Cycle 1
Health 2025-09-11 · Fire 2025-09-11
5 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Atlanta, GA
A.g. Rhodes Home Wesley Woods
4-star overall rating with 3-star inspections with $8,018 in total fines with 5 recent health deficiencies
1819 Clifton Road, N.e., Atlanta, GA
(404) 315-0900
Overall
4 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
150
Certified beds
Average residents
129
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1967-01-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.53
Registered nurse staffing · state 0.49 · national 0.68
LPN hours / resident day
1.19
Licensed practical nurse staffing · state 0.93 · national 0.87
Aide hours / resident day
2.75
Nurse aide staffing · state 2.15 · national 2.35
Total nurse hours
4.48
All reported nurse hours · state 3.57 · national 3.89
Licensed hours
1.73
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
4.03
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
0.28
Weekend registered nurse coverage · state 0.33 · national 0.47
Physical therapist
0.11
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.50
CMS adjusted RN staffing hours
Adjusted total hours
4.22
CMS adjusted total nurse staffing hours
Case-mix index
1.45
Higher values indicate more complex resident acuity
RN turnover
28%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
36%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
2,076
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
51.96
Composite VBP score used to determine payment impact.
Payment multiplier
1.0064
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.99
Baseline 18.51% · Performance 18.19% · Measure score 6.99 · Achievement 6.99 · Improvement 1.64
Healthcare-associated infections
3.60
Baseline 5.06% · Performance 6.76% · Measure score 3.60 · Achievement 3.60 · Improvement 0
Total nurse turnover
5.36
Baseline 33.05% · Performance 41.77% · Measure score 5.36 · Achievement 5.36 · Improvement 0
Adjusted total nurse staffing
4.84
Baseline 3.85 hours · Performance 4.45 hours · Measure score 4.84 · Achievement 4.84 · Improvement 2.62
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.95% |
10.72%
0.2 pts worse
|
No Different than the National Rate · Eligible stays 353 · Observed rate 9.07% · Lower 95% interval 8.57% |
| Discharge to community | 66.43% |
50.57%
15.9 pts better
|
Better than the National Rate · Eligible stays 338 · Observed rate 63.02% · Lower 95% interval 61.41% |
| Medicare spending per beneficiary | 1.1 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 95.81% |
95.27%
0.5 pts better
|
Numerator 183 · Denominator 191 |
| Falls with major injury | 0.52% |
0.77%
0.2 pts better
|
Numerator 1 · Denominator 191 |
| Discharge self-care score | 68.06% |
53.69%
14.4 pts better
|
Numerator 98 · Denominator 144 |
| Discharge mobility score | 46.53% |
50.94%
4.4 pts worse
|
Numerator 67 · Denominator 144 |
| Pressure ulcers or injuries, new or worsened | 2.09% |
2.29%
0.2 pts better
|
Numerator 4 · Denominator 191 · Adjusted rate 1.81% |
| Healthcare-associated infections requiring hospitalization | 6.76% |
7.12%
0.4 pts better
|
No Different than the National Rate · Eligible stays 220 · Observed rate 5.45% · Lower 95% interval 4.4% |
| Staff COVID-19 vaccination coverage | 0.92% |
8.2%
7.3 pts worse
|
Numerator 2 · Denominator 218 |
| Staff flu vaccination coverage | 80.4% |
42%
38.4 pts better
|
Numerator 160 · Denominator 199 |
| Discharge function score | 59.03% |
56.45%
2.6 pts better
|
Numerator 85 · Denominator 144 |
| Transfer of health information to provider | 87.8% |
95.95%
8.2 pts worse
|
Numerator 36 · Denominator 41 |
| Transfer of health information to patient | 97.71% |
96.28%
1.4 pts better
|
Numerator 128 · Denominator 131 |
| Resident COVID-19 vaccinations up to date | 34.09% |
25.2%
8.9 pts better
|
Numerator 30 · Denominator 88 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
2.2
0.4 pts better
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.4 · Expected 1.5 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.0 |
2.0
1 pts better
|
1.8
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.0 · Observed 0.8 · Expected 1.3 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 95.4% |
91.2%
4.2 pts better
|
93.4%
2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 87.3% · Q2 93.8% · Q3 100.0% · Q4 100.0% · 4Q avg 95.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 96.2% |
95.0%
1.2 pts better
|
95.5%
0.7 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 96.2% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 3.9% |
3.2%
0.7 pts worse
|
3.3%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 4.1% · Q3 4.8% · Q4 3.8% · 4Q avg 3.9% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.0% |
9.6%
7.6 pts better
|
11.4%
9.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 2.4% · Q3 2.2% · Q4 2.2% · 4Q avg 2.0% |
| Percentage of long-stay residents who lose too much weight | 6.0% |
5.9%
0.1 pts worse
|
5.4%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.5% · Q2 4.8% · Q3 3.1% · Q4 10.5% · 4Q avg 6.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 4.2% |
20.7%
16.5 pts better
|
19.6%
15.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.3% · Q2 4.5% · Q3 4.1% · Q4 4.0% · 4Q avg 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 12.2% |
21.4%
9.2 pts better
|
16.7%
4.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.8% · Q2 15.0% · Q3 10.8% · Q4 9.3% · 4Q avg 12.2% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 14.9% |
17.9%
3 pts better
|
16.3%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.1% · Q2 7.4% · Q3 21.3% · Q4 23.5% · 4Q avg 14.9% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 7.6% |
16.2%
8.6 pts better
|
14.9%
7.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.1% · Q2 11.4% · Q3 6.9% · Q4 5.6% · 4Q avg 7.6% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.8% |
1.1%
0.7 pts worse
|
1.0%
0.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.7% · Q2 2.8% · Q3 2.9% · Q4 0.7% · 4Q avg 1.8% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 2.3% |
2.5%
0.2 pts better
|
1.7%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 4.3% · Q3 1.0% · Q4 2.0% · 4Q avg 2.3% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 18.0% |
16.1%
1.9 pts worse
|
19.8%
1.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 21.6% · Q2 14.8% · Q3 17.0% · Q4 18.4% · 4Q avg 18.0% |
| Percentage of long-stay residents with pressure ulcers | 4.4% |
6.2%
1.8 pts better
|
5.1%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.4% · Q2 3.0% · Q3 4.6% · Q4 5.5% · 4Q avg 4.4% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 90.8% |
80.4%
10.4 pts better
|
81.7%
9.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 79.0% · Q2 92.1% · Q3 97.9% · Q4 96.0% · 4Q avg 90.8% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 5.9% |
12.2%
6.3 pts better
|
12.0%
6.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 5.9% · Observed 5.7% · Expected 10.8% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.3% |
2.2%
1.9 pts better
|
1.6%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.8% · Q4 0.8% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 83.5% |
78.2%
5.3 pts better
|
79.7%
3.8 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 83.5% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 16.1% |
24.2%
8.1 pts better
|
23.9%
7.8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 16.1% · Observed 15.8% · Expected 23.4% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-04-07 · Fire 2024-04-07
4 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Cycle 3
Health 2022-05-19 · Fire 2022-05-19
4 health deficiencies
Top issue: Infection Control (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2024-04-07
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2024-05-03
D · Potential for more than minimal harm
2024-04-07
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2024-05-03
D · Potential for more than minimal harm
2024-04-07
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2024-05-03
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-09-11
F554 · Resident Rights Deficiencies
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2025-10-25
D · Potential for more than minimal harm
2025-09-11
F584 · Resident Rights Deficiencies
Health
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.
Corrected 2025-10-25
D · Potential for more than minimal harm
2025-09-11
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-10-25
D · Potential for more than minimal harm
2025-09-11
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-10-25
D · Potential for more than minimal harm
2025-09-11
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-10-25
G · Actual harm
2024-04-07
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-05-05
F · Potential for more than minimal harm
2024-04-07
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-05
D · Potential for more than minimal harm
2024-04-07
F645 · Resident Assessment and Care Planning Deficiencies
Health
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected 2024-05-05
D · Potential for more than minimal harm
2024-04-07
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2024-05-05
D · Potential for more than minimal harm
2022-05-19
F554 · Resident Rights Deficiencies
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2022-07-01
D · Potential for more than minimal harm
2022-05-19
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2022-07-01
D · Potential for more than minimal harm
2022-05-19
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2022-07-01
D · Potential for more than minimal harm
2022-05-19
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2022-07-01
Penalties and ownership
What sits behind the stars
$8,018
2024-04-07
Fine
Fine · fine $8,018
Fine
$0
2024-04-07
Payment Denial
Payment Denial · denial start 2024-05-04 · 1 days
1 day denial
Ownership
Barrington, Lisa
Operational/Managerial Control · Individual
Brown, Nicole
Operational/Managerial Control · Individual
Care Solutions
General Partnership Interest · Organization
Cateau, Deke
Corporate Officer · Individual
Fortune, Rochelle
Operational/Managerial Control · Individual
Helton, Mary
Corporate Officer · Individual
Hill, Vincent
Operational/Managerial Control · Individual
Jerome, Farrah
Operational/Managerial Control · Individual
Lenning, Justin
Corporate Director · Individual
Luther, Tammy
Corporate Director · Individual
Minor, Ariana
Corporate Director · Individual
Mitchell, Daphne
Operational/Managerial Control · Individual
Phangestu, Christina
Corporate Officer · Individual
Price, Crystal
Operational/Managerial Control · Individual
Unidine Corporation
Operational/Managerial Control · Organization
Ward, Latasha
Operational/Managerial Control · Individual
Webster, Sean
Operational/Managerial Control · Individual
Wilson, Keith
Corporate Officer · Individual
Nearby options
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4-star overall rating with 3-star inspections with 7 recent health deficiencies
#2
Lenbrook
Atlanta, GA
5-star overall rating with 5-star inspections with 2 recent health deficiencies
#3
Decatur Center For Nursing And Healing LLC
Decatur, GA
2-star overall rating with 2-star inspections with 9 recent health deficiencies
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