8 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Canton, GA
2-star overall rating with 3-star inspections with 8 recent health deficiencies
321 Hospital Road, Canton, GA
(770) 479-8791
Overall
2 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Beds
100
Certified beds
Average residents
84
Average occupied residents
Ownership
Government
Publicly displayed owner type
Chain
Empire Care Centers
Operator or chain grouping
Approved since
1997-02-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
18 facilities
Chain averages 2 overall / 2 health / 1 staffing / 3 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
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
0.43
Registered nurse staffing · state 0.49 · national 0.68
LPN hours / resident day
1.09
Licensed practical nurse staffing · state 0.93 · national 0.87
Aide hours / resident day
1.80
Nurse aide staffing · state 2.15 · national 2.35
Total nurse hours
3.31
All reported nurse hours · state 3.57 · national 3.89
Licensed hours
1.51
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
2.87
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
0.23
Weekend registered nurse coverage · state 0.33 · national 0.47
Physical therapist
0.13
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.41
CMS adjusted RN staffing hours
Adjusted total hours
3.18
CMS adjusted total nurse staffing hours
Case-mix index
1.42
Higher values indicate more complex resident acuity
RN turnover
0%
Annual RN turnover
Total nurse turnover
63%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Program rank
13,726
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
0
Composite VBP score used to determine payment impact.
Payment multiplier
0.9803
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
0
Baseline 22.99% · Performance 24.68% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
0
Baseline 6.68% · Performance 10.77% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
0
Performance 68.97% · Measure score 0 · Achievement 0 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
0
Performance 2.86 hours · Measure score 0 · Achievement 0 · This facility did not have sufficient data to calculate a baseline period measure result.
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 16.3% |
10.72%
5.6 pts worse
|
Worse than the National Rate · Eligible stays 371 · Observed rate 18.33% · Lower 95% interval 12.72% |
| Discharge to community | 53.2% |
50.57%
2.6 pts better
|
No Different than the National Rate · Eligible stays 384 · Observed rate 47.14% · Lower 95% interval 47.8% |
| Medicare spending per beneficiary | 0.96 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 99.15% |
95.27%
3.9 pts better
|
Numerator 234 · Denominator 236 |
| Falls with major injury | 0.42% |
0.77%
0.4 pts better
|
Numerator 1 · Denominator 236 |
| Discharge self-care score | 63.11% |
53.69%
9.4 pts better
|
Numerator 65 · Denominator 103 |
| Discharge mobility score | 63.11% |
50.94%
12.2 pts better
|
Numerator 65 · Denominator 103 |
| Pressure ulcers or injuries, new or worsened | 5.08% |
2.29%
2.8 pts worse
|
Numerator 12 · Denominator 236 · Adjusted rate 4.49% |
| Healthcare-associated infections requiring hospitalization | 10.77% |
7.12%
3.6 pts worse
|
Worse than the National Rate · Eligible stays 224 · Observed rate 12.95% · Lower 95% interval 7.61% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 98 |
| Staff flu vaccination coverage | Not Available |
42%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Discharge function score | 67.96% |
56.45%
11.5 pts better
|
Numerator 70 · Denominator 103 |
| Transfer of health information to provider | 96.81% |
95.95%
0.9 pts better
|
Numerator 91 · Denominator 94 |
| Transfer of health information to patient | 95.9% |
96.28%
0.4 pts worse
|
Numerator 117 · Denominator 122 |
| Resident COVID-19 vaccinations up to date | 12.61% |
25.2%
12.6 pts worse
|
Numerator 15 · Denominator 119 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 68.8% |
91.2%
22.4 pts worse
|
93.4%
24.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 66.7% · Q2 61.8% · Q3 63.6% · Q4 82.5% · 4Q avg 68.8% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 87.9% |
95.0%
7.1 pts worse
|
95.5%
7.6 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 87.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 3.7% |
3.2%
0.5 pts worse
|
3.3%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.9% · Q2 5.5% · Q3 1.8% · Q4 3.5% · 4Q avg 3.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
9.6%
9.6 pts better
|
11.4%
11.4 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 who lose too much weight | 6.9% |
5.9%
1 pts worse
|
5.4%
1.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.0% · Q2 7.3% · Q3 11.1% · Q4 2.2% · 4Q avg 6.9% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 33.0% |
20.7%
12.3 pts worse
|
19.6%
13.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 23.3% · Q2 32.6% · Q3 42.6% · Q4 32.6% · 4Q avg 33.0% |
| Percentage of long-stay residents who received an antipsychotic medication | 24.4% |
21.4%
3 pts worse
|
16.7%
7.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 32.1% · Q2 32.1% · Q3 19.4% · Q4 17.9% · 4Q avg 24.4% · 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 | 49.1% |
17.9%
31.2 pts worse
|
16.3%
32.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 49.1% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 29.7% |
16.2%
13.5 pts worse
|
14.9%
14.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 38.1% · Q2 23.1% · Q3 28.6% · Q4 28.6% · 4Q avg 29.7% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.4% |
1.1%
0.7 pts better
|
1.0%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.9% |
2.5%
0.6 pts better
|
1.7%
0.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.8% · Q3 1.9% · Q4 1.8% · 4Q avg 1.9% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 22.6% |
16.1%
6.5 pts worse
|
19.8%
2.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 29.7% · Q2 29.4% · Q3 17.4% · Q4 15.3% · 4Q avg 22.6% |
| Percentage of long-stay residents with pressure ulcers | 5.8% |
6.2%
0.4 pts better
|
5.1%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.3% · Q2 7.6% · Q3 4.3% · Q4 4.2% · 4Q avg 5.8% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 74.4% |
80.4%
6 pts worse
|
81.7%
7.3 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 78.3% · Q2 74.4% · Q3 76.0% · Q4 68.1% · 4Q avg 74.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 14.7% |
12.2%
2.5 pts worse
|
12.0%
2.7 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 14.7% · Observed 14.6% · Expected 11.0% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 3.1% |
2.2%
0.9 pts worse
|
1.6%
1.5 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 3.5% · Q3 3.5% · Q4 1.9% · 4Q avg 3.1% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 76.4% |
78.2%
1.8 pts worse
|
79.7%
3.3 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 76.4% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 24.4% |
24.2%
0.2 pts worse
|
23.9%
0.5 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 24.4% · Observed 23.5% · Expected 22.9% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Top issue: Quality of Life and Care (2 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
No concentrated health issue counts in this cycle.
3 fire-safety deficiencies
Top issue: Emergency Preparedness (3 deficiencies)
Fire safety
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-12-18
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-12-18
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2023-12-18
Fire Safety
List the names and contact information of those in the facility.
Corrected 2022-06-18
Fire Safety
Establish staff and initial training requirements.
Corrected 2022-06-18
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2022-06-18
Inspection history
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2026-02-07
Health
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Corrected 2026-02-07
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2025-09-26
Health
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected 2025-09-26
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2025-09-26
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-09-26
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2025-09-26
Health
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Corrected 2025-09-26
Health
Provide and implement an infection prevention and control program.
Corrected 2024-02-02
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 2024-02-02
Health
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected 2024-02-02
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-02-02
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-02-02
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-02-02
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2024-02-02
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Direct Ownership Interest · Individual
W-2 Managing Employee · Individual
Operational/Managerial Control · Organization
Operational/Managerial Control · Organization
Operational/Managerial Control · Individual
Corporate Officer · Individual
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Nearby options
Canton, GA
1-star overall rating with 1-star inspections with $185,650 in total fines with 5 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
Woodstock, GA
2-star overall rating with 3-star inspections with 5 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
Jasper, GA
5-star overall rating with 4-star inspections with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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