Below average — CMS composite of the measures below.
The next survey window likely opens around December 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 Presbyterian Village during CMS and state inspections, most recent first.
Pureed Diet Recipes Not Followed: Dietary staff failed to follow standardized pureed food recipes for nine residents on pureed diets. During an observation, a cook prepared pureed green beans for about 10 residents without using a recipe, added broth and thickener by judgment, and stated he had only received verbal training and was "just winging it." Dietary leadership confirmed standardized pureed recipes were not being used at the time, and the Dietary Director later stated she had only recently learned where to access them.
Improper Food Labeling, Dating, and Storage: The facility failed to ensure food items were properly labeled, dated, sealed, and discarded when expired in the pantry, freezer, cooler, and a resident refrigerator. Surveyors found multiple opened or stored food items without required dates, several expired items, and some visibly spoiled food, while the DKM, Director of Dining, and President of Operations stated staff shared responsibility for checking dates and discarding expired items.
Stained Wall Surface in Resident Room: A resident room on F Hall had multiple visible brown and yellowish stains, splatter marks, and streaking on the wall directly beside the bed, with some stains appearing dried and layered. Housekeeping staff said the material looked like spit, feces, and food and appeared to have been there for a while, while the ADON/IP and Housekeeping Supervisor identified the condition as inconsistent with a clean, dignified, and homelike environment.
Medication refrigeration temperatures were not maintained or documented as required. A first-floor med refrigerator was observed at 50 F, while the log showed 41 F, and the ADON confirmed the unit was too warm for medication storage. In a second-floor med room, the temperature log had no entries for 14 days, despite instructions for nightly checks. The DON stated nursing staff were expected to check and document refrigerator temperatures nightly and follow the log instructions.
An LPN was observed eating popcorn while leaning over a medication cart during med administration, and popcorn fell onto the cart. The LPN acknowledged she knew she was not supposed to eat on the cart. The DON and VPO stated staff were not permitted to eat at nurse stations or over medication carts, and the facility policy prohibited food or beverages on medication carts.
The facility failed to implement an effective infection prevention and control program, with no surveillance for infections and missing Enhanced Barrier Precautions (EBP) signs. A resident with a stage four pressure ulcer received improper wound care, and shared equipment was not cleaned after use, increasing infection risk.
The facility failed to establish and maintain an antibiotic stewardship monitoring system, affecting all 71 residents. The Infection Preventionist (IP) had not completed her training and was working part-time due to staffing shortages, limiting her ability to perform her duties. The Assistant Director of Nursing (ADON) acknowledged the IP was not trained when hired and had been assigned other roles. The Director of Nursing (DON) was aware of the requirement for an antibiotic stewardship line listing but noted inadequate monitoring. The Executive Director expected a line listing and full program implementation, but the facility's failure to adhere to the policy and monitor antibiotic use was evident.
The facility failed to employ a certified Infection Preventionist (IP), leading to a lapse in infection prevention leadership. The IP did not complete the required CDC training until 19 days after being hired, and there was a two-month gap without a fully trained IP. The IP faced challenges due to insufficient time, incomplete training, and a lack of existing infection control policies. The ADON, who was training the IP, had an expired Infection Prevention Certificate, and the IP was assigned to other roles, limiting her infection control duties. This led to communication breakdowns and delayed responses to infection control issues like UTIs.
The facility failed to provide adequate fingernail care and grooming for five residents, leading to a deficiency in ADLs care. Despite the facility's policy requiring grooming services, observations revealed that residents had long and dirty fingernails over several days. Staff acknowledged the issue but did not address it promptly, resulting in unmet grooming needs for residents with varying levels of cognitive impairment and assistance requirements.
A facility failed to implement a stop date for a PRN psychotropic medication for a resident with cognitive impairments and anxiety. The resident was prescribed lorazepam with an indefinite stop date, contrary to facility policy requiring a 14-day limit unless a clinical rationale is documented. Observations and staff interviews indicated the resident was often sleepy and disengaged, potentially affecting their well-being.
A medication security lapse occurred on Hall B when an LPN left a medication cart unlocked and unattended, with multiple medication cards and a cup of capsules on top. This action violated the facility's policy requiring drugs to be stored securely, posing a potential risk to residents, visitors, and staff.
Pureed Diet Recipes Not Followed
Penalty
Summary
The facility failed to ensure dietary staff followed standardized pureed food recipes for nine of nine residents receiving pureed diets. During an observation of pureed green beans being prepared for approximately 10 residents, the cook stated he was looking for a medium consistency and was observed scooping the food, adding vegetable broth twice, and later adding thickener when he felt the puree was not the consistency he wanted. He stated he was not following a recipe for the pureed foods, that the facility had recipes for regular diets but not for pureed diets, and that he had been verbally trained by the Executive Chef to give each resident eight ounces. He also stated he had never followed a pureed recipe and was typically the staff member who prepared pureed foods, describing his method as "just winging it." Interviews with dietary leadership confirmed the lack of standardized pureed recipes at the time of the observation. The Dietary Director stated the facility did not currently have standardized recipes for pureed foods and that the facility planned to work with a company to develop them. The Regional Director of Operations confirmed there were no puree diets available, and the Dietary Kitchen Manager stated she was not aware recipes were not being used, although she expected staff to follow recipes and later provided a copy of a pureed green bean recipe. The Dietary Director later stated she had recently learned where and how to access the pureed food recipes and that staff needed to be trained appropriately and consistently follow recipes to ensure resident safety and nutritional adequacy.
Improper Food Labeling, Dating, and Storage
Penalty
Summary
The facility failed to ensure food items were properly labeled, dated, sealed, and discarded when expired in the pantry, freezer, cooler, and resident refrigerator. Review of the facility’s policies showed that prepared foods, leftovers, and opened products were to be labeled with the product name, date prepared or opened, date to be used by, and the name of the person creating the label, and that opened products were to be dated and stored in tight-fitting containers. Observations in the freezer found tilapia not properly sealed and without an expiration date, hot dogs with no date, and pancakes with no expiration date. Observations in the cooler found multiple items stored without expiration or use-by dates, including orange segments with only a received-by date, spinach, jalapenos, mint with only a received-by date, thyme with no dates, cut potatoes with an expired shelf-life date, gluten-free bread slices with an expired shelf-life date, greek nonfat yogurt with an expired expiration date, and sourdough bread dated 10/15/2025 with no expiration date. The pantry contained opened elbow pasta and opened gluten-free spaghetti that were not labeled or dated, expired light molasses, expired shrimp and crab boil concentrate, expired tea, and a bag with two visibly spoiled melons. The resident refrigerator on the first floor contained half and half with an expired use-by date. The Dietary Kitchen Manager stated staff were responsible for checking expiration dates and discarding expired items, and the Director of Dining and President of Operations stated all kitchen staff shared responsibility for proper labeling, dating, and discarding expired food items.
Stained Wall Surface in Resident Room
Penalty
Summary
The facility failed to maintain a clean and homelike environment in Room F8 on F Hall because the wall surface directly adjacent to a resident bed had multiple visible brown and yellowish stains, splatter marks, and streaking. The stains were observed at multiple heights on the wall and some appeared dried and layered. These conditions were documented during repeated observations of the room, and the report states that the wall surface remained stained during those observations. The facility policy titled Environmental Services Policy - Cleanliness and Homelike Environment stated that resident rooms, bathrooms, and common areas are to be cleaned and sanitized regularly, that routine inspections are to be conducted to ensure cleanliness and homelike standards, and that all staff are responsible for maintaining a clean and dignified environment. During interviews, Housekeeping BB stated she was responsible for cleaning splatter on walls and said the stains looked like spit, feces, and food and appeared to have been there for a while. The ADON/IP stated that if the material was food, it could be molding and the resident could pick up an infection, and the Housekeeping Supervisor stated the wall could be mucus or food and that she would not want to live with stains on the wall. The VPO stated that anyone who sees something like that should report it and have it cleaned right away.
Medication Refrigeration Temperatures Not Maintained or Documented
Penalty
Summary
Medications and biologicals were not stored at proper temperatures to maintain their integrity. Review of the facility policy titled, Storage of Medications, showed that drugs and biologicals are to be stored in locked compartments under proper temperature, light, and humidity controls, and that medications requiring refrigeration are to be stored in a secured refrigerator. The refrigerator temperature log instructions for the first-floor medication room required a range of 36 F to 46 F, with adjustment and comment if out of range, and the second-floor log instructed staff to act quickly if temperatures were too warm or too cold and move items to another refrigerator. On observation, the first-floor medication refrigerator was 50 F at 9:46 AM, and the LPN confirmed the reading and stated night shift was responsible for checking and documenting refrigerator temperatures. The log for that same date showed the temperature documented as 41 F. When the refrigerator was rechecked at 10:02 AM, it again read 50 F, which the ADON confirmed, and the ADON stated the temperature was too warm for medication storage and that medications should have been relocated and maintenance notified. In the second-floor medication room, the ADON observed that temperature checks had not been documented in the log for 14 days in January 2025, and stated night shift was responsible for completing the log daily. The DON stated her expectation was for nursing staff to check and document medication refrigerator temperatures nightly and to take action based on the log instructions.
Food Present on Medication Cart During Medication Administration
Penalty
Summary
Infection prevention and control practices were not maintained during medication administration when food was present on a medication cart. The facility policy titled Medication Administration Policy stated that medication carts were to be used exclusively for medication storage and administration supplies, that food or beverages were strictly prohibited on or within the cart, and that carts must be kept clean, uncluttered, and free from contamination during medication passes. During observation on 01/28/2026 at 3:18 PM, an LPN was seen eating popcorn from a bag while leaning over a medication cart during medication administration activities. After noticing the surveyor, the LPN discarded the popcorn bag and picked up popcorn pieces that had fallen onto the cart. The LPN stated her blood sugar had dropped, which was why she was eating, and acknowledged she knew she was not supposed to eat on the medication cart. The DON and VPO both stated staff were not permitted to eat at nurse stations or over medication carts and that eating on a medication cart created an infection control concern.
Inadequate Infection Control and Wound Care Practices
Penalty
Summary
The facility failed to implement an effective infection prevention and control program, as evidenced by the lack of proper surveillance and monitoring for infections and communicable diseases for all 71 residents. The Infection Preventionist (IP) admitted to not having tracked infection control data for the past six months due to insufficient training and time constraints. The facility's policies on infection control were not fully implemented, and there was a breakdown in communication regarding testing and infection control procedures. Enhanced Barrier Precautions (EBP) signs were missing from the doors of residents requiring them, and staff were not adequately informed about the necessary precautions. The facility also failed to provide proper wound care for a resident with a stage four pressure ulcer. The Registered Nurse (RN) did not follow appropriate infection control techniques, such as performing hand hygiene and using a clean field for wound care supplies. Shared and single-use items were placed on the resident's bed, and the treatment cart was taken into the room, contrary to infection control protocols. The resident, who had severe cognitive impairment and was dependent on care, was observed to be in discomfort during the procedure. Additionally, staff did not consistently practice infection prevention techniques with shared equipment. An LPN was observed using a blood pressure machine on a resident without cleaning it afterward, which is against the facility's infection control expectations. The lack of proper cleaning of shared equipment and the absence of EBP signage increased the risk of infection spread within the facility.
Failure to Implement Antibiotic Stewardship Monitoring
Penalty
Summary
The facility failed to establish and maintain an antibiotic stewardship monitoring system, which had the potential to affect all 71 residents. The facility's policy, titled Antibiotic Stewardship Policy, outlined the need for a committee to oversee antimicrobial stewardship functions as part of the Infection Prevention and Control Program (IPCP). However, observations revealed that the facility did not have a line listing of residents on antibiotics, indicating a lack of proper monitoring. Interviews with staff highlighted several issues contributing to the deficiency. The Infection Preventionist (IP) had not completed her full training and was working part-time due to staffing shortages, which limited her ability to perform her duties effectively. The Assistant Director of Nursing (ADON) acknowledged that the IP was not trained when hired and had been assigned other roles, which hindered her focus on antibiotic stewardship. Additionally, the Director of Nursing (DON) was aware of the requirement for an antibiotic stewardship line listing but noted that monitoring was inadequate. The Executive Director expressed expectations for maintaining an antibiotic stewardship line listing and fully implementing the program. Despite these expectations, the facility's failure to adhere to the policy and adequately monitor antibiotic use was evident. The lack of a comprehensive monitoring system and incomplete data tracking contributed to the deficiency, as noted by the ADON's incomplete tracking of antibiotic use data for October 2024.
Deficiency in Infection Prevention Leadership and Training
Penalty
Summary
The facility failed to employ a certified Infection Preventionist (IP) and experienced a lapse in infection prevention leadership, potentially affecting all 71 residents. The facility's policy required the IP to complete the Nursing Home Infection Preventionist Training Course provided by the CDC, but the current IP did not complete this training until 19 days after being hired. Additionally, there was a gap of approximately two months without a fully trained IP in place. The IP acknowledged her responsibility for infection control but noted insufficient time and incomplete training hindered her ability to perform tracking and reporting duties effectively. She also highlighted a lack of existing policies and procedures for infection control upon her arrival, which she had to establish from scratch. Interviews revealed that the Assistant Director of Nursing (ADON) was training the IP without a current Infection Prevention Certificate, as his training was completed five years ago and had expired. The IP was also assigned to other roles within the facility, limiting her time for infection control duties. The Director of Nursing (DON) was unaware of the training requirements for the IP, and the Executive Director expected at least one person in the facility to have an active IP certification. This deficiency in infection prevention leadership and training led to a breakdown in communication and delayed response to infection control issues, such as urinary tract infections (UTIs).
Deficiency in Resident Grooming and Nail Care
Penalty
Summary
The facility failed to provide adequate fingernail care and grooming for five residents, leading to a deficiency in activities of daily living (ADLs) care. The facility's policy on ADLs, revised in October 2024, mandates that residents receive care to maintain or improve their ability to perform ADLs, including grooming. However, observations and interviews revealed that residents R33, R42, R28, R55, and R31 had long and dirty fingernails, indicating a lack of proper grooming care. This deficiency was observed over several days, with staff acknowledging the issue but failing to address it promptly. Resident R33, who is cognitively intact and requires substantial assistance with ADLs, was observed with long and dirty fingernails over multiple days. Despite being well-groomed otherwise, R33 reported that staff would cut her nails when they had time, particularly noting low staffing on weekends. Similarly, resident R42, also cognitively intact and needing maximum assistance, had long and dirty fingernails, with staff delaying nail care. Resident R28, with moderate cognitive impairment, was observed with long and dirty fingernails, despite being alert and well-groomed otherwise. Resident R55, with moderate cognitive impairment, was observed with uncombed hair and long, dirty fingernails. Despite receiving extensive assistance for ADLs, R55's grooming needs were not met. Resident R31, with severely impaired cognition, was observed with a black substance under her fingernails and facial hair, despite receiving substantial assistance with personal hygiene. Staff interviews confirmed that nail care was part of the routine ADL assistance, yet these residents' grooming needs were not adequately addressed, leading to the deficiency.
Failure to Implement Stop Date for PRN Psychotropic Medication
Penalty
Summary
The facility failed to implement a stop date for a PRN psychotropic medication for a resident, identified as R53, which was reviewed for unnecessary medications. The facility's policy on the use of psychotropic medication requires that PRN orders for such drugs be limited to a duration of 14 days unless a clinical rationale is documented. However, the physician orders for R53 included lorazepam 0.5 mg every 4 hours as needed for agitation, anxiety, and restlessness, with an indefinite stop date and no documented clinical rationale for the duration. This oversight was noted despite a previous reminder from the consultant pharmacist to the attending physician about the CMS regulations regarding PRN psychotropic medication orders. R53, who has diagnoses including cognitive communication deficit, Alzheimer's disease, depression, and generalized anxiety disorder, was observed to have severely impaired cognition and was dependent on assistance for daily activities. Observations revealed that R53 was often sleepy and disengaged, with instances of crying and sleeping during the day. Interviews with facility staff, including a CNA and an RN, confirmed that R53 was frequently seen crying and sleeping, indicating a potential impact on the resident's well-being due to the continued use of the PRN lorazepam without a defined stop date or documented rationale.
Medication Security Lapse on Hall B
Penalty
Summary
The facility failed to ensure medications were secured on one of the medication carts on Hall B, as observed during a survey. A Licensed Practical Nurse (LPN) was seen preparing for medication administration and left the medication cart unlocked and unattended while retrieving a blood pressure machine. The cart was left with multiple medication cards and a cup containing capsules on top, which is against the facility's policy that requires all drugs to be stored in locked compartments and not left unattended. During an interview, the LPN acknowledged the oversight, admitting that leaving the medication cart unlocked and unattended was not appropriate practice. The Assistant Director of Nursing (ADON) confirmed that the facility's expectation is for no medications or empty capsules to be left unattended, as this could lead to someone ingesting something harmful. The facility's policy emphasizes the importance of maintaining medication storage in a safe and secure manner, which was not adhered to in this instance.
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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 Austell
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Anderson Mill Center For Nursing And Healing Llc | 1.2 mi | ★★★★★ | 1 | 0 |
| Powder Springs Center For Nursing & Healing | 2.2 mi | ★★★★★ | 3 | 0 |
| Pruitthealth - Austell | 2.2 mi | ★★★★★ | 10 | 0 |
| Delmar Gardens Of Smyrna | 6.7 mi | ★★★★★ | 2 | 0 |
| Pruitthealth - Marietta | 7.1 mi | ★★★★★ | 6 | 0 |
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