Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Azalealand Nursing Home during CMS and state inspections, most recent first.
The facility failed to comply with food safety standards, as the Food Service Director served food without a beard restraint, contrary to FDA guidelines. Additionally, food items in the nourishment refrigerator were not labeled or dated, violating the facility's policy. Staff interviews confirmed the expectation for labeling and dating, but this was not consistently practiced.
The facility failed to conduct background checks for three LPNs, as required by their abuse policy, due to a misunderstanding of the rules. The HR Director and Administrator believed that if an LPN's license was in good standing, no additional checks were needed. This oversight potentially placed 70 residents at risk of abuse, neglect, and exploitation.
A facility failed to evaluate the competencies of a Wound Care RN in infection control, observed during wound care for a resident. The RN placed clean dressings on the bed without a barrier, did not wash hands or change gloves between treating wounds, and provided a snack without handwashing. The RN was unaware of proper procedures, and the facility lacked a policy on nurse competencies, with no documentation of competency evaluations.
The facility failed to lock and secure two of five treatment and medication carts when unattended, as required by their policy. Observations revealed unlocked carts containing medications and biologicals, with staff confirming the carts should have been secured. Interviews with staff, including an RN, LPNs, the DON, and the Administrator, highlighted the importance of locking carts to prevent unauthorized access and ensure resident safety.
A facility failed to implement enhanced barrier precautions and proper infection control during wound care for a resident with multiple wounds. The Wound Care RN did not follow procedures for changing gloves and washing hands between treating different wounds, nor did she use a barrier for clean supplies. Despite active orders for EBP, the RN did not adhere to these precautions, increasing the risk of cross-contamination. Interviews revealed a lack of awareness and training among staff regarding infection control practices.
Deficiencies in Food Safety Practices
Penalty
Summary
The facility failed to ensure compliance with food safety standards as outlined in the FDA Food Code 2022 and its own policies. The Food Service Director (FSD) was observed serving food without wearing a beard restraint, despite having facial hair, which is against the FDA guidelines that require food employees to wear hair restraints to prevent hair from contacting food. The FSD admitted to not requiring staff to wear beard restraints unless the beard was full and long, and the facility lacked a specific policy addressing the use of beard restraints. The Administrator acknowledged the availability of beard restraints and the regulatory requirement for their use, but the facility's policy did not specify this requirement. Additionally, the facility did not adhere to its policy regarding the labeling and dating of resident food items stored in the nourishment refrigerator. Observations revealed that several food items in the nourishment refrigerator were neither labeled nor dated, contrary to the facility's policy that mandates all food items be labeled with content and date. Interviews with staff, including a CNA, LPN, Dietary Manager, and the Administrator, confirmed that the expectation was for all food items to be labeled and dated, yet this was not consistently practiced. These deficiencies in food safety practices had the potential to affect all residents receiving meals from the dietary department.
Failure to Conduct Background Checks for LPNs
Penalty
Summary
The facility failed to consistently implement the screening component of their abuse policy, as evidenced by the lack of background checks for three Licensed Practical Nurses (LPNs) out of five licensed staff whose files were reviewed. The facility's policy, titled 'Abuse Neglect and Exploitation,' mandates background, reference, and credentials checks for potential employees, including licensed staff. However, the facility did not provide evidence of background checks for LPN 7, LPN 9, and LPN 10, who were exempt from the Georgia Crime Information Center/Criminal Background Check. This oversight had the potential to place the 70 residents at risk of abuse, neglect, and exploitation. Interviews with the Human Resources Director and the Administrator revealed a misunderstanding regarding the requirements for background checks. The HR Director stated that license checks were conducted yearly, and any issues would be reflected in the license status. She believed that since the Georgia Board of Nursing completed background checks for licensed nurses, additional checks were unnecessary if the license was in good standing. The Administrator confirmed this understanding, stating that the facility assumed no further criminal background checks were needed if the LPN's license was clear. Consequently, no criminal background checks were conducted for the LPNs in question.
Deficiency in Wound Care and Infection Control Competency
Penalty
Summary
The facility failed to evaluate the competencies of the Wound Care Registered Nurse (RN) in providing wound care and infection control, which was observed during wound care for a resident. The Wound Care RN entered the resident's room with clean dressings and medication, placing them directly on the resident's bed without a barrier. She did not wash her hands or put on a gown before applying gloves. During the wound care process, the Wound Care RN did not wash her hands or change gloves between removing and treating multiple wounds, and she left some wounds open to air while obtaining additional supplies. After completing the treatments, she provided a snack to the resident without washing her hands after removing her gloves. Interviews revealed that the Wound Care RN was unaware of the need to clean hands and change gloves between treating wounds and did not know to use a barrier for clean supplies. The RN had received training from an online wound care company, but neither the Infection Control Preventionist nor the Director of Nursing (DON) had observed her performing wound care. The DON confirmed the lack of a policy addressing nurse competencies and had no documentation of competency evaluations for the Wound Care RN. The Administrator also expected nurses to be competent in infection control during wound care.
Failure to Secure Medication and Treatment Carts
Penalty
Summary
The facility failed to ensure that two of five treatment and medication carts were locked and secured when unattended by staff, as required by their policy titled 'Medication Storage in The Facility.' This policy mandates that medications and biologicals be stored safely and securely, accessible only to authorized personnel. During an observation, a treatment cart on the [NAME] Hall was found unlocked, containing various medications and biologicals. Interviews with staff, including a Registered Nurse (RN) and a Licensed Practical Nurse (LPN), confirmed that the treatment cart should have been locked when not attended or within the staff's line of sight. However, the RN walked away without securing the cart. Further observations revealed an unlocked medication cart outside the nurses' station on Skidaway Hall, with no staff present in the area. An LPN acknowledged that he was trained to lock the cart to prevent unauthorized access to medications. Interviews with other LPNs and the Director of Nursing (DON) reiterated the importance of securing medication carts to prevent unauthorized access and ensure resident safety. The Administrator also confirmed the expectation that medication carts should be locked when not in use to prevent unauthorized access to medications.
Failure to Implement Enhanced Barrier Precautions and Proper Infection Control
Penalty
Summary
The facility failed to implement enhanced barrier precautions (EBP) and ensure proper infection control practices during wound care for a resident with multiple wounds. The Wound Care Registered Nurse (RN) did not follow the facility's Wound Care Procedure, which required treating each wound individually and changing gloves and washing hands between handling different wounds. During an observation, the RN placed clean dressings and medication directly on the resident's bed without a barrier, did not wash hands or change gloves between removing and treating wounds, and did not use a gown as required by EBP. The resident, identified as having severe cognitive impairment, had multiple wounds requiring specific treatments, including a wound vacuum and negative pressure dressing. Despite having active orders for EBP due to wounds on the right thigh and knee, the RN did not adhere to these precautions. The RN also failed to use a barrier for clean supplies and did not change gloves or wash hands between treating different wounds, increasing the risk of cross-contamination. Interviews with the RN and other staff revealed a lack of awareness and training regarding the necessity of using barriers and changing gloves between wound treatments. The Director of Nursing (DON) confirmed the expectation for EBP and proper infection control practices, including using barriers and changing gloves between wound care tasks. The RN's actions, or lack thereof, demonstrated a failure to follow established protocols, potentially increasing the risk of infection for the resident and others.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Savannah
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Riverview Health & Rehab Ctr | 1.3 mi | — | 11 | 0 |
| Candler Skilled Nursing Unit | 1.6 mi | — | 3 | 0 |
| Thunderbolt Care Center Llc | 1.7 mi | — | 0 | 0 |
| Savannah Post Acute Llc | 3.6 mi | — | 2 | 0 |
| Pruitthealth - Savannah | 4.6 mi | — | 1 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.