Cycle 1
Health 2025-04-03 · Fire 2025-04-03
4 health deficiencies
Top issue: Administration (2 deficiencies)
13 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Pulaski, GA
Orchard Health And Rehabilitation
1-star overall rating with 1-star inspections with abuse icon flag with $57,161 in total fines with 4 recent health deficiencies with 13 fire-safety deficiencies in the latest cycle
1321 Pulaski School Road, Pulaski, GA
(912) 685-5072
Overall
1 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
89
Certified beds
Average residents
72
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
Ethica Health
Operator or chain grouping
Approved since
1992-05-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
48 facilities
Chain averages 4 overall / 4 health / 3 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
Staffing
Hours and turnover
RN hours / resident day
0.41
Registered nurse staffing · state 0.49 · national 0.68
LPN hours / resident day
0.83
Licensed practical nurse staffing · state 0.93 · national 0.87
Aide hours / resident day
2.19
Nurse aide staffing · state 2.15 · national 2.35
Total nurse hours
3.44
All reported nurse hours · state 3.57 · national 3.89
Licensed hours
1.25
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
2.89
Weekend nurse staffing · state 3.09 · national 3.43
Weekend RN hours
0.38
Weekend registered nurse coverage · state 0.33 · national 0.47
Physical therapist
0.07
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.43
CMS adjusted RN staffing hours
Adjusted total hours
3.53
CMS adjusted total nurse staffing hours
Case-mix index
1.33
Higher values indicate more complex resident acuity
RN turnover
40%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
44%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
9,670
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
22.91
Composite VBP score used to determine payment impact.
Payment multiplier
0.9830
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Healthcare-associated infections
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Total nurse turnover
2.91
Baseline 28.21% · Performance 51.79% · Measure score 2.91 · Achievement 2.91 · Improvement 0
Adjusted total nurse staffing
1.67
Baseline 3.94 hours · Performance 3.55 hours · Measure score 1.67 · Achievement 1.67 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | Not Available |
10.72%
|
Not Available · Eligible stays 4 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly. |
| Discharge to community | Not Available |
50.57%
|
Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · No data were submitted for this measure. |
| Medicare spending per beneficiary | Not Available |
1.02
|
Too few residents or stays to report publicly. |
| Drug regimen review with follow-up | Not Available |
95.27%
|
Numerator Not Available · Denominator 12 · Too few residents or stays to report publicly. |
| Falls with major injury | Not Available |
0.77%
|
Numerator Not Available · Denominator 12 · Too few residents or stays to report publicly. |
| Discharge self-care score | Not Available |
53.69%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Discharge mobility score | Not Available |
50.94%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Pressure ulcers or injuries, new or worsened | Not Available |
2.29%
|
Numerator Not Available · Denominator 12 · Adjusted rate Not Available · Too few residents or stays to report publicly. |
| Healthcare-associated infections requiring hospitalization | Not Available |
7.12%
|
Not Available · Eligible stays 6 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly. |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 60 |
| Staff flu vaccination coverage | 31.18% |
42%
10.8 pts worse
|
Numerator 29 · Denominator 93 |
| Discharge function score | Not Available |
56.45%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 2 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 1 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 89.9% |
91.2%
1.3 pts worse
|
93.4%
3.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 93.4% · Q2 88.7% · Q3 82.6% · Q4 94.3% · 4Q avg 89.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 97.4% |
95.0%
2.4 pts better
|
95.5%
1.9 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 97.4% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 7.3% |
3.2%
4.1 pts worse
|
3.3%
4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.6% · Q2 7.0% · Q3 7.2% · Q4 8.6% · 4Q avg 7.3% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 43.0% |
9.6%
33.4 pts worse
|
11.4%
31.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 35.8% · Q2 45.9% · Q3 52.3% · Q4 36.4% · 4Q avg 43.0% |
| Percentage of long-stay residents who lose too much weight | 7.7% |
5.9%
1.8 pts worse
|
5.4%
2.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.1% · Q2 10.0% · Q3 8.2% · Q4 6.6% · 4Q avg 7.7% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 43.2% |
20.7%
22.5 pts worse
|
19.6%
23.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 42.6% · Q2 40.6% · Q3 42.9% · Q4 46.9% · 4Q avg 43.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 72.1% |
21.4%
50.7 pts worse
|
16.7%
55.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 77.3% · Q2 75.0% · Q3 68.2% · Q4 68.2% · 4Q avg 72.1% · 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 | 8.5% |
17.9%
9.4 pts better
|
16.3%
7.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.2% · Q2 10.9% · Q3 9.5% · Q4 0.0% · 4Q avg 8.5% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 8.9% |
16.2%
7.3 pts better
|
14.9%
6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 14.3% · Q3 11.9% · Q4 5.3% · 4Q avg 8.9% · 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 1.5% · 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 | 1.1% |
2.5%
1.4 pts better
|
1.7%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 1.5% · Q3 0.0% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 13.2% |
16.1%
2.9 pts better
|
19.8%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.8% · Q2 15.0% · Q3 16.8% · Q4 7.3% · 4Q avg 13.2% |
| Percentage of long-stay residents with pressure ulcers | 3.9% |
6.2%
2.3 pts better
|
5.1%
1.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q2 1.9% · Q3 3.6% · Q4 4.9% · 4Q avg 3.9% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 87.1% |
80.4%
6.7 pts better
|
81.7%
5.4 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 87.1% |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-02-26 · Fire 2023-02-26
0 health deficiencies
No concentrated health issue counts in this cycle.
7 fire-safety deficiencies
Top issue: Miscellaneous (3 deficiencies)
Cycle 3
Health 2021-07-15 · Fire 2021-07-15
3 health deficiencies
Top issue: Environmental (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-04-03
E26 · Emergency Preparedness Deficiencies
Fire Safety
Establish roles under a Waiver declared by secretary.
Corrected 2025-05-02
F · Potential for more than minimal harm
2025-04-03
E39 · Emergency Preparedness Deficiencies
Fire Safety
Conduct testing and exercise requirements.
Corrected 2025-05-02
F · Potential for more than minimal harm
2025-04-03
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K223 · Egress Deficiencies
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
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 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K341 · Smoke Deficiencies
Fire Safety
Install a fire alarm system that can be heard throughout the facility.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K351 · Smoke Deficiencies
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K781 · Miscellaneous Deficiencies
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-03
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2025-05-02
E · Potential for more than minimal harm
2023-02-26
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-04-11
E · Potential for more than minimal harm
2023-02-26
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-04-11
E · Potential for more than minimal harm
2023-02-26
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-04-11
E · Potential for more than minimal harm
2023-02-26
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-04-11
D · Potential for more than minimal harm
2023-02-26
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-04-11
D · Potential for more than minimal harm
2023-02-26
K700 · Miscellaneous Deficiencies
Fire Safety
Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors.
Corrected 2023-04-11
D · Potential for more than minimal harm
2023-02-26
K781 · Miscellaneous Deficiencies
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2023-04-11
F · Potential for more than minimal harm
2021-07-15
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 2021-08-25
D · Potential for more than minimal harm
2021-07-15
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2021-08-25
D · Potential for more than minimal harm
2021-07-15
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2021-08-25
Inspection history
Recent health citations
J · Immediate jeopardy
2025-04-03
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2025-05-02
J · Immediate jeopardy
2025-04-03
F740 · Quality of Life and Care Deficiencies
Health
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Corrected 2025-05-02
J · Immediate jeopardy
2025-04-03
F835 · Administration Deficiencies
Health
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Corrected 2025-05-02
J · Immediate jeopardy
2025-04-03
F867 · Administration Deficiencies
Health
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected 2025-05-02
D · Potential for more than minimal harm
2021-07-15
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 2021-08-25
D · Potential for more than minimal harm
2021-07-15
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2021-08-25
D · Potential for more than minimal harm
2021-07-15
F914 · Environmental Deficiencies
Health
Provide bedrooms that don't allow residents to see each other when privacy is needed.
Corrected 2021-08-25
Penalties and ownership
What sits behind the stars
$57,161
2025-04-03
Fine
Fine · fine $57,161
Fine
Ownership
Piedmont Regional Health Inc
5% Or Greater Direct Ownership Interest · Organization
Clinical Services Inc
Operational/Managerial Control · Organization
Foskey, Linda
Corporate Officer · Individual
Foskey, Linda
W-2 Managing Employee · Individual
Macadag Um Gibson, Feona
W-2 Managing Employee · Individual
Patel, Maulikkumar
Contracted Managing Employee · Individual
Nearby options
Other facilities in reach
#1
Pleasant View Nursing Center
Metter, GA
1-star overall rating with 2-star inspections with 13 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
#2
Azalea Health And Rehabilitation
Metter, GA
3-star overall rating with 3-star inspections with 6 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Westwood Healthcare And Rehabilitation
Statesboro, GA
3-star overall rating with 3-star inspections with $3,728 in total fines with 6 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
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