Average — CMS composite of the measures below.
A standard survey is most likely before around November 2026
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 Macon Rehabilitation And Healthcare during CMS and state inspections, most recent first.
A resident was transported to a dialysis center with no apparent injuries but later developed a serious head injury and was sent to the emergency room, where they were pronounced deceased. The facility did not report the injury of unknown origin to the SSA within the required timeframe, as the Administrator delayed notification until after receiving information from the Coroner.
A resident was transported to dialysis without apparent injury but later developed a bleeding scalp laceration and was diagnosed with a subarachnoid hemorrhage, leading to death. The facility did not obtain key records or statements from the ER, law enforcement, or dialysis clinic, and relied on outside investigators without persistent follow-up, resulting in an incomplete investigation of the injury.
Food items were found in the kitchen unwrapped, uncovered, unlabeled, and undated, including meat, produce, cheese, buns, blueberries, eggs, and prepared foods in 6-qt containers. Two ice machines also had an ice scoop inside and black-like substance near the dispenser, and the kitchen had black and gray substance on a ventilation unit and black substance on a fan and ceiling. The DM, Administrator, and Maintenance Director confirmed the findings, and the DM stated he and the cooks were responsible for labeling and dating food items.
A CNA provided incontinent care to a resident with a stage 3 pressure ulcer and on Enhanced Barrier Precautions without wearing a protective gown, as required by facility policy. The CNA acknowledged the omission, and the DON confirmed that staff are expected to use gowns and gloves for residents on EBP.
Failure to Refer Resident for PASRR Evaluation: The facility failed to refer a resident for PASRR evaluation by the appropriate State-designated authority. The resident had diagnoses including anxiety disorder and PTSD, but the PASRR Level I application did not list those diagnoses. The MDSs documented anxiety disorder and PTSD, the resident had mood symptoms and no psychological therapy, and later orders included buspirone for anxiety and a psych/psych eval as needed. Staff confirmed the PASRR submission should have been redone because of the resident’s anxiety and PTSD.
Two residents did not receive ordered ADL assistance. One resident with a recent femur fracture, spinal stenosis, and muscle weakness missed scheduled showers, and the DON confirmed missed shower care by the CNA. Another resident with schizoaffective disorder, diabetes, wheelchair use, and bilateral lower extremity impairment had no documentation of hair washing and reported an itchy scalp and prolonged lack of hair care; staff and the DON acknowledged grooming and hair washing were part of ADL care.
The facility failed to ensure care plans were developed or implemented for six residents, leading to deficiencies such as untrimmed beards, unclean fingernails, uncovered catheter bags, incorrect oxygen therapy, improper tube feeding, and lack of care plan updates for medications.
The facility failed to provide necessary care and services to five residents, leading to unmet personal needs and diminished quality of life. Specifically, the facility did not ensure that two residents had clean and trimmed nails, one resident had a trimmed and clean beard without food particles, and two residents received baths and removal of facial hair. These deficiencies were observed through resident and staff interviews, record reviews, and direct observations by surveyors.
The facility failed to ensure a urinary catheter privacy bag was provided for a resident, resulting in the resident's urine being visible from the hallway. Observations and staff interviews confirmed the deficiency, and the DON noted that the resident often removes the privacy bag, but staff should ensure it is covered.
The facility failed to update the care plan for a resident whose indwelling urinary catheter had been removed five months prior. Despite the removal, the care plan still included goals and interventions for the catheter, leading to a risk of unmet needs and diminished quality of life. Staff interviews and direct observation confirmed the oversight.
The facility failed to obtain a podiatry appointment for a resident who required toenail care, despite multiple requests and notifications to staff. The resident, who is dependent on staff for all activities of daily living, showed a thick, long toenail with jagged edges and experienced discomfort due to the lack of timely care.
A resident with a history of cerebrovascular accident, dysphagia, type 2 diabetes, and mild protein-calorie malnutrition was administered Glucerna instead of the physician-ordered Nepro formula. This discrepancy was confirmed by the DON, who acknowledged the error in tube feeding administration.
The facility failed to ensure proper documentation and availability of tracheostomy supplies for two residents and did not follow physician orders for oxygen therapy for two other residents. Observations revealed missing physician orders, unstocked supplies, and dirty oxygen concentrators, indicating lapses in communication and responsibility among staff.
Failure to Timely Report Injury of Unknown Origin
Penalty
Summary
The facility failed to report an injury of unknown origin involving a resident to the State Survey Agency (SSA) within the required timeframe. According to the facility's Abuse Prevention Policy, all alleged violations involving abuse, neglect, exploitation, mistreatment, or injuries of unknown source must be reported immediately, but no later than two hours after the allegation is made, especially if the event involves abuse or results in serious bodily injury. In this case, a resident was transported from the facility to a dialysis center without any apparent injury. While at the dialysis center, the resident developed a hematoma to the head that was bleeding profusely and was subsequently sent to the emergency room, where a CT scan revealed a subarachnoid hemorrhage. The resident received care in the emergency room and was later pronounced deceased. The facility received notification of the incident after the resident was sent to the emergency room. The Administrator was informed by the Coroner of the resident's death and the nature of the injuries later that evening. The initial report to the SSA was not submitted until after the Administrator received this information, which was outside the required reporting timeframe. The facility's final investigative summary concluded that there was no substantiated evidence that the injury occurred at the facility, but the delay in reporting the incident to the SSA constituted a failure to comply with the facility's own policy and regulatory requirements.
Failure to Thoroughly Investigate Injury of Unknown Origin
Penalty
Summary
The facility failed to thoroughly investigate an allegation of injury of unknown origin for one resident. According to the facility's Abuse Prevention Policy, injuries of unknown source require a comprehensive investigation, especially when the injury is suspicious due to its extent, location, or frequency. In this case, the resident was transported from the facility to a dialysis center without any apparent injury, but later developed a bleeding scalp laceration and was sent to the emergency room, where he was diagnosed with a subarachnoid hemorrhage and subsequently died. The facility's investigative summary concluded that there was no substantiated evidence the injury occurred at the facility. However, there was no documentation that the facility obtained critical information necessary for a thorough investigation, such as the emergency room medical record, the County Sheriff's report, the supplemental report from the Sheriff's Department Investigator, or statements from the dialysis clinic. The facility relied on the County Investigator to gather information from the dialysis clinic and did not pursue further contact or visit the clinic after initial attempts to reach them by phone were unsuccessful. Interviews revealed that the facility administrator did not follow up in person with the dialysis clinic or persistently seek out the necessary records and reports. The administrator deferred the investigation to the County Investigator and did not obtain the investigator's report, despite being informed it was available for pickup. As a result, there was no evidence of a complete and thorough investigation into the resident's injury of unknown origin, as required by facility policy.
Food Storage and Kitchen Sanitation Deficiencies
Penalty
Summary
Food items were found stored in the kitchen without being covered, wrapped, labeled, or dated as required by the facility policy titled Food Storage: Cold Food. During the initial kitchen tour with the Dietary Manager, the cooler contained one unwrapped piece of ham, one unwrapped half of a tomato, a 5-lb bag of shredded cheddar cheese that was unlabeled and undated, five hamburger buns that were unlabeled and undated, a 5-lb bag of blueberries that was unlabeled and undated, and an unwrapped opened bag containing three boiled eggs. The three-door reach-in refrigerator contained one 6-qt container with a brown-like food substance that was undated and unlabeled, one 6-qt container with a yellow pudding-like substance that was undated and unlabeled, and one 6-qt container labeled as pineapples with an expiration date of 8/16/2025. The Dietary Manager confirmed the findings and stated that if a package lacks an expiration date, it is not considered valid, and that he and the cooks were responsible for proper labeling and dating of food items. Sanitary conditions were also not maintained in two ice machines and in the kitchen area. During the kitchen tour, both the north and kitchen hall ice machines had an ice scoop inside and a black-like substance present on the inside near the ice dispenser. On a later observation, the kitchen ceiling showed a black and gray substance on the ventilation unit next to the meat/produce sink, and a fan near the steam table and three-door refrigerator had a black substance on both the blades and the ceiling. The Dietary Manager confirmed these findings and stated he had reported the concerns through the facility's computerized reporting system. The Administrator and Maintenance Director later confirmed that the ceiling ventilation unit and fan had black substances on them and needed to be cleaned, and the Maintenance Director stated he was unable to clean the ice machine on a normal schedule.
Failure to Follow Enhanced Barrier Precautions During Incontinent Care
Penalty
Summary
A deficiency was identified when a certified nursing aide (CNA) failed to follow the facility's infection prevention and control policy while providing care to a resident on Enhanced Barrier Precautions (EBP). The resident had multiple diagnoses, including a stage 3 pressure ulcer, was always incontinent of bowel and bladder, and required substantial to maximal assistance with toileting hygiene. Facility policy required staff to wear appropriate personal protective equipment (PPE), including gowns and gloves, when providing care to residents on EBP to prevent exposure to potentially infectious materials. During an observation, the CNA was seen providing incontinent care to the resident without wearing a protective gown, contrary to facility policy and the resident's EBP order. The CNA confirmed in an interview that she did not wear a gown and acknowledged that she should have done so. The Director of Nursing (DON) also confirmed that the expectation was for staff to wear gowns and gloves during such care for residents on EBP.
Failure to Refer Resident for PASRR Evaluation
Penalty
Summary
The facility failed to refer one of two residents reviewed for PASRR, R5, for evaluation by the appropriate State-designated authority. The deficiency was identified during staff interviews, record review, and review of the facility policy titled Behavioral Management Program. The policy stated that residents must receive necessary behavioral health care and services and that the interdisciplinary team will use information from the PASARR process to complete a comprehensive assessment of resident needs. R5 was admitted on 9/20/2024 with diagnoses including anxiety disorder and PTSD. The admission MDS documented that the resident was not considered by the State Level II PASRR process to have a serious mental illness and/or intellectual disability or related condition, while the active diagnoses section listed anxiety disorder and PTSD. The quarterly MDS dated 6/25/2025 also listed anxiety disorder and PTSD, documented little interest or pleasure in doing things 12-14 days, and indicated the resident did not receive psychological therapy. Physician orders dated 7/2/2025 included buspirone for anxiety and a psychiatric/psychological evaluation and treatment as needed. Review of the PASRR Level I application dated 9/20/2024 showed that the resident did not have a primary diagnosis of dementia, anxiety, or PTSD. The Social Services Worker confirmed there were no diagnoses of dementia, anxiety, or PTSD on the PASRR Level I application, and Admissions Staff confirmed a new PASRR submission should have been conducted due to the diagnoses of anxiety and PTSD.
Failure to Provide Scheduled ADL Assistance
Penalty
Summary
The facility failed to ensure two sampled residents received assistance with ADL care. For R53, the EMR showed an admission on 4/22/2025 with diagnoses including displaced intertrochanteric fracture of the left femur, spinal stenosis, lack of coordination, and muscle weakness. The annual MDS dated 7/22/2025 documented a BIMS of 15 and that R53 required partial to moderate assistance with showering and bathing. The August 2025 bathing/shower schedule showed R53 was scheduled for showers twice weekly, but the record showed only five showers from 8/1/2025 through 8/21/2025. R53 told surveyors on multiple interviews that she had not been showered as expected, that staff kept telling her it would be tomorrow, and that she had never refused a shower. The DON later confirmed that the CNA responsible for R53 failed to provide showers on 8/12/2025 and 8/19/2025. For R72, the EMR showed an admission on 7/12/2023 with diagnoses including schizoaffective disorder, bipolar type, type 2 diabetes mellitus with hyperglycemia, and a history of falling. The quarterly MDS dated 7/26/2025 documented a BIMS of 15, lower extremity impairment on both sides, wheelchair use, and a need for assistance with ADLs with two or more persons. The care plan identified an ADL self-care performance deficit related to limited mobility and included assistance with bathing and personal hygiene. The clinical record contained no documentation that R72’s hair was washed. R72 told surveyors her scalp itched and it had been a long time since anyone had washed her hair. A CNA told her to ask for hair washing and stated grooming was documented on the shower sheet, while the hairdresser stated she came once a week, could not provide services to all residents, and only saw residents who were placed on a list in advance. The DON confirmed that hair washing, nail trimming, and personal grooming were part of ADL care that should be provided by staff.
Failure to Implement and Update Care Plans
Penalty
Summary
The facility failed to ensure a care plan was developed or implemented for six residents, leading to various deficiencies in their care. For instance, one resident with an ADL self-care performance deficit due to a cerebral vascular accident was observed with a full beard containing food and long fingernails with a brown substance underneath, despite the care plan's goal for a clean and neat appearance. Another resident with moderate cognitive impairment had long fingernails with a thick brown substance underneath, contrary to her preference for clean nails, which was documented in her care plan but not followed by the staff. A resident with an indwelling catheter was observed with an uncovered catheter drainage bag filled to the top and visible from the door, despite the care plan's intervention to provide a privacy device and ensure the bag is emptied when under 3/4 full. Additionally, a resident receiving oxygen therapy was observed with varying oxygen flow rates that did not align with the physician's orders, and there were no documented oxygen saturations to justify the use of oxygen according to the care plan. Another resident on continuous tube feeding was observed receiving a different nutritional product than what was ordered by the physician, indicating a failure to follow the care plan. Lastly, a resident recently readmitted from hospitalization had no care plan areas or interventions for the use of antipsychotic, antidepressant, and anticoagulant medications, as the care plan had not been updated since the readmission. These deficiencies highlight the facility's failure to develop and implement appropriate care plans, potentially placing residents at risk for medical complications and unmet needs.
Failure to Provide Adequate Personal Care and Hygiene
Penalty
Summary
The facility failed to provide necessary care and services to five residents, leading to unmet personal needs and diminished quality of life. Specifically, the facility did not ensure that two residents had clean and trimmed nails, one resident had a trimmed and clean beard without food particles, and two residents received baths and removal of facial hair. These deficiencies were observed through resident and staff interviews, record reviews, and direct observations by surveyors. One resident with moderate cognitive impairment had long fingernails with a thick brown substance underneath. The resident expressed a preference for having her nails cleaned but could not recall the last time staff cleaned them. Another resident with moderate cognitive impairment had a full beard with food particles and long fingernails with a brown substance. Despite expressing a desire for a trimmed beard, the resident was observed in the same clothes with food particles in his beard on consecutive days. Two other residents did not receive their scheduled baths and had long facial hair. One resident with Alzheimer's disease and muscle weakness received only four bed baths in 20 days, and staff did not document any facial hair removal. Another resident with morbid obesity and decreased mobility received only one bath in 20 days and expressed frustration over inconsistent shower schedules. Additionally, a resident with Alzheimer's disease and depression had long fingernails and broken nails, and staff did not provide nail care during scheduled baths or approach the resident for nail care activities.
Failure to Provide Urinary Catheter Privacy Bag
Penalty
Summary
The facility failed to ensure a urinary catheter privacy bag was provided for a resident with a urinary catheter, which had the potential to diminish the resident's quality of life. The facility's policy on urinary catheter care, revised April 2, 2024, stated that catheter drainage bags should be covered when residents are in public areas. However, observations on two separate occasions revealed that the resident's urinary catheter drainage bag was uncovered and visible from the hallway, allowing the resident's urine to be seen by other residents, staff, and visitors. Interviews with a CNA and an LPN confirmed that the catheter drainage bag was not in a privacy bag and its contents were visible from the hallway. Further interviews with the Director of Nursing (DON) revealed that the resident often removes the privacy bag and places it in the top drawer. The DON stated that staff should make attempts to ensure the bag is covered to provide privacy for the resident. The deficiency was identified for one of four residents with a urinary catheter in the facility, highlighting a failure to adhere to the facility's policy and ensure the resident's dignity and privacy.
Failure to Update Care Plan for Discontinued Urinary Catheter
Penalty
Summary
The facility failed to update the care plan for a resident (R56) related to an indwelling urinary catheter that had been removed and discontinued. The care plan still included goals and interventions for the catheter, despite it being removed five months prior. This discrepancy was identified during a review of the resident's records and confirmed through staff interviews and direct observation. The facility's policy requires care plans to be reviewed and updated as necessary, but this was not adhered to in this case, leading to a risk of unmet needs and diminished quality of life for the resident. The resident's Quarterly Minimum Data Set (MDS) assessment indicated no cognitive impairment and documented that there was no indwelling urinary catheter. However, the care plan had not been updated to reflect this change. Interviews with the MDS Director and the Director of Nursing revealed that care plan revisions were behind schedule, and the staff was unaware of the catheter removal. The Director of Nursing confirmed that the catheter had been discontinued and removed on November 1, 2023, but the care plan had not been updated accordingly.
Failure to Obtain Podiatry Appointment for Resident
Penalty
Summary
The facility failed to obtain a podiatry appointment for a resident (R39) who required toenail care, as observed and confirmed through interviews and record reviews. The facility's policy on nail care mandates reporting any issues with nails, including when they are too hard or thick to cut. R39, who has intact cognition and is dependent on staff for all activities of daily living, had requested a podiatry appointment multiple times but did not receive one. On 4/19/2024, R39 asked about seeing a podiatrist and showed a thick, long toenail with jagged edges on her left great toe. She had previously informed a CNA about her need for toenail care, but no action was taken until she spoke with the Social Worker on 4/19/2024. The Social Services Director (SSD) confirmed that R39 had asked to be put on the list to see the podiatrist on 4/19/2024. The SSD relies on staff, residents, and family members to notify her when someone needs podiatry care, and admitted that R39 fell through the cracks. A CNA revealed that she had informed a nurse a few weeks ago about R39's need for a podiatry appointment and had also informed the SSD. Despite these notifications, no appointment was made, leading to the resident's discomfort and potential decrease in quality of life.
Failure to Administer Correct Enteral Nutrition
Penalty
Summary
The facility failed to provide enteral nutrition according to physician orders for a resident (R54) who was receiving tube feeding. The resident's medical record indicated a physician's order for continuous Nepro formula at 65 cubic centimeters (cc) per hour for 22 hours. However, observations on April 19, 2024, revealed that Glucerna, instead of Nepro, was being administered via a pump at the prescribed rate. This discrepancy was confirmed by the Director of Nursing (DON), who acknowledged that the nursing staff had administered the wrong tube feeding product. R54's medical history included cerebrovascular accident, dysphagia, type 2 diabetes, and mild protein-calorie malnutrition. The facility's policy on enteral nutrition, last reviewed on April 16, 2024, stated that adequate nutritional support would be provided to residents as ordered. Despite this policy, the incorrect administration of Glucerna instead of Nepro placed R54 at risk for medical complications and a diminished quality of life.
Deficiencies in Tracheostomy and Oxygen Therapy Management
Penalty
Summary
The facility failed to ensure that two residents had written physician orders for the tracheostomy tube sizes in use. Specifically, Resident 71 did not have a written order for the tracheostomy tube size of 6.5 mm or the previous size of 7.5 mm. Additionally, tracheostomy supplies were not available at the bedside for Resident 71. The Director of Nursing (DON) confirmed that the supplies, including a resuscitator, oxygen, suction machine, and a replacement tracheostomy tube, were not properly stocked. The Central Supply Clerk (CSC) was responsible for restocking these supplies but failed to do so due to being off on the scheduled restocking day. Similarly, Resident 14 had a tracheostomy tube size change that was not documented in the physician's orders until two days later, indicating a lapse in proper documentation and communication between the Respiratory Therapist (RT) and the nursing staff. The facility also failed to ensure that two residents receiving oxygen therapy had written physician orders for oxygen use and that oxygen was administered as ordered. Resident 4 had an order for oxygen at 2 liters per minute (LPM) if oxygen saturation was less than 92 percent, but observations revealed the resident was receiving oxygen at 3 LPM without a humidification bottle, and the oxygen concentrator was dirty. The DON and LPN confirmed that the current oxygen order was not being followed and that there was confusion about who was responsible for cleaning the concentrator filters. Similarly, Resident 24 was observed using oxygen without a current physician's order, and the oxygen concentrator was also found to be dirty. The DON confirmed that the oxygen order was not reinstated after the resident's recent hospital readmission. These deficiencies indicate a lack of adherence to the facility's policies on tracheostomy care and oxygen therapy. The failure to maintain proper documentation, ensure the availability of necessary supplies, and follow physician orders for oxygen therapy could lead to medical complications and a diminished quality of life for the residents involved. The DON and other staff members acknowledged these lapses during interviews, highlighting systemic issues in communication and responsibility within the facility.
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 75 citations issued within 25 miles in the last 12 months — including the 2 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 Macon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pruitthealth - Eastside | 2.4 mi | ★★★★★ | 5 | 0 |
| Pruitthealth - Lakeside, Llc | 2.6 mi | ★★★★★ | 5 | 0 |
| Medical Management Health And Rehab Center | 3 mi | ★★★★★ | 6 | 0 |
| Pruitthealth - Macon | 4 mi | ★★★★★ | 0 | 0 |
| Archway Transitional Care Center | 4.9 mi | ★★★★★ | 5 | 2 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Macon Rehabilitation And Healthcare.
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.