Eatonton Health And Rehabilitation
125 Sparta Highway 16 East, Eatonton, GA 31024 · Non profit - Other · 104 certified beds · (706) 485-8573 Medicare & Medicaid certified
This home’s record is mixed — some reassuring signs, some worth asking about.
- a middle-of-the-pack inspection score (3/5)
- no federal fines or payment denials on record
- a high number of inspection citations overall (16) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its facility-reported quality-measure rating is low (2/5)
- about 21% of its spending goes to commonly-owned related companies
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) | 3 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 | 2 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 | 14.0% | 15.3% | 15.4% | typical |
| Long-stay residents who lose too much weight | 0.4% | 5.6% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 2.5% | 0.9% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 0.4% | 2.5% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.4% | 11.3% | 6.5% | better |
| Long-stay residents who were physically restrained | 0.0% | 0.1% | 0.1% | better |
| Long-stay residents with falls causing major injury | 3.3% | 3.2% | 3.3% | typical |
| Long-stay residents whose ability to walk worsened | 15.2% | 15.2% | 16.1% | typical |
| Long-stay residents on antianxiety or hypnotic medication | 26.4% | 20.5% | 18.9% | worse |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 95.0% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 8.9% | 5.6% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 9.6% | 15.8% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 31.6% | 19.9% | 17.1% | worse |
| Short-stay residents who newly got an antipsychotic medication | 4.3% | 2.6% | 1.4% | worse |
| Short-stay residents given the seasonal flu vaccine | 80.0% | 78.4% | 79.4% | typical |
| Short-stay residents rehospitalized after admission | 16.6% | 25.0% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 16.4% | 11.6% | 12.0% | worse |
§ 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.
50.2% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 30 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Therapy staffing: this home’s payroll records show 0.13 therapist hours per resident per day in 2026Q1 — more than 9% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 8% 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 | 50.2%CMS range 33.1–65.6 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 10.1%CMS range 6.8–14.8 | 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 | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 75.0% | 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 | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality 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 | 4.2% | 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 | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.02 | 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 104 beds and averages 77.2 residents a day — about 74% 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 3.24 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.37 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.16 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 2.72 hrs/resident/day on weekends vs 3.45 on weekdays — 21% thinner on weekends — a notable drop. RN hours go from 0.47 to 0.13 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 42% is about the same as the national median of 45%.
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 unchanged from the previous inspection. 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.
16 citations, most serious first. The 10 most serious are shown; the remaining 6 are one tap away and print in full.
- Potential for harm · E2025-06-26 · tag F0761 — failed to label and store drugs safely — patternEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, staff interviews, record review, and review of the facility's policies titled Medication Storage in the Care Center, the facility failed to ensure that medications were properly stored in one of one medication storage rooms. This deficient practice had the potential to increase the risk of residents receiving medications with altered effectiveness. Findings include: Review of the facility policy titled Medication Storage in the Care Center, provided by the facility and dated 2023 stated, .Medications requiring 'refrigeration' or 'temperatures between 2°C (36°) and 8° (46°F) are kept in a refrigerator with a thermometer to allow temperature monitoring . During an observation on 6/25/2025 beginning at 5:20 pm, of the medication storage room with Licensed Practical Nurse/Charge Nurse (LPN/CN) 1 and the Assistant Director of Nurses (ADON) confirmed the following medication storage concerns: R1's NovoLog FlexPen was opened on 5/23/2025 with no expiration date. LPN/CN1 confirmed the pen was almost empty. LPN/CN1 further stated that all opened insulin should have 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 · D2025-06-26 · tag F0554 — isolatedAllow residents to self-administer drugs if determined clinically appropriate.
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, resident and staff interviews, record review, and review of the facility's policy titled Self-Administration of Drugs, the facility failed to ensure two of 17 sampled residents (R) (R29 and R48) were assessed for medication self-administration before allowing unsecured medications to be kept at the bedside. This deficient practice had the potential to place R29 and R48 at risk of unauthorized use of medication, inaccurate medication dosing, and a diminished quality of life. Findings include: Review of the facility's policy titled Self-Administration of Drugs reviewed 12/27/2024, indicated, Intent- It is the intent to promote safe medication practices for patients that choose to self-administer medication. Guideline- To permit patients to self-administer their drugs and medication unless such practice for the patient is deemed unsafe. Procedure- Should the patient wish to self-administer his or her own drugs or medications, the patient should be permitted to do so. Drugs and medication…
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 · D2025-06-26 · tag F0585 — failed to handle grievances — isolatedHonor 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.
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 policy titled Grievance/Concern Guidelines for Patients, the facility failed to document resident grievances and failed to provide a resolution for the grievance for one of 17 sample residents (R) (R6). This deficient practice had the potential to place R6 at risk of unresolved grievances. Findings include: Review of the facility's policy titled Grievance/Concern Guidelines for Patients, dated 12/27/2024, revealed the intent of the facility was to assist, encourage, and educate the residents to file grievances or concerns and to assure the resident that after receiving a concern/grievance, the facility would actively seek a resolution and keep the resident apprised of their progress towards a resolution. The policy also stipulated that the Social Worker (SW) was responsible for entering the concern/grievance into the tracking system, with the investigation and appropriate action recorded. Review of R6's Face Sheet, found under…
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 · D2025-06-26 · tag F0628 — isolatedProvide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
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's policy titled Bed Hold During Hospital Stays and Therapeutic Leaves, the facility failed to ensure one of four residents (R) (R8) reviewed for hospitalizations, or their Resident Representative (RR), received written notice that specified the duration of the bed hold policy. Specifically, the facility failed to include the current rate for the reserve bed payment in the event the resident did not return within seven days. This failure had the potential to place R8 at risk of denial of re-admission and loss of their room following hospitalization. Findings include: Review of the facility's policy titled Bed Hold During Hospital Stays and Therapeutic Leaves, dated 12/27/2024 indicated, .the intent of this nursing center to offer all residents and/or his/her designee the choice of either paying the appropriate amount to hold the bed when the resident goes to the hospital .the Financial Controller, or the Administrator's designee, should prepare…
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 · D2025-06-26 · 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 resident, resident Power of Attorney (POA), and staff interviews and record review, the facility failed to ensure three of three dependent residents (R) (R29, R8, and R64) from a sample of 17 residents received showers according to the schedule. This failure had the potential to place the residents at risk for diminished self-worth, self-esteem, feelings of embarrassment, and/or medical issues. Findings include: 1. Review of R29's Face Sheet, found under the Face Sheet tab of the electronic medical record (EMR), revealed R29 was admitted to the facility on [DATE] with a diagnosis of Alzheimer's disease. Review of R29's Annual Minimum Data Set (MDS) with an assessment reference date (ARD) of 4/28/2025 indicated R29 needed substantial/maximal assistance with bathing. Further review revealed R29 scored 10 out of 15 on the Brief Interview for Mental Status (BIMS), indicating moderately impaired cognition. Review of R29's ADL [Activities of Daily Living] Sheet, found under the ADL tab of the EMR, revealed…
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 · D2025-06-26 · tag F0688 — failed to keep residents mobile / prevent decline — isolatedProvide 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.
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, resident Power of Attorney ([NAME]), and staff interviews, record review, and review of the facility policy titled Restorative, the facility failed to ensure splint application was provided for one of one resident (R) (R64) sampled for Restorative Nursing from a sample of 17. This failure had the potential to place R64 at risk for increased contractures and decreased range of motion. Findings include: Review of the facility's policy titled Restorative, provided by the facility dated 12/27/2024 stated, .This center promotes nursing interventions that assist the patient in his/her ability to adapt and adjust to living conditions .may be captured in a formalized restorative nursing care plan overseen by Nursing Supervisor(s) .The plan of care will be outlined in electronic medical record (EMR) and will be followed by staff trained in restorative care .Documentation of minutes of care provided will be documented in the EMR by staff providing restorative services. Review of R64's Face…
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 · D2025-06-26 · tag F0755 — failed to provide safe pharmacy services — isolatedProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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's policy titled Medication Destruction: Collection Receptacle All Medications (Non-Controlled and Controlled), the facility failed to ensure discontinued medications were stored in a manner to maintain control and accountability for five of 17 sampled residents (R) (R2, R8, R54, R59, and R273). This failure had the potential to increase the risk for drug diversion or misappropriation of medications. Findings include: Review of the facility policy titled Medication Destruction: Collection Receptacle All Medications (Non-Controlled and Controlled), provided by the facility and dated [DATE] indicated, .When medications (non-controlled and controlled substance medications) are expired, discontinued from use, or the patient for whom they were ordered is no longer a patient, the drugs should be promptly removed from the active stock and inventoried by two licensed nurses (either Registered Nurse (RN) or Licensed Practical Nurse (LPN)…
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 · D2025-06-26 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
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's policy titled Documentation in the Medical Record, the facility failed to maintain an accurate medical record for one of 17 sampled residents (R) (R29). Specifically, the facility failed to ensure the staff member delivering care was also the staff member who documented the care related to Activities of Daily Living (ADLs) and showers. Finding include Review of the facility's policy titled Documentation in the Medical Record, dated 12/27/2024, indicated, . Pertinent observations, medications, services performed, etc., should be recorded in the patient's medical record. Review of R29's Face Sheet, found under the Face Sheet tab of the electronic medical record (EMR), revealed R29 was admitted to the facility on [DATE] with a diagnosis of Alzheimer's disease, unspecified. Review of R29's Annual Minimum Data Set (MDS) with an assessment reference date (ARD) of 4/28/2025 indicated R29 had a Brief Interview for Mental Status (BIMS) score of 10…
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 · F2024-01-28 · 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 and staff interviews the facility failed to remove ice build-up from cases of food items in the stand-up freezer to prevent contamination. This deficient practice had the potential to affect 51 of 53 residents receiving an oral diet. Findings include: Observation on 1/27/2024 at 8:30 am of the two-door stand-up freezer located by the back exterior entrance of the kitchen revealed ice build-up on three cases of food products with extension to the top of a case of a nutritional supplement. Observation on 1/28/2024 at 9:15 am of the two-door stand-up freezer near the back exterior entrance revealed the ice on the three cases of food product remained. During an interview on 1/28/2024 at 9:15 am the Dining and Nutritional Services Manager (DNSM) confirmed that there was ice build-up on the cases of food products in the stand-up freezer. The DNSM confirmed that the ice had covered part of the top lid of the case of nutritional supplement. The DNSM revealed that she had not seen ice build-up occur in the freezer before and she expected the Dietary Staff to have…
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 · F2024-01-28 · tag F0881 — failed to use antibiotics responsibly — widespreadImplement a program that monitors antibiotic use.
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 Antibiotic Stewardship, the facility failed to identify trends in antibiotic use, maintain documentation for clinical indication of use for antibiotics, implement systematic protocols to monitor, decrease use, and measure the effectiveness of antibiotics, and failed to create an action plan to lower the use of antibiotics that did not meet criteria for one of 28 sampled residents (R) (R28). Findings include: A review of the policy titled Antibiotic Stewardship reviewed 12/20/2022, indicated the main components of the facility's antimicrobial stewardship program (ASP) include: Formulary restriction. Prospective audit and feedback by pharmacy and feedback to physicians. Staff and physician education. Parenteral to oral conversion protocol. Dose optimization/automatic dose adjustment. Streamlining/de-escalation of therapy. Indication clarification required in patient record. Infectious disease consults when necessary. Reporting on…
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 6 citations
- Potential for harm · E2024-01-28 · tag F0880 — failed to prevent and control infections — patternProvide 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 observations, staff interviews, a review of the facility document titled Personal Items, and a review of the facility policy titled Laundry Services, the facility failed to ensure resident personal care items and 12 clean mop heads were stored in a manner to prevent cross-contamination. These failures had the potential to expose residents to infections due to cross-contamination. Findings include: 1. A review of an undated facility document titled Personal Items, revealed the following: Patient personal items should be labeled with room number. Washbasins should be discarded after patient use. If the patient uses it daily, then should be changed out weekly. Items should be stored in such a way to prevent cross-contamination. Washbasins and bedpans must be stored clean and dry. They do not have to be placed in plastic bags and covered. Observations on 1/26/2024 revealed: at 9:33 am in the shared bathroom for rooms [ROOM NUMBERS] a wash basin was unbagged, not labeled, and on the floor. There also was a…
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 · D2024-01-28 · tag F0558 — failed to accommodate residents' needs and preferences — isolatedReasonably accommodate the needs and preferences of each resident.
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, staff interviews, record review, and review of the facility document titled Call Light Guidelines, the facility failed to ensure the call light was within reach for one resident (R) (R24). The facility census was 53 residents. Findings include: A review of the facility's undated document titled Call Light Guidelines, revealed that staff was to monitor and ensure that call lights were within reach of the residents every two hours and as needed. A review of the Minimum Data Set (MDS) OBRA Quarterly assessment dated [DATE], revealed that R24 had a Brief Interview for Mental Status (BIMS) score of 8, indicating moderate cognitive impairment. A further review revealed that R24 was dependent on staff for all hygiene and mobility needs. An observation of R24 on 1/26/2024 at 9:07 am revealed the resident's call light was on the wall and out of reach of the resident. An observation of R24 on 1/26/2024 at 10:00 am revealed the resident's call light was on the wall and out of reach of the resident.…
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 · D2024-01-28 · tag F0655 — isolatedCreate 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 Based on staff interviews, record review, and review of facility policy titled Baseline Care Plans, the facility failed to develop a baseline care plan for two residents (R) (R20 and R55) of six newly admitted residents in the past 30 days. Specifically, the facility failed to develop a baseline care plan related to dementia care and antipsychotic medication use for R20 and failed to develop a baseline care plan for R55. Findings include: A review of facility policy titled Baseline Care Plan, review date 12/30/2022 revealed the Procedure section to state: Admitting nurses, review the care plan for each patient, after completing the admission assessment to individualize patient care needs. Baseline care plans will address, at a minimum, the patient's initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendations, if applicable, and completed within 48 hours of admission. The Interdisciplinary team will collaborate with nursing to address…
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 · D2024-01-28 · 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 2. A review of R13's Quarterly MDS assessment dated [DATE] revealed: Section K - Swallowing and Nutritional Status: Received a mechanically altered and therapeutic diet while in the facility. A review of the physician orders for R13 revealed an order dated 5/18/2023 for a renal diet and an order dated 5/30/2023 for a puree diet. A review of the comprehensive care plan revealed a care area/problem for altered nutrition as evidenced by a therapeutic diet and mechanically altered diet. Interventions included providing a diet as prescribed. Observation on 1/28/2024 at 12:30 pm revealed R13 was served pureed lasagna instead of a pureed beef patty that the facility document titled Diet Spreadsheet indicated to be provided for a renal diet, in place of the lasagna. During an interview on 1/28/2024 at 12:50 pm, the Corporate Nurse Consultant revealed that she expects R13 to be served the correct food items on a renal diet. 3. A review of R20's admission Minimum Data Set (MDS) assessment dated [DATE] revealed: Section C…
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 · D2024-01-28 · tag F0692 — failed to prevent malnutrition and dehydration — isolatedProvide enough food/fluids to maintain a resident's health.
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, staff interviews, and record review, the facility failed to serve a proper renal diet for one resident (R) (R13) of one resident ordered to receive a renal diet. The deficient practice had the potential to adversely affect R13's nutritional intake. Findings include: Clinical record review revealed that R13 was admitted to the facility on [DATE] with a diagnosis including, but not limited to, acute pyelonephritis. A review of the Physician orders for R13 revealed an order dated 5/18/2023 for a renal diet and an order dated 5/30/2023 for a puree diet. Observation on 1/28/2024 at 12:30 pm of R13 revealed she was sitting in the main dining room eating lunch. Continued observation revealed she was served pureed lasagna, pureed lettuce salad, pureed bread, and chocolate pudding on her lunch plate. R13 had eaten several bites of the puree lasagna and continued eating the lasagna. A review of the Resident Dietary Menu for week 5 for the 1/28/2024 lunch meal revealed that lasagna with meat sauce was…
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 · C2024-01-28 · tag F0732 — widespreadPost nurse staffing information every day.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations and staff interviews, the facility failed to ensure that the daily nurse staffing information was posted daily and was readily accessible to residents and visitors on three of three survey dates, 1/26/2024, 1/27/2024, and 1/28/2024. The facility census was 53 residents. Findings include: Observation on 1/26/2024 at 8:34 am during the initial tour of the facility revealed that the required daily nurse staffing assignment sheet was located behind the nurse's station on the desk and not accessible to residents or visitors. Observation on 1/27/2024 at 8:55 am revealed the required daily nurse staffing assignment sheet was located behind the nurse's station on the desk and not accessible to residents or visitors. Observation on 1/28/2024 at 9:13 am revealed the required daily nurse staffing assignment sheet was located behind the nurse's station on the desk and not accessible to residents or visitors. During an interview on 1/28/2024 at 11:25 am, the Director of Nurses (DON) stated she concurred that the daily nurse staffing assignment sheet was not located in a…
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.
- 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.
Part of a chain
This home belongs to ETHICA HEALTH — 50 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 3 of 5 | 3.6 | -0.6 vs chain |
| Health inspection | 3 of 5 | 3.6 | -0.6 vs chain |
| Staffing | 3 of 5 | 3.1 | -0.1 vs chain |
| Quality measures | 2 of 5 | 2.8 | -0.8 vs chain |
The other 49 homes this chain runs (chain average 3.6★, per CMS)
Showing 40 of 49; lowest-rated first.
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| HEALTH SCHOLARSHIPS INC | Organization | DIRECT OWNERSHIP INTEREST | since 07/01/2023 |
| COMMUNITY HEALTH SYSTEMS INC | Organization | INDIRECT OWNERSHIP INTEREST | since 01/01/2008 |
| CABLE, PAUL | Individual | MANAGING CONTROL - GOVERNING BODY | since 03/14/2003 |
| DAVIS, GREGORY | Individual | MANAGING CONTROL - GOVERNING BODY; OPERATIONAL/MANAGERIAL CONTROL | since 09/01/2023 |
| DENNIS, KATHRYN | Individual | MANAGING CONTROL - GOVERNING BODY | since 11/17/2015 |
| NICHOLS, JOSEPH | Individual | MANAGING CONTROL - GOVERNING BODY | since 11/19/2024 |
| ROLLINS, RONNIE | Individual | MANAGING CONTROL - GOVERNING BODY | since 03/14/2003 |
| WALL, JOSEPH | Individual | MANAGING CONTROL - GOVERNING BODY | since 03/14/2003 |
| WARNOCK, RALPH | Individual | MANAGING CONTROL - GOVERNING BODY | since 06/23/2020 |
| CLINICAL SERVICES INC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 01/01/2008 |
| RINGER, DAVE | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 07/01/2025 |
| WELLS, SHALONDA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 02/09/2026 |
| YARBROUGH, MARISSA | Individual | OPERATIONAL/MANAGERIAL CONTROL | since 10/22/2025 |
| SHEFFIELD, KIMBERLY | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/29/2025 |
CMS files one row per role, so the 18 rows in the source record cover these 14 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.
3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
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.
This home reported $1.2M paid to related parties — landlords or management companies under common ownership — equal to about 21% 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. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.
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 115595. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-06-26, 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.