: All treatments must be recorded on the TAR with the exact date…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-04-27 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review and staff interviews, the facility failed to follow physician orders for one of eight residents (R) #49. Specifically, the facility failed to ensure intravenous (IV) access site was removed from resident as ordered by physician after antibiotic regime was completed. The deficient practice had the potential to increase the probability of infection to occur at the IV insertion site. Findings: Review of the electronic medical record revealed that resident (R# 49) was admitted to the facility with diagnoses that included but were not limited to cardiovascular accident, hemiplegia of left hand, hypertension, neurogenic bladder, urinary retention, foley catheter and history of recurrent urinary tract infections (UTI). Review of Minimum Data Set (MDS) Quarterly assessment dated [DATE], revealed that resident has a Brief Interview for Mental Status (BIMS) score of 15, which means the resident is cognitively intact. Section H (Bladder and Bowel) revealed that resident was utilizing an…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-04-27 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and staff interviews the facility failed to ensure that oxygen (02) tubing and respiratory equipment were properly stored for two (2) of 15 residents (R) R#32 and R#35. Specifically, the facility failed to ensure that the 02 tubing for R#32 was changed weekly as ordered, the facility also failed to ensure R#35 C-PAP (Continuous Positive Airway Pressure) (ventilation in which a constant level of pressure is continuously applied to the upper respiratory tract of a person) mask was properly stored when not in use. Findings: Review of the electronic medical record (EHR) for resident R #32 revealed that the resident was admitted to the facility with diagnoses that included but are not limited to peripheral vascular disease, chronic obstructive pulmonary disease, and right upper lobe pneumonia. Review of the Physicians' orders revealed that oxygen therapy is to be routine, as needed to keep oxygen stats more than or equal to 90%. Review of the Minimum Data set (MDS) Annual…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-04-27 · tag F0812 — failed to store, cook, and serve food safely — isolatedProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and staff interviews. The facility failed to ensure the kitchen was maintained in a clean and sanitary condition. The deficient practice had the potential to affect 58 of 62 residents receiving an oral diet. Findings include: During the initial tour of the kitchen on 4/25/2023 at 9:00 a.m. the floor and walls were observed to have brown/black/and yellow stains throughout the kitchen. The main kitchen had four air condition units with dirty vents, and spider webs noted between the unit space and the window. Continued observation revealed of the window unit located in the rear of the kitchen had a white blanket positioned underneath the unit that was wet with brown stains noted. Observation on 4/25/2023 at 9:02 a.m. of the dishwasher room revealed the floor under the single compartment sink had missing and lose tile noted from the wall to the middle of the floor. The walls under the dishwashing sink had a thick black substance that was noted on the wall and around the drainage pipe that was attached to the wall. Interview on 4/25/2023 at 12:08 p.m. with the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 8 citations
- Potential for harm · Dcited before2023-04-27 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and review of the facility policies titled, LTC-Pressure Ulcers and Hand Hygiene. The facility failed to ensure that proper hand hygiene was conducted during wound care treatment for one of 10 residents (R#31). The deficient practice had the potential to increase the probability of infection risks for the resident. Findings include: Review of the facility policy titled, Hand Hygiene effective date 5/2022 revealed under: Indications for Hand Washing and Hand Antisepsis; If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands before and after patient contact. Under: Use of Gloves; Gloves should always be worn when contact with blood, body fluids, or other potentially infectious material, mucous membranes and non-intact skin could occur. Gloves do not provide complete protection and glove integrity may be compromised by long or poorly groomed nails. Review of the facility policy titled, LTC-Pressure Ulcers effective date 11/2021…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2021-09-30 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interview, and review of policy titled, Food Safety Requirements the facility failed to label and date items in the walk-in cooler and dry food pantry. There were 55 residents that received an oral diet with a census of 57 residents. Findings include: Review of the policy titled Food Safety Requirements (not dated): Policy Interpretation and Implementation revealed the following information: 7. Dry foods that are stored in bins will be removed from original packaging, labeled, and dated (use by date). Such foods will be rotated using a first in- first out system. 8. All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by). An observation on 9/28/2021 at 8:39 a.m. during a brief kitchen tour with the Food Supervisor revealed the following: 1. In the walk-in cooler there was a one-gallon unlabeled or dated bag containing approximately 7 to 10 uneaten pimento cheese sandwiches. 2. In the walk-in cooler there was a serving container with pureed food that was unlabeled or dated. 3. In the dry food pantry there was one unlabeled or…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2021-09-30 · tag F0655 — patternCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 2. Record review of R#51 's medical record revealed an admission date of 9/7/2021. Further record review revealed that R#51 was admitted to the facility with the following diagnoses but not limited to End Stage Renal disease (ESRD), Foley Catheter, Type 2 Diabetes Mellitus, peripheral vascular disease, coronary artery disease, and colostomy bag. During a record review of R#51's electronic baseline care plan (dated 9/7/2021) with the facility Minimum Data Set (MDS) Coordinator on 9/30/21 at 10:01 a.m. the MDS Coordinator confirmed no interventions to communicate the type of care required to address resident care services for dialysis and diabetes. The MDS Coordinator also confirmed and verified the omission of a hard copy record of a baseline care plan which was available for licensed nursing staff. During the survey on 9/30/31 at 2:00 p.m. an interview was conducted with the Senior (hospital based) MDS Coordinator who revealed that baseline care plan should have identified specific care areas. This information…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2021-09-30 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, staff interview, and review of policy titled, Care Plans, the facility failed to develop a care plan for one of 15 sampled residents, (R) R#52) who was admitted to the facility with a diagnosis of urinary tract infection (UTI) and the facility failed to follow the care plan to ensure one of 15 sampled residents (R#11) received routine care serves with bathing and personal hygiene. Findings include: Review of facility policy titled Care Plans (dated on 6/7/21) stated It is the facilities responsibilities to adequately capture each residents baseline ability along with any changes in condition or new diagnoses that trigger risks in each resident's care plan. If changes in condition occur, care plans must be updated to reflect the changes and interventions put in place in an attempt to reduce the opportunity for further decline. 1. Record review revealed that R#52 was originally admitted to the facility on [DATE] with the following diagnoses but not limited to Foley Catheter…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-09-30 · tag F0677 — failed to help fully-dependent residents with daily care — isolatedProvide care and assistance to perform activities of daily living for any resident who is unable.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record reviews, and interviews, the facility failed to ensure that care was provided for residents who are unable to carry out Activities of Daily Living (ADL) to maintain proper grooming and personal hygiene for two residents (R#11 and R#503) of 15 sampled residents. Findings Include: 1. Observations of R#11 on 9/28/21 at 11:44 a.m., 9/29/21 at 9:54 a.m., 09/30/21 at 9:45 a.m. revealed her hair was disheveled and her fingernails were long with a thick black substance underneath the nails. Review of R#11's Quarterly Minimum Data Set (MDS) dated [DATE] revealed R#11 has a Brief Interview for Mental Status (BIMS) score of 7 indicating severe cognitive impairment and requires extensive assistance with ADLs Review of the 7AM to 7 PM Bath List revealed R#11 is scheduled to get a bath on Tuesdays, Thursdays, and Saturdays. However, there is no evidence to support that R#11 received a bath on 9/18/21, 9/25/21, and 9/28/21. During interview on 9/28/21 at 11:25 a.m. with family member of R#11,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2021-09-30 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, interview, and review of facility policy titled Aerosol Administration, the facility failed to provide proper respiratory care for one resident (R#11) of six residents receiving respiratory treatment. Findings include: Review of policy tilted Aerosol Administration dated 6/7/21 revealed, Intent: To deliver aerosol medications to restore and maintain normal function of the mucociliary escalator, improve efficiency of cough mechanism, provide bronchodilator therapy, and other medications to the airway. Purpose: 6. Empty and residual liquid and place the nebulizer in a plastic patient bag. Record review revealed R#11 was admitted to the facility on [DATE] with diagnoses including but not limited to atrial fibrillation, wheezing, and cardiac pacemaker. Review of Physicians order revealed R#11 had an order for ipratropium-albuterol 0.5 milligrams (mg)-2.5mg/3 milliliters inhalation solution every four hours as needed for wheezing via nebulizer. Observation on 9/28/21 10:19 a.m.…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-09-30 · tag F0758 — failed to limit and justify psychotropic drugs — isolatedImplement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to ensure that one of five residents (R) R#505 reviewed for unnecessary medications had a proper diagnosis for the use of prescribed psychotropic medication. Findings Include: Record review revealed that R#505 admitted to the facility on [DATE], with diagnoses that included Alzheimer's disease unspecified, acute kidney failure, history of Transient Ischemic Attack (TIA), hypothyroidism, hyperlipidemia, retention of urine requiring indwelling catheter, Foley catheter in place, unspecified dementia with behavioral disturbance. Review of the clinical record revealed a physician order for medications that included but not limited to, Risperidone 1 milligram (mg) orally/by mouth (po) every 12 hours (q12 hrs); start date 9/9/21. (Risperidone is classified as an antipsychotic primarily used to treat schizophrenia and Bipolar disorder). Review of the most current comprehensive Minimum Data Set (MDS) 5-day entry assessment dated [DATE] revealed no…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2021-09-30 · tag F0570 — widespreadAssure the security of all personal funds of residents deposited with the facility.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and staff interview, the facility failed to maintain a surety bond sufficient to cover the resident trust fund account balance. There was a total of 39 residents with trust fund accounts. Findings include: Review of the resident trust fund bank statements for the past six months revealed: In March 2021, the beginning balance was $93,658.42 and the ending balance was $75,967.79. In April 2021, the beginning balance was $75,967.79 and the ending balance was $101,163.11. In May 2021, the beginning balance was $101,163.11 and the ending balance was $87,255.40. In June 2021, the beginning balance was $87,255.40 and the ending balance was $80,894.33. In July 2021, the beginning balance was $80,894.33 and the ending balance was $80,878.57. In August 2021, the beginning balance was $80,878.57 and the ending balance was $98,409.31. Review of the Long Term Care (LTC) surety bond #105878419 revealed effective dates were January 02, 2021 through January 02, 2022, and had a bond limit of $50,000.00. Interview on 9/30/21 at 11:05 a.m. with the Administrator who confirmed…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| ALMEIDA, NESTOR | Individual | CORPORATE DIRECTOR; ADP OF THE SNF | since 01/01/2025 |
| TEEMER, VICKIE | Individual | CORPORATE DIRECTOR; ADP OF THE SNF | since 01/01/2025 |
| CARTER, JESSICA | Individual | CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL | since 03/06/2015 |
| GAUTNEY, STEVEN | Individual | CORPORATE OFFICER | since 09/21/2012 |
CMS files one row per role, so the 7 rows in the source record cover these 4 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 75% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $862K paid to related parties — landlords or management companies under common ownership — equal to about 13% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2024. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2024). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in GA
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Georgia Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 115429. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-04-03, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.