Cycle 1
Health 2025-02-13 · Fire 2025-02-13
5 health deficiencies
Top issue: Resident Rights (2 deficiencies)
8 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Gainesville, GA
New Horizons Limestone
3-star overall rating with 3-star inspections with 5 recent health deficiencies with 8 fire-safety deficiencies in the latest cycle
2020 Beverly Road Ne, Gainesville, GA
(770) 219-8600
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
142
Certified beds
Average residents
184
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1989-09-01
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
Hospital-based
Yes
CMS reports the provider resides in a hospital
Staffing
Hours and turnover
RN hours / resident day
0.62
Registered nurse staffing · state 0.49 · national 0.68
LPN hours / resident day
1.02
Licensed practical nurse staffing · state 0.93 · national 0.87
Aide hours / resident day
2.28
Nurse aide staffing · state 2.15 · national 2.35
Total nurse hours
3.92
All reported nurse hours · state 3.57 · national 3.89
Licensed hours
1.64
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
3.46
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
0.50
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
0.62
CMS adjusted RN staffing hours
Adjusted total hours
3.93
CMS adjusted total nurse staffing hours
Case-mix index
1.36
Higher values indicate more complex resident acuity
RN turnover
15%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
24%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
1,373
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
57.11
Composite VBP score used to determine payment impact.
Payment multiplier
1.0123
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
5.21
Baseline 16.67% · Performance 19.02% · Measure score 5.21 · Achievement 5.21 · Improvement 0
Healthcare-associated infections
5.26
Baseline 4.96% · Performance 6.26% · Measure score 5.26 · Achievement 5.26 · Improvement 0
Total nurse turnover
9.39
Baseline 31.54% · Performance 25.31% · Measure score 9.39 · Achievement 9.39 · Improvement 8.82
Adjusted total nurse staffing
2.99
Baseline 3.42 hours · Performance 3.93 hours · Measure score 2.99 · Achievement 2.99 · Improvement 1.65
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.99% |
10.72%
0.7 pts better
|
No Different than the National Rate · Eligible stays 112 · Observed rate 9.82% · Lower 95% interval 7.6% |
| Discharge to community | 59.6% |
50.57%
9 pts better
|
No Different than the National Rate · Eligible stays 90 · Observed rate 55.56% · Lower 95% interval 47.08% |
| Medicare spending per beneficiary | 0.8 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 96.84% |
95.27%
1.6 pts better
|
Numerator 92 · Denominator 95 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 95 |
| Discharge self-care score | 34.38% |
53.69%
19.3 pts worse
|
Numerator 22 · Denominator 64 |
| Discharge mobility score | 32.81% |
50.94%
18.1 pts worse
|
Numerator 21 · Denominator 64 |
| Pressure ulcers or injuries, new or worsened | 1.05% |
2.29%
1.2 pts better
|
Numerator 1 · Denominator 95 · Adjusted rate 0.81% |
| Healthcare-associated infections requiring hospitalization | 6.26% |
7.12%
0.9 pts better
|
No Different than the National Rate · Eligible stays 83 · Observed rate 4.82% · Lower 95% interval 3.85% |
| Staff COVID-19 vaccination coverage | 4.7% |
8.2%
3.5 pts worse
|
Numerator 11 · Denominator 234 |
| Staff flu vaccination coverage | 89.25% |
42%
47.2 pts better
|
Numerator 191 · Denominator 214 |
| Discharge function score | 25% |
56.45%
31.5 pts worse
|
Numerator 16 · Denominator 64 |
| Transfer of health information to provider | 61.54% |
95.95%
34.4 pts worse
|
Numerator 24 · Denominator 39 |
| Transfer of health information to patient | 48.15% |
96.28%
48.1 pts worse
|
Numerator 13 · Denominator 27 |
| Resident COVID-19 vaccinations up to date | 47.83% |
25.2%
22.6 pts better
|
Numerator 22 · Denominator 46 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.7 |
2.2
0.5 pts better
|
1.9
0.2 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.7 · Observed 2.3 · Expected 2.5 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.5 |
2.0
1.5 pts better
|
1.8
1.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.5 · Observed 0.5 · Expected 1.9 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.1% |
91.2%
5.9 pts better
|
93.4%
3.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 95.8% · Q2 97.6% · Q3 96.9% · Q4 98.2% · 4Q avg 97.1% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
95.0%
5 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.3% |
3.2%
0.9 pts better
|
3.3%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 2.4% · Q3 1.9% · Q4 3.0% · 4Q avg 2.3% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 4.1% |
9.6%
5.5 pts better
|
11.4%
7.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.3% · Q2 4.2% · Q3 4.3% · Q4 3.5% · 4Q avg 4.1% |
| Percentage of long-stay residents who lose too much weight | 4.2% |
5.9%
1.7 pts better
|
5.4%
1.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 2.1% · Q3 2.9% · Q4 5.4% · 4Q avg 4.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 14.7% |
20.7%
6 pts better
|
19.6%
4.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.5% · Q2 16.2% · Q3 13.6% · Q4 13.5% · 4Q avg 14.7% |
| Percentage of long-stay residents who received an antipsychotic medication | 4.5% |
21.4%
16.9 pts better
|
16.7%
12.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.3% · Q2 5.2% · Q3 3.0% · Q4 2.9% · 4Q avg 4.5% · 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 | 26.6% |
17.9%
8.7 pts worse
|
16.3%
10.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 21.2% · Q2 40.7% · Q3 21.4% · Q4 23.8% · 4Q avg 26.6% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 14.2% |
16.2%
2 pts better
|
14.9%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.3% · Q2 18.8% · Q3 13.1% · Q4 13.5% · 4Q avg 14.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 3.2% |
1.1%
2.1 pts worse
|
1.0%
2.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 3.6% · Q3 4.0% · Q4 2.5% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.5% |
2.5%
2 pts better
|
1.7%
1.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.9% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 19.5% |
16.1%
3.4 pts worse
|
19.8%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 17.1% · Q2 20.4% · Q3 18.3% · Q4 22.1% · 4Q avg 19.5% |
| Percentage of long-stay residents with pressure ulcers | 6.7% |
6.2%
0.5 pts worse
|
5.1%
1.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.9% · Q2 5.2% · Q3 6.1% · Q4 8.8% · 4Q avg 6.7% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 79.5% |
80.4%
0.9 pts worse
|
81.7%
2.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 75.6% · Q2 83.9% · Q3 80.3% · Q4 77.8% · 4Q avg 79.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 8.9% |
12.2%
3.3 pts better
|
12.0%
3.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 8.9% · Observed 9.4% · Expected 11.8% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.3% |
2.2%
0.9 pts better
|
1.6%
0.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.3% · Q3 2.4% · Q4 1.4% · 4Q avg 1.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 90.0% |
78.2%
11.8 pts better
|
79.7%
10.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 90.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 17.6% |
24.2%
6.6 pts better
|
23.9%
6.3 pts better
|
Short Stay · 20240701-20250630 · Adjusted 17.6% · Observed 19.8% · Expected 26.9% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2022-09-01 · Fire 2022-09-01
2 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2019-05-09 · Fire 2019-05-09
6 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-02-13
E4 · Emergency Preparedness Deficiencies
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2025-03-30
F · Potential for more than minimal harm
2025-02-13
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2025-03-30
F · Potential for more than minimal harm
2025-02-13
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-03-30
E · Potential for more than minimal harm
2025-02-13
K200 · Egress Deficiencies
Fire Safety
Meet other general requirements.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-03-30
E · Potential for more than minimal harm
2019-05-09
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2019-06-23
D · Potential for more than minimal harm
2019-05-09
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2019-06-23
D · Potential for more than minimal harm
2019-05-09
K341 · Smoke Deficiencies
Fire Safety
Install a fire alarm system that can be heard throughout the facility.
Corrected 2019-06-23
Inspection history
Recent health citations
F · Potential for more than minimal harm
2025-02-13
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 2025-03-30
D · Potential for more than minimal harm
2025-02-13
F554 · Resident Rights Deficiencies
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
F625 · Resident Rights Deficiencies
Health
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-03-30
D · Potential for more than minimal harm
2025-02-13
F761 · Pharmacy Service Deficiencies
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 2025-03-30
D · Potential for more than minimal harm
2022-09-01
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2022-10-16
D · Potential for more than minimal harm
2022-09-01
F688 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected 2022-10-16
D · Potential for more than minimal harm
2019-05-09
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 2019-06-23
D · Potential for more than minimal harm
2019-05-09
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2019-06-23
D · Potential for more than minimal harm
2019-05-09
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2019-06-23
D · Potential for more than minimal harm
2019-05-09
F685 · Quality of Life and Care Deficiencies
Health
Assist a resident in gaining access to vision and hearing services.
Corrected 2019-06-23
D · Potential for more than minimal harm
2019-05-09
F761 · Pharmacy Service Deficiencies
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 2019-06-23
D · Potential for more than minimal harm
2019-05-09
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2019-06-23
Penalties and ownership
What sits behind the stars
Ownership
Blair, Steven
Corporate Director · Individual
Blankenship, Lua
Corporate Director · Individual
Bowen, Robert
Corporate Director · Individual
Burrell, Carol
Corporate Director · Individual
Burrell, Carol
W-2 Managing Employee · Individual
Dent, Larry
Corporate Director · Individual
Hearth, Kaye
Corporate Director · Individual
Herdener, Anthony
Corporate Director · Individual
Herdener, Anthony
W-2 Managing Employee · Individual
Hortenstine, Jay
Corporate Director · Individual
Keener, Jack
Corporate Director · Individual
Lewis, Ronald
Corporate Director · Individual
Mack, Deborah
Corporate Director · Individual
Nicholson, Linda
W-2 Managing Employee · Individual
Northeast Georgia Medical Center, Inc.
Operational/Managerial Control · Organization
Scully, Timothy
Corporate Director · Individual
Smith, Rodney
Corporate Director · Individual
Smoot, Jane
Corporate Director · Individual
Steines, Brian
Corporate Officer · Individual
Steines, Brian
W-2 Managing Employee · Individual
Terry, Jeffrey
Corporate Director · Individual
Wallace, Jacquelyn
Corporate Director · Individual
Wayne, Alexander
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
PruittHealth - Limestone
Gainesville, GA
4-star overall rating with 3-star inspections with 5 recent health deficiencies
#2
Bell Minor Home, The
Gainesville, GA
1-star overall rating with 1-star inspections with Special Focus status with abuse icon flag with $74,979 in total fines with 20 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
#3
Willowbrooke Court At Lanier Village Estates
Gainesville, GA
5-star overall rating with 5-star inspections with 1 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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