Latest reports, citations, and penalties from CMS data
When facility staff assessed the resident, they found no pulse or respirations and immediately began cardiopulmonary resuscitation....
The keys were also left unattended on the medication cart while a corporate nurse conducted routine checks for expired and unlabeled medications....
Snellville facility administered incorrect oxygen levels and failed to maintain clean equipment filters, putting residents at serious respiratory risk....
Stand lifts are mechanical devices used to safely transfer residents with mobility limitations from beds, toilets, and wheelchairs....
The resident, who was on aspiration precautions and required assistance with meals, began vomiting while lying in bed after lunch....
Inspectors reviewed the facility's policy dated December 2024, which establishes the foundation for all pharmaceutical services within the nursing home....
## Medical Risks of Improper Electrical Setup Extension cord misuse in healthcare settings poses significant risks beyond typical household hazards....
No justification was documented for the significant delay in this case....
Staff A attempted the transfer alone despite **clear instructions posted inside the resident's closet door** and verbal warnings from the resident's spouse....
The contamination resulted from improper cleaning procedures that violated both manufacturer specifications and FDA Food Code requirements....
## **Repeated Nail Care Failures** The April 2025 inspection revealed troubling patterns of neglected personal hygiene across multiple residents....
The resident indicated the pain made eating difficult and sometimes left him hungry due to his inability to chew food properly....
The resident, identified as Resident #1, had exited through an emergency fire door that should have been alarmed but was found to be disarmed....
Kitchen staff interviewed during the inspection expressed uncertainty about proper food storage timelines....
## Inappropriate Contact with Sleeping Resident The incident occurred on the evening of February 7, 2025, when a resident was sleeping peacefully in his bed....
Federal inspectors identified critical supervision lapses that placed vulnerable residents at risk of serious harm....
This recurring citation pattern indicates the facility has struggled to fully correct underlying safety issues that initially triggered regulatory action....
Documentation shows the resident made sexually inappropriate comments to staff on June 8, with the behavior continuing and escalating over the following weeks....
## Complete Care Abandonment Captured on Video Surveillance footage from March revealed the shocking extent of the care abandonment at Jefferson Manor....
The BIMS scale ranges from 0-15, with lower scores indicating greater cognitive decline....