Inspection Reports for Pine Knoll Nursing & Rehab Ctr
156 PINE KNOLL DRIVE, CARROLLTON, GA, 30117
Back to Facility ProfileInspection Report Summary
The most recent inspection on June 16, 2025, substantiated a complaint but did not cite any deficiencies. Prior inspections showed a pattern of deficiencies related mainly to infection control practices, food storage and labeling, and life safety code compliance, including fire safety issues and emergency preparedness documentation. Earlier complaint investigations were mostly unsubstantiated or substantiated without deficiencies, though some prior surveys identified medication administration errors and sanitation concerns in the kitchen. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility has demonstrated correction of previously cited deficiencies over time, with the most recent surveys indicating improvement in compliance.
Deficiencies (last 8 years)
Deficiencies (over 8 years)
7.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
51% worse than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
101 residents
Based on a June 2025 inspection.
Census over time
Inspection Report
Abbreviated Survey
Census: 101
Deficiencies: 0
Date: Jun 16, 2025
Visit Reason
An abbreviated/partial extended survey was conducted at Pine Knoll Nursing and Rehab Center to investigate complaint number GA00255373.
Complaint Details
Complaint GA00255373 was substantiated with no deficiencies cited.
Findings
The complaint GA00255373 was substantiated, but no deficiencies were cited during the survey.
Report Facts
Census: 101
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Jun 12, 2025
Visit Reason
This document is a Statement of Deficiencies and Plan of Correction for Pine Knoll Nursing & Rehab Center following a survey completed on June 12, 2025.
Findings
The report contains initial comments but does not provide specific details on deficiencies or findings within the provided page.
Inspection Report
Re-Inspection
Census: 101
Deficiencies: 0
Date: Jun 12, 2025
Visit Reason
A revisit was conducted at Pine Knoll Nursing & Rehab Center to verify correction of deficiencies identified in the April 10, 2025 recertification survey.
Findings
All deficiencies from the April 10, 2025 recertification survey have been corrected.
Inspection Report
Follow-Up
Deficiencies: 0
Date: May 28, 2025
Visit Reason
A Follow-Up Survey was conducted to verify correction of previously cited survey deficiencies.
Findings
All previously cited survey tags have been corrected as noted by the surveyor.
Inspection Report
Complaint Investigation
Census: 104
Deficiencies: 2
Date: Apr 10, 2025
Visit Reason
A standard survey was conducted from April 8 through April 10, 2025, including investigation of multiple complaint intake numbers (GA00253152, GA00253289, GA00253343, GA00253508, GA00253684). The purpose was to assess compliance with Medicare/Medicaid regulations for long term care facilities.
Complaint Details
The investigation included multiple complaint intake numbers (GA00253152, GA00253289, GA00253343, GA00253508, GA00253684) and was conducted in conjunction with the standard survey.
Findings
The facility was found not in substantial compliance with regulations, with deficiencies including failure to properly label and discard food items, improper food storage, and failure to ensure proper hand hygiene among staff, which could potentially affect resident safety and infection control.
Deficiencies (2)
Failure to discard food in the walk-in refrigerator by the use by date, to label opened food items in the walk-in refrigerator and dry storage area, and to follow recipes in the preparation of puree foods, potentially affecting 102 residents receiving an oral diet.
Failure to ensure that all staff used proper hand hygiene during resident care, potentially causing widespread infections among residents and staff.
Report Facts
Facility census: 104
Residents potentially affected: 102
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA FF | Certified Nursing Assistant | Observed failing to perform hand hygiene when entering and exiting resident rooms; interviewed about hand hygiene practices |
| CNA GG | Agency Certified Nursing Assistant | Observed failing to perform hand hygiene when leaving and reentering resident room with clean linen; interviewed about hand hygiene practices |
| CNA II | Certified Nursing Assistant | Observed failing to perform hand hygiene when entering resident room; interviewed about hand hygiene practices |
| LPN Infection Preventionist | Licensed Practical Nurse - Infection Preventionist | Provided instruction to staff on hand hygiene practices |
| Director of Nursing | Director of Nursing | Interviewed regarding expectations for staff hand hygiene compliance |
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Apr 10, 2025
Visit Reason
A State Licensure survey was conducted at Pine Knoll Nursing & Rehab Center from April 8, 2025, through April 10, 2025, to assess compliance with state health regulations.
Findings
The facility was found deficient in ensuring proper hand hygiene among staff during resident care, posing a risk of infection spread. Additionally, the facility failed to properly discard expired food, label opened food items, and follow recipes for puree foods, potentially affecting 102 residents on an oral diet.
Deficiencies (2)
Failure to ensure all staff used proper hand hygiene during resident care.
Failure to discard food in the walk-in refrigerator by the use-by date, label opened food items, and follow recipes in puree food preparation.
Report Facts
Residents potentially affected: 102
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA FF | Certified Nursing Assistant | Observed not performing hand hygiene and interviewed regarding hand hygiene practices |
| CNA GG | Agency Certified Nursing Assistant | Observed not performing hand hygiene and interviewed regarding hand hygiene practices |
| CNA II | Certified Nursing Assistant | Observed not performing hand hygiene and interviewed regarding hand hygiene practices |
| Licensed Practical Nurse Infection Preventionist | LPN Infection Preventionist | Interviewed about hand hygiene instructions to staff |
| Director of Nursing | DON | Interviewed regarding expectations for staff hand hygiene compliance |
| Cook NN | Cook | Observed during kitchen tour regarding food storage |
| Certified Dietary Manager | CDM | Interviewed regarding food labeling, storage, and use of Styrofoam containers |
Inspection Report
Life Safety
Census: 105
Capacity: 122
Deficiencies: 3
Date: Apr 9, 2025
Visit Reason
A Life Safety Code Survey was conducted to assess compliance with fire safety and emergency preparedness regulations at Pine Knoll Nursing and Rehabilitation.
Findings
The facility was found not in substantial compliance with the Life Safety Code requirements, including missing sprinkler escutcheon in the kitchen, illegible sprinkler system data design plate, unsealed penetration in a fire/smoke barrier, and failure to perform the required 4-hour load test for the emergency generator within the last 36 months.
Deficiencies (3)
Missing sprinkler escutcheon in the kitchen and illegible sprinkler system data design plate on the riser.
Unsealed penetration through a fire/smoke barrier in the main hallway building separation on the east side.
Failure to perform the required 4-hour load test for the emergency generator every 36 months.
Report Facts
Census: 105
Total Capacity: 122
Deficiencies cited: 3
Generator load test interval: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M confirmed findings during the facility tour and record review |
Inspection Report
Abbreviated Survey
Census: 108
Deficiencies: 0
Date: Dec 19, 2024
Visit Reason
An abbreviated/partial extended survey was conducted to investigate multiple complaint numbers GA00241200, GA00242153, GA00239776, GA00241611, and GA00242741.
Complaint Details
The survey investigated five complaint numbers; two complaints were unsubstantiated and three were substantiated with no regulatory violations cited.
Findings
Complaint numbers GA00241200 and GA00242153 were unsubstantiated, while GA00239776, GA00241611, and GA00242741 were substantiated. No regulatory violations were cited.
Inspection Report
Abbreviated Survey
Census: 114
Deficiencies: 0
Date: Sep 19, 2024
Visit Reason
An abbreviated/partial extended survey was conducted at Pineknoll Nursing and Rehab Center to investigate Complaint Intake Number GA00250703.
Complaint Details
Complaint Intake Number GA00250703 was investigated and found unsubstantiated.
Findings
The complaint was found unsubstantiated and no deficiencies were cited during the investigation.
Inspection Report
Abbreviated Survey
Census: 114
Deficiencies: 0
Date: Sep 19, 2024
Visit Reason
An abbreviated/partial extended survey was conducted at Pineknoll Nursing and Rehab Center to investigate Complaint Intake Number GA00250703.
Complaint Details
Complaint Intake Number GA00250703 was investigated and found unsubstantiated.
Findings
The complaint was found unsubstantiated and no deficiencies were cited during the investigation.
Inspection Report
Re-Inspection
Deficiencies: 0
Date: Nov 28, 2023
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the Complaint Survey conducted on October 5, 2023.
Complaint Details
The visit was a follow-up to a complaint survey conducted on October 5, 2023. All cited deficiencies were corrected.
Findings
All deficiencies cited as a result of the Complaint Survey conducted on October 5, 2023 were found to be corrected.
Inspection Report
Abbreviated Survey
Deficiencies: 1
Date: Oct 5, 2023
Visit Reason
An Abbreviated/Partial Extended Survey was conducted from 10/3/23 to 10/5/23 to investigate multiple complaint allegations identified by codes GA00238940, GA00238750, GA00235307, and GA00235000.
Complaint Details
The complaint investigation was initiated due to multiple complaint allegations. GA00238750 and GA00235000 were unsubstantiated. GA00238940 was substantiated with no deficiency. GA00235307 was substantiated with a citation of F658 related to medication administration failure for resident R11.
Findings
The investigation substantiated one complaint with a citation (F658) related to failure to follow physician orders for medication administration for one resident (R11), who did not receive prescribed inhaler medication on 5/12/2023 and 5/13/2023. Other complaints were unsubstantiated or substantiated with no deficiency.
Deficiencies (1)
Failure to ensure that Physician Orders for medication were followed for one of 25 residents (R11), specifically not administering inhaler medication on 5/12/2023 and 5/13/2023.
Report Facts
Residents reviewed for professional standards: 25
Dates medication not administered: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed and acknowledged failure to administer nebulizer treatment on 5/12/2023 and 5/13/2023 |
Inspection Report
Deficiencies: 0
Date: Apr 4, 2023
Visit Reason
The document is a Statement of Deficiencies and Plan of Correction for Pine Knoll Nursing & Rehab Center, indicating a regulatory inspection was conducted.
Findings
No specific deficiencies or findings are detailed in the provided document.
Inspection Report
Re-Inspection
Census: 112
Deficiencies: 0
Date: Apr 4, 2023
Visit Reason
A Revisit Survey was conducted at Pine Knoll Nursing and Rehabilitation Center to verify correction of deficiencies cited in the Recertification Survey concluded on February 2, 2023.
Findings
All deficiencies cited as a result of the Recertification Survey were found to be corrected during this revisit survey.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Mar 21, 2023
Visit Reason
A Follow-Up Survey was conducted to verify that all previously cited survey tags have been corrected.
Findings
The surveyor noted that all previously cited deficiencies had been corrected during the follow-up visit.
Inspection Report
Life Safety
Census: 106
Capacity: 122
Deficiencies: 3
Date: Feb 7, 2023
Visit Reason
The visit was a Life Safety Code Survey conducted to assess compliance with Medicare/Medicaid participation requirements related to fire safety and the NFPA 101 Life Safety Code 2012 edition.
Findings
The facility was found not in substantial compliance with fire safety requirements, including improper installation of the fire alarm system, corridor doors failing to close properly, and failure to perform and document quarterly fire drills.
Deficiencies (3)
Fire alarm system did not have a locking device on the fire alarm breaker and the fire alarm panel was not identified.
Corridor doors near Room 104 and Room 114 did not close properly when released from the holding device, dragging on the floor and closing only about one-third of the distance.
Facility failed to perform and document quarterly fire drills for multiple shifts and quarters.
Report Facts
Census: 106
Total Capacity: 122
Number of smoke enclosures affected: 1
Fire drill documentation missing: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings related to fire alarm system, corridor doors, and missing fire drill documentation |
Inspection Report
Renewal
Deficiencies: 6
Date: Feb 2, 2023
Visit Reason
A Licensure Survey was conducted from January 31, 2023 through February 2, 2023 to assess compliance with licensure requirements and facility policies.
Findings
The facility was found deficient in multiple areas including improper storage and labeling of medications, unsecured medication carts with resident information visible, failure to count controlled substances properly, improper storage of nebulizer masks, and unsanitary conditions due to buildup of white fuzzy material on bathroom vent covers.
Deficiencies (6)
Failure to ensure treatment dressings were stored properly and medications were labeled with open or discard dates as required.
Failure to secure medications, injection supplies, and resident identifying information on medication carts when unattended.
Failure to lock medication carts when unattended and out of nurse's view.
Failure to count and document controlled medications at the beginning and end of each shift on multiple medication carts.
Failure to ensure nebulizer mask was stored in a protective bag to prevent cross contamination.
Failure to maintain a safe, clean, sanitary environment related to buildup of white fuzzy material on vent covers in multiple resident bathrooms.
Report Facts
Sample size: 22
Missing signatures: 57
Missing signatures: 97
Missing signatures: 61
Residents potentially affected: 39
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN BB | Licensed Practical Nurse | Verified absence of open dates and beyond use dates for medications; aware of controlled medication count sheet requirements. |
| LPN CC | Licensed Practical Nurse | Verified absence of open dates and beyond use dates for medications; aware of controlled medication count sheet requirements. |
| LPN DD | Licensed Practical Nurse | Verified missing signatures on controlled medication count sheet; aware of count and documentation requirements. |
| RN EE | Registered Nurse | Observed unsecured medication cart with resident information visible and medications unattended. |
| LPN JJ | Licensed Practical Nurse | Verified treatment dressings improperly stored in resident room. |
| LPN MM | Licensed Practical Nurse | Observed unlocked medication cart unattended in hallway. |
| LPN HH | Licensed Practical Nurse | Verified nebulizer mask was not stored in protective bag. |
| DON | Director of Nursing | Provided expectations for medication storage, labeling, securing medication carts, and plans for staff education. |
| Pharmacist GG | Pharmacist | Provided medication storage guidelines from Omnicare Pharmacy Services. |
| Director of Housekeeping | Verified buildup of white fuzzy material on bathroom vents and discussed cleaning schedules and plans for staff education. | |
| Administrator | Provided expectations for routine cleaning including restroom vents. |
Inspection Report
Routine
Census: 107
Deficiencies: 4
Date: Feb 2, 2023
Visit Reason
A standard survey was conducted from January 31, 2023 through February 2, 2023, including investigation of two complaint intakes (GA00231867 and GA00231685). The survey aimed to assess compliance with Medicare/Medicaid regulations for long term care facilities.
Complaint Details
Complaint Intake Numbers GA00231867 and GA00231685 were investigated in conjunction with the standard survey.
Findings
The facility was found not in substantial compliance with regulations, with deficiencies including failure to maintain resident dignity related to urinary catheter privacy bags, unsafe sanitary conditions due to buildup on bathroom vents, medication storage and labeling issues, unsecured medication carts, and improper storage of nebulizer masks.
Deficiencies (4)
Failure to promote and protect resident dignity by not keeping urinary catheter bags covered in privacy bags for two residents.
Failure to maintain a safe, clean, sanitary environment due to buildup of white fuzzy material on vent covers in six bathrooms.
Failure to ensure proper medication storage, labeling of opened medications, secure storage of medications and injection supplies, and proper controlled substance counts on multiple medication carts.
Failure to ensure nebulizer mask was stored in a protective bag to prevent cross contamination for one resident.
Report Facts
Resident census: 107
Sample size: 22
Residents potentially affected: 39
Missing controlled medication count signatures: 57
Missing controlled medication count signatures: 97
Missing controlled medication count signatures: 61
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN HH | Licensed Practical Nurse | Interviewed regarding urinary catheter bag privacy and care |
| CNA II | Certified Nursing Assistant | Interviewed about catheter care and privacy bag use |
| LPN LL | Licensed Practical Nurse | Interviewed about catheter bag privacy and care |
| CNA KK | Certified Nursing Assistant | Interviewed about catheter bag privacy and availability |
| DON | Director of Nursing | Interviewed about expectations for catheter bag privacy, medication storage, and staff education |
| Director of Housekeeping | Interviewed about bathroom vent cleaning and housekeeping staffing | |
| Regional Manager AA | Verified presence of white fuzzy material on bathroom vents | |
| LPN BB | Licensed Practical Nurse | Verified medication labeling issues and controlled medication count signatures |
| LPN CC | Licensed Practical Nurse | Verified medication labeling issues and controlled medication count signatures |
| LPN DD | Licensed Practical Nurse | Verified controlled medication count signatures |
| RN EE | Registered Nurse | Observed unattended medication cart with resident information and medications |
| LPN MM | Licensed Practical Nurse | Observed near unlocked medication cart |
| Pharmacist GG | Provided pharmacy guidelines for medication discard | |
| LPN JJ | Licensed Practical Nurse | Interviewed about treatment dressing storage |
| Activity Director | Interviewed about delivery of medical supplies to residents | |
| CNA II | Certified Nursing Assistant | Interviewed about respiratory equipment care |
Inspection Report
Abbreviated Survey
Census: 100
Deficiencies: 0
Date: Dec 29, 2021
Visit Reason
An Abbreviated/Partial Extended Survey was conducted to investigate multiple complaints (#GA00211912, #GA00212011, #GA00212155, #GA00212495, #GA00212892, and #GA00220178).
Complaint Details
Complaints #GA00211912, #GA00212011, #GA00212155, #GA00212892, and #GA00220178 were substantiated with no deficiencies cited. Complaint #GA00212495 was unsubstantiated.
Findings
Complaint #GA00212495 was unsubstantiated. Complaints #GA00211912, #GA00212011, #GA00212155, #GA00212892, and #GA00220178 were substantiated but no deficiencies were cited.
Report Facts
Resident Census: 100
Inspection Report
Follow-Up
Deficiencies: 0
Date: Dec 28, 2021
Visit Reason
A Follow-Up Survey was conducted to verify that all previously cited survey tags have been corrected.
Findings
The survey noted that all previously cited deficiencies have been corrected.
Inspection Report
Follow-Up
Deficiencies: 1
Date: Nov 30, 2021
Visit Reason
A Follow-Up Survey was conducted to verify correction of previously cited deficiencies.
Findings
The facility was found to have corrected all previously cited survey tags except for deficiencies related to the Emergency Preparedness Training Program, specifically the lack of documentation for initial and ongoing emergency preparedness training for staff, individuals providing services under arrangement, and volunteers.
Deficiencies (1)
Lack of documentation for Emergency Preparedness and Training Program including initial training in emergency preparedness policies and procedures for all new and existing staff, individuals providing services under arrangement, and volunteers.
Inspection Report
Re-Inspection
Census: 101
Deficiencies: 0
Date: Nov 22, 2021
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the recertification survey on 9/30/2021.
Findings
All deficiencies cited as a result of the recertification survey on 9/30/2021 were found to be corrected.
Inspection Report
Re-Inspection
Census: 101
Deficiencies: 0
Date: Nov 22, 2021
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited during the 9/30/2021 recertification survey.
Findings
All deficiencies cited in the prior recertification survey were found to be corrected during this revisit survey.
Inspection Report
Annual Inspection
Census: 95
Deficiencies: 6
Date: Sep 30, 2021
Visit Reason
Licensure Survey conducted from September 24, 2021 through September 30, 2021 to assess compliance with state and federal regulations for Pine Knoll Nursing & Rehab Center.
Findings
The facility failed to ensure proper medication management including dating opened medications, labeling biologicals, and discarding expired medications. The facility also failed to follow COVID-19 screening protocols for staff and visitors, and failed to provide effective infection control practices during medication administration. Additionally, deficiencies were found in nursing care related to respiratory status documentation, oxygen therapy care plans, and dialysis communication and assessments.
Deficiencies (6)
Medications were not dated appropriately when opened; expired biologicals and medical supplies were not discarded; refrigerator was not locked.
Failure to follow COVID-19 screening protocols for staff and visitors upon entrance to the facility.
Failure to provide effective infection control practices related to medication administration for two of 27 medication opportunities.
Failure to follow care plan for documentation of respiratory status each shift for one resident.
Failure to develop a care plan for oxygen therapy for two residents.
Failure to ensure pre and post dialysis assessments were conducted and documented for one resident; lack of ongoing communication between facility and dialysis center.
Report Facts
Census: 95
Medication opportunities: 27
Residents sample size: 40
Staff not screened: 17
Staff not screened: 23
Staff not screened: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kimberley A. Gray | Mentioned in relation to screening process and compliance | |
| Stacey Young | Mentioned in relation to respiratory care documentation | |
| LPN AA | Registered Nurse | Confirmed expired drugs and opened medications with no open dates |
| LPN FF | Licensed Practical Nurse | Failed to wash hands during medication administration |
| LPN BB | Licensed Practical Nurse | Provided information about tracheostomy care and documentation |
| Receptionist HH | Receptionist | Responsible for screening process but failed to enforce screening |
| LPN GG | Licensed Practical Nurse | Confirmed expired medications and dialysis communication form issues |
| LPN KK | Licensed Practical Nurse | Confirmed expired medications and lack of open dates |
| LPN JJ | Licensed Practical Nurse | Described dialysis post-assessment procedures |
| DON | Director of Nursing | Provided multiple interviews regarding deficiencies and expectations |
| Staffing Coordinator | Responsible for monitoring screening logs | |
| Ward Clerk | Responsible for monitoring screening logs |
Inspection Report
Routine
Census: 95
Deficiencies: 5
Date: Sep 30, 2021
Visit Reason
A standard survey was conducted at Pine Knoll Nursing and Rehabilitation from 9/28/2021 through 9/30/2021 to assess compliance with Medicare/Medicaid regulations and long term care facility requirements.
Findings
The facility was found not in substantial compliance with multiple regulatory requirements including comprehensive care planning, respiratory and tracheostomy care, dialysis care, medication labeling and storage, infection prevention and control, and staff screening procedures. Deficiencies included failure to follow care plans, lack of physician orders for oxygen therapy, expired medications, inadequate infection control practices, and failure to properly screen staff and visitors for COVID-19.
Deficiencies (5)
Failed to develop and implement comprehensive care plans for residents requiring oxygen therapy and respiratory status documentation.
Failed to ensure residents receiving oxygen therapy had physician orders and proper tracheostomy care instructions.
Failed to ensure pre and post dialysis assessments and communication with dialysis center for a resident receiving dialysis.
Failed to properly label, date, store, and discard expired medications and biologicals; refrigerator was unlocked.
Failed to establish and maintain an effective infection prevention and control program including proper COVID-19 screening of staff and visitors and hand hygiene during medication administration.
Report Facts
Resident census: 95
Staff not screened: 17
Staff not screened: 23
Staff not screened: 13
Medication opportunities observed: 27
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN FF | Licensed Practical Nurse | Failed to perform hand hygiene during medication administration |
| Receptionist HH | Receptionist | Failed to actively screen staff and visitors for COVID-19 upon entrance |
| LPN BB | Licensed Practical Nurse | Unable to locate tracheostomy care documentation for resident R#16 |
| DON | Director of Nursing | Unaware of missing physician orders for oxygen therapy and tracheostomy care; responsible for infection control program |
Inspection Report
Routine
Census: 95
Capacity: 122
Deficiencies: 6
Date: Sep 29, 2021
Visit Reason
The inspection was conducted to review the facility's Emergency Preparedness Program and compliance with Life Safety Code requirements, including fire safety and emergency preparedness training and testing.
Findings
The facility was found not in substantial compliance with emergency preparedness requirements including lack of documentation for tracking staff and patients during emergencies, missing emergency contact information, inadequate emergency preparedness training and testing documentation, blocked egress pathways, and failure to perform monthly fire extinguisher inspections.
Deficiencies (6)
Facility's Emergency Preparedness Program was not in substantial compliance with 42 CFR 483.73, including failure to track location of on-duty staff and sheltered residents during emergencies.
Emergency Preparedness communication plan lacked documentation of names and contact information for staff, service providers, physicians, other facilities, and volunteers.
Emergency Preparedness training program lacked documentation of initial and ongoing training for staff, individuals providing services, and volunteers.
Emergency Preparedness testing requirements were not met; documentation of drills, exercises, and emergency events was missing.
Facility failed to maintain clear egress pathways; hallways were blocked by equipment and materials such as wheelchairs, walkers, linen carts, floor cleaning machines, and beds.
Fire extinguishers in all four smoke compartments lacked monthly inspection records on service tags.
Report Facts
Certified Beds: 122
Census: 95
Stories: 1
Construction Type: V (1,1,1)
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings related to emergency preparedness and fire safety deficiencies |
Inspection Report
Abbreviated Survey
Census: 83
Deficiencies: 0
Date: Feb 4, 2021
Visit Reason
An Abbreviated/Partial Extended Survey was conducted to investigate multiple complaints and to perform a COVID-19 Focused Infection Control Survey.
Complaint Details
Complaints GA00210960, GA00210700, GA00208858, and GA00207014 were unsubstantiated with no deficiencies. Complaint GA00208662 was substantiated with no deficiencies.
Findings
The facility was found to be in compliance with COVID-19 emergency preparedness and infection control regulations. Four complaints were unsubstantiated with no deficiencies, and one complaint was substantiated but with no deficiencies.
Report Facts
Complaints investigated: 5
Total Census: 83
Inspection Report
Routine
Census: 100
Deficiencies: 0
Date: Nov 9, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness and Infection Control Survey was conducted to assess compliance with federal regulations and recommended practices related to COVID-19 preparedness and infection control.
Findings
The facility was found to be in compliance with 42 CFR §483.73 and §483.80 infection control regulations and has implemented CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Date: Oct 9, 2020
Visit Reason
An abbreviated/partial extended survey was conducted to investigate complaints GA00206882, GA00207013, and GA00207014 from 10/7/2020 through 10/9/2020.
Complaint Details
The complaint investigation for complaints GA00206882, GA00207013, and GA00207014 was unsubstantiated.
Findings
The complaints investigated during the survey were found to be unsubstantiated.
Inspection Report
Re-Inspection
Census: 100
Deficiencies: 0
Date: Sep 28, 2020
Visit Reason
A revisit survey was conducted to verify correction of deficiencies cited in previous COVID-19 Infection Control Focus Surveys conducted on July 24, 2020 and June 24, 2020.
Findings
All deficiencies cited in the prior COVID-19 Infection Control Focus Surveys were found to be corrected during this revisit survey.
Report Facts
Census: 100
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 9, 2020
Visit Reason
A complaint survey was conducted to investigate multiple complaints identified by numbers GA00205672, GA00205048, GA00204056, and GA002038080.
Complaint Details
Complaints investigated were not substantiated as no deficiencies were cited.
Findings
The complaint survey found no deficiencies and determined the facility was in compliance with Federal and State Long Term Care Requirements, including infection control practices related to COVID-19.
Inspection Report
Abbreviated Survey
Census: 95
Deficiencies: 2
Date: Jun 24, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted on June 23-24, 2020 by Ascellon on behalf of the Georgia Department of Community Health to assess compliance with infection control regulations related to COVID-19.
Findings
The facility was found not to be in compliance with 42 CFR §483.80 infection control regulations due to failure to ensure residents' rooms were properly disinfected according to standard and transmission-based precautions. Issues included improper disinfectant dwell times and unlabeled or mislabeled disinfectant spray bottles on cleaning carts.
Deficiencies (2)
Failure to ensure residents' rooms were properly disinfected with appropriate dwell times for EPA-registered disinfectants.
Presence of one unlabeled and one mislabeled disinfectant spray bottle on the cleaning cart.
Report Facts
Total census: 95
Disinfectant dwell time: 10
Disinfectant dwell time observed: 5
Quarantine period: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff GG | Housekeeping Staff | Observed cleaning with disinfectant and interviewed regarding disinfectant use |
| Staff FF | Housekeeping Staff | Observed cleaning and interviewed regarding disinfectant use and labeling |
| Staff EE | Housekeeping Manager | Interviewed about disinfectant policies, training, and monitoring |
| Administrator | Interviewed regarding COVID-19 unit designation and infection control procedures |
Inspection Report
Abbreviated Survey
Census: 101
Deficiencies: 0
Date: Mar 2, 2020
Visit Reason
An Abbreviated/Partial Extended Survey was conducted from 2020-02-27 to 2020-03-02 to investigate complaints GA00199879, GA00199885, and GA00201372 and determine compliance with Federal and State Long Term Care Requirements.
Complaint Details
Complaint GA00199879 was substantiated with no deficiencies cited. Complaints GA00199885 and GA00201372 were unsubstantiated.
Findings
Complaints GA00199885 and GA00201372 were unsubstantiated with no deficiencies cited. Complaint GA00199879 was substantiated with no deficiencies cited.
Report Facts
Resident Census: 101
Inspection Report
Follow-Up
Deficiencies: 0
Date: Nov 4, 2019
Visit Reason
A follow-up to the Abbreviated/Partial Extended survey of August 30, 2019 was conducted to verify correction of previously identified deficiencies.
Findings
The follow-up survey revealed that all deficiencies were corrected and the facility was in substantial compliance as of October 4, 2019.
Inspection Report
Abbreviated Survey
Census: 110
Deficiencies: 1
Date: Aug 30, 2019
Visit Reason
An Abbreviated/Partial Extended Survey was conducted to investigate complaints GA00198785 and GA00198398 to determine compliance with Federal and State Long Term Care Requirements.
Complaint Details
Complaint GA00198785 was unsubstantiated. Complaint GA00198398 was substantiated with the cited deficiency related to failure to timely report an injury of unknown source.
Findings
Complaint GA00198785 was unsubstantiated. Complaint GA00198398 was substantiated due to the facility's failure to notify the State Survey Agency within the required two-hour time period after a resident sustained an injury of unknown source, specifically a hematoma on the resident's forehead.
Deficiencies (1)
Facility failed to notify the State Survey Agency within two hours after Resident #1 sustained an injury of unknown source (hematoma on forehead).
Report Facts
Resident census: 110
Number of sampled residents: 3
BIMS score: 3
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 4, 2019
Visit Reason
A complaint survey was conducted on 3/4/19 to investigate complaint GA00194840 by a Registered Nurse Surveyor to determine compliance with Federal and State Long Term Care Requirements.
Complaint Details
Complaint GA00194840 was investigated and found to have no deficiencies.
Findings
No deficiencies were cited during the complaint investigation survey.
Inspection Report
Re-Inspection
Census: 113
Deficiencies: 0
Date: Nov 28, 2018
Visit Reason
A revisit survey was conducted to verify correction of deficiencies found during the annual survey conducted from September 24, 2018 through September 27, 2018.
Findings
All deficiencies resulting from the annual survey were found to be corrected during the revisit survey conducted on November 27 and 28, 2018.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Nov 19, 2018
Visit Reason
A Follow-Up Survey was conducted to verify that all previously cited survey tags have been corrected.
Findings
The surveyor noted that all previously cited deficiencies had been corrected during the follow-up visit.
Inspection Report
Routine
Census: 111
Deficiencies: 2
Date: Sep 27, 2018
Visit Reason
A standard survey was conducted at Pine Knoll Nursing and Rehab Center from September 24, 2018 through September 27, 2018 to assess compliance with Medicare/Medicaid regulations for long term care facilities.
Findings
The survey revealed the facility was not in substantial compliance with regulations. Key findings included a failure to ensure adequate supervision and assistive devices to prevent falls for one resident who fell from a mechanical lift, and multiple sanitation and maintenance deficiencies in the kitchen that created potential for foodborne illness.
Deficiencies (2)
Failure to ensure one resident received adequate supervision and assistive devices to prevent falls from a mechanical stand-up lift, with no investigation or corrective actions taken after the fall.
Failure to maintain the kitchen in a sanitary manner, including issues with handwashing sink drainage, dish machine sanitizer levels, dirty and cracked dishware, food spills on clean dish carts, cracked and damaged floor tiles, rust on walk-in refrigerator floor, and accumulated dirt and grease in various kitchen areas.
Report Facts
Resident census: 111
Fall risk score: 14
Chlorine sanitizer level: 0
Chlorine sanitizer level: 50
Chlorine sanitizer level: 100
Number of cracked floor tiles: 23
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN AA | Licensed Practical Nurse | Wrote nursing progress note on resident fall and documented incident |
| CNA BB | Certified Nurse Assistant | Involved in transferring resident during fall incident |
| RN CC | Registered Nurse, Restorative Coordinator | Provided information on proper use of mechanical lift and fall interventions |
| CNA EE | Certified Nurse Assistant | Interviewed regarding use of mechanical lift and fall incident |
| CNA DD | Restorative Aide/CNA | Verified condition of mechanical lift slings |
| Maintenance Director | Provided information on maintenance of mechanical lifts and kitchen repairs | |
| Dietary Manager | Provided information on kitchen sanitation and dish machine issues |
Inspection Report
Routine
Census: 111
Deficiencies: 10
Date: Sep 27, 2018
Visit Reason
The inspection was conducted to assess the sanitary conditions and physical plant standards of the kitchen serving 111 residents at Pine Knoll Nursing & Rehab Center.
Findings
The facility failed to maintain the kitchen in a sanitary manner, with multiple sanitation issues including clogged sinks, inadequate dish machine sanitization, cracked and uncleanable floor tiles, soiled dishware storage, and damaged walls. Maintenance and service records showed ongoing issues with the dish machine and kitchen infrastructure.
Deficiencies (10)
Hand washing sink was clogged with soapy grey water and caulking was peeling with discoloration.
Dish machine was not sanitizing dishes properly due to clogged chlorine line; chlorine sanitizer was absent during initial dishwashing.
Clean dishes stored on soiled plastic carts with food crumbs and stained plates.
Numerous crumbs, food particles, and spills on floor and shelving where clean dishes were stored.
Floor tiles significantly cracked and damaged, making surfaces uncleanable.
Wall behind grease trap and double sink was damaged with missing paint, cracks, and dirt.
Walk-in refrigerator floor covered with rust, making it uncleanable.
Dish machine interior had a sticky adhesive substance buildup not removed by routine cleaning.
Floor drain had standing water due to crushed line; maintenance used vacuum to clear backups.
Cleaning checklists showed incomplete cleaning tasks and lack of documentation for key sanitation activities.
Report Facts
Residents receiving meals: 108
Residents present: 111
Dish machine sanitizer chlorine level: 50
Dish machine sanitizer chlorine level: 100
Floor tiles cracked: 15
Floor tiles cracked: 8
Cleaning checklist days reviewed: 24
Cleaning checklist completed: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Manager | Interviewed and involved in dish machine and kitchen sanitation observations | |
| Maintenance Director | Interviewed regarding maintenance issues and work orders related to kitchen | |
| Independent Service Contractor | Worked on dish machine and provided service recommendations |
Inspection Report
Life Safety
Census: 112
Capacity: 122
Deficiencies: 1
Date: Sep 26, 2018
Visit Reason
The Life Safety Code Survey was conducted to assess compliance with 42 CFR Subpart 483.70(a) and NFPA 101 Life Safety Code 2012 edition requirements for participation in Medicare/Medicaid.
Findings
The facility was found not in substantial compliance due to failure to provide a remote annunciator with storage battery backup hardwired to indicate alarm conditions of the emergency power source in a location readily observed by operating personnel, which could place residents at risk during a generator malfunction.
Deficiencies (1)
Failed to provide a remote annunciator with storage battery backup hardwired to indicate alarm conditions of the emergency power source outside the generating room in a location readily observed by operating personnel.
Report Facts
Census: 112
Certified beds: 122
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Confirmed findings regarding the lack of remote annunciator during facility tour |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 9, 2018
Visit Reason
A complaint survey was conducted on 8/9/2018 and 8/15/2018 to investigate complaints GA00190538 by a Qualified Surveyor to determine compliance with Federal and State Long Term Care Requirements.
Complaint Details
Complaint GA00190538 was investigated and found to have no deficiencies.
Findings
No deficiencies were cited during the complaint survey.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 6, 2018
Visit Reason
The inspection was conducted to investigate complaint #GA00183131 to determine compliance with Federal and State Long Term Care regulations.
Complaint Details
Complaint #GA00183131 was investigated and found to have no deficiencies.
Findings
No deficiencies were cited during the complaint survey conducted from 2/5/18 through 2/6/18.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Dec 7, 2017
Visit Reason
A Follow-Up Survey was conducted to verify that all previously cited survey tags have been corrected.
Findings
The survey noted that all previously cited deficiencies had been corrected.
Inspection Report
Routine
Census: 109
Deficiencies: 0
Date: Oct 5, 2017
Visit Reason
A standard survey was conducted at Pine Knoll Nursing and Rehabilitation from October 2, 2017 through October 5, 2017 to assess compliance with Medicare/Medicaid regulations.
Findings
The standard survey revealed that the facility was in substantial compliance with Medicare/Medicaid regulations at 42 Code of Federal Regulations Part 483, Subpart B - Requirements for Long Term Care Facilities.
Inspection Report
Life Safety
Census: 109
Capacity: 116
Deficiencies: 4
Date: Oct 3, 2017
Visit Reason
A Life Safety Code Survey was conducted to assess the facility's compliance with fire safety requirements under 42 CFR Subpart 483.70(a) and NFPA 101 Life Safety Code 2012 edition.
Findings
The facility was found not in substantial compliance with fire safety requirements due to failures in properly sealing joints and penetrations in hazardous areas, inadequate identification and protection of the fire alarm control panel circuit breaker, failure to maintain smoke barriers and smoke barrier doors, and issues with fire alarm system installation.
Deficiencies (4)
Failed to properly seal joints and through penetrations in hazardous areas using unapproved spray foam in water heater rooms and electrical room.
Failed to identify the location of the disconnecting means and properly identify and protect the circuit breaker for the fire alarm control panel.
Failed to maintain joints and through penetrations in smoke barriers dividing smoke compartments to maintain a ½ hour fire resistant rating.
Failed to maintain doors in smoke barriers so they will completely close, specifically smoke barrier separation doors at room 215 / 216.
Report Facts
Census: 109
Total Capacity: 116
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff M | Staff member who confirmed findings during facility tour |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 2, 2017
Visit Reason
The inspection was conducted to investigate complaint #GA 00173023 at Pine Knoll Nursing & Rehab Center to determine compliance with Federal and State Long Term Care regulations.
Complaint Details
Complaint #GA 00173023 was investigated and found to have no deficiencies.
Findings
No deficiencies were cited during the complaint survey conducted on 4/2/2017.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 17, 2017
Visit Reason
The inspection was conducted to investigate complaint #GA 00172727 at Pine Knoll Nursing & Rehab Center to determine compliance with Federal and State Long Term Care regulations.
Complaint Details
Complaint #GA 00172727 was investigated and found to have no deficiencies.
Findings
No deficiencies were cited during the complaint survey conducted by a Registered Nurse.
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