Below average — CMS composite of the measures below.
The next survey window likely opens around February 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 Archbold Living Thomasville during CMS and state inspections, most recent first.
Facility Assessment Not Updated Annually: The facility failed to update its annual facility assessment. The Facility Assessment Tool showed a current population date that was not updated, and both the Administrator and LTCD confirmed the assessment had not been fully revised even though the date had been changed. The facility policy states the assessment is conducted annually to determine and update the facility’s capacity to meet resident needs during day-to-day operations.
A resident with a stroke history, right-sided hemiplegia, and aphasia had multiple MDS assessments that coded no upper extremity impairment despite OT orders and staff confirmation of a right-hand contracture. During observation, the resident stated he could not open his right hand, and the MDSC acknowledged the assessments were inaccurate.
Failure to update PASRR screening after a new mental health diagnosis. A resident with stroke-related hemiplegia and moderate cognitive impairment was later diagnosed with major depressive disorder, recurrent, severe with psychotic symptoms, but the resident’s PASRR Level I remained unchanged and did not reflect the psychiatric diagnosis. The care plan included depression, a mental health referral, and behavioral management services, and the SSD confirmed the resident should have been referred for a Level II PASRR when the new diagnosis was identified.
The facility did not ensure that an area was free from accident hazards and failed to provide adequate supervision to prevent accidents. Surveyors observed environmental hazards and insufficient staff monitoring, resulting in increased risk of resident accidents.
A resident with intact cognition reported to a therapy assistant that another resident exposed himself. The incident was documented and referred to social services the same day, but the allegation was not reported to the State Agency until three days later, contrary to facility policy requiring reporting within two hours. The DON and Administrator confirmed the delay and acknowledged the reporting failure.
A facility failed to accurately document a resident's code status in the EMR, leading to a discrepancy with the POLST, which indicated a DNR status. Despite the POLST being signed by a physician, the care plan and EMR continued to reflect a Full Code status. Staff interviews revealed reliance on the POLST in case of conflict, but the inconsistency highlights a deficiency in updating records to honor the resident's wishes.
A facility failed to follow a care plan for a resident with COPD and dementia, which required weekly weight checks to monitor unintended weight loss. Instead, only monthly weights were recorded, and staff were unaware of the resident's weight loss. The facility lacked a policy to ensure adherence to care plans, relying on the RAI Manual instead.
The facility failed to timely monitor the weights of two residents, leading to significant weight loss that was not promptly addressed. One resident with hemiplegia and dysphagia lost 6.05% of their weight over 30 days, while another with COPD and dementia lost 12.52% over six months. Despite care plans requiring weight monitoring, the Registered Dietitians were unaware of the losses due to inadequate processes, including CNAs being unable to see previous weights. The facility's policy for notifying dieticians of significant weight changes was not followed, resulting in delayed intervention.
A resident with a history of pneumonitis and autism was observed receiving oxygen at 3.5 LPM instead of the prescribed 2 LPM, potentially causing respiratory distress. Facility staff, including a CNA and RN, were unaware of the correct oxygen settings, and the DON confirmed that changes to oxygen settings should be communicated to the physician. The facility's policy stressed the importance of following physician orders for oxygen administration.
A facility failed to implement Enhanced Barrier Precautions (EBP) for a resident with a feeding tube and wounds, as observed when an LPN did not wear a gown during medication administration. Staff interviews revealed inconsistencies in understanding EBP requirements, with some relying on verbal communication rather than posted signs. The facility's policy required gowns and gloves for high-contact care activities, but this was not followed, indicating a deficiency in infection control.
Facility Assessment Not Updated Annually
Penalty
Summary
The facility failed to review and update its facility assessment annually. Review of the Facility Assessment Tool dated 06/30/25 showed the current population as of 06/30/24, indicating the assessment was not fully updated. During interview, the Administrator confirmed the assessment was dated 06/30/25 but based on the past 12 months and stated it was an error that all dates were not updated when the assessment was completed. The Long Term Care Director also confirmed the annual assessment was not updated and stated the previous administrator changed the date without updating the assessment and did not realize it until the assessment was compared to the prior year's assessment. Review of the facility policy titled Facility Assessment stated that a facility assessment is conducted annually to determine and update the facility's capacity to meet resident needs and competently care for residents during day-to-day operations.
Inaccurate MDS Coding for Upper Extremity Impairment
Penalty
Summary
The facility failed to ensure the MDS accurately reflected the condition and needs of one resident with a history of cerebral arteritis (stroke), right-sided hemiplegia, and aphasia. The resident’s annual MDS with an ARD of 08/19/25, quarterly MDS with an ARD of 11/04/25, and MDS with an ARD of 02/04/26 all coded no upper extremity impairment, despite OT orders dated 09/08/25 identifying a right-hand contracture. During observation, the resident was in bed and stated he could open and close his left hand but was unable to open his right hand. OT staff confirmed the resident had a right-hand contracture, and the MDS Coordinator reviewed the three MDS assessments and confirmed they were inaccurate. The DON and ADON stated their expectation was for all MDS to be accurate. The facility’s MDS policy stated that comprehensive assessments, care planning, and care delivery involve collecting and analyzing information, choosing and initiating interventions, and then monitoring results and adjusting interventions.
Failure to Update PASRR Screening After New Mental Health Diagnosis
Penalty
Summary
The facility failed to ensure that one resident reviewed for PASRR had an updated Level I screening after a new psychiatric diagnosis was identified. R14 was admitted with hemiplegia and hemiparesis following cerebral infarction, and the facility’s Behavioral Health Assessment dated 03/11/25 documented major depressive disorder, recurrent, severe with psychotic symptoms effective 11/08/24. The annual MDS dated 11/18/25 showed a BIMS score of 9 out of 15, indicating moderate cognitive impairment, and also reflected a diagnosis of depression with no Level II PASRR. R14’s care plan dated 11/20/25 included depression, a mental health referral, and behavioral management services. However, the PASRR Level I Assessment dated 01/16/19 still showed no diagnosis of serious mental illness. During interview, the SSD stated she was not employed at the facility when the new diagnosis was identified and confirmed R14 should have been referred for a Level II PASRR assessment when the mental illness diagnosis was discovered. The facility policy stated that residents are screened for MD, ID, or RD and that if the Level I screen indicates possible criteria, the resident is referred for Level II evaluation.
Failure to Maintain Accident-Free Environment and Adequate Supervision
Penalty
Summary
The facility failed to ensure that an area was free from accident hazards and did not provide adequate supervision to prevent accidents. Surveyors observed that the environment contained hazards that could lead to resident accidents, and staff did not implement sufficient measures to monitor or protect residents from these risks. This deficiency was identified based on direct observations and findings during the survey, which indicated lapses in maintaining a safe environment and in providing necessary supervision to prevent accidents.
Failure to Timely Report Alleged Abuse
Penalty
Summary
The facility failed to report an allegation of abuse within the required two-hour timeframe after a resident reported that another resident exposed his genitals to her. According to the facility's Abuse Prohibition Policy and Procedures, any alleged mistreatment, neglect, or abuse must be reported immediately, but no later than two hours after the allegation is made. The resident who made the allegation was cognitively intact, as indicated by a BIMS score of 15. The incident was initially reported by the resident to a therapy assistant, who then notified the social worker and documented the event in the health record. The complaint was received by the social worker and referred to the appropriate department on the same day the allegation was made. However, the facility did not report the allegation to the State Agency until three days later. The Director of Nursing (DON) and the Administrator both confirmed that the DON, who serves as the abuse coordinator, was not made aware of the allegation until the day it was reported to the state. The DON acknowledged that the report should have been made within two hours of the initial allegation. There were no other incidents between the time of the initial report and the eventual notification to the state.
Discrepancy in Resident's Code Status Documentation
Penalty
Summary
The facility failed to ensure that a resident's code status was accurately reflected in the medical record according to the resident's wishes. Resident 16, who was admitted with diagnoses of hemiplegia and hemiparesis following a stroke and protein-calorie malnutrition, had a discrepancy between the electronic medical record (EMR) and the Physician Orders for Life-Sustaining Treatment (POLST). The EMR indicated a Full Code status, while the POLST, signed by the physician, indicated a Do Not Attempt Resuscitation (DNR) status. This inconsistency was not updated in the resident's care plan, which continued to reflect a Full Code status. Interviews with facility staff, including the Registered Nurse, Assistant Director of Nursing, Medical Records Coordinator, Social Services Coordinator, MDS Coordinator, Director of Nursing, Medical Director, and Administrator, revealed a lack of communication and coordination in updating the resident's code status across different records. The staff acknowledged the discrepancy and stated that they would follow the POLST in case of a conflict. However, the failure to update the EMR and care plan to reflect the resident's DNR wishes as documented in the POLST represents a deficiency in honoring the resident's right to make decisions about their care.
Failure to Follow Care Plan for Resident's Weight Monitoring
Penalty
Summary
The facility failed to adhere to a care plan related to weight loss for a resident diagnosed with chronic obstructive pulmonary disease (COPD) and dementia. The care plan, which was intended to address unintended weight loss, required weekly weight checks to monitor the resident's condition. However, the facility only recorded monthly weights, contrary to the care plan's directive. This discrepancy was identified during a review of the resident's electronic medical record, which showed a series of monthly weights but no weekly weights as stipulated in the care plan. Interviews with facility staff revealed a lack of awareness and adherence to the care plan. The Registered Dietician was unaware of the resident's weight loss, as she had not yet tabulated the monthly weights. The MDS Coordinator indicated that weekly weights were not conducted unless there was a significant weight change, suggesting that the care plan for weekly weights was outdated. The Director of Nursing expected the care plan to be followed, but the facility lacked a specific policy to ensure compliance with care plans, relying instead on the Resident Assessment Instrument (RAI) Manual. This oversight had the potential to delay the response to the resident's weight loss.
Failure to Timely Monitor Resident Weights
Penalty
Summary
The facility failed to timely monitor the weights of two residents, R39 and R8, which led to significant weight loss that was not promptly addressed. R39, who was admitted with hemiplegia and dysphagia, experienced a weight loss of 6.05% over approximately 30 days. Despite having a care plan that included monthly weight monitoring and interventions for unintended weight loss, the resident's intake was consistently low, with meals often substituted with grilled cheese, and the weight loss was not identified until after the 30-day weight review. The Registered Dietitian (RD) was unaware of the significant weight loss until the weights were reviewed, indicating a lapse in timely monitoring and intervention. R8, admitted with COPD and dementia, also experienced significant weight loss, with a 12.52% decrease over six months. The resident's care plan included weekly weight monitoring due to unintended weight loss, but the RD was unaware of the weight loss for the month as the monthly weights had not been tabulated. The facility's process for monitoring weight changes was inadequate, as the CNAs responsible for weighing residents could not see previous weights, leading to a lack of awareness of significant changes. The MDS Coordinator confirmed that residents were not placed on weekly weight monitoring unless a significant weight change was identified, which did not occur in a timely manner for R8. The facility's policy required immediate notification of the dietician for any weight change of 5% or more, but this was not adhered to in the cases of R39 and R8. The Director of Nursing expected the dietician to pull weight reports timely, but this expectation was not met, resulting in delayed identification and response to significant weight loss in these residents. The failure to monitor and address weight changes in a timely manner highlights deficiencies in the facility's processes for ensuring adequate nutrition and hydration for its residents.
Failure to Administer Oxygen at Prescribed Dose
Penalty
Summary
The facility failed to administer oxygen at the physician-prescribed dose for a resident, which had the potential to cause respiratory distress. The resident, who was admitted with diagnoses including pneumonitis due to inhalation of food and vomit and autistic disorder, had an order for oxygen at two liters per minute (LPM) to maintain oxygen saturation levels at or above 92%. However, observations on multiple occasions revealed that the resident's oxygen concentrator was set at 3.5 LPM, contrary to the prescribed order. Interviews with facility staff, including a Certified Nursing Assistant (CNA) and a Registered Nurse (RN), indicated a lack of awareness regarding the specific oxygen settings for the resident. The CNA was not informed of the correct settings, and the RN initially verified the incorrect setting without knowledge of the prescribed order. The Director of Nursing (DON) confirmed that any changes to the oxygen setting should be communicated to the physician and that administering oxygen at a non-prescribed setting could have adverse effects. The facility's policy on oxygen administration emphasized the importance of adhering to physician orders to prevent inappropriate administration.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to properly implement Enhanced Barrier Precautions (EBP) for a resident, identified as R14, who was at increased risk of infection due to a feeding tube and wounds. R14 was admitted with diagnoses of urinary tract infection and diabetes and had short- and long-term memory problems. The resident's care plan included EBP due to the potential for infection, but during an observation, it was noted that the required EBP sign was not posted outside R14's room, and the Licensed Practical Nurse (LPN) did not wear a gown while administering medication through the resident's PEG tube. Interviews with staff revealed inconsistencies in understanding and implementing EBP. A Certified Nursing Assistant (CNA) and a Registered Nurse (RN) provided conflicting information about when gowns should be worn, with the CNA indicating gowns should be worn for any point of contact, while the RN stated gowns were not needed for activities like toileting or dressing. The LPN involved in the incident believed EBP was only necessary for residents who tested positive for an infection, and communication about EBP was reportedly verbal from the infection control nurse, rather than relying on posted signs. The Director of Nursing/Infection Preventionist (DON) confirmed that signs by residents' names and orders in the electronic medical record indicated the need for EBP. The facility's policy required the use of gowns and gloves during high-contact care activities for residents at increased risk of MDRO acquisition, such as those with wounds or indwelling medical devices. However, the failure to adhere to these precautions during the observed medication administration for R14 highlighted a deficiency in the facility's infection prevention and control program.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 61 citations issued within 25 miles in the last 12 months — including the 7 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Thomasville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Harborview Thomasville | 2.8 mi | ★★★★★ | 1 | 0 |
| Camellia Gardens Of Life Care | 3 mi | ★★★★★ | 0 | 0 |
| Thomasville Vistas Of Journey Llc | 3.7 mi | ★★★★★ | 25 | 0 |
| Archbold Living Cairo | 16.3 mi | ★★★★★ | 2 | 0 |
| Brynwood Health And Rehabilitation Center | 17.3 mi | ★★★★★ | 1 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Archbold Living Thomasville.
100% money-back within 48 hours.
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.