Inspection Reports for
Cedarhurst of Oakwood

Investigation was complaint-related for complaints #GA50005561, #GA50005762, and #GA50005574. Resident #5 confirmed medications were administered late on 10/17/25. Staff A was made aware of the findings on 10/29/25.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5). Specifically, medications scheduled for 8:00 a.m. were administered at 9:19 a.m., more than one hour late.

Investigation was conducted based on complaints #GA50005561, #GA50005762, and #GA50005574. Resident #5 confirmed medications were administered late on 10/17/2025.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5). Specifically, medications scheduled for 8:00 a.m. were administered more than one hour late at 9:19 a.m. on 10/17/2025.

Investigation was conducted based on complaints #GA50005561, #GA50005762, and #GA50005574. Resident #5 confirmed medications were administered late on 10/17/25. Staff A was made aware of the findings on 10/29/25.

Staff failed to provide medications at the right time for one of five sampled residents (Resident #5), administering medications more than one hour late at 9:19 a.m. instead of the scheduled 8:00 a.m. time.

Investigation was conducted based on complaints #GA50005561, #GA50005762, and #GA50005574. Resident #5 confirmed medications were administered late on 10/17/25. Staff A was made aware of the findings on 10/29/25.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5), with medications administered more than one hour late at 9:19 a.m. instead of the scheduled 8:00 a.m.

Investigation was complaint-driven based on three complaint numbers. Resident #5 confirmed medications were administered late on 10/17/25. Staff A was made aware of the findings on 10/29/25.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5), with medications scheduled for 8:00 a.m. administered at 9:19 a.m. The resident confirmed the late administration during interview.

Investigation was complaint-related based on complaint numbers #GA50005561, #GA50005762, and #GA50005574. Resident #5 confirmed medications were administered late on 10/17/2025.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5), with medications scheduled for 8:00 a.m. administered more than one hour late at 9:19 a.m. on 10/17/2025.

Investigation was conducted based on complaints #GA50005561, #GA50005762, and #GA50005574. Resident #5 substantiated the complaint by stating medications were administered late on 10/17/2025.

Staff failed to provide medications at the right time for 1 of 5 sampled residents (Resident #5), with medications scheduled for 8:00 a.m. administered at 9:19 a.m. on 10/17/2025. Resident #5 confirmed medications were administered late during an interview.

The visit was complaint-related, investigating intake #GA50002208.

The facility failed to ensure that staff hired to provide hands-on personal services received required training and certifications. Specifically, one of four staff (Staff C) lacked emergency first aid and CPR certification, and one of four staff (Staff D) assigned to the memory care unit did not receive required dementia-specific orientation and training within the mandated timeframes.

Investigation of complaint #GA00246389 confirmed that Resident #1 wandered out of the memory care unit on 4/30/24 at 6:40 a.m., fell, and was transported to the emergency room. The resident was at risk for elopement and falls per care plan. Staff failed to adequately monitor the resident, leading to the incident.

The facility failed to ensure adequate and appropriate care for one resident who wandered out of the memory care unit, fell, and sustained a head injury. Staff interviews and record reviews confirmed the resident was at risk for elopement and falls, but monitoring was insufficient to prevent the incident.

Investigation of intake #GA00237536 regarding failure to notify responsible party and complete incident report for Resident #2 after hospital transfer on 5/16/23. Substantiation status not explicitly stated.

The facility failed to ensure immediate and appropriate action was taken in case of an accident or sudden adverse change in a resident's condition, including notifying the representative or legal surrogate for Resident #2. Documentation and incident reporting were incomplete, and responsible parties were not notified timely.

Investigation of complaint #GA00232273 found Staff C administered medications without certification; substantiation status not explicitly stated.

The facility failed to ensure that a certified medication aide (CMA) administered medications to residents, as Staff C was found to have no active CMA certification or training documentation while administering medications to residents on 2/5/2023 and 2/7/2023.

Investigation was initiated due to complaint #GA00225283. The complaint was substantiated based on findings that the facility failed to provide timely medical care to Resident #1 after the injury.

Based on record review and interviews, the facility failed to ensure that a resident received appropriate medical care after an incident where one resident rolled over another resident's foot with a wheelchair, resulting in a foot fracture that was not promptly addressed.

The inspection included an investigation of complaint #GA00220682.

The facility failed to have policies and procedures for services available, admissions, refunds, medication management, staff training, recertifications, sufficient staffing, memory care certification, quarterly drug regimen reviews, medication administration records, incident reporting, and disaster preparedness. Multiple deficiencies were noted including late medication administration, lack of staff training, missing documentation, and inadequate emergency plans.