Below 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 Pruitthealth - Lakehaven, Llc during CMS and state inspections, most recent first.
Surveyors found that the ice machine in the kitchen had a buildup of a black substance in its corners and crevices, indicating it was not properly cleaned and sanitized according to facility policy. The Dietary Manager confirmed the issue, noting that cleaning tasks are rotated among dietary staff but the corners of the machine had been missed. This deficiency had the potential to affect most residents receiving an oral diet.
A resident with end-stage renal disease repeatedly refused dialysis treatments, but the facility did not update the care plan to address these refusals or provide interventions for staff. Staff interviews confirmed that a dialysis care plan and refusal interventions were missing, despite facility policy requiring updates for significant changes.
A resident with a history of respiratory issues experienced severe distress and was neglected by an LPN, who failed to assess, document, or provide necessary care. The resident called 911 for help, but staff attempted to cancel the call. EMS found the resident in critical condition, requiring immediate intervention. The facility lacked proper documentation and training for the LPN, contributing to the deficiency.
A facility failed to create a baseline care plan for a resident with chronic respiratory issues, leading to a severe incident where the resident experienced a respiratory crisis. Despite the resident's requests for help, the nursing staff allegedly ignored her, forcing her to call 911 herself. EMS found the resident in critical condition and transferred her to the hospital. The Director of Health Services was unaware of the missing care plan, and the resident expressed fear of returning due to inadequate care.
A resident with a history of respiratory issues experienced distress and did not receive necessary care from the nursing staff, who failed to assess, notify the physician, or document the incident. The resident had to call 911, and EMS found her in severe distress. The facility lacked a policy for acute changes, relying on an ineffective SBAR tool.
A facility failed to oversee an abuse prevention program and provide adequate respiratory care, leading to a resident's delayed treatment during acute respiratory distress. Staff attempted to intercept a 911 call, and an LPN did not assess or document the resident's condition or alert the physician. The administration also failed to implement a baseline care plan for the resident's chronic respiratory issues.
Ice Machine Not Properly Cleaned and Sanitized
Penalty
Summary
Surveyors observed that the facility failed to maintain a clean and sanitary ice machine in accordance with its own policies and professional standards. During an inspection, the inside of the ice machine, specifically in the corners and crevices on both the left and right sides where the door opens, was found to have a buildup of a black substance. This was confirmed by the Dietary Manager, who acknowledged the presence of the black substance when it was wiped with a white paper towel. The Dietary Manager stated that although the ice machine had been cleaned, the corners had not been adequately addressed. The facility's policies require the Dietary Manager to develop and enforce cleaning schedules and to monitor the completion of assigned cleaning tasks to ensure a sanitary environment. The monthly cleaning of the ice machine is rotated among dietary staff, who are expected to sign off upon completion. However, the observation and interview revealed that the cleaning was not thorough, as debris remained in the corners of the ice machine. This deficiency had the potential to affect 64 out of 70 residents who were receiving an oral diet at the time.
Failure to Develop Care Plan for Dialysis Refusals
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan addressing a resident's dialysis needs, specifically neglecting to include the resident's repeated refusals of dialysis treatments. The resident, who was admitted with diagnoses including Type 2 diabetes mellitus with diabetic chronic kidney disease stage 5, was receiving dialysis three times per week. Documentation showed that the resident had little to no cognitive impairment and had a dialysis access site that required monitoring. Despite multiple documented refusals of dialysis, including four refusals noted on one occasion, the care plan did not reflect these refusals or provide goals and interventions related to dialysis or the refusals. Staff interviews confirmed that a care plan should have been in place for the resident's dialysis and for addressing treatment refusals, but none was found. The last care plan conference occurred prior to the documented refusals, and the care plan lacked any focus on dialysis or interventions for refusals. The facility's policy required that care plans be updated to reflect significant changes in condition or needs, but this was not done for the resident in question.
Neglect of Resident in Respiratory Distress
Penalty
Summary
The facility failed to protect a resident's right to be free from neglect, as evidenced by the actions and inactions of an LPN. The resident, who had a history of acute and chronic respiratory issues, experienced a significant decline in respiratory status, becoming hypoxic and cyanotic. Despite the resident's clear distress and request for assistance, the LPN did not assess the resident, administer necessary medications, or document the change in condition. The resident was forced to call 911 herself, as the staff did not respond to her needs. Upon the arrival of EMS, the resident was found in severe respiratory distress, with low oxygen saturation levels and requiring immediate medical intervention. The EMS report indicated that the resident had to be stabilized with high-flow oxygen and CPAP before being transported to the hospital. The facility staff did not assist EMS upon their arrival, nor did they provide any report or documentation regarding the resident's condition. Interviews with EMS personnel and the resident confirmed that the facility staff attempted to cancel the 911 call, further neglecting the resident's urgent medical needs. The facility's failure to document the resident's condition, notify the physician, or provide appropriate care highlights a significant deficiency in the care provided. The LPN admitted to not taking necessary actions and failing to communicate with more experienced staff or the resident's emergency contacts. The lack of a competency checklist for newly hired staff and inadequate training contributed to the deficiency, as the LPN was not adequately prepared to handle the resident's medical emergency.
Failure to Develop Baseline Care Plan for Resident with Respiratory Complications
Penalty
Summary
The facility failed to develop a person-centered baseline care plan for a resident with chronic respiratory complications, which had the potential to cause serious harm. The facility's policy required a baseline care plan to be developed within 48 hours of admission, but this was not done for the resident, who had multiple diagnoses including acute and chronic respiratory failure, COPD, and other serious conditions. The resident was cognitively intact, as indicated by a BIMS score of 15, and was readmitted to the facility with significant respiratory issues. On the night of the incident, the resident experienced severe shortness of breath and requested assistance from the nursing staff, who allegedly ignored her pleas. The resident had to call 911 herself, and despite the nurse reportedly canceling the call, she called again, leading to EMS being dispatched. Upon arrival, EMS found the resident in a critical state, requiring immediate intervention and transfer to the hospital. The facility's records did not show any documented interventions for the resident during this respiratory crisis. The Director of Health Services confirmed that there was no care plan addressing the resident's respiratory conditions and was unaware of this oversight until informed. The resident expressed fear of returning to the facility due to the inadequate care received during the night shift, which she felt jeopardized her life. The lack of a baseline care plan and appropriate interventions during the respiratory crisis were significant deficiencies identified by the surveyors.
Failure to Provide Necessary Respiratory Care
Penalty
Summary
The facility failed to provide necessary respiratory care to a resident, identified as R1, who experienced an acute change in condition. The nursing staff did not assess the resident during this critical time, failed to notify the physician, and attempted to cancel a 911 call that the resident had initiated. Furthermore, there was no documentation in R1's clinical record regarding the change in condition, which is a significant oversight in patient care. R1, who was cognitively intact, had a complex medical history including acute and chronic respiratory failure, COPD, and other serious conditions. On the night of the incident, R1 was in respiratory distress and requested assistance from the nursing staff, who did not respond appropriately. The resident had to call 911 herself due to the lack of response from the staff, and even then, the staff attempted to cancel the emergency call. When EMS arrived, R1 was found in severe respiratory distress and required immediate medical intervention. Interviews with staff and the resident revealed that the nurse on duty did not perform an assessment, administer necessary medications, or document the situation. The nurse admitted to making mistakes and not reacting in time. The facility's Director of Health Services and Administrator were unaware of the full extent of the incident until later, and there was no policy in place for handling acute changes in condition, relying instead on the SBAR communication tool, which was not effectively utilized in this case.
Failure to Address Resident's Respiratory Needs and Emergency Response
Penalty
Summary
The facility administration failed to effectively oversee an abuse prevention program and provide adequate monitoring and oversight for respiratory care, resulting in a serious deficiency. Specifically, the administration did not protect a resident's right to be free from neglect by failing to assess, medicate, and assist with emergency care during an acute change in condition. The staff attempted to intercept a 911 call made by the resident, which led to a delay in treatment for her chronic respiratory issues while she was in acute respiratory distress. The administration also failed to monitor, assess, document, and address the resident's chronic respiratory issues. This resulted in the resident being admitted to the hospital's critical care unit and initially placed on BiPAP. An LPN on duty during the incident did not assess the resident, implement any interventions, document the change in condition, or call the physician. The LPN witnessed the resident in distress but did not stay with her until emergency personnel arrived, nor did she alert more experienced staff or provide a report to emergency medical staff. The LPN acknowledged her mistakes and the delay in response. Additionally, the administration failed to develop and implement person-centered baseline care plans for the resident's chronic respiratory problems. The Director of Health Services confirmed that a baseline care plan related to the resident's respiratory diagnoses was not in place and was unaware of the issue until the survey. The resident was discharged before a comprehensive care plan was completed, but the baseline care plan should have addressed her chronic respiratory issues.
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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 Valdosta
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pruitthealth - Valdosta, Llc | 0.5 mi | ★★★★★ | 0 | 0 |
| Pruitthealth - Crestwood, Llc | 0.5 mi | ★★★★★ | 0 | 0 |
| Pruitthealth - Holly Hill, Llc | 0.5 mi | ★★★★★ | 10 | 2 |
| Sgmc Health Villa | 16.9 mi | ★★★★★ | 0 | 0 |
| Hospital Authority Of Brooks County, Georgia, The | 18.1 mi | ★★★★★ | 9 | 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.