Inspection Reports for Cannon Wood Village
2834 OLD US HIGHWAY 441, TIGER, GA, 30576
Back to Facility ProfileInspection Report Summary
The most recent inspection on May 8, 2025, identified multiple deficiencies related to administrator licensing, staff training and qualifications, personnel files, resident physical examinations and needs assessments, and proxy caregiver documentation. Earlier inspections showed a consistent pattern of issues with administrator licensure, staff training and competency documentation, criminal background checks, and resident care documentation, including medication assistance and plans of care for proxy caregivers. Complaint investigations were substantiated regarding administrator licensing and medication assistance, but fines, immediate jeopardy findings, or license actions were not listed in the available reports. Prior inspections also noted some physical plant and safety concerns, though these were not repeated in recent reports. The facility’s deficiencies have persisted over time with no clear pattern of improvement or worsening.
Deficiencies (last 6 years)
Deficiencies (over 6 years)
8.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
67% worse than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
16
12
8
4
0
Inspection Report
Complaint Investigation
Deficiencies: 12
Date: May 8, 2025
Visit Reason
The purpose of this visit was to investigate intake #GA50002473 and conduct the compliance inspection.
Complaint Details
The visit was conducted to investigate intake #GA50002473 and conduct a compliance inspection.
Findings
The facility failed to meet multiple regulatory requirements including lack of a valid administrator license, incomplete workforce training and qualifications, missing personnel files, incomplete resident physical examinations and needs assessments, and deficiencies in proxy caregiver documentation and training.
Deficiencies (12)
Administrator of homes licensed for 25 or more beds did not hold a valid license from the State Board of Long-Term Care Facility Administrators.
Failed to ensure work-related training within the first 60 days of employment for 3 sampled staff.
Failed to ensure all direct care staff had at least 16 hours of training per year for 2 sampled staff.
Failed to obtain satisfactory criminal history background checks for 5 sampled staff.
Failed to maintain personnel file for 1 sampled staff available for inspection.
Failed to maintain evidence of trainings, skills competency determinations and recertifications for 2 sampled staff.
Failed to maintain written evidence of satisfactory initial and annual work performance reviews including skills competency checklists for 4 sampled staff.
Failed to obtain a complete physical examination report within 30 days prior to admission for 2 residents.
Failed to complete resident needs assessment at time of admission for 3 residents.
Failed to ensure written informed consent for proxy caregiver services for 1 resident.
Failed to ensure a written plan of care was developed for proxy caregiver services for 1 resident.
Failed to maintain written evidence of satisfactory performances on initial and annual skills competency determinations for proxy caregivers for 2 sampled staff.
Report Facts
Number of sampled staff without valid administrator license: 1
Number of sampled staff without work-related training within 60 days: 3
Number of sampled staff without 16 hours of training per year: 2
Number of sampled staff without fingerprint checks: 5
Number of sampled staff without personnel files available: 1
Number of sampled staff without evidence of trainings and recertifications: 2
Number of sampled staff without satisfactory work performance reviews: 4
Number of residents without complete physical exam within 30 days: 2
Number of residents without resident needs assessment at admission: 3
Number of residents without informed consent for proxy caregiver: 1
Number of residents without written plan of care for proxy caregiver: 1
Number of sampled staff without skills competency checklists for proxy caregiver duties: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Administrator without valid license; lacked training hours for 2024; lacked updated CPR and first aid certification; lacked skills competency checklist; involved in insulin administration without proxy training; unable to locate personnel files for Staff F; acknowledged multiple deficiencies. | |
| Staff B | Sampled staff without work-related training within 60 days; no fingerprint check. | |
| Staff C | Sampled staff without work-related training within 60 days; no fingerprint check; administered insulin without proxy training; lacked proxy caregiver training. | |
| Staff D | Sampled staff without 16 hours of training per year; no fingerprint check; lacked CPR and first aid certification; lacked skills competency checklist; administered insulin without proxy training. | |
| Staff E | Sampled staff without work-related training within 60 days; no fingerprint check. | |
| Staff F | No fingerprint check; no personnel file available; administered insulin without proxy training; lacked skills competency checklist. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Jul 23, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00247971. An onsite visit was made on 2024-07-23 and the investigation was completed on 2024-07-30.
Complaint Details
Investigation was initiated based on intake #GA00247971. The complaint was substantiated with findings related to administrator licensing and medication assistance.
Findings
The facility failed to ensure that the administrator held a valid license as required for homes licensed for twenty-five or more beds. Additionally, the facility failed to provide proper assistance with medication self-administration for one resident, as medications were left unattended and not administered following the Five Rights of medication assistance.
Deficiencies (2)
Facility failed to ensure that administrators of homes licensed for twenty-five or more beds held a valid license from the State Board of Long-Term Care Facility Administrators for 1 of 1 staff (Staff A).
Facility failed to provide assistance that followed the Five Rights of medication assistance for 1 of 1 resident (Resident #1), as medications were left unattended and taken without staff presence.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Named in findings for lacking administrator license and medication assistance issues. |
Inspection Report
Complaint Investigation
Deficiencies: 9
Date: Mar 12, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00244041 and conduct the compliance inspection. An onsite visit was made on 3/12/24 and the investigation was completed on 3/14/24.
Complaint Details
The visit was complaint-related based on intake #GA00244041. The investigation included review of staff training, resident files, proxy caregiver documentation, and competency checklists. Staff A was interviewed and aware of multiple findings.
Findings
The facility failed to meet multiple regulatory requirements including ensuring direct care staff had required annual training hours, maintaining evidence of CPR and first aid training, obtaining complete physical examinations with TB screening prior to admission, completing resident needs assessments, inventories of personal items, criminal background checks for staff, and proper documentation and plans of care for proxy caregivers. Several residents lacked written informed consent for proxy services and staff lacked competency checklists for catheter care.
Deficiencies (9)
Facility failed to ensure all direct care staff had at least sixteen hours of training per year for 3 of 5 staff (Staff A, Staff D, Staff E).
Facility failed to maintain evidence of trainings, skills competency and recertification for 3 of 3 sampled staff (Staff A, Staff D, Staff E), including expired CPR and first aid training.
Facility failed to obtain a physical examination on the Department's form, completed in its entirety with TB screening results, prior to admission for 2 of 4 sampled residents (Resident #1 and Resident #3).
Facility failed to ensure a resident needs assessment was completed on admission for 3 of 4 sampled residents (Resident #1, Resident #3, Resident #4).
Facility failed to complete an inventory of items brought in by the resident on admission for 4 of 4 sampled residents (Resident #1, Resident #2, Resident #3, Resident #4).
Facility failed to ensure direct care staff had required criminal background checks upon employment or prior to placement for 2 of 5 staff (Staff D and Staff E).
Facility failed to ensure written informed consent was completed to permit a proxy caregiver to provide health maintenance activities for 2 of 4 residents (Resident #1 and Resident #4).
Facility failed to ensure a written plan of care was developed for proxy caregivers for 2 of 4 residents (Resident #1 and Resident #4).
Facility failed to maintain annual skills competency determinations utilizing skills competency checklists for 2 of 3 staff (Staff A and Staff D), including catheter care.
Report Facts
Staff training hours missing: 3
Residents without physical exam: 2
Residents without needs assessment: 3
Residents without inventory of personal items: 4
Staff without criminal background check: 2
Residents without proxy caregiver consent: 2
Staff without competency checklists: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Named in multiple findings including lack of training hours, expired CPR/first aid, awareness of findings, and lack of competency checklists. | |
| Staff D | Named in findings for lack of training hours, expired CPR/first aid, missing criminal background check, and lack of competency checklists. | |
| Staff E | Named in findings for lack of training hours, expired CPR/first aid, and missing criminal background check. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 12, 2022
Visit Reason
The purpose of this visit was to investigate intake #GA00228139 and #GA00227009. The investigation began on 2022-09-20, an onsite visit was made on 2022-09-27, and the investigation was completed on 2022-10-12.
Complaint Details
Investigation was complaint-related based on intake numbers #GA00228139 and #GA00227009. The investigation was substantiated by the finding that Staff B lacked a criminal background check.
Findings
The facility failed to ensure that prior to serving as an employee, a satisfactory records check determination was obtained for 1 of 2 sampled staff (Staff B). A review showed no criminal background check on file for Staff B, hired in 2016.
Deficiencies (1)
Facility failed to obtain a satisfactory records check determination prior to employment for Staff B.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in deficiency for lacking a criminal background check. | |
| Staff A | Interviewed and stated that Staff B had a background check on file but it was missing. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 3, 2020
Visit Reason
The purpose of this inspection was to investigate intake #GA00207510.
Complaint Details
Investigation of intake #GA00207510 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, 2020
Visit Reason
The purpose of this inspection was to investigate intake GA00206147 and GA00206246.
Complaint Details
Investigation began on 2020-07-10 and was completed on 2020-07-14. No rule violations were found.
Findings
There were no rule violations cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 23, 2020
Visit Reason
The purpose of this inspection was to investigate intake #GA00205240, which began on 2020-06-10 and was completed on 2020-06-23.
Complaint Details
Investigation of intake #GA00205240 was completed with no rule violations cited.
Findings
No rule violations were cited as a result of this investigation.
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 process.
Findings
The report focuses on monitoring COVID-19 cases and assessing the infection control process at the facility.
Inspection Report
Routine
Deficiencies: 15
Date: Oct 16, 2019
Visit Reason
The purpose of this visit was to conduct a compliance inspection with an onsite visit made on 2019-09-25 and the inspection completed on 2019-10-16.
Findings
The facility was found to have multiple deficiencies including failure to ensure staff received required training and certifications within 60 days of employment, incomplete physical exams for residents, medication administration errors, lack of proper fire drill documentation, unsafe physical plant conditions, failure to maintain incident records, and failure to report serious incidents to the Department within 24 hours.
Deficiencies (15)
Failure to ensure staff received work-related training within the first 60 days of employment for 3 of 5 staff (Staff C, Staff D, Staff E).
Failure to ensure staff obtained current certification in emergency first aid within 60 days for 3 of 5 staff (Staff C, Staff D, Staff E).
Failure to ensure staff obtained current certification in cardiopulmonary resuscitation (CPR) within 60 days for 3 of 5 staff (Staff C, Staff D, Staff E).
Failure to ensure employees involved in personal services had at least 16 hours of training per year for 2 of 5 staff (Staff A and Staff B).
Failure to ensure employees received physical examination and TB screening within 12 months prior to employment for 2 of 5 staff (Staff B and Staff D).
Failure to obtain satisfactory criminal records check prior to employment for 2 of 5 staff (Staff B and Staff E).
Failure to have initial and/or annual work performance reviews including skills competency checklists for 3 of 3 unlicensed staff (Staff A, Staff B, Staff E) performing specialized tasks for medication administration to 1 of 6 residents (Resident #3).
Failure to comply with fire and safety rules requiring quarterly fire drills per shift; no drills conducted on third shift in 2018.
Unsafe physical plant condition: approximately 1.5 foot opening space between deck railing and house on back porch deck, creating a dangerous drop off.
Failure to obtain physical examination by licensed provider within 30 days prior to admission for 3 of 8 residents (Resident #3, #4, #9).
Failure to ensure staff returned medication containers to proper secured storage; prefilled medication cups observed unsecured.
Failure to update Medication Assistance Record (MAR) each time medication was offered or taken for 1 of 8 residents (Resident #4).
Failure to ensure resident medications stored in resident's room were kept locked for 1 of 9 residents (Resident #2).
Failure to retain records of incidents, accidents, or sudden adverse changes and the home's response in resident files for 2 of 8 residents (Resident #6 and Resident #8).
Failure to report serious incidents to the Department within 24 hours for 4 of 8 residents (Resident #5, #6, #7, #8).
Report Facts
Staff training hours: 5
Medication pills discrepancy: 5
Fire drills: 0
Medication cups: Prefilled medication cups observed unsecured on counter.
Over-the-counter medications: 11
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed multiple times regarding training, certifications, medication errors, and incident reporting. | |
| Staff B | Mentioned in relation to missing training hours, physical exam, criminal records check, and skills competency. | |
| Staff C | Missing required training and certifications within 60 days. | |
| Staff D | Missing required training, certifications, physical exam, and TB screening. | |
| Staff E | Missing required training, certifications, criminal records check, and skills competency. |
Inspection Report
Annual Inspection
Deficiencies: 10
Date: Feb 21, 2017
Visit Reason
The purpose of this visit was to conduct an annual inspection of Cannon Wood Village, with an on-site visit made on 2/21/17 and inspection completed on 2/22/17.
Findings
The inspection identified multiple deficiencies related to workforce qualifications and training, including failure to ensure current certification in emergency first aid and CPR for several staff, lack of physical examinations and tuberculosis screenings within required timeframes, missing fingerprint and criminal background checks, absence of initial and annual work performance reviews for unlicensed staff, incomplete or missing physical examinations for residents prior to admission, failure to maintain Medication Assistance Records for some residents, medications not kept in original labeled containers, and lack of written plans of care for proxy caregiver services for certain residents.
Deficiencies (10)
Facility failed to ensure that each staff obtained current certification in emergency first aid within the first sixty days of employment for 4 of 5 sampled staff.
Facility failed to ensure that each staff received current certification in cardiopulmonary resuscitation (CPR) where training required return demonstration of competency for 3 of 5 sampled staff.
Facility failed to ensure each employee received a physical examination and TB screening within 12 months prior to employment for 2 of 5 sampled staff.
Facility failed to obtain a satisfactory fingerprint records check determination prior to employment for the administrator.
Facility failed to obtain a satisfactory criminal records check prior to employment for 1 of 5 sampled staff.
Facility failed to have initial and annual work performance reviews, including skills competency checklists, for 4 of 5 unlicensed staff performing specialized tasks of medication administration.
Facility failed to ensure residents had a physical examination by a licensed provider dated within 30 days prior to admission using the specific form for 2 of 5 sampled residents.
Facility failed to maintain a Medication Assistance Record (MAR) for each resident receiving assistance with medications for 1 of 5 sampled residents.
Facility failed to keep medications in original containers with original labels intact for 1 of 5 residents.
Facility failed to ensure a written plan of care for proxy caregiver services was developed for 2 of 5 sampled residents receiving such services.
Report Facts
Staff sampled: 5
Residents sampled: 5
Staff without current emergency first aid certification: 4
Staff without current CPR certification: 3
Staff without physical exam and TB screening: 2
Staff without fingerprint check: 1
Staff without criminal records check: 1
Unlicensed staff without skills competency checklists: 4
Residents without complete physical exam prior to admission: 2
Residents without Medication Assistance Record: 1
Residents without proxy caregiver plan of care: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Administrator | Named in multiple findings including lack of emergency first aid certification, fingerprint check, and skills competency reviews |
| Staff B | Named in findings related to lack of emergency first aid and CPR certification, and skills competency reviews | |
| Staff C | Named in findings related to missing physical exam and TB screening | |
| Staff D | Named in findings related to lack of emergency first aid and CPR certification, missing physical exam and TB screening, missing criminal records check, and skills competency reviews | |
| Staff E | Named in findings related to lack of emergency first aid and CPR certification, and skills competency reviews |
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