Greene Point Health And Rehabilitation

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Interview on 10/29/2025 at 4:49 pm with the Director of Nursing (DON) revealed she was aware of the reported choking incident. The DON revealed she did question CNA BB about the incident on the same day that it occurred, since she reported it. She spoke with the Nurse Practitioner (NP) because she wanted Resident R2 to be 1013'd (involuntary treatment) to the psychiatric hospital. The NP said she would monitor her and

review medications in house. From there the DON stated staff observed 1:1 ration with Resident R2 on that Sunday when the incident happened and told the nurse on duty to get the 1:1 sheet off copier and start for two days. When the DON returned to work on the following Tuesday and Resident R2 was reassessed by the NP (who comes three times per week). The 1:1 for Resident R2 was discontinued on 9/2/2025 when the DON returned to work.

Interview with the Administrator on 10/29/2025 at 5:09 pm revealed the Administrator had received complaints regarding Resident R2 because she wandered into resident rooms and was touchy, but staff would redirect her. The Administrator further revealed she was not aware of the reported choking incident.

Cross refer to F-F609 and F-F610

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greene Point Health and Rehabilitation

1321 Washington Highway Union Point, GA 30669

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609

diseases classified elsewhere, severe, with agitation.

Level of Harm - Minimal harm or potential for actual harm

Review of Resident R2 quarterly and annual MDS assessment dated [DATE REDACTED] revealed a BIMS of 99, which indicates Resident R2 has severe cognitive impairment. Section GG, functional status, revealed Resident R2 required/was assistance for activities of daily living (ADLs) with one person assistance. Walks without assistance, toileting, setup or clean-up assistance, shower/bathe self- partial/moderate assistance, upper body dressing, lower body dressing, putting on/taking off footwear- independent, and personal hygiene- supervision or touching assistance.

Residents Affected - Few

Review of Resident R2 care plan dated 10/1/2024 indicated a problem of behaviors. Goals included but not limited to patient's needs will be met and safety maintained during review period and patient will demonstrate improvements during the review period. Interventions included but not limited to administer medications for

a clearly defined goal aimed at a specific target behavior for which the drug is effective, analyze key times, places, circumstances, triggers, and what de-escalates behavior, assess for the need of pain medication adjustment, and assess patterns of behavior with behavior monitoring.

Record review of the requested facility state reportable incidents from the last 12 months revealed no reported incident of Resident R1 and Resident R2 which involved choking.

Interview on 10/29/2025 with Registered Nurse (RN) AA at 3:09 pm revealed she did complete an incident report regarding the choking incident between Resident R1 and Resident R2 and was told by the administrative team to start 1:1 (one to one) with Resident R2. She further revealed the protocol was to report to the Director of Nursing (DON), Administrator, and family members along with ensuring resident safety first.

Joint Interview on 10/29/2025 with the DON and the Administrator at 5:09 pm revealed the Administrator was not aware of choking incident between Resident R1 and Resident R2. The DON revealed she was aware, but she didn't report to state agency. The DON stated she cannot remember if she reported the incident to the Administrator. The DON further revealed she spoke to the facility Nurse Practitioner about the choking incident.

Cross refer to F-F600 and F-F610

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greene Point Health and Rehabilitation

1321 Washington Highway Union Point, GA 30669

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

places, circumstances, triggers, and what de-escalates anxiety, psychiatric/psychological evaluation as indicated.

1. 2. Review of the EMR revealed resident Resident R2 was admitted to the facility with pertinent diagnoses including

but was not limited to Alzheimer's disease, Altered mental status, unspecified, dementia in other diseases classified elsewhere, severe, with agitation.

Review of Resident R2 quarterly and annual MDS assessment dated [DATE REDACTED] revealed a BIMS of 99, which indicates Resident R2 has severe cognitive impairment. Section GG, functional status, revealed Resident R2 required/was assistance for activities of daily living (ADLs) with one person assistance. Walks without assistance, toileting, setup or clean-up assistance, shower/bathe self- partial/moderate assistance, upper body dressing, lower body dressing, putting on/taking off footwear- independent, and personal hygiene- supervision or touching assistance.

Review of Resident R2 care plan dated 10/1/2024 indicated a problem of behaviors. Goals included but not limited to patient's needs will be met and safety maintained during review period and patient will demonstrate improvements during the review period. Interventions included but not limited to administer medications for

a clearly defined goal aimed at a specific target behavior for which the drug is effective, analyze key times, places, circumstances, triggers, and what de-escalates behavior, assess for the need of pain medication adjustment, and assess patterns of behavior with behavior monitoring.

Review of the facility state reportable incidents (FRIs) of the last 12 months failed to document a complete investigation of the incident between Resident R1 and Resident R2 on 8/31/2025.

Cross refer F-F600 and F-F609

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet