Inspection Report
Complaint Investigation
Deficiencies: 0
May 31, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00244438 with an onsite visit made on 5/30/24 and inspection completed on 5/31/24.
Findings
No rule violations were cited during the inspection.
Complaint Details
Investigation of intake #GA00244438 with no rule violations cited.
Inspection Report
Complaint Investigation
Deficiencies: 2
Mar 1, 2024
Visit Reason
The purpose of this visit was to conduct a compliance inspection and investigate intake #GA00243769, triggered by concerns regarding Resident #1's injuries.
Findings
The facility failed to provide adequate and appropriate care for Resident #1, who was found with unexplained bruising and cuts above the left eye. The facility also failed to notify the resident's representative of the adverse change in condition.
Complaint Details
The investigation was initiated due to a complaint intake #GA00243769 regarding unexplained injuries to Resident #1, including a black eye and cuts. The complaint was substantiated by observations, interviews, and record reviews.
Severity Breakdown
Level D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to render adequate and appropriate services for Resident #1, evidenced by unexplained bruising and cuts. | Level D |
| Facility failed to notify the representative of an adverse change in Resident #1's physical condition. | Level D |
Report Facts
Sampled residents: 3
Cuts observed: 3
Date of resident admission: Jun 30, 2023
Date of care plan: Jan 15, 2024
Date of police report: Jan 26, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Conducted investigation and reported inability to determine how injury occurred | |
| Staff C | Overnight caregiver on 1/26/24, reported cuts but did not document incident | |
| Staff D | Received report of cuts from Staff C and attempted first aid | |
| Staff E | Noticed bruising and cuts on Resident #1 but unaware if representative was notified | |
| Staff F | Asked to notify resident representative BB |
Inspection Report
Complaint Investigation
Deficiencies: 0
May 16, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00234615 and #GA00234795 with an onsite visit made on 5/16/2023.
Findings
The inspection was completed following the investigation of the complaint intakes. No specific findings or deficiencies are detailed in the provided report.
Complaint Details
Investigation of complaint intakes #GA00234615 and #GA00234795.
Inspection Report
Complaint Investigation
Deficiencies: 1
Sep 8, 2022
Visit Reason
The purpose of this visit was to investigate intake #GA00227197 with an onsite visit made on 2022-09-08 and the investigation completed on 2022-09-15.
Findings
The facility failed to ensure adequate and appropriate care and services for 3 sampled residents, including failure to properly turn residents with pressure ulcers and ongoing skin issues, despite hospice and home health involvement.
Complaint Details
Investigation was complaint-related for intake #GA00227197. The complaint was substantiated based on observations, record reviews, and interviews indicating inadequate care for residents with pressure ulcers.
Severity Breakdown
SS= D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure each resident received adequate and appropriate care and services for 3 sampled residents with pressure ulcers and skin issues. | SS= D |
Report Facts
Number of sampled residents with deficiencies: 3
Date of onsite visit: Sep 8, 2022
Date survey completed: Sep 15, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Stated on 9/15/22 that the issue would be taken care of. | |
| DD | Interviewed on 9/8/22 stating no one comes to turn Resident #1 and that he/she turned the resident. | |
| AA | Interviewed on 9/9/22 stating hospice visits and private sitters turn Resident #1; staff tried but resident refused. | |
| CC | Interviewed on 9/9/22 stating Resident #3 had stage II pressure ulcers and staff did not turn resident every 2 hours. | |
| FF | Interviewed on 9/14/22 stating Resident #2 is not turned for pressure ulcers and receives home health services. |
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