Average — CMS composite of the measures below.
The next survey window likely opens around October 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 Peachtree Nursing And Rehabilitation Llc during CMS and state inspections, most recent first.
Refrigerated Food Items Left Unlabeled and Undated: Numerous food items in the reach-in refrigerators were found without labels or dates, including cooked meats, raw meats, vegetables, dairy items, and sauces. The DFNS confirmed the issue, stated it was unacceptable, and said cooks were responsible for checking and maintaining proper labeling and dating of refrigerated foods. Staff interviews showed awareness of the requirement, and the facility policy required refrigerated foods, including leftovers, to be labeled, dated, and monitored for use by the use-by date or discarded.
A resident with chronic respiratory failure, Reiter’s disease, and cervicalgia was neglected and abused when a CNA removed the resident’s call light from reach, failed to provide requested incontinent care, and stood over the resident while telling her not to use the call light again. The resident, who was cognitively intact, said she felt intimidated and had to yell for help until an LPN found the call light out of reach. The charge nurse and DON confirmed the incident, and the CNA admitted removing the call light because the resident kept calling for assistance.
Failure to timely report alleged abuse and neglect: A cognitively intact resident’s call light was removed from reach by a CNA, and the resident was told not to use it again after pressing it for incontinent care. An LPN found the resident yelling for help and the call light out of reach, and a CN later confirmed the allegation, but the concern was not promptly reported to the DON or SSA within the required timeframe.
Call Light Not Available After Malfunction: A resident with CVA, hemiplegia, and mild protein calorie malnutrition had a call light that was malfunctioning and was removed from the wall by a CNA. The resident stated she was not given another way to communicate with staff, and an LPN confirmed the call light was turning on and off without being pressed. Facility policy required a working call light at the bedside, toilet, and bathing area, with immediate or alternative solutions when problems occurred.
Code status orders did not match POLSTs or resident wishes for two residents. One resident with stroke and sepsis had a POLST for DNR, but the EMR showed full code after a hospital stay and there was no documented follow-up discussion; the resident said he did not want CPR. Another cognitively intact resident had documentation that shifted between full code and DNR/DNI, and she stated she wanted CPR. Staff relied on hospital discharge orders and EMR profile information, while the former SSD confirmed there was no documented follow-up when discrepancies occurred.
The facility failed to properly store and label food items in the kitchen cooler, with several items lacking stored or discard dates. Additionally, expired food was found in a resident nourishment pantry, and an ice maker was not maintained in a clean manner. These practices posed a risk for foodborne illness to the 106 residents consuming an oral diet from the kitchen.
A resident with severe cognitive impairment was observed eating ice cream with her fingers due to the facility's failure to properly set up her meal tray. The flatware was left wrapped and inaccessible, contrary to her care plan which required staff to ensure utensils were within reach. Multiple staff members confirmed the oversight, acknowledging that the flatware should have been unwrapped and accessible.
A resident with severe cognitive impairment was found to have various chemical products in their bathroom, despite facility policy prohibiting such items. Staff interviews revealed that the resident's family frequently brought these items in, and the expected procedure for removing them was not consistently followed.
Refrigerated Food Items Left Unlabeled and Undated
Penalty
Summary
The facility failed to keep track of when refrigerated food items should be discarded by not labeling and dating them. During a kitchen observation in the reach-in refrigerators, numerous items were found without labels or dates, including cooked chicken breasts, sliced ham, opened hot dogs, roast beef, fresh and cooked yellow squash, fresh broccoli, sliced cheese, pork chops, raw fish, raw chicken breast, raw hamburger, ranch dressing, coleslaw, and marinara sauce. The Director of Food and Nutrition Service confirmed that all of these items were in the refrigerators without being labeled or dated and stated that this practice was unacceptable. The Director of Food and Nutrition Service stated that it was the cooks' responsibility to maintain the reach-in refrigerators and ensure items were labeled and dated, and said staff had received training on labeling and dating refrigerated food items. During interviews, Cook2 stated she did not know why she had not checked the reach-in refrigerator at the beginning of her shift, and Cook1 confirmed it was the cook's responsibility to ensure items were labeled and dated. Review of the facility policy showed that refrigerated food, including leftovers, was to be labeled, dated, and monitored so it would be used by its use-by date or frozen/discarded.
Resident’s call light was removed and resident was intimidated by CNA
Penalty
Summary
The facility failed to ensure a resident was free from abuse and neglect when CNA 1 removed the resident’s call light from within reach and told the resident not to use it again. The resident, who was cognitively intact with a BIMS score of 15 out of 15, had diagnoses including chronic respiratory failure, Reiter’s disease, and cervicalgia. The incident occurred after the resident pressed the call light because she was wet and needed incontinent care. According to the record and staff interviews, CNA 1 entered the resident’s room, moved the call light behind the resident’s head and out of reach, stood over the resident, and told her not to press the call light again because she had been calling for assistance all morning. The resident stated she felt intimidated by CNA 1. After CNA 1 left, the resident yelled for help until an LPN entered the room and found the call light out of reach. The resident then reported the incident to staff. The charge nurse confirmed the resident’s call light had been moved out of reach and that CNA 1 admitted removing it because the resident kept calling for assistance. The charge nurse provided incontinent care and placed the call light back within reach. The DON confirmed CNA 1 neglected and abused the resident by placing the call light out of reach, not providing incontinent care as requested, and standing over the resident while telling her not to use the call light again. The facility policy stated residents are to be free from abuse and neglect by anyone, including staff.
Failure to Timely Report Alleged Abuse and Neglect
Penalty
Summary
The facility failed to ensure suspected abuse and neglect were reported timely to the DON and the State Survey Agency when a CNA removed a cognitively intact resident’s call light from reach and told the resident not to use it again. Resident 49 had a BIMS score of 15 on the annual MDS, indicating the resident was cognitively intact. On 10/30/25 at about 5:30 AM, LPN 3 heard the resident yelling for help and found the call light behind the bed and out of reach. The resident stated CNA 1 had removed the call light after the resident pressed it for incontinent care and told the resident not to use it again. LPN 3 reported the concern to CN 2, who also found the call light out of reach and documented that the resident said CNA 1 moved it behind the resident’s head and stood over the resident while telling the resident not to use it again. CN 2 completed a grievance/complaint form and gave it to UM 1, but did not report the allegation to the DON. The facility’s incident report stated the investigation confirmed neglect and abuse occurred and that the allegation was reported to the State Survey Agency at 10:30 AM. The DON later confirmed UM 1 reported the allegation to her at about 8:00 AM, and the Administrator stated she was notified by the DON at about 8:30 AM. During interview, the Administrator confirmed she was not notified when the event was first observed and stated allegations of abuse should be reported within two hours to the SSA, but that timeframe was not met.
Call Light Not Available After Malfunction
Penalty
Summary
The facility failed to ensure another method for calling staff was available when a resident's call light malfunctioned and was removed from the wall. The resident was admitted with diagnoses including CVA, hemiplegia following CVA, and mild protein calorie malnutrition, and her MDS indicated a BIMS score of 12 out of 15, showing she was cognitively intact. A facility incident report stated that the resident's daytime caregiver found the call light cord rolled up on the bedside table and not in the wall for the last two mornings. The investigation found that a CNA removed the call light from the wall because it was turning on every 15 to 20 minutes without being pressed, and the malfunction was entered into the maintenance workbook. The call light was not placed back in the wall, and another means to communicate with nursing staff was not provided to the resident. The CNA stated she told the agency CNA assigned to the resident on the evening shift to round on the resident every one to two hours. During an interview, the resident stated someone removed the call light from the wall and she was not provided another means to communicate with staff, although care was provided for her. An LPN confirmed she observed the call light turning on and off without the resident pressing it and saw it lying across the resident's abdomen during medication administration. The facility policy required call lights to be available at each resident's bedside, toilet, and bathing facility and stated staff would provide immediate or alternative solutions until a call light problem could be remedied.
Code Status Orders Did Not Match POLSTs or Resident Wishes
Penalty
Summary
The facility failed to ensure physician orders for code status matched residents’ POLST forms and stated wishes for two residents reviewed for advance directives. For one resident with diagnoses including cerebral infarction and sepsis, the EMR showed a POLST indicating allow natural death and DNR, but after a hospital stay the discharge summary and EMR orders reflected full code. The record contained no documentation of a discussion with the resident about code status after return from the hospital, and a new POLST was not completed. The resident’s BIMS score indicated moderate cognitive impairment, and during interview he stated he did not want CPR if his heart stopped. Staff interviews showed nurses relied on the EMR profile tab and hospital discharge orders to determine code status, while social services handled discussions about wishes. The LPN, UM, RN, DON, and former SSD all described processes that depended on hospital orders or quarterly care plan review, and the former SSD confirmed there was no documentation that anyone followed up with this resident regarding code status wishes after the hospitalization. The care plan conference summary also documented that neither the resident nor family participated and that the resident remained full code. For a second resident with chronic respiratory failure, Reiter's disease, and cervicalgia, the record showed conflicting code status documentation over time, including full code orders, a POLST indicating attempt CPR, later hospital discharge orders for DNR/DNI, and subsequent EMR orders and care plan documentation reflecting DNR/DNI. The resident, who was cognitively intact with a BIMS score of 15, stated she wanted CPR and had completed a form in the past. The UM confirmed she entered the hospital discharge orders for DNR/DNI and did not know who was responsible for updating the POLST, and the former SSD stated there was no documentation that anyone followed up with the resident after she returned from the hospital.
Deficiencies in Food Storage and Sanitation Practices
Penalty
Summary
The facility failed to ensure proper food storage and labeling practices in the kitchen cooler, as observed by surveyors. Several food items, including seasoned chicken, bacon, condiments, green beans, and various cheeses, were found without labels indicating stored or discard dates. Additionally, a plastic tub labeled as squash contained a bag of cauliflower without a label. These observations were made during multiple visits, indicating a consistent issue with labeling and storage practices. The Certified Dietary Manager (CDM) and Sous Chef acknowledged the problem, noting that staff education on proper labeling was ongoing. Further deficiencies were noted in the resident nourishment pantries and ice maker maintenance. An open box of a frozen dessert product in a resident nourishment pantry was found without an opened or discard date, despite having a manufacturer's expiration date. Additionally, an industrial ice machine was observed with a build-up of a dark brown/black substance, despite claims that it had been cleaned earlier that day. These practices placed the 106 residents consuming an oral diet from the kitchen at risk for avoidable foodborne illness.
Failure to Provide Dining Assistance
Penalty
Summary
The facility failed to provide appropriate dining assistance to a resident, identified as R38, during a dining observation. R38, who has severe cognitive impairment due to Alzheimer's disease and other conditions, was observed eating ice cream with her fingers while her meal tray was not properly set up. The flatware was still wrapped and inaccessible, contrary to the care plan which required staff to set up trays, cut food, and ensure utensils were within reach. This oversight was confirmed by multiple staff members, including a Unit Support Associate, a Licensed Practical Nurse, and a Certified Nursing Assistant, who acknowledged that the flatware should have been unwrapped and accessible to the resident. The resident's care plan, which was revised in 2023, specified that she required setup or clean-up assistance for eating and needed supervision and cues to finish her meals. Despite these documented needs, the staff failed to follow the care plan during the meal setup, leaving the resident without the necessary tools to eat independently. This deficiency in care placed the resident at risk for unmet care needs and a diminished quality of life, as the facility did not accommodate her individual needs and preferences as outlined in their policy.
Failure to Maintain a Chemical Hazard-Free Environment
Penalty
Summary
The facility failed to maintain an environment free from chemical hazards for a resident with severe cognitive impairment, placing them at risk for avoidable chemical incidents and injuries. The resident, diagnosed with unspecified dementia and cognitive communication deficit, was observed to have various chemical products, including disinfectant sprays and cleaners, in their bathroom on multiple occasions. These observations were made despite the facility's policy that prohibits residents from having chemical items in their rooms. Interviews with staff revealed that the resident's family frequently brought these items into the room, believing the resident knew how to handle them safely. However, staff were expected to remove such items and inform the family, a process that was not consistently followed. The Wound Care Nurse confirmed the presence of an aerosol spray can in the resident's bathroom and removed it, while the Bath Technician stated she would place chemicals out of reach if found. The Registered Nurse acknowledged the ongoing issue with the family bringing in chemicals and confirmed that the expected procedure for removing these items was not adhered to.
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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 Lagrange
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Lagrange Trails Of Journey Llc | 1.1 mi | ★★★★★ | 2 | 0 |
| Green Acres Care Center Llc | 4 mi | ★★★★★ | 13 | 0 |
| Diversicare Of Lanett | 14.5 mi | ★★★★★ | 0 | 0 |
| Eamc Lanier Nursing Home | 15.7 mi | ★★★★★ | 0 | 0 |
| Pruitthealth - Franklin | 16.8 mi | ★★★★★ | 5 | 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.