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 Chestnut Ridge Nsg & Rehab Ctr during CMS and state inspections, most recent first.
The facility failed to conduct annual competency evaluations for CNAs, as required by their policy. Despite meeting state in-service training requirements, the facility could not provide documentation of yearly evaluations for sampled CNAs. The Director of Human Resources confirmed that no evaluations had been completed in four years, with the responsibility lying with the DON, a position with high turnover.
The facility failed to meet food safety standards, with improperly labeled and stored food items, and cold fruit served at an incorrect temperature. An ice machine was also found to be unsanitary. These issues were confirmed by staff during a survey.
The facility failed to maintain the area around the dumpster free from garbage and refuse, contrary to its policy. Observations revealed garbage on the ground, and a staff member admitted to leaving the dumpster lid open when it was too full, allowing wind to scatter garbage. This practice had the potential to attract pests.
The facility failed to maintain a safe and homelike environment, with observations of dirty PTAC filters, walls in disrepair, and missing ceiling tiles in resident rooms and the kitchen. The maintenance policy required regular cleaning and upkeep, but observations showed non-compliance, confirmed by the Corporate Maintenance Director. These deficiencies posed potential risks to residents' safety and quality of life.
A facility failed to conduct a PASARR Level II assessment for a resident admitted with PTSD, depression, and anxiety. The PASRR Level I form did not include these diagnoses, and no Level II assessment was completed. Staff interviews revealed uncertainty about responsibility for ensuring accurate diagnoses on the PASRR form.
The facility failed to implement comprehensive care plans for four residents, leading to unmet medical and personal care needs. One resident's refusal of medications was not documented in the care plan, while another's personal hygiene requests were ignored. Two other residents experienced inadequate personal care, with observations of poor hygiene and lack of assistance, despite documented ADL deficits.
The facility failed to provide adequate assistance with ADLs for three residents, leading to unmet needs in personal hygiene and grooming. A resident with multiple diagnoses did not receive scheduled showers, resulting in oily hair and dirty fingernails. Another resident required assistance with nail care, which was not provided, and a third resident requested help with facial hair removal, which was ignored. Staff interviews confirmed that these services should have been provided but were not.
The facility failed to ensure soiled linen hampers in hallways were emptied immediately when full, as required by policy. Observations showed overflowing hampers on the A and C halls, with lids left ajar, indicating they were not being emptied promptly. Interviews confirmed CNAs were responsible for emptying hampers every two hours and during mealtimes, but accountability was inconsistent despite in-service training sessions.
Failure to Conduct Annual CNA Competency Evaluations
Penalty
Summary
The facility failed to conduct annual performance reviews to ensure competency for the Certified Nursing Assistants (CNAs) employed by the facility, as required by their policy titled Competency of Nursing Staff. The policy mandates that competency evaluations be conducted upon hire, annually, and as deemed necessary. However, the facility was unable to provide documentation of yearly competency evaluations for the sampled CNAs, despite meeting the state in-service training requirements. Specifically, CNA MM, who was hired in 2004, only had an evaluation from 2005, and there were no evaluations for CNA LL and CNA NN, hired in 2018 and 2017, respectively. Interviews revealed that the Director of Human Resources and Payroll, who has been with the facility for four years, confirmed that no competency evaluations had been completed for any CNAs during her tenure. The responsibility for these evaluations lies with the Director of Nursing (DON), a position that has experienced high turnover rates, making it difficult to maintain consistent oversight. The current DON is new to the position, and the facility acknowledged the need to address the completion of competency evaluations for the nursing staff.
Food Safety and Sanitation Deficiencies
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, as evidenced by several observations during a survey. In the kitchen, an open bag of breaded chicken patties and an open box of sweet potato pie were found in the walk-in freezer without open or discard dates and were left open to air. Additionally, a container of peaches and a metal container of coleslaw in the walk-in cooler were improperly dated, and various cheeses and seasonings were not labeled with open or discard dates. These lapses were confirmed by a staff member, who admitted to not labeling the items due to time constraints. Further deficiencies were noted during meal preparation, where cold fruit was served at an inappropriate temperature of 68 degrees Fahrenheit. The Regional Dietary Manager acknowledged that this was not the correct serving temperature. Additionally, an ice machine in the kitchen was found to have discoloration on the inside, indicating a lack of cleanliness. The responsibility for cleaning the ice machine was attributed to the Maintenance department, as confirmed by a staff member.
Improper Garbage Disposal Around Dumpster
Penalty
Summary
The facility failed to ensure proper disposal of garbage and refuse around the dumpster area, as observed during a survey. The facility's policy, revised in October 2017, mandates that garbage and refuse containing food wastes be stored in a manner inaccessible to pests, with outside dumpsters kept closed and free of surrounding litter. However, during an initial tour of the kitchen, it was observed that garbage and refuse were present on the ground around the dumpster. An interview with a staff member revealed that when the dumpster became too full, the lid was left open to make more room for garbage, which allowed the wind to blow garbage out onto the ground. This practice was contrary to the facility's policy and had the potential to attract pests.
Facility Fails to Maintain Safe and Homelike Environment
Penalty
Summary
The facility failed to maintain a safe, clean, and homelike environment for its residents, as evidenced by observations of dirty filters in the Packaged Terminal Air Conditioner (PTAC) units, walls in disrepair, missing paint, missing chair rails, and missing or falling ceiling tiles in nine resident rooms across three halls and the kitchen. The facility's maintenance policy required regular upkeep of the building and equipment, including cleaning PTAC filters every three months. However, observations revealed that the PTAC filters in multiple rooms were covered in a gray, fuzzy substance, indicating they had not been cleaned as per the recommended schedule. Additionally, walls in several rooms had peeling wallpaper, missing chair rails, and mismatched paint, further contributing to the deficient environment. Interviews with the Corporate Maintenance Director and the Administrator in Absence confirmed the observations and acknowledged that the PTAC filters should be cleaned monthly and documented in the TELS system. The maintenance director also stated that the building should be maintained in good repair, with issues such as peeling wallpaper and missing chair rails addressed promptly. The report highlights that these deficiencies had the potential to place residents at risk for accidents and hazards, diminishing their quality of life.
Failure to Conduct PASARR Level II Assessment for Resident with Mental Disorder
Penalty
Summary
The facility failed to ensure that a resident with a serious mental disorder was referred for a Level II PASARR assessment upon admission or within 30 days of a new diagnosis. The resident, identified as R99, was admitted with diagnoses including PTSD, depression, and anxiety. However, the PASRR Level I request dated 12/20/2022 did not include these diagnoses, and there was no subsequent PASARR Level II assessment conducted. This oversight was identified through staff interviews, record reviews, and a review of the facility's policy on coordinating assessments with the PASARR program. Interviews with the Social Services Director and the Director of Nursing revealed uncertainty about who was responsible for ensuring the accuracy of diagnoses on the PASRR Level I form upon admission. The Director of Nursing confirmed that the PASRR Level I form for R99 did not reflect the resident's actual diagnoses, and no PASRR Level II assessment was completed. This deficiency had the potential to affect the appropriate level of care and services provided to the resident.
Failure to Implement Comprehensive Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for four residents, leading to potential risks for medical complications and unmet needs. For one resident, R84, the care plan did not address the resident's behavior of refusing medications, such as docusate sodium and acetaminophen, despite documentation in nurse's progress notes indicating multiple refusals. Interviews with staff, including the LPN/UM and MDS LPNs, confirmed that such behaviors should be documented and included in the care plan, but this was not done. Another resident, R50, was observed with facial hair and reported that staff had not assisted her with personal hygiene despite her requests. The care plan for R50 noted ADL and cognitive deficits but lacked specific interventions for personal hygiene. Interviews with the LPN/UM and DON revealed that personal hygiene needs should be addressed in the care plan and added to the task list, but this was not implemented. Residents R20 and R90 also experienced deficiencies in personal care. R20 was observed with oily hair and dirty fingernails, and reported not receiving a bath since admission, despite the care plan indicating a self-care deficit and need for assistance with ADLs. Similarly, R90, who required maximum assistance for ADLs, was observed with long, dirty fingernails and expressed a desire for assistance in cutting them. The care plan for R90 did not adequately address these personal hygiene needs, leading to unmet care requirements.
Failure to Provide Adequate ADL Assistance
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs) for three residents, leading to unmet needs in personal hygiene and grooming. Resident R20, who was admitted with multiple diagnoses including skin infection and diabetes, required substantial assistance with bathing and moderate assistance with personal hygiene. Despite being scheduled for showers twice a week, R20 reported not receiving a bath since admission, and observations confirmed her hair was oily and her fingernails were dirty. Interviews with staff revealed that nail care should accompany showers, but R20's needs were not met, as staff were reportedly too busy or unhelpful. Resident R90, with diagnoses including peripheral vascular disease and dementia, required substantial assistance for personal hygiene. Observations showed R90's fingernails were long and dirty, and he expressed a desire for assistance with nail care. Staff interviews indicated that nail care should occur on shower days, but this was not provided. Resident R50, with moderate cognitive impairment, required assistance with personal hygiene and had requested help with facial hair removal, which was not provided. Observations confirmed the presence of facial hair, and staff interviews indicated that CNAs should ask residents if they want facial hair removed, but this was not done for R50.
Failure to Empty Soiled Linen Hampers Promptly
Penalty
Summary
The facility failed to ensure that soiled linen hampers located in the hallways were emptied immediately when full, as required by their policy. Observations revealed that on multiple occasions, soiled linen hampers on the A and C halls were overflowing, with lids left ajar, indicating they were not being emptied promptly. This was observed during a facility tour and subsequent visits, where hampers were found overflowing in the hallways, including in front of a resident's room without any CNA present to address the issue. Interviews with facility staff, including the Housekeeping Director and CNAs, confirmed that the responsibility for emptying the soiled linen hampers fell on the CNAs, who were expected to do so at least every two hours and during mealtimes. However, the Regional Nurse Consultant acknowledged that ensuring hampers were emptied when full had been a persistent issue. Despite in-service training sessions conducted to address this, staff interviews indicated a lack of consistent accountability among CNAs for maintaining the cleanliness of the hampers.
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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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How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Cumming Operating Company Llc | 0.9 mi | — | 5 | 0 |
| Pruitthealth - Lanier | 9.7 mi | — | 0 | 0 |
| D Scott Hudgens Center For Skilled Nursing, The | 12.7 mi | — | 2 | 0 |
| Salude - The Art Of Recovery | 13.2 mi | — | 0 | 0 |
| Crossroads Of Flowery Branch Of Journey Llc, The | 13.5 mi | — | 15 | 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.