Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Arbor Walk Healthcare Center during CMS and state inspections, most recent first.
A cognitively intact male resident inappropriately touched a severely cognitively impaired female resident, including rubbing her thigh and side of her breast while visiting another resident in the same room. The female resident reported telling him to stop, and another cognitively impaired resident in the room reported witnessing the touching in the groin area. A CNA observed the male resident with his hand in the female resident’s brief and his mouth on her breast but did not immediately report the incident, and the ADM did not receive the allegation until several days later, resulting in a failure to protect the resident from sexual abuse and a delay in initiating an investigation.
A staff member engaged in a loud, profane verbal exchange with a resident in the dining room, witnessed by several staff members. The staff member responded to the resident's profanities with identical language, despite the resident's severe cognitive impairment and the facility's policy prohibiting verbal abuse.
Two residents experienced verbal abuse from nursing staff, including being yelled at and spoken to in a threatening or disrespectful manner when requesting pain medication or assistance with personal care. These incidents were witnessed by staff and reported by a resident's representative, indicating a failure to protect residents from abuse as required by policy.
A resident's diet was changed to pureed after a speech therapist identified swallowing difficulties and entered a new order. The resident's representative was not notified of this change and only became aware during a visit. Staff interviews confirmed that the notification did not occur, and the DON stated that the nurse confirming the order should have informed the representative.
The facility failed to notify the NP of significant weight loss in a resident and a change in condition in another. Despite the RD's recommendations and the Dietary Manager's notification to the DON, there was no documentation that the NP or physician was informed of the weight loss. Additionally, the NP was not notified of a resident's lethargy, which led to the holding of Ativan doses. Interviews confirmed the lack of communication and documentation.
A resident experienced significant weight loss due to the facility's failure to implement care plan interventions. Despite recommendations from the RD to adjust tube feeding, the care plan was not updated, leading to a decrease in weight from 172 lbs to 127.4 lbs. The DON confirmed the lack of intervention implementation.
A resident experienced significant weight loss due to the facility's failure to implement the Registered Dietitian's recommendations. Despite the RD's assessment and suggested changes to the resident's tube feeding regimen, the Director of Nursing did not communicate these recommendations to the physician or obtain necessary orders. As a result, the resident's weight continued to decline significantly over a 30-day period.
Failure to Protect Resident From Sexual Abuse and Delay in Reporting Incident
Penalty
Summary
The facility failed to ensure a resident’s right to remain free from sexual abuse when one cognitively intact male resident engaged in inappropriate physical contact with a severely cognitively impaired female resident. On the afternoon of 12/27/25, while visiting another resident in the same room, the male resident rubbed the female resident across her thigh and belly. The female resident, who had a Brief Interview for Mental Status (BIMS) score of 4 indicating severely impaired cognition and a diagnosis of schizophrenia, later reported that he rubbed her leg on the outside of her thigh and the side of her breast, and that she told him to stop, at which point he stopped and left the room. She denied any skin-to-skin contact. Another severely cognitively impaired resident in the room reported witnessing the male resident rubbing the female resident and pointed to her groin area. The male resident, who had a BIMS score of 15 indicating no cognitive deficits, acknowledged rubbing the female resident across the thigh and belly. The incident was not reported to facility administration at the time it occurred. A CNA observed the male resident in the female resident’s room with his hand in her brief and his mouth on her breast on the afternoon of 12/27/25 but did not immediately report this allegation of sexual abuse. The Administrator did not receive the allegation until 12/31/25 at approximately 3:00 PM, at which time the investigation was initiated. The delay in reporting and response, combined with the observed and reported inappropriate physical contact between the residents, constituted the failure to protect the resident from sexual abuse as required by the facility’s abuse prohibition policy.
Staff Member Engages in Verbal Abuse Toward Resident
Penalty
Summary
A deficiency occurred when a staff member engaged in a loud, profane verbal exchange with a resident in the dining room, violating the resident's right to be free from verbal abuse. The incident was witnessed by multiple staff members, including the Maintenance Director, Housekeeping Supervisor, Activities Director, and a Certified Nursing Assistant. The staff member, a housekeeper, responded to the resident's profanities by repeating the same profane language back to the resident in a public area. The Administrator overheard the exchange but was initially unaware that an employee was involved. The resident involved had a history of Focal Traumatic Brain Injury and Pseudobulbar Affect, with a documented severe cognitive impairment as indicated by a BIMS score of 4. The facility's policy clearly prohibits all forms of abuse, including verbal abuse, and mandates that residents be protected from such treatment. Despite this, the staff member's actions constituted verbal abuse as defined by facility policy and were validated by the facility's internal investigation.
Failure to Prevent Verbal Abuse of Residents
Penalty
Summary
The facility failed to protect residents from verbal abuse, as evidenced by multiple incidents involving two residents. In one case, a resident with a diagnosis of pain and a BIMS score indicating cognitive intactness requested pain medication from a CNA, after which an RN entered the room and yelled at the resident, stating she was always asking for pain medicine and would receive it only when the RN was ready. The RN was also reported to have made threatening remarks such as, 'You better be good today or else.' Multiple staff members, including the Corporate Nurse and MDS Nurse, overheard the RN speaking loudly and rudely to the resident, with statements like, 'We not gonna do this today. I always give you your pain medicine, but today you gonna learn. I will give it to you when I get ready,' and, 'You're in pain, you gonna stay in pain. You gonna be nasty to me, I'll be nasty to you.' These interactions were corroborated by witness statements and interviews. In another incident, a resident's representative reported overhearing a nurse respond disrespectfully after the resident, who required assistance with personal care, used the call light without response and soiled herself. The nurse reportedly told the resident, 'I heard you calling, but you can just sit in it.' This complaint was documented in the facility's grievance log. Both incidents demonstrate a failure to ensure residents were free from verbal abuse, as required by facility policy and resident rights regulations.
Failure to Notify Resident Representative of Change in Diet Order
Penalty
Summary
The facility failed to notify the resident representative (RR) of a change in condition for one resident. Specifically, the resident's diet was changed to pureed following an evaluation by a speech therapist due to episodes of coughing and vomiting while being fed. The speech therapist documented the swallowing impairment and recommended the diet change, which was then ordered and entered into the system. However, the RR was not informed of this change and only discovered it during a visit when he noticed the resident was receiving a pureed diet. Interviews with facility staff confirmed that the RR had not been notified of the diet change or the reason for it. The speech therapist stated that it was not facility practice for therapists to notify families, and the DON explained that the nurse who confirms the order is responsible for notifying the RR. Due to subsequent clarifications in the order, the original confirming nurse could not be identified. The resident involved had a history of cerebral infarction, dysphagia, and seizures, and was admitted with these diagnoses.
Failure to Notify Nurse Practitioner of Resident Changes
Penalty
Summary
The facility failed to notify the Nurse Practitioner (NP) of significant weight loss in a resident and a change in condition in another resident. For the first resident, the Registered Dietitian (RD) noted a significant weight loss from 172 pounds to 127.4 pounds over a period of time. Despite the Dietary Manager notifying the Director of Nursing (DON) about the weight change, there was no documentation that the NP or physician was informed. Interviews confirmed that the NP was not notified of the weight loss, and the DON acknowledged the lack of documentation. For the second resident, the facility did not notify the NP of the resident's lethargy, which led to the holding of Ativan doses on two occasions. The resident had an order for Ativan 0.5 mg twice a day, and the lethargy was noted on two separate dates. The NP confirmed she was not informed of the resident's condition, and the DON verified the absence of documentation regarding the notification. The Administrator expected that the staff would have notified the NP of these changes in the resident's status.
Failure to Implement Care Plan Interventions for Weight Loss
Penalty
Summary
The facility failed to implement care plan interventions to prevent significant weight loss for a resident. The resident was admitted with diagnoses including attention to gastrostomy and gastroparesis. A review of the resident's weight records showed a significant decrease from 172 lbs to 127.4 lbs over a period of approximately one month. The Registered Dietitian (RD) assessed the resident and recommended changes to the tube feeding regimen due to a significant weight loss of 6.98% since admission. However, these recommendations were not implemented in the resident's care plan. The care plan for the resident included interventions such as serving a renal diet, obtaining weight per facility protocol, monitoring meal intakes, and allowing ample time to finish meals. Despite these interventions, the facility did not update the care plan with new interventions after the RD identified the significant weight loss. An interview with the Director of Nursing confirmed that the facility failed to implement necessary care plan interventions to address the resident's weight loss.
Failure to Implement Dietary Recommendations for Weight Loss
Penalty
Summary
The facility failed to implement interventions for a resident who experienced significant weight loss. The resident, who was on a renal diet and received enteral nutrition via a PEG tube, showed a weight loss of 6.98% since admission. The Registered Dietitian (RD) recommended changes to the resident's tube feeding regimen to address the weight loss, but these recommendations were not communicated to the resident's physician or implemented. The resident's weight continued to decline, with a documented loss of 20.38% over 30 days. Interviews with facility staff revealed that the Director of Nursing (DON) was responsible for notifying the physician of the RD's recommendations and obtaining necessary orders, but this was not done. The RD and other staff members confirmed that the recommendations were not followed up on, and there was no documentation indicating that the resident's care providers were informed of the dietary recommendations. The facility's failure to act on the RD's recommendations resulted in continued weight loss for the resident.
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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 Greenville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ms Care Center Of Greenville | 0.4 mi | ★★★★★ | 0 | 0 |
| Washington Care Center | 0.9 mi | ★★★★★ | 6 | 0 |
| Legacy Manor Nursing And Rehabilitation Center | 1.2 mi | ★★★★★ | 2 | 0 |
| River Heights Healthcare Center | 1.3 mi | ★★★★★ | 9 | 0 |
| Lake Village Rehabilitation And Care Center | 16.4 mi | ★★★★★ | 6 | 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.