Inspection Reports for Laurel Lodge
210 Hope Dr, Cleveland, GA 30528, United States, GA, 30528
Back to Facility ProfileInspection Report Summary
The most recent inspection on October 21, 2025, found no deficiencies following a complaint investigation. Earlier inspections showed a pattern of deficiencies primarily related to medication administration, staff training, and communication of care plans. Several complaint investigations substantiated issues such as missed medication doses, uncertified staff administering medications, and inadequate staff training in the memory care center. No fines, immediate jeopardy findings, or license actions were listed in the available reports, and most complaint investigations were unsubstantiated. The facility appears to have addressed prior deficiencies, as follow-up visits in October 2025 found no ongoing violations.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
5.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
14% worse than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 21, 2025
Visit Reason
The purpose of this visit was to investigate intakes #GA50006054, #GA50005873, and GA50005877.
Complaint Details
Investigation was completed on 2025-10-23 with no rule violations cited.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Follow-Up
Deficiencies: 0
Date: Oct 6, 2025
Visit Reason
The purpose of this visit was to conduct a follow-up to the 7/8/25 inspection.
Findings
No rule violations were cited as a result of this follow-up visit conducted on 10/6/25. The report lists several regulatory requirements related to governance and medication administration that were not met in prior inspections, but no deficiencies were cited during this visit.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 2, 2025
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA50005253 and #GA50004719 with an onsite visit conducted on 2025-08-25.
Complaint Details
Investigation of complaint intakes #GA50005253 and #GA50004719 with no rule violations found.
Findings
No rule violations were cited as a result of this complaint investigation visit.
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Jul 10, 2025
Visit Reason
The purpose of the visit was to investigate intake numbers GA50004327, GA50004099, and GA50002117 with an onsite visit on 2025-07-07 and investigation completion on 2025-07-08.
Complaint Details
The investigation was complaint-driven based on intake numbers GA50004327, GA50004099, and GA50002117. Allegations included medications not being given as prescribed. The complaint was substantiated by findings of missed medication doses for Resident #1.
Findings
The facility failed to ensure medication administration services were provided in accordance with physicians' orders for one resident, resulting in missed doses of multiple medications. Additionally, the facility failed to administer skills competency checks for a certified medication aide. These deficiencies place the resident at risk for serious health complications and represent repeated violations.
Deficiencies (3)
Failure to ensure the governing body provided oversight to operate in compliance with state rules and regulations, including medication administration services.
Failure to provide medication administration services to residents in accordance with physicians' orders, resulting in missed doses for Resident #1.
Failure to administer skills competency checks for certified medication aides to ensure proper medication administration knowledge and skills for Staff C.
Report Facts
Dates medications were on hold: 10
Resident #1 missed medication doses: 25
Staff C hire date: Jun 27, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Certified Medication Aide | Named in deficiency for lacking a completed medication skills competency checklist. |
| Staff A | Interviewed and stated unawareness of missed medication doses and lack of skills checklist for Staff C. | |
| Staff E | Informed AA that Resident #1's medications were on hold and that he/she would speak with Staff B for instructions. | |
| Staff B | Instructed Staff E to administer Resident #1's medications. | |
| AA | Interviewed and questioned Staff E about Resident #1's medications being on hold. |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Jun 19, 2025
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA50003464, #GA50003442, and #GA50003475, with the investigation beginning on 2025-06-02, an onsite visit on 2025-06-03, and completion on 2025-06-09.
Complaint Details
The investigation was complaint-driven based on three intake numbers. The investigation included interviews and record reviews revealing staff training deficiencies, care plan communication failures, and inadequate resident care including laundry service issues.
Findings
The facility failed to ensure that all staff were properly trained initially to provide safe, quality care in the memory care center, care plans were not shared with direct care staff as a guide for resident care, and residents did not consistently receive adequate and appropriate care, including issues with laundry services for multiple residents.
Deficiencies (3)
Facility failed to ensure all staff were properly trained initially to provide safe, quality care in the memory care center.
Facility failed to ensure care plans were shared with direct care staff and served as a guide for delivery of care to residents.
Facility failed to provide care and services which were adequate, appropriate, and in compliance with state law and regulations for 4 sampled residents, including issues with laundry not being done as scheduled.
Report Facts
Intake numbers investigated: 3
Dates of investigation: 8
Number of sampled residents with care issues: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff F | Named in staff training deficiency and interview stating no memory care training received | |
| Staff G | Named in staff training deficiency | |
| Staff I | Certified Medication Aide (CMA) | Named in staff training deficiency and interview denying working on 6/2/25 |
| Staff H | Named in medication administration on 6/2/25 by agency staff | |
| Staff B | Interviewed regarding medication administration record update | |
| Staff A | Provided email correspondence about agency staff training and acknowledged laundry issues | |
| CC | Interviewed about medication administration and laundry issues | |
| AA | Interviewed about agency staff performance and feeding assistance | |
| DD | Interviewed about lack of access to updated resident care plans | |
| EE | Interviewed about not reviewing care plans due to lack of access | |
| BB | Interviewed about ongoing laundry issues |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Apr 21, 2025
Visit Reason
The purpose of this visit was to investigate complaint numbers #GA50001602 and #GA50002405, and to conduct a compliance inspection at Laurel Lodge Assisted Living & Memory Care.
Complaint Details
The visit was complaint-related, investigating complaints #GA50001602 and #GA50002405. The findings were substantiated as deficiencies in staff training, health screenings, and resident admission documentation.
Findings
The inspection found multiple deficiencies including failure to ensure ongoing staff training with required continuing education hours for 2 of 5 staff, failure to ensure tuberculosis screenings and physical examinations within twelve months for 3 of 5 staff, and failure to maintain required physical examination documentation for 2 of 4 residents prior to admission.
Deficiencies (3)
Staff providing hands-on personal services did not have the required sixteen hours of job-related continuing education annually for 2 of 5 staff (Staff C and Staff D).
Employees did not receive tuberculosis screening and physical examination by a licensed provider within twelve months prior to providing care for 3 of 5 staff (Staff B, Staff C, and Staff F).
Documentation of physical examination within 30 days prior to admission reflecting no need for continuous medical or nursing care and free of active tuberculosis was not maintained for 2 of 4 residents (Resident #3 and Resident #4).
Report Facts
Staff requiring continuing education: 2
Staff lacking required health screenings: 3
Residents lacking admission physical exam documentation: 2
Total staff reviewed: 5
Total residents reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Failed to have 16 hours of continuing education and lacked required physical exam and TB screening. | |
| Staff D | Failed to have 16 hours of continuing education. | |
| Staff B | Lacked physical exam and had TB screening completed by LPN, not licensed physician. | |
| Staff F | Lacked physical exam and TB screening results. | |
| Staff A | Interviewed and aware of findings regarding staff training and health screenings. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Mar 11, 2025
Visit Reason
The purpose of this visit was to investigate multiple complaints identified by case numbers GA50000683, GA00252711, GA00252210, GA50000674, and GA50000212, with onsite visits conducted on 2/27/25 and 3/11/25.
Complaint Details
The investigation was complaint-driven, initiated on 2/24/25, with onsite visits on 2/27/25 and 3/11/25. The complaints involved medication administration by uncertified staff and medication procurement delays affecting residents.
Findings
The facility failed to ensure that only certified medication aides administered medications, as Staff A administered medications without certification. Additionally, the facility did not obtain timely refills of prescribed medications for three residents, resulting in interruptions in routine dosing and medication availability issues.
Deficiencies (2)
Failed to ensure that certified medication aides administered medications; Staff A administered medications without certification.
Failed to obtain timely refills of prescribed medications for 3 of 7 residents, causing interruptions in routine dosing.
Report Facts
Staff involved: 6
Residents affected: 3
Medication doses missed: 3
Dates of onsite visits: 2/27/25 and 3/11/25
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Uncertified staff who administered medications and acknowledged lack of medical training | |
| Staff G | Staff who took over medication cart from Staff A on 3/11/25 | |
| Staff B | Staff who stated med techs had no system for reordering medications | |
| Staff F | Staff who explained MAR documentation and insulin needle shortages | |
| DD | Interviewed staff who confirmed Staff A passed medications | |
| EE | Interviewed staff who observed Staff A passing medications | |
| CC | Interviewed staff who reported Resident #3 was out of insulin and taken to ER |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 13, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00250784.
Complaint Details
Investigation started on 2024-11-07, on-site visit was made on 2024-11-13, and the investigation was completed on 2024-11-19.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Sep 24, 2024
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA00249906, #GA00249803, and #GA00250420 with an onsite visit made on 9/24/24 and the investigation completed on 9/26/24.
Complaint Details
Investigation was complaint-related based on intakes #GA00249906, #GA00249803, and #GA00250420. The report details discrepancies in medication administration times for Resident #1, with interviews confirming the issue and lack of staff awareness.
Findings
The facility failed to ensure medication administration was provided according to physicians' orders for one resident. Specifically, Resident #1 was given Quetiapine at incorrect times not matching the physician's orders, indicating a medication administration discrepancy.
Deficiencies (1)
Failed to ensure medication administration services were provided in accordance with physicians' orders for Resident #1, who was given Quetiapine 25 mg at 9:00 p.m. instead of the ordered 12:00 p.m.
Report Facts
Intakes investigated: 3
Medication doses given incorrectly: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| AA | Interviewed staff who stated Resident #1 was given Seroquel four times a day but prescribed once a day | |
| BB | Interviewed staff who stated dementia worsened and Quetiapine was increased; confirmed correct medication times | |
| Staff B | Interviewed staff unaware of medication time discrepancy; suggested pharmacy error |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 11, 2024
Visit Reason
The purpose of this visit was to investigate allegation Intake GA00247446.
Complaint Details
Investigation of allegation Intake GA00247446 with no rule violations found.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 12, 2024
Visit Reason
The purpose of this visit was to investigate complaints #GA00245887, #GA00246164, and #GA00247078.
Complaint Details
Investigation of complaints #GA00245887, #GA00246164, and #GA00247078 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 11, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00244142.
Complaint Details
Investigation of intake #GA00244142 with no rule violations found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 6
Date: Nov 7, 2023
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA00238610, #GA00238492, #GA00239575, and #GA00240349 with onsite visits on 9/27/23, 10/24/23, and 11/7/23, and the investigation completed on 11/7/23.
Complaint Details
The visit was complaint-related, investigating four complaint intakes as stated in the initial comments section.
Findings
The facility was found deficient in multiple areas including failure to ensure criminal background checks for direct care staff, lack of current emergency first aid and CPR certifications for staff providing hands-on personal services, failure to maintain proper physical examination documentation for residents, and multiple medication administration and procurement issues including inaccurate medication administration records, delayed medication availability, and failure to timely obtain new prescriptions and refills.
Deficiencies (6)
Failed to ensure direct care staff had required criminal background check upon employment or prior to placement for 1 of 9 sampled staff.
Failed to ensure staff hired to provide hands-on personal services received current certification in emergency first aid for 1 of 9 sampled staff.
Failed to ensure staff hired to provide hands-on personal services received current certification in CPR for 1 of 9 sampled staff.
Failed to maintain documentation of a physical examination within 30 days prior to admission stating resident does not require continuous medical or nursing care for 1 of 8 sampled residents.
Failed to ensure staff updated medication administration record (MAR) each time medication was offered or taken for 2 of 8 sampled residents.
Failed to obtain new prescriptions within 48 hours and timely refills to avoid interruption in routine dosing for 3 of 8 residents.
Report Facts
Sampled staff: 9
Sampled residents: 8
Medication doses missed: 13
Medication delay days: 6
Date of survey completion: Nov 7, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Interviewed multiple times regarding deficiencies including medication issues and staff training | |
| Staff C | Interviewed regarding medication procurement and documentation issues | |
| Staff D | Interviewed regarding background check and physical exam deficiencies | |
| Staff E | Direct care staff missing criminal background check | |
| Staff F | Staff missing current emergency first aid and CPR certifications | |
| Staff I | Staff member who documented medication administration record incorrectly and received additional training | |
| BB | Interviewed regarding medication administration and procurement issues | |
| AA | Reported multiple complaints about medication refill issues |
Inspection Report
Original Licensing
Deficiencies: 0
Date: Jun 15, 2023
Visit Reason
The purpose of this visit was to conduct an initial inspection.
Findings
No violations were cited as a result of this survey.
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Mar 28, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00232562.
Complaint Details
Investigation of intake #GA00232562 revealed that Staff C falsified medication administration records by signing another staff member's initials for oxycodone administration that was not given. Staff C was terminated for this violation. The resident did not receive scheduled oxycodone at 10:00 p.m. on multiple dates due to being asleep, contrary to physician orders.
Findings
The facility failed to ensure that the medication administration record (MAR) was accurately updated for one resident, including falsification of medication administration by a staff member. Additionally, the facility failed to ensure physician orders were followed for the same resident, who did not receive scheduled medication due to being asleep.
Deficiencies (2)
Facility failed to ensure that the medication administration record (MAR) was updated each time the medication was offered or taken for 1 of 1 resident (Resident #1), including falsification of medication administration by Staff C.
Facility failed to ensure that physician orders were followed according to instructions for 1 of 1 resident (Resident #1), with medication not given at scheduled times due to resident being asleep.
Report Facts
Dates medication not given: 6
Medication frequency: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Terminated for falsifying medication administration record by signing another staff's initials. | |
| Staff D | Named in medication error finding; did not give medication at 10:00 p.m. due to resident asleep and alerted others. | |
| Staff B | Reported suspicions about Staff C's documentation and provided interview information. | |
| Staff E | Received message from Staff D about medication not given and confirmed forged signature. | |
| Staff A | Aware of the findings. |
Inspection Report
Routine
Deficiencies: 8
Date: Mar 24, 2022
Visit Reason
The purpose of this survey was to conduct a compliance inspection of Laurel Lodge Assisted Living & Memory Care.
Findings
The facility failed to ensure staff were properly trained and certified in emergency preparedness, emergency first aid, cardiopulmonary resuscitation, medical and social needs of residents, medication training, and continuing education. Additionally, the facility failed to display the memory care certificate and failed to update medication administration records for sampled residents.
Deficiencies (8)
Staff were not trained in emergency preparedness for 1 of 6 sampled staff (Staff B).
Staff hired to provide hands-on personal services did not have current certification in emergency first aid for 2 of 6 sampled staff (Staff B and Staff C).
Staff hired to provide hands-on personal services did not have current certification in cardiopulmonary resuscitation requiring return demonstration of competency for 2 of 6 sampled staff (Staff B and Staff C).
Staff were not trained in medical and social needs and characteristics of the resident population for 2 of 6 sampled staff (Staff B and Staff C).
Staff were not trained in medication training for 2 of 6 sampled staff (Staff B and Staff C).
Staff providing hands-on personal services lacked documentation of minimum sixteen (16) hours of job-related continuing education for 1 of 6 sampled staff (Staff E).
Facility failed to display the memory care certificate in a conspicuous place visible to residents and visitors.
Facility failed to update the medication administration record (MAR) each time medication was offered or taken for 2 of 5 sampled residents (Resident #1 and Resident #5).
Report Facts
Number of sampled staff with training deficiencies: 6
Number of sampled residents with MAR deficiencies: 2
Hours of continuing education required: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in multiple findings related to lack of training and certification | |
| Staff C | Named in multiple findings related to lack of training and certification | |
| Staff E | Named in finding related to lack of continuing education documentation | |
| Staff A | Interviewed staff aware of findings and deficiencies | |
| Staff F | Interviewed staff regarding MAR update deficiencies |
Inspection Report
Original Licensing
Deficiencies: 0
Date: Sep 11, 2020
Visit Reason
The purpose of this visit was to conduct the initial inspection of the facility.
Findings
No rule violations were cited as a result of this inspection.
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