Inspection Report Summary
The most recent inspection on November 30, 2023, found no deficiencies. Earlier complaint investigations also consistently found no rule violations, indicating a pattern of compliance in recent years. Prior deficiencies involved issues such as failure to update care plans, medication refill delays, and incidents of physical abuse and inadequate protective oversight, including an incident where a resident was physically contacted by staff and another involving unsecured exit doors. Enforcement actions included staff suspensions and terminations related to abuse allegations, and police involvement was documented in one case; fines or license actions were not listed in the available reports. The facility’s record shows improvement over time, with no deficiencies noted in the most recent inspections following earlier substantiated complaints.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
1.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
73% better than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 30, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00240472.
Complaint Details
Investigation of intake #GA00240472 with no rule violations cited.
Findings
No rule violations were cited as a result of this visit.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 10, 2023
Visit Reason
A visit was made to the facility on 10/10/2023 to investigate intake #GA 00238719 and #GA00238917.
Complaint Details
Investigation of intake #GA 00238719 and #GA00238917 with no rule violations cited.
Findings
The investigation was completed on 10/10/2023 with no rule violations cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 21, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00237897.
Complaint Details
Investigation of intake #GA00237897 found no rule violations.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 9, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00237300.
Complaint Details
Investigation of intake #GA00237300 with no rule violations found.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 14, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00236386. The onsite visit was made on 7/14/23.
Complaint Details
Investigation of intake #GA00236386 with no violations cited.
Findings
No violations were cited as a result of this survey.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 22, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00235795. The onsite visit was made on 6/22/23 and completed on 6/23/23.
Complaint Details
Investigation of intake #GA00235795 with no violations cited.
Findings
No violations were cited as a result of this survey.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 18, 2023
Visit Reason
The visit was conducted to investigate intake #GA00233892 with an onsite visit made on 4/18/2023.
Complaint Details
Investigation of intake #GA00233892 was conducted starting 4/18/2023 and completed on 4/25/2023 with no rule violations found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 15, 2023
Visit Reason
The purpose of this visit was to investigate intakes GA00232731 and GA00232220.
Complaint Details
Investigation of intakes GA00232731 and GA00232220 with no rule violations cited.
Findings
No rule violations were cited as a result of this visit.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jan 5, 2023
Visit Reason
The purpose of this visit was to investigate intake Ga00229040. An onsite visit was made to the facility on 2022-12-13. The investigation was started on 2022-12-13 and completed on 2023-01-05.
Complaint Details
Investigation of intake Ga00229040; no rule violations were found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 5, 2022
Visit Reason
The purpose of this visit was to investigate intake GA00227399 with an onsite visit made to the facility on 10/5/22.
Complaint Details
The investigation was triggered by intake GA00227399 regarding an incident on 8/25/22 where Resident #1 was hit on the back of the hand by Staff B. Resident was not injured. Staff B was suspended pending investigation and later terminated. Police report case # 01-22-013289 was filed. Resident #1 was unable to recall the incident due to cognitive impairment.
Findings
The facility failed to ensure each resident received adequate and appropriate care in compliance with state law for 1 sampled resident. An incident was reported where Resident #1 was hit on the back of the hand by a staff member, resulting in staff suspension and police involvement.
Deficiencies (1)
Facility failed to ensure each resident received care and services which were adequate, appropriate, and in compliance with state law and regulation for Resident #1 who was physically contacted inappropriately by staff.
Report Facts
Incident report date: Aug 25, 2022
Police report case number: 13289
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Staff member who hit Resident #1 and was suspended pending investigation and later terminated | |
| Staff A | Interviewed and stated Staff B was terminated and physical contact was made | |
| Staff C | Interviewed and stated Resident #1 has a history of agitation and should have been managed differently |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 23, 2022
Visit Reason
The purpose of this visit was to investigate intake GA00222167 and GA0022265.
Complaint Details
Investigation started on 2022-03-21, on-site visit was made on 2022-03-23, and it was completed on 2022-04-20.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 21, 2022
Visit Reason
The purpose of this visit was to investigate intake GA00221347.
Complaint Details
Investigation started on 02/21/22 and on-site visit was made on 02/21/22 and it was completed on 03/16/22.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Feb 4, 2022
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA00219990 and #GA00220933 with an onsite visit made on 2022-01-24 and the investigation completed on 2022-02-04.
Complaint Details
Investigation of complaint intakes #GA00219990 and #GA00220933. The complaint was substantiated based on failure to update care plan per physician order and conflicting staff statements regarding resident care.
Findings
The facility failed to include a physician order for full assistance with bathing and toileting in the care plan for Resident #1, despite the physician's order dated 2021-11-04. Interviews revealed disagreement among staff regarding the resident's care needs and attempts to obtain physician signature on the care plan were unsuccessful.
Deficiencies (1)
Facility failed to include in the care plan a physician order for full assistance with bathing and toileting for Resident #1.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Contacted the resident's physician to request signature on care plan and provided statements regarding resident's care needs. | |
| Staff B | Assessed Resident #1 and stated the resident did not need full ADL care. | |
| AA | Stated Resident #1 was unable to wash face and arms and that the facility changed the standard of care despite physician's order. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 29, 2021
Visit Reason
The visit was conducted to perform a compliance inspection and investigate complaint intakes #GA00217903 and #GA00218156 with onsite visits on 10/6/21 and 10/26/21, and the investigation completed on 10/29/21.
Complaint Details
The investigation was related to complaint intakes #GA00217903 and #GA00218156. The complaint was substantiated as the facility failed to timely reorder Olanzapine for Resident #3, causing missed doses and increased agitation.
Findings
The facility failed to ensure timely medication refills for one of three sampled residents (Resident #3), resulting in missed doses of Olanzapine due to delayed reorder and medication arrival.
Deficiencies (1)
Failure to ensure medication refills were obtained timely to prevent interruption in routine dosing for Resident #3.
Report Facts
Missed doses: 2
Missed doses: 1
Medication dosage: 5
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jul 29, 2020
Visit Reason
The purpose of this inspection was to investigate complaint intakes #GA00206413 and #GA00206338, started on 2020-07-16 and completed on 2020-07-29.
Complaint Details
The investigation was triggered by allegations of physical abuse toward Resident #1. The abuse was substantiated based on video evidence and interviews. Staff C was terminated following the investigation.
Findings
The facility failed to ensure that Resident #1 was free from physical abuse. Evidence included an incident report, police report, video review, and interviews confirming Staff C caused scratches on Resident #1's neck. Staff C was suspended and subsequently terminated for misconduct and abuse allegations.
Deficiencies (1)
Failure to ensure each resident was free from physical abuse, evidenced by physical abuse of Resident #1 by Staff C.
Report Facts
Intake start date: Jul 16, 2020
Intake completion date: Jul 29, 2020
Incident date: Jun 28, 2020
Staff C hire date: Apr 1, 2020
Staff C termination date: Jul 7, 2020
Staff C scheduled shift: 8
Resident #1 admission date: Mar 12, 2019
Resident #1 memory care admission date: Jul 9, 2020
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Named in physical abuse allegation and termination for misconduct | |
| Staff B | Interviewed witness who reviewed video and reported incident | |
| Staff A | Interviewed witness who viewed video of incident | |
| Staff E | Received incident report, coordinated police notification, and reviewed video |
Inspection Report
Monitoring
Deficiencies: 0
Date: Apr 6, 2020
Visit Reason
The purpose of this review is to monitor COVID 19 cases and assess infection control processes.
Findings
The report focuses on monitoring COVID-19 cases and evaluating the facility's infection control procedures.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 21, 2019
Visit Reason
The purpose of this visit was to investigate intake #GA00200803.
Complaint Details
Investigation of intake #GA00200803 found no rule violations.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Mar 8, 2019
Visit Reason
The purpose of this visit was to conduct a follow-up to the complaint investigation intake #GA00191802.
Complaint Details
Follow-up to complaint investigation intake #GA00191802; no rule violations cited.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Oct 15, 2018
Visit Reason
The purpose of this visit was to investigate complaint GA00191802 regarding the facility's failure to provide protective care and watchful oversight for a resident at risk of wandering.
Complaint Details
The investigation was triggered by complaint GA00191802 concerning Resident #1 wandering away from the facility unattended due to inadequate security measures.
Findings
The facility failed to provide adequate protective care and watchful oversight for Resident #1, who had dementia and a history of wandering. The resident left the facility unattended on multiple occasions due to unsecured exit doors without audible alarms. Additionally, the facility did not retain a current photograph of the resident at risk of eloping.
Deficiencies (4)
Failure to provide protective care and watchful oversight for Resident #1 with dementia and history of wandering.
Exit door near side street was unsecured and lacked an audible alarm.
Third floor stairwell exit door had an inoperable audible alarm and maglock did not engage.
Failure to retain on file a current photograph of Resident #1 at risk of eloping.
Report Facts
Date of incident report: Sep 26, 2018
Date of incident report: Oct 6, 2018
Resident age: 82
Resident admission date: Sep 24, 2018
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding maglock and alarm status on exit doors and lack of photograph for Resident #1 | |
| Staff C | Interviewed regarding inoperable audible alarm on third floor stairwell exit door |
Inspection Report
Original Licensing
Deficiencies: 0
Date: Jun 27, 2018
Visit Reason
The purpose of this visit was to conduct the change of ownership inspection.
Findings
No rule violations were cited as a result of this inspection.
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