Average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at 4angels Of Byromville Healthcare Center during CMS and state inspections, most recent first.
Failure to Check G-Tube Placement and Residual Before Feeding: An LPN administered tube feed, meds, and flushes to a resident with dysphasia and a feeding tube without checking tube placement or residual, despite physician orders requiring both. The LPN confirmed the omission, and the DON stated nurses were expected to verify placement and residual before giving feedings, medications, or flushes.
Expired medications were found in a medication room on the 100 Hall, including [NAME]-Vite, bisacodyl, acetaminophen, and zinc tablets with expired dates. An LPN confirmed the medications were expired and should not have been stored there, and the DON stated nurses were responsible for removing expired medications from the medication room.
Failure to Follow Hand Hygiene, Glove Use, and Soiled Linen Handling Protocols: The DON, an LPN, and a CNA were observed not sanitizing their hands after removing gloves and before putting on new gloves. The CNA was also observed wearing gloves in the hallway, opening doors with gloved hands, and carrying unbagged soiled linen from a resident’s room down the hallway. Interviews confirmed these actions and that gloves should not be worn outside resident rooms or between tasks without hand hygiene, and soiled linen should be bagged before removal.
Failure to Check Feeding Tube Placement and Residual Before Administration
Penalty
Summary
The facility failed to provide appropriate treatment and services for a resident with a feeding tube by not checking gastrostomy tube placement and residual as ordered before administering tube feeding, medications, and flushes. The resident, R6, was readmitted with dysphasia and had a feeding tube documented on the MDS. The care plan addressed tube feedings and monitoring for signs and symptoms of aspiration, tube dislodgement, infection, tube dysfunction, abdominal symptoms, diarrhea, nausea/vomiting, and dehydration. Physician orders dated 07/24/2025 included Jevity 1.5 240 mL every 4 hours, flushes before and after feeding, and orders to check and record residual every shift, notify the MD if residual exceeded 50 mL, and check tube placement before initiation of formula, medication administration, and flushing. During observation on 04/08/2026, an LPN administered a 100 mL water flush, 233 mL of Jevity, and another 100 mL water to R6 without checking tube placement or residual. In interview, the LPN confirmed she did not perform either check and acknowledged there were physician orders to do so. The DON stated her expectation was that nurses check residual and placement before administering feedings, medications, and flushes, and explained that failure to do so could result in too much fluid being given or the tube being out of place.
Expired Medications Found in Medication Room
Penalty
Summary
The facility failed to remove expired medications from one of one medication room reviewed. During observation of the medication room on the 100 Hall, surveyors found expired medications stored there, including one bottle of [NAME]-Vite tablets with an expiration date of 07/2025, one bottle of bisacodyl 5 mg tablets with an expiration date of 03/2026, one bottle of acetaminophen 325 mg tablets with an expiration date of 02/2026, and two bottles of zinc 50 mg tablets with an expiration date of 01/2026. The facility policy titled Medication Labeling and Storage stated that discontinued, outdated, or deteriorated medications or biologicals are to be handled by contacting the dispensing pharmacy for instructions regarding return or destruction. During interview, an LPN confirmed the medications were expired and stated they should not have been in the medication room because they were expired. The LPN stated the expired medications could be given to residents, would not help residents' conditions, would not provide the full potential of the medications, and could allow residents' conditions to worsen. The DON stated her expectation was that no expired medications be in the medication room and said nurses were responsible for removing expired medications from the medication room. She also stated that if expired medications were given to residents, they could have allergic reactions and the medications would not work.
Failure to Follow Hand Hygiene, Glove Use, and Soiled Linen Handling Protocols
Penalty
Summary
The facility failed to implement infection control protocols related to hand hygiene, glove use, and handling of soiled linen. Review of the facility’s policies stated that hand hygiene is the primary means to prevent the spread of infections, that hand hygiene is required after removing gloves, that gloves do not replace handwashing, and that used gloves are to be discarded in the room where the procedure is performed. The laundry policy stated that soiled laundry is to be handled as potentially contaminated and bagged or contained at the point of collection. On 04/08/2026 at 8:55 AM, the DON was observed exiting a resident’s room, removing her gloves, and putting on a new pair of gloves without sanitizing her hands. At 9:14 AM, the DON was observed removing gloves in the 100 hallway, rolling them in her hands, walking down the hallway with the gloves in her hands, returning to the medication cart, disposing of the gloves in the garbage bin on the cart, and then donning a new pair of gloves without sanitizing her hands. At 3:58 PM, LPN BB was observed leaving a resident’s room wearing gloves, removing them, disposing of them in the garbage bin on the medication cart, and putting on a new pair of gloves without sanitizing her hands before attending to a resident sitting in the hallway near the nurses’ station. Also on 04/08/2026 at 10:38 AM, CNA AA was observed walking out of a resident’s room wearing gloves, opening and closing the shower room door with the same gloves, and then returning to a resident’s room and opening that door with the gloved hand. At 10:40 AM, CNA AA was observed taking linen that was not bagged from a resident’s room and walking it down the hallway to another shower room. In interviews, CNA AA, LPN BB, and the DON each confirmed the observations and stated that gloves should not be worn out of resident rooms or between tasks without hand hygiene, and that soiled linen should be bagged before being taken out of resident rooms.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Byromville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Montezuma Health And Rehabilitation | 9.4 mi | ★★★★★ | 2 | 0 |
| Cordele Health And Rehabilitation | 17.3 mi | ★★★★★ | 0 | 0 |
| Oaks Nursing Home, Inc, The | 17.4 mi | ★★★★★ | 0 | 0 |
| Crisp Regional Nsg & Rehab Ctr | 17.6 mi | ★★★★★ | 14 | 0 |
| Summerhill Elderliving Home & Care | 19.6 mi | ★★★★★ | 15 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.