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Complaint Investigation

Perimeter Rehabilitation Suites By Harborview

December 19, 2025 · Atlanta, GA · 5470 Meridian Mark Road, Bldg E
Citations 7
Beds 240
Provider ID 115270
Healthcare Facility
Perimeter Rehabilitation Suites By Harborview
Atlanta, GA  ·  View full profile →
Inspection Summary

PERIMETER REHABILITATION SUITES BY HARBORVIEW in ATLANTA, GA — inspection on December 19, 2025.

Found 7 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0550
Resident Rights Deficiencies
Potential for More Than Minimal Harm

email was sent due to it was not sent from her email address.

During an interview on 12/17/2025 at 11:03 am, the Administrator stated, Nursing has a consent to treat form that should be signed upon admission in the physical chart.

During an interview on 12/17/2025 at 1:01 pm, the [NAME] President of Operations (VPO) stated, The resident's consent for treatment and admission packet was not signed at admission.

The packet was created on 11/6/2025.

The admissions person, who was responsible, resigned from the position at the time of admission.

There is no paper consent to treat form signed.

There is no documentation that the resident/representative was informed of the resident's rights or benefits and costs.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

resident interviews, and further investigation showed no additional residents had been affected by FT1.

The Administrator stated it was against facility policy for staff to request money or gifts from residents, and it was considered exploitation/abuse.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

Based on interviews, document review, and review of the policy titled Abuse, Neglect and Exploitation, the facility failed to ensure that one of three staff, Floor Technician (FT) (FT1), completed and documented a criminal background history, including a history of abuse, neglect, or exploitation, before employment.

This failure had the potential to contribute to a substantiated allegation of exploitation for a facility resident (R) (R6).

Findings included:A review of the facility's Abuse, Neglect and Exploitation policy dated 7/15/2025 revealed, The components of the facility abuse prohibition plan are discussed herein:I.

ScreeningA.

Potential employees will be screened for a history of abuse, neglect, exploitation, or misappropriation of resident property.1.

Background, reference, and credentials checks shall be conducted on potential employees,contracted temporary staff, students affiliated with academic institutions, volunteers, andconsultants.2.

Screenings may be conducted by the facility itself, a third-party agency, or an academic institution.3.

The facility will maintain documentation of proof that the screening occurred.A review of the Final Report dated 5/15/2025 regarding the investigation of an allegation of exploitation by R6, provided in the incident folder, revealed that R6 alleged that FT1 sent text messages to her asking for money.

The investigation also included screenshots of R6's text messages confirming that FT1 requested money.

The allegation of exploitation was substantiated, and FT1 was terminated.A review of the personnel file for FT1 provided by the Administrator revealed a hire date of 3/27/2024.

There was no evidence of a criminal background check or reference checks before employment.

The file indicated that two reference checks were attempted on 3/19/2024; however, not completed.

During an interview on 12/17/2025 at 1:04 pm with the Administrator, who served as the facility's Abuse Prevention Coordinator, confirmed that he was unable to locate a background check on FT1, and the only evidence of reference checks was the two that were not completed.Cross-reference F-F602: Free from Misappropriation/exploitation

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

During an interview on 12/18/2025 at 4:02 pm, Assistant Director of Nursing (ADON) 2 stated that he was not at the facility but was informed by LPN9 that R28 was found in the day room, foaming at the mouth.

ADON2 said that he communicated with LPN9 during the incident. He said the resident was given oxygen, and his neuros were taken. ADON2 said that paramedics came quickly. He said they did a follow-up and found out R28 had a cervical fracture. ADON2 said that he had talked to other residents, but no one could explain what had happened. He said that the facility did not know. ADON2 stated that the Administrator would follow up with any reported events to the SA.

During an interview on 12/18/2025 at 4:45 pm, the Director of Nursing (DON) stated that the facility staff called and told her what happened with R28.

She stated that the facility reviewed the incident the next day.

She said that it was determined that R28 had been in the day room when it happened.

She confirmed he was a frequent faller.

She said that it looked like R28 might have had seizure activity, but there was no way to know if he had the fall or the seizure first before the injury.

During an interview on 12/18/2025 at 5:00 pm, the Administrator stated that when he was notified of a resident going to the hospital, he submitted a Facility Incident Report Form to the SA.

The Administrator said that he would use the resident's record and then document what happened in the report.

Upon reviewing the resident's record of the incident and the subsequent Facility Incident Report Form submitted to the SA, the Administrator confirmed that they did not correspond. He said he was not sure why he documented the date of the fall as 10/7/2025, and that it was witnessed. He stated that if he had known it was unwitnessed, he would have done an investigation as an injury of unknown origin.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

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During an interview on 12/18/2025 at 2:34 pm, the [NAME] President (VP) of Clinical Reimbursement stated the MDS Coordinators were trained to code a UTI when the resident was diagnosed and treated for a UTI in the hospital within the last 30 days.

The VP of Clinical Reimbursement stated she expected the staff to follow the RAI Manual and accurately code the MDS assessments.

The VP of Clinical Reimbursement indicated she had regional MDS coordinators over the facilities, and they had not started auditing MDS assessments for accurately coding the UTIs yet.

During an interview on 12/18/2025 at 1:29 pm, the Administrator stated he expected staff to code the MDS assessments correctly according to the RAI Manual.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

During a telephone interview on 12/18/2025 at 1:04 pm, LPN4 stated the expectation was that the nurse on the night shift would retrieve faxes from the fax machine, as there was one on each floor, and follow up immediately by calling the physician for any critical results. LPN4 stated that sometimes, however, she was unable to get to the faxes on the night shift because she was so busy taking care of the residents, and in that case, the ADON would look at the faxes when she came in the next day. LPN4 stated she had not worked at the facility in months and did not recall this specific resident or situation.

During an interview on 12/19/2025 at 12:05 pm, the Director of Nursing (DON) stated her expectation was that the nurse on duty receive a fax and notify the physician of the results at the time.

During a follow-up interview on 12/19/2025 at 12:30 pm, the DON stated she was unable to find any evidence of physician notification of R4's hip arthroplasty dislocation from the time of the fax on 9/2/2025 at 9:02 pm to the time of documented physician notification at 2:01 pm.

The DON stated she had noticed there was a delay in notification and subsequently sending R4 to the hospital.

The DON stated there was no incident report or investigation into this incident.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Perimeter Rehabilitation Suites by Harborview

5470 Meridian Mark Road, Bldg E Atlanta, GA 30342

SUMMARY STATEMENT OF DEFICIENCIES

jeopardy to resident health or safety

above the stairway door, but the door was locked with a special locking arrangement and did not open or sound an alarm.

The exit door near 225, leading to a stairway, opened in 15 seconds with pressure, as did the exit door near 249.

The cross corridor exits access doors near 205 also opened in 15 seconds (no sign,) each with special locking arrangements.

These two doors were also accessed by using special knowledge or a code.

The two elevator doors used for residents also lock when a wander guard sensor is near and alarm when the doors open, as well as the service elevator near bedroom [ROOM NUMBER]. A code pad was also at each elevator.Further interview with [NAME] on 11/19/2025 at 9:30 am revealed that a contractor unlocked the exit discharge door about two weeks ago to work on an exterior wooden fence in the area. He must not have relocked the door when he was finished.

When asked by the [NAME] if the contractor had a key, he stated, No, he would have to get the key from the facility and relock through a key with the facility.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ATLANTA, GA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from PERIMETER REHABILITATION SUITES BY HARBORVIEW or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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