1 health deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Savannah, GA
5-star overall rating with 4-star inspections with 1 recent health deficiencies
5353 Reynolds Street, Savannah, GA
(912) 819-6262
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Beds
22
Certified beds
Average residents
20
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1996-08-06
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
No
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Hospital-based
Yes
CMS reports the provider resides in a hospital
Staffing
RN hours / resident day
1.52
Registered nurse staffing · state 0.49 · national 0.68
LPN hours / resident day
3.91
Licensed practical nurse staffing · state 0.93 · national 0.87
Aide hours / resident day
2.70
Nurse aide staffing · state 2.15 · national 2.35
Total nurse hours
8.14
All reported nurse hours · state 3.57 · national 3.89
Licensed hours
5.44
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
8.16
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
1.36
Weekend registered nurse coverage · state 0.33 · national 0.47
Physical therapist
0.23
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
1.53
CMS adjusted RN staffing hours
Adjusted total hours
8.19
CMS adjusted total nurse staffing hours
Case-mix index
1.36
Higher values indicate more complex resident acuity
RN turnover
33%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
29%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Program rank
1,828
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
53.74
Composite VBP score used to determine payment impact.
Payment multiplier
1.0085
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
1.30
Baseline 20.68% · Performance 20.83% · Measure score 1.30 · Achievement 1.30 · Improvement 0
Healthcare-associated infections
8.41
Baseline 5.99% · Performance 5.32% · Measure score 8.41 · Achievement 8.41 · Improvement 6.24
Total nurse turnover
6.41
Baseline 30.00% · Performance 37.50% · Measure score 6.41 · Achievement 6.41 · Improvement 0
Adjusted total nurse staffing
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 15.33% |
10.72%
4.6 pts worse
|
Worse than the National Rate · Eligible stays 203 · Observed rate 21.18% · Lower 95% interval 12% |
| Discharge to community | 65.94% |
50.57%
15.4 pts better
|
Better than the National Rate · Eligible stays 166 · Observed rate 56.63% · Lower 95% interval 58.86% |
| Medicare spending per beneficiary | 0.86 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 95.35% |
95.27%
0.1 pts better
|
Numerator 123 · Denominator 129 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 129 |
| Discharge self-care score | 45.05% |
53.69%
8.6 pts worse
|
Numerator 41 · Denominator 91 |
| Discharge mobility score | 51.65% |
50.94%
0.7 pts better
|
Numerator 47 · Denominator 91 |
| Pressure ulcers or injuries, new or worsened | 0.78% |
2.29%
1.5 pts better
|
Numerator 1 · Denominator 129 · Adjusted rate 1% |
| Healthcare-associated infections requiring hospitalization | 5.32% |
7.12%
1.8 pts better
|
No Different than the National Rate · Eligible stays 112 · Observed rate 2.68% · Lower 95% interval 3.13% |
| Staff COVID-19 vaccination coverage | 0.95% |
8.2%
7.2 pts worse
|
Numerator 11 · Denominator 1156 |
| Staff flu vaccination coverage | Not Available |
42%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Discharge function score | 42.86% |
56.45%
13.6 pts worse
|
Numerator 39 · Denominator 91 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 119 · Denominator 119 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 14.1% |
25.2%
11.1 pts worse
|
Numerator 11 · Denominator 78 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.9% |
80.4%
19.5 pts better
|
81.7%
18.2 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.6% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 99.9% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 5.4% |
12.2%
6.8 pts better
|
12.0%
6.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 5.4% · Observed 5.3% · Expected 11.0% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 2.9% |
2.2%
0.7 pts worse
|
1.6%
1.3 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 2.3% · Q3 2.9% · Q4 4.6% · 4Q avg 2.9% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.2% |
78.2%
20 pts better
|
79.7%
18.5 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 98.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 26.0% |
24.2%
1.8 pts worse
|
23.9%
2.1 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 26.0% · Observed 26.5% · Expected 24.4% · Used in QM five-star |
Survey summary
Top issue: Nutrition and Dietary (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Top issue: Infection Control (1 deficiency)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Top issue: Quality of Life and Care (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Fire safety
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-01-15
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-11-04
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2022-11-04
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2022-11-04
Inspection history
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-04-16
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-01-15
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-01-15
Health
Provide and implement an infection prevention and control program.
Corrected 2024-01-15
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-10-11
Penalties and ownership
5% Or Greater Indirect Ownership Interest · Organization
Corporate Director · Individual
W-2 Managing Employee · Individual
W-2 Managing Employee · Individual
Corporate Director · Individual
Corporate Officer · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
Corporate Director · Individual
W-2 Managing Employee · Individual
Nearby options
Savannah, GA
3-star overall rating with 3-star inspections with 5 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
Savannah, GA
1-star overall rating with 2-star inspections with $5,446 in total fines with 12 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
Savannah, GA
1-star overall rating with 1-star inspections with Special Focus status with abuse icon flag with $92,794 in total fines with 9 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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