Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around December 2026
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 River Brook Healthcare Center during CMS and state inspections, most recent first.
Two residents with complex medical conditions, including one with traumatic brain injury and another with ESRD on dialysis and paraplegia, were transferred to other SNFs within 24 hours without 30‑day discharge notices, physician discharge orders, or completed discharge recapitulations. In both cases, the ombudsman was not notified prior to the facility‑initiated transfers, and one resident reported being told the move was temporary for room work, while another was moved following a conflict involving family, law enforcement, and a roommate. The Social Services Director acknowledged not issuing 30‑day notices or contacting the ombudsman before arranging these discharges.
Surveyors found that the facility did not follow its RAI/care planning policy or honor the documented wishes of two residents who wanted to remain in LTC. One resident with multiple conditions, including hypertension, depression, and traumatic brain injury, had a care plan specifying long‑term residency with interventions such as activity participation and Social Services involvement. Another resident with ESRD on dialysis, paraplegia, hypertensive heart and CKD, diabetes, hypertension, and seizures had a care plan stating no desire for discharge, a need for 24‑hour care, and a family unable to provide care, with instructions to involve Social Services if interest in outside resources arose. An LPN MDS Coordinator reported that the Social Services Director is responsible for initiating transfers/discharges but could not explain why the required process was not followed for these residents.
The facility failed to ensure that the designated Infection Preventionist (IP) had completed the required specialized training in Infection Prevention and Control. The Unit Manager, temporarily filling in as the IP, and the DON were not certified, although they were enrolled in an online certification course. This deficiency placed all 68 residents at risk for potential transmission of infections.
The facility failed to implement enhanced barrier precautions (EBP) for three residents with pressure ulcers. Observations showed the wound care nurse did not wear a gown, and there was no signage indicating EBP. Staff interviews revealed a lack of instruction and ongoing efforts to implement EBP and educate staff.
Failure to Provide Required 30‑Day Discharge Notices and Ombudsman Notification for Two Residents
Penalty
Summary
The facility failed to provide required 30‑day discharge notices, obtain physician discharge orders, complete discharge documentation, and notify the ombudsman for two residents who were transferred or discharged within 24 hours. One resident with hypertension, depression, diffuse traumatic brain injury with loss of consciousness, and traumatic ischemia of muscle was admitted on an unspecified date and later accepted to an out‑of‑county facility. Progress notes documented that the resident and a family member were informed of the discharge and that transport would arrive the next morning, and the resident was transferred via EMS with belongings. However, there was no physician order for discharge, no 30‑day discharge notice, no documented request for transfer to another SNF, no documented behaviors, and no ombudsman notification. The discharge recapitulation form contained only demographic information and the resident’s name, with all other sections left blank. The ombudsman reported not being notified and stated the family was also not notified, and the resident reported being told the move was temporary and related to room work, later learning at the receiving facility that he would not return. The Maintenance Director stated no renovation was done to the room, while the Social Services Director stated she told the resident he would be leaving the next morning due to environmental issues and acknowledged she did not contact the ombudsman. A second resident with end‑stage renal disease on dialysis, paraplegia, hypertensive heart and chronic kidney disease, type 2 diabetes, hypertension, and seizures was also discharged without a 30‑day notice, physician discharge order, or completed discharge recapitulation. Progress notes documented that a family member accused the resident’s roommate of slapping the resident, that the roommate denied the allegation, and that law enforcement was contacted due to family members attempting to fight and verbally threaten the roommate; the roommate was moved to another room. There was no physician order related to the discharge and no evidence of a 30‑day discharge notice. The ombudsman stated the resident wanted to return, was not given a 30‑day notice, and that the facility did not notify the ombudsman prior to discharge, which would have allowed the resident to appeal with assistance. The Social Services Director reported she sent a referral package to another facility after speaking with corporate and the previous administrator, stated that a family member had to be escorted out by law enforcement, and that the resident kept the television on all night and talked loudly on the phone using speaker mode. She acknowledged the resident was not given a 30‑day discharge notice because another facility had been found, the ombudsman was not notified, and the resident was transferred within 24 hours.
Failure to Honor Residents’ Care Plan Goals to Remain in LTC
Penalty
Summary
Surveyors identified that the facility failed to develop and implement care plans that honored two residents’ expressed wishes to remain in the facility. The facility’s policy titled “RAI/Care Planning Management,” revised August 2017, states that a discharge plan will be included in the care plan at admission and that goals will be resident-specific, measurable, and realistic. For one resident with diagnoses including hypertension, depression, diffuse traumatic brain injury with loss of consciousness, and traumatic ischemia of muscle, the admission record and care plan documented that the resident’s plan was to remain a long‑term care resident. The care plan interventions included encouraging and assisting the resident to participate in activities of choice and directing the Social Services Director to visit as needed. Another resident was admitted with end‑stage renal disease on dialysis, paraplegia, hypertensive heart and chronic kidney disease, type 2 diabetes, hypertension, and seizures. This resident’s care plan documented that the resident had voiced no desire to be discharged from long‑term care, required 24‑hour care, and that the family was unable to provide care at that time. The care plan further directed staff to refer to Social Services if the resident voiced or demonstrated interest in seeking outside resources to live elsewhere. During an interview, the LPN MDS Coordinator stated that the Social Services Director is responsible for initiating the transfer/discharge process and acknowledged not knowing why the required process was not followed for these residents, despite their care plans indicating they wished to remain in the facility.
Infection Preventionist Lacks Required Certification
Penalty
Summary
The facility failed to ensure that the designated Infection Preventionist (IP) had completed specialized training in Infection Prevention and Control, as required by the job description. This deficiency was identified during a review of records and staff interviews. The job description for the Infection Control Preventionist, dated 2020, specified a requirement for certification in Infection Control Preventionist training. However, during an interview, the Unit Manager, who had been working at the facility for about a week and was temporarily filling in as the IP, confirmed that she did not have the necessary IP certification. Additionally, the Administrator acknowledged that both the Unit Manager and the Director of Nursing (DON) were not certified as IPs, although they were enrolled in an online IP certification course. This lack of certification placed all 68 residents at risk for the potential transmission of infections and communicable diseases.
Failure to Implement Enhanced Barrier Precautions for Residents with Pressure Ulcers
Penalty
Summary
The facility failed to implement enhanced barrier precautions (EBP) for three residents with pressure ulcers, as observed during wound care treatments. The undated document titled 'Implementation of Personal Protective Equipment (PPE) Use In Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs)' outlines that EBP should be used for residents with wounds or indwelling medical devices, regardless of MDRO colonization status. This includes the use of gowns and gloves during high-contact resident care activities. However, during observations, the wound care nurse did not wear a gown, and there was no signage indicating the need for EBP on the residents' doors. Interviews with staff revealed a lack of instruction and implementation regarding EBP. The wound nurse stated she had not been instructed to use EBP unless a resident had a specific condition like ESBL. Additionally, a registered nurse mentioned that they had received an email about EBP a week prior and were in the process of implementing it and educating the staff. This indicates a gap in communication and training regarding the proper use of PPE and EBP for residents with pressure ulcers.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 7 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Homerville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Sgmc Health Villa | 20.1 mi | — | 0 | 0 |
| Baptist Village, Inc. | 23.4 mi | — | 7 | 0 |
| Waycross Health And Rehabilitation | 26.5 mi | — | 0 | 0 |
| Harborview Satilla | 26.7 mi | — | 21 | 0 |
| Berrien Oaks Nursing And Rehab Center | 31.3 mi | — | 1 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for River Brook Healthcare Center.
100% money-back within 48 hours.
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.