Chulio Hills Health and Rehab: Notification Failures - GA
Federal inspectors who visited Chulio Hills Health and Rehab on May 22 found that nurses there were not making those calls.
The inspection, triggered by a complaint, identified failures in how the facility handled changes in residents' physical, mental, and psychological conditions. Inspectors rated the level of harm as actual harm, not the potential for harm, not a technical deficiency. Actual harm to real residents. The number of people affected was listed as few, the regulatory language for a small but specific group, not an isolated incident involving a single person.
The facility's own written policy described exactly what nurses were supposed to do. Before reaching a physician, a nurse was required to make detailed observations and gather relevant information, using a structured communication format to organize what they found. The policy named the tool explicitly. It was not a vague directive. It was a step-by-step process, and it existed because gaps in communication between nursing staff and physicians are among the most documented causes of preventable decline in long-term care.
The policy also required nurses to contact a resident's representative, meaning a family member or designated decision-maker, when the resident was involved in any accident or incident resulting in injury, or when there was a significant change in their physical, mental, or psychological status. That notification requirement existed for a reason. Families cannot advocate for someone they don't know is in trouble.
What inspectors found was that neither obligation was being met consistently.
The same policy required nurses to document changes in a resident's medical record, a step that creates the paper trail physicians rely on when they do eventually get involved. Without that documentation, a doctor arriving at the bedside, or reviewing a chart remotely, is working without the history they need.
Chulio Hills is a 115-bed facility on Chulio Road in Rome, in northwest Georgia. The complaint inspection in May produced a deficiency that carries weight precisely because of how CMS categorizes harm. The agency distinguishes between deficiencies that create the potential for harm and those that result in it. This one landed in the latter category.
The facility's plan of correction was not included in the inspection documents reviewed for this report. CMS directs anyone seeking that information to contact the nursing home or the Georgia state survey agency directly.
What the inspection record does not contain is the name of any resident who was harmed, the nature of the condition change that went unreported, or how long the lapse lasted before someone intervened. Those details, if they exist in the underlying complaint file, were not part of the public-facing inspection narrative. What remains is the finding itself: nurses who did not call, families who were not told, physicians who were left waiting for information that never came.
In a nursing home, a significant change in condition can mean a resident stopped eating. It can mean new confusion, a fall, a sudden drop in blood pressure, the early signs of an infection that, caught in time, stays manageable. The gap between a nurse noticing something and a doctor knowing about it is exactly where preventable harm lives.
The policy at Chulio Hills was not the problem. The policy was clear. What the inspectors found was the distance between what was written and what was done.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Chulio Hills Health and Rehab from 2026-05-22 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 31, 2026 · Our methodology
CHULIO HILLS HEALTH AND REHAB in ROME, GA was cited for violations during a health inspection on May 22, 2026.
Federal inspectors who visited Chulio Hills Health and Rehab on May 22 found that nurses there were not making those calls.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.