Peachtree Nursing and Rehabilitation LLC

In the surveyor’s words

From the most serious findings on record at Peachtree Nursing and Rehabilitation LLC, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Nov 21, 2025

  Based on observations, record reviews, and interviews, the facility failed to keep track of when to discard refrigerated food items through labeling and dating the items. This failure had the potential to negatively impact (through foodborne illness) 139 residents residing at the facility by exposing them to food items that may have spoiled.Findings include:An observation on 11/18/25 at 8:50 AM, during the Flash Tour. completed with the Director of Food and Nutrition Service (DFNS), of the kitchen revealed numerous food items located in the reach in refrigerators were not labeled or dated. […]

• No harm, potential for more than minimal, widespreadF812Jul 25, 2024

  Based on observations and staff interviews, the facility failed to ensure food items in the kitchen cooler were properly stored and labeled with open or discard dates, failed to dispose of expired foods in a resident nourishment pantry, and failed to ensure an ice maker was maintained in a clean and sanitary manner. The deficient practices placed the 106 residents (R) who consumed an oral diet from the kitchen at risk for avoidable foodborne illness. Findings include: The Food Safety policy was requested and was not provided. Observations of the kitchen cooler on [DATE] at 9:15 am revealed the following: One industrial-size cooking sheet containing seasoned chicken was covered with plastic wrap with a light orange substance on the wrap without a label indicating a stored or discard date. […]

• No harm, potential for more than minimal, isolatedF578Nov 21, 2025

  Based on interviews, record review, and policy review, the facility failed to ensure physician orders for code status matched the residents' Physician Orders for Life Sustaining Treatment (POLST) and wishes for two of four residents (Resident (R) 57 and R49) reviewed for advance directives out of 29 sampled residents. This failure increased the likelihood of causing severe harm or death if CPR (Cardiopulmonary Resuscitation) was performed or withheld against a resident's wishes.Findings include:1. Review of the admission Record, located in the electronic medical record (EMR) under the Profile tab revealed R57 was admitted to the facility on [DATE] and returned from a hospital stay on [DATE]. […]

• No harm, potential for more than minimal, isolatedF600Nov 21, 2025

  Based on interviews, record review, and policy review, the facility failed to ensure residents were free from abuse and neglect for one of four residents (Resident (R) 49) reviewed for abuse and neglect out of 29 sampled residents. The facility neglected the resident when Certified Nurse Aide (CNA) 1 removed the call light out of the resident's reach. CNA 1 intimidated R49 when she stood over her and told the resident not to use the call light again. These failures had the potential to cause unmet care needs. Findings include:Review of R49's undated admission Record, located in the Electronic Medical Record (EMR) under the Profile tab, revealed she was admitted to the facility on [DATE] with diagnoses that included chronic respiratory failure, Reiter's disease, and cervicalgia. […]

• No harm, potential for more than minimal, isolatedF609Nov 21, 2025

  Based on interviews, record review, and policy review, the facility failed to ensure abuse and neglect by staff was reported timely to the Director of Nursing (DON) and to the State Survey Agency (SSA) when a resident's call light was placed out of reach, and told not to use the call light anymore by Certified Nursing Assistant (CNA)1 for one of four residents (Resident (R) 49) reviewed for neglect out of 29 sampled residents. Findings include:Review of R49's annual Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 09/29/25, located in the EMR under the MDS tab revealed a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was cognitively intact.Review of R49's Nursing Progress Note, dated 10/30/25, located in the EMR under the Prog Notes tab,… […]