Bonterra Transitional Care & Rehabilitation
East Point, Georgia · CCN 115555
18 surveys since 2010. The first finding at harm level was recorded in 2014.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 77
- Surveys
- 18
- Harm or worse
- 12
- Immediate jeopardyall corrected before survey
- 3
Findings at the most serious level CMS records. All were recorded as past non-compliance — corrected before the survey.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 118
- Ownership
- For profit - Partnership
- Chain
- WELLINGTON HEALTH CARE SERVICES
- County
- Fulton
- Medicare-certified since
- 1993
CMS ratings
- Overall
- 1
- Health inspection
- 2
- Staffing
- 1
- Quality measures
- 2
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded more weighted findings than most of its peer group.
Weighted by harm level, against 96 for-profit facilities of 100–127 beds in Georgia.
Last survey on record
Apr 30, 2026
193 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 2.96 | 3.35 |
| Registered-nurse hours per resident day | 0.17 | — |
| Annual nurse turnover | 60.0% | 46.5% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $40,596 across 4 penalties
- Payment denials
- 1
Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J38.1% | K— | L— |
| Actual harm | G410.8% | H— | I— |
| No harm, potential for more than minimal | D2054.1% | E821.6% | F25.4% |
| No harm, potential for minimal | A— | B— | C— |
Most frequently cited here
In CMS’s current monthly file.
- F6563×
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- F6893×
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- F8803×
Provide and implement an infection prevention and control program.
- F5502×
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- F5842×
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
In the surveyor’s words
From the most serious findings on record at Bonterra Transitional Care & Rehabilitation, in the surveyor’s own words.
- Immediate jeopardy, isolatedF656Mar 19, 2025
Based on record reviews, staff interviews, and a review of the facility's policy titled Care Plan Policy, the facility failed to implement the care plan for one of 26 sampled residents (R) (R165) related to nutrition. Specifically, the facility provided R165 a sandwich which resulted in him being sent out to the local emergency room (ER) and admitted to a hospice facility where he expired on [DATE]. On [DATE] a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy (IJ) for F656, F684, and F835 on [DATE] at 12:48 pm. […]
- Immediate jeopardy, isolatedF684Mar 19, 2025
Based on observations, record reviews, staff interviews, and review of the facility's policies Modified Texture of Food and Resident Food Preferences, the facility failed to provide a pureed snack to one of 26 sampled residents (R) (R165) ordered to receive a mechanically altered diet. Specifically, the facility provided R165 a sandwich which resulted in him being sent out to the local emergency room (ER) and admitted to a hospice facility where he expired on [DATE]. On [DATE] a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents. […]
- Immediate jeopardy, isolatedF835Mar 19, 2025
Based on interviews, record reviews, and a review of the documents Administrator and Director of Nursing, the Administration failed to effectively and efficiently manage facility compliance with federal regulatory requirements related to Quality of Care for one of 26 sampled residents (R) (R165) receiving an altered diet. Specifically, the facility provided R165 a sandwich, which resulted in him being sent out to the local emergency room (ER) and admitted to a hospice facility where he expired on [DATE]. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents. […]
- Actual harm, isolatedF697Mar 19, 2025
Based on observations, resident and staff interviews, record review, and the facility's policy titled Pain Management - Acute, Chronic, and Subacute, the facility failed to ensure that pain management was provided for one of 36 sampled residents (R) (R71) who require such services consistent with professional standards of practice and the comprehensive person-centered care plan. Actual Harm was identified on 3/13/2025, when staples became embedded in R71's amputation surgical site after the facility failed to provide transportation for post-operation (post-op) appointments. […]
- Actual harm, isolatedF774Mar 19, 2025
Based on interviews and record review, the facility failed to schedule transportation arrangements for a medical appointment for one of 36 sampled residents (R) (R71), resulting in a missed post-operation (post-op) appointment after a surgical procedure. Actual Harm was identified on 3/13/2025, when staples became embedded in R71's amputation surgical site after the facility failed to provide transportation for post-operation (post-op) appointments. Findings included: A review of the electronic medical record (EMR) revealed that R71 was admitted to the facility on [DATE] with a diagnoses of encounter for orthopedic aftercare following surgical amputation, acquired absence of right leg below knee, acquired absence of left above knee, type 2 diabetes mellitus with other skin conditions,… […]
Read 27 findings in full →The most serious and the most recent: 27 of 77 on record.
Every survey on record
FindingsAt actual harm or above
- Apr 30, 2026Standard and complaint1 finding
- Mar 19, 2025Standard21 findings · 5 harm
- Feb 22, 2024Complaint4 findings
- Aug 16, 2023Complaint4 findings · 2 harm
- Jan 5, 2023Standard and complaint7 findings
- May 27, 2021Standard5 findings
- Dec 5, 2019Standard2 findings
- Aug 2, 2018Standard2 findings
Show the 10 earlier surveys
- Aug 31, 2017Standard2 findings
- Apr 14, 2016Standard and complaint10 findings · 2 harm
- Mar 12, 2015Standard2 findings
- Sep 16, 2014Complaint3 findings · 3 harm
- Aug 28, 2013—3 findings
- Apr 3, 2013—1 finding
- Dec 12, 2012—2 findings
- Mar 1, 2012—4 findings
- Apr 11, 2011—1 finding
- Aug 3, 2010—3 findings
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
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