Heardmont Health And Rehabilitation

Location & what’s nearby

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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

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.

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.

Therapy staffing: this home’s payroll records show 0.05 therapist hours per resident per day in 2026Q1 — more than 2% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 50% 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.

Staffing

How full it usually is: this home is certified for 60 beds and averages 46.6 residents a day — about 78% occupied, or roughly 13 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 3.71 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.29 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.66 is at or above 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 2.95 hrs/resident/day on weekends vs 4.02 on weekdays — 27% thinner on weekends — a notable drop. RN hours go from 0.28 to 0.29 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 49% 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 fewer than at the previous inspection — improving. 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.

28 citations, most serious first. The 17 most serious are shown; the remaining 11 are one tap away and print in full.

• Immediate jeopardy · L2023-12-15 · tag F0835 — failed to run the facility competently — widespread
  Administer the facility in a manner that enables it to use its resources effectively and efficiently.
  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 interviews, record review and review of the Administrator's Job Description, Administration failed to protect residents from abuse, failed to report allegations of abuse, and failed to thoroughly investigate allegations of abuse. In addition, Administration failed to provide protective oversight of the facility environment including adequate supervision for wandering residents and ensuring proper functioning of the electronic alert system. Two Immediate Jeopardy situations were identified when abuse and allegations of abuse for four residents (R8, R14, R17, and R18) were not reported to the State Agency (SA); and 10 allegations of abuse were not thoroughly investigated; and two residents (R) (R6 and R10) eloped four times in a three-month period; The sample size was 19. On 12/5/2023, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment, or death to…

  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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · L2023-12-15 · tag F0867 — failed to act on quality-improvement findings — widespread
  Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
  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 interview, record review and review of the policy titled Quality Assurance and Performance Improvement (QAPI), the facility failed to ensure the QAPI program effectively identified, developed and implemented appropriate action plans to meet the needs of six of 19 sampled residents (R) (R6, R10, R8, R14, R17, and R18). Specifically, the Quality Assurance Performance Improvement program failed to protect R8, R14, R17, and R18 from abuse and failed to provide safety and oversight of the elopement prevention program for R6 and R10. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. The facility's Administrator, Regional Administrator (RA), Director of Nursing (DON) and Regional Nurse Consultant (RNC) were informed of two Immediate Jeopardy's (IJ) on [DATE] at 3:45 pm. The noncompliance related to the Immediate Jeopardy 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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · K2023-12-15 · tag F0600 — failed to protect residents from abuse and neglect — pattern
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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 interviews, record review, and review of the policy titled Abuse Prohibition Policy and Procedures, the facility failed to ensure that four of 19 sampled residents (R) (R8, R14, R17, and R18) were free from physical, verbal, and sexual abuse. The allegations of abuse are identified to have been committed by R3, R5, and a Contracted Facility Staff. On 12/5/2023, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. The facility's Administrator, Regional Administrator (RA), Director of Nursing (DON) and Regional Nurse Consultant (RNC) were informed of two Immediate Jeopardy's (IJ) on 12/5/2023 at 3:45 pm. The noncompliance related to the first Immediate Jeopardy was identified to have existed on 7/5/2022 when the facility failed to protect four residents (R) (R8, R14, R17 and R18) from physical, verbal, and sexual abuse. A Credible…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · K2023-12-15 · tag F0609 — failed to report abuse allegations — pattern
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  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 interview, record review and review of policy titled Abuse Prohibition Policy and Procedures, the facility failed to ensure allegations of sexual, physical and verbal abuse, were reported to the State Agency (SA) in a timely manner for four of 19 sampled residents (R) (R8, R14, R17 and R18). The allegations of abuse are identified to have been committed by R3, R5, and a Contracted Facility Staff. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. The facility's Administrator, Regional Administrator (RA), Director of Nursing (DON) and Regional Nurse Consultant (RNC) were informed of two Immediate Jeopardy's (IJ) on [DATE] at 3:45 pm. The noncompliance related to the Immediate Jeopardy was identified to have existed on [DATE] when the facility failed to protect four residents (R8, R14, R17, and R18) from physical, verbal,…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · K2023-12-15 · tag F0610 — failed to investigate and act on abuse reports — pattern
  Respond appropriately to all alleged violations.
  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 interview, record review and review of policy titled Abuse Prohibition Policy and Procedures, the facility failed to investigate, correct, and prevent allegations of abuse for four of 19 sampled residents (R) (R8, R14, R17, and R18) with multiple documented incidences of physical, sexual, and verbal abuse by R3, R5, and a Contracted Physical Therapist. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. The facility's Administrator, Regional Administrator (RA), Director of Nursing (DON) and Regional Nurse Consultant (RNC) were informed of two Immediate Jeopardy's (IJ) on [DATE] at 3:45 pm. The noncompliance related to the IJ was identified to have existed on [DATE] when the facility failed to protect four residents (R8, R14, R17, and R18) from physical, verbal, and sexual abuse. A Credible Allegation of Compliance 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Kcited before2023-12-15 · tag F0656 — failed to write and follow a full care plan — pattern
  Develop 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, interviews, and review of the policy titled Care Plans, Comprehensive Person-Centered the facility failed to develop and implement the person- centered care plan that focused on risks for wandering and elopement for two residents (R) (R6 and R10) from a sample of 19 residents. On 12/5/2023, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. The facility's Administrator, Regional Administrator (RA), Director of Nursing (DON) and Regional Nurse Consultant (RNC) were informed of two Immediate Jeopardy's (IJ) on 12/5/2023 at 3:45 pm. The second Immediate Jeopardy (IJ) was identified to have existed on 7/14/2023 when the facility failed to provide protective oversight for residents at risk for elopement when R6 eloped three times and R10 eloped in a three-month timeframe. A Credible Allegation of Compliance…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · K2023-12-15 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
  Ensure 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, interviews, record review, and review of the facility policy titled Elopements, the facility failed to provide adequate monitoring and protective oversight of the elopement prevention program and failed to ensure the mechanisms of the electronic alert system was functioning properly to prevent residents at risk for elopement to exit the facility undetected. In addition, the facility failed to have a process in place for the four remaining exit doors not equipped with the electronic alert system. Specifically, resident (R) R6 and R10, both wearing electronic alert system devices, eloped from the facility for approximately three hours, before being spotted by local citizens, and reported to the facility that they were missing. The sample size was 19. On 12/5/2023, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-11-18 · tag F0880 — failed to prevent and control infections — isolated
  Provide 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, staff interviews, and review of the facility's policy titled Cleaning and Disinfection of Resident-Care Items and Equipment, the facility failed to ensure a single use resident care item was not shared between residents in two of 21 rooms (room [ROOM NUMBER] and room [ROOM NUMBER]). Specifically, a foam wedge was taken from room [ROOM NUMBER] and used to reposition a resident bed in room [ROOM NUMBER]. This deficient practice had the potential to place the resident at risk for medical complications, unmet needs, and a diminished quality of life.Findings include:Review of the facility's policy titled Cleaning and Disinfection of Resident-Care Items and Equipment revised October 2018, under the Policy statement revealed, Resident care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Blood bore Pathogens Standard. Under the section titled Policy Interpretation and…

  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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-04-07 · tag F0656 — failed to write and follow a full care plan — pattern
  Develop 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 observation, staff interview, record review, and review of the facility policy titled Comprehensive Care Plans, the facility failed to develop a comprehensive person-centered care plan for five of 24 sampled residents (R) (R37, R20, R9, R22, R31) related to dementia for (R37 and R31), psychotropic medication use for (R37, R22, and R31), anxiety disorder for (R37), schizophrenia for (R9), and Activities of Daily Living (ADL) care for (R20). Findings include: A review of the policy titled Care Plans, Comprehensive-Person Centered, dated 2001 under the Policy Interpretation and Implementation revealed, 2. The comprehensive, person-centered care plan would be developed within seven days at the completion of the required MDS assessment (Admission, Annual, or Significant Change in Status), and no more than 21 days after admission. 3. The care plan interventions would be derived from a thorough analysis of the information gathered as part of the comprehensive assessment. 4. Each resident's comprehensive…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-04-07 · tag F0641 — isolated
  Ensure each resident receives an accurate assessment.
  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, and record reviews, the facility failed to develop an accurate Minimum Data Set (MDS) assessment for one of three Residents (R) (R14) related to dental status. Findings include: A review of the Electronic Medical Record (EMR) revealed that R14 was admitted to the facility on [DATE] and readmitted on [DATE] with the diagnoses of, but not limited to, major depressive disorder and dementia. During observations on 4/5/2025 at 11:03 am, 12:55 pm, and 2:00 pm, R14 was observed to have broken and decayed natural teeth. His mouth had a foul odor and a thick white caked residue when he spoke. He was alert with confusion. A review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Section C (Cognitive Patterns) revealed a Brief Interview for Mental Status (BIMS) score of six, indicating severe cognitive impairment. A review of the admission MDS dated [DATE] for Section L (Oral/Dental status) revealed that the resident presented with no dental concerns. During 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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-04-07 · tag F0655 — isolated
  Create 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 observations, interviews, record review, and a review of the facility policy titled Care Plans - Baseline, the facility failed to develop a baseline care plan for one of five sampled Residents (R) (R345) reviewed for catheter care and Activities of Daily Living (ADL) care. Findings include: A review of the policy titled Care Plans-Baseline dated 2001 under the Policy Statement revealed, A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within 48 hours of admission. Under Policy Interpretation and Implementation revealed, 1. The baseline care plan includes instructions needed to provide effective person-centered care of the resident that meets professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident including . physician orders. 2. The baseline care plan is used until staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-04-07 · tag F0660 — isolated
  Plan the resident's discharge to meet the resident's goals and needs.
  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, interviews, record review, and a review of the facility policy titled Discharge Summary and Plan, the facility failed to develop and implement an effective discharge planning process for one of two Residents (R) R6 reviewed for discharges. Specifically, the facility failed to ensure documentation that R6 had been asked about their interest in receiving information regarding returning to the community, updating the resident's comprehensive care plan and discharge plan, and if discharge to the community was determined not to be feasible, ensuring to document who made the determination and why. Findings include: A review of the facility policy titled Discharge Summary and Plan dated 2001 under the Policy Statement revealed, When a resident's discharge is anticipated, a discharge summary and post-discharge plan are developed to assist the resident with discharge. Under Policy Interpretation and Implementation revealed, 4. The post-discharge plan is developed by the care…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-04-07 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
  Provide 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 observations, interviews, record review, and review of the facility policy titled Activities of Daily Living (ADL), Supporting, the facility failed to provide Activities of Daily Living (ADL) care for three of 24 sampled Residents (R) (R14, R20, and R345) related to personal hygiene and showers. Findings include: Review of the facility policy titled Activities of Daily Living (ADL), Supporting, dated March 2018 under the Policy Statement revealed, Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal, and oral hygiene. 1. A review of the Electronic Medical Record (EMR) revealed that R14 was admitted to the facility on [DATE] and readmitted on [DATE] with the diagnoses of, but not limited to, major depressive disorder and dementia.…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-04-07 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  Provide 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, staff and resident interviews, record review, and review of the facility policy titled Oxygen Administration, the facility failed to ensure one of two residents (R) (R22) reviewed for oxygen was administered oxygen as ordered by the physician. Findings include: Review of the policy titled Oxygen Administration dated October 2010 under the Purpose section revealed, The purpose of this procedure is to provide guidelines for safe oxygen administration. Under the section titled Preparation revealed, 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration.2. Review the resident's care plan to assess any special needs of the resident . Under the section titled Documentation revealed, After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record: 3. The rate of oxygen flow, route, and rationale. Observation on 4/5/2025 at 9:30 am revealed R22 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-04-07 · tag F0791 — failed to provide routine dental services — isolated
  Provide or obtain dental services for 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 observations, interviews, record reviews, and a review of the facility policy titled Dental Services, the facility failed to provide routine dental services for two of three Residents (R) (R14 and R20) reviewed for dental concerns. Findings include: A review of the facility policy titled Dental Services dated 2001 under the Policy Statement revealed, Routine and emergency dental services are available to meet the resident's oral health services in accordance with the resident's assessment and plan of care. Under the Policy Interpretation and Implementation section revealed, 1. Routine and 24-hour emergency dental services are provided to our residents through a contract agreement with a licensed dentist that comes to the facility monthly; . referral to the resident's personal dentist; referral to a community dentist; or referral to other health care organizations that provide dental services 11. All dental services provided are recorded in the resident's medical record . 1. A review of the Electronic…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2024-03-17 · tag F0880 — failed to prevent and control infections — widespread
  Provide 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, record review, staff interviews, and review of facility's policy titled Infection Prevention Control Program the Transmission of Communicable Disease, the facility failed to maintain an effective infection prevention and control program that demonstrated ongoing surveillance, recognition, and investigation to prevent the onset and spread of infections. Specifically, the facility failed to provide complete and accurate surveillance data; failed to follow infection control practices in the laundry room and failed to properly label and store resident personal care items. The census was 42 residents. Findings include: 1. Review of the policy titled Infection Prevention Control Program the Transmission of Communicable Disease dated 5/10/2023 revealed Policy Explanation and Compliance Guidelines: Number 1. The Infection Preventionist is responsible for oversight of the program and serves as a consultant to staff on infectious diseases, resident room placement, implementing isolation precautions, staff and resident exposures, surveillance, and epidemiological…

  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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2024-03-17 · tag F0883 — failed to offer flu and pneumonia vaccines — pattern
  Develop and implement policies and procedures for flu and pneumonia vaccinations.
  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, interviews and review of policies titled Vaccination of Residents and Pneumococcal Vaccine, the facility failed to provide education, offer, or administer pneumonia vaccinations for three of five sampled residents (R) (R9, R25, R39) reviewed for vaccinations. Findings include: Review of the policy titled Vaccination of Residents revised October 2019, documented the policy statement that all residents will be offered vaccines that aid in preventing infectious diseases unless contraindicated or the resident has already been vaccinated. Policy Interpretation and Implementation: Number 1. Prior to receiving vaccinations, the resident or legal representative will be provided with information and education regarding the benefits and potential side effects of the vaccinations. Number 2. Provisions of such education will be documented in the resident's medical record. Number 3. All new residents shall be assessed for current vaccination status upon admission. Number 4. The resident or 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.

  Infection Control Deficiencies · Deficient, Provider has date of correction

“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.

Fines & penalties

$170,259 in federal fines across 1 penalty.

• $170,259 — penalty dated 2023-12-15

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

CMS files one row per role, so the 10 rows in the source record cover these 5 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.

2 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 $168K paid to related parties (affiliated landlords or management companies) in its most recent cost report. 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