Inspection Reports for Summerset
3711 BENJAMIN E MAYS DRIVE SW, ATLANTA, GA, 30331
Back to Facility ProfileInspection Report Summary
The most recent inspection on March 11, 2025, found no deficiencies. Earlier inspections showed a mixed record, with some substantiated deficiencies primarily related to staffing and supervision in the memory care unit, medication administration, and resident care issues such as inadequate response to falls and personal care. Notable events included a resident injury due to lack of supervision in 2023 and a failure to report a serious injury in 2020, but no fines, license suspensions, or enforcement actions were listed in the available reports. Most complaint investigations were unsubstantiated, with substantiated cases focusing on care and supervision concerns. The facility’s recent inspections indicate improvement, as no deficiencies have been cited in the last several complaint investigations.
Deficiencies (last 8 years)
Deficiencies (over 8 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
59% better than Georgia average
Georgia average: 4.9 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
16 residents
Based on a August 2023 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 11, 2025
Visit Reason
An onsite visit was made to this facility to investigate intake GA 50001424.
Complaint Details
Investigation began on 2025-03-06 and completed on 2025-03-11. No violations were found.
Findings
No rules violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 13, 2024
Visit Reason
The purpose of this visit was to complete the compliance inspection and investigate intake #GA00252208. An unannounced visit was made on 12/11/2024.
Complaint Details
Investigation of intake #GA00252208; no rule violations were found.
Findings
The inspection was completed on 12/13/2024. No rule violations were cited.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 18, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00247682 through an unannounced visit made on 2024-07-16, with the inspection completed on 2024-07-18.
Complaint Details
Investigation of intake #GA00247682; no violations found.
Findings
No rule violations were cited during the investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 22, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00243141 with an onsite visit made on 2/22/2024 and inspection completed on 2/23/2024.
Complaint Details
Investigation of intake #GA00243141; no violations found.
Findings
No rule violations were cited during the investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jan 10, 2024
Visit Reason
The purpose of this visit was to investigate intake # GA00240937.
Complaint Details
Investigation started and completed on 2024-01-10 with no rule violations cited.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 9, 2023
Visit Reason
A desk review was completed to investigate intake #GA00239994. The investigation began on 2023-11-02 and was completed on 2023-11-09.
Complaint Details
Investigation of intake #GA00239994 was completed with no rule violations cited.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Census: 16
Deficiencies: 5
Date: Aug 1, 2023
Visit Reason
The purpose of this visit was to investigate intake #GA00236995 and #GA00237100. An onsite visit was made on 8/1/23 and the investigation was completed on 8/23/23.
Complaint Details
The investigation was triggered by intake #GA00236995 and #GA00237100. The complaint involved inadequate staffing and supervision in the memory care unit, resulting in resident injuries and medication administration issues. The complaint was substantiated based on observations, interviews, and record reviews.
Findings
The facility failed to display a current certification for the memory care unit, failed to ensure adequate staffing with registered nurses or certified medication aides on-site at all times in the memory care unit, and failed to provide two direct care staff persons on site in the memory care unit at all times. Additionally, the facility failed to ensure proper documentation of medication administration and adequate care and supervision, resulting in a resident injury.
Deficiencies (5)
Facility failed to display a current certification for the memory care unit.
Facility failed to ensure at least one registered nurse, licensed practical nurse, or certified medication aide on-site at all times in the memory care unit.
Facility failed to provide two direct care staff persons on site in memory care unit at all times.
Facility failed to ensure staff updated the Medication Administration Record (MAR) each time medication was offered or taken for 2 sampled residents.
Facility failed to ensure each resident received adequate care and services, resulting in a resident with a fractured wrist due to lack of supervision.
Report Facts
Census in memory care unit: 16
Missed MAR signatures: 29
Medication administration missed cells: 100
Inspection Report
Complaint Investigation
Census: 45
Deficiencies: 1
Date: Apr 12, 2023
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA00231094, #GA00231489, and #GA00232947. An onsite visit was made on 2023-03-29 and the investigation was completed on 2023-04-12.
Complaint Details
The investigation was triggered by complaints that Resident #1 had fallen and was left on the floor all night calling for help without staff response. The call button was not working, and staff failed to check on the resident. The complaint was substantiated based on observations, record review, and interviews.
Findings
The facility failed to provide adequate and appropriate care and services for Resident #1, who had a non-functional call button and was found lying on the floor for an extended period without staff response. Multiple interviews confirmed the resident fell and was left unattended overnight, despite attempts to call for help.
Deficiencies (1)
Failure to provide adequate care and services to Resident #1, including non-functional call button and lack of staff response after a fall.
Report Facts
Residents observed: 45
Staff observed: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| BB | Interviewed regarding Resident #1's fall and non-functional call button | |
| CC | Interviewed regarding complaint call and video monitoring of Resident #1 | |
| GG | Interviewed as contact who received call from Resident #1 and reported fall | |
| Staff A | Interviewed about call button functionality and room check sheets |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 27, 2022
Visit Reason
The purpose of this visit was to investigate intake numbers GA00226278 and GA00225977.
Complaint Details
Investigation of intake numbers GA00226278 and GA00225977; no violations found.
Findings
No rule violations were cited as a result of this visit.
Inspection Report
Complaint Investigation
Census: 30
Deficiencies: 3
Date: Jul 5, 2022
Visit Reason
The purpose of this visit was to investigate complaint intakes #GA00224424, #GA00224715, #GA00224753, and #GA00224890. An onsite visit was made on 2022-06-17 and the investigation was completed on 2022-07-05.
Complaint Details
The investigation was complaint-driven based on multiple intakes. The findings included substantiated deficiencies related to linen laundering, medication administration errors, and inadequate personal care for residents.
Findings
The facility failed to change and launder linens weekly for one resident, failed to provide medication administration services in accordance with physician's orders for two residents, and failed to provide adequate care and services for one resident, including timely changing of incontinent products.
Deficiencies (3)
Failed to change and launder linens weekly for Resident #2, resulting in the resident sleeping on a plastic mattress cover without sheets for three days.
Failed to provide medication administration services in accordance with physician's orders for Residents #2 and #4, including delayed administration of Torsemide and continued administration of discontinued Lisinopril.
Failed to provide adequate care and services for Resident #1, who was observed wet and not changed regularly despite requiring maximum assistance with activities of daily living.
Report Facts
Residents observed during tour: 30
Sampled residents: 4
Medication administration delay: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Interviewed regarding knowledge of resident laundry and bed making, and medication order discontinuation process | |
| BB | Interviewed about bed linen replacement for Resident #2 | |
| AA | Interviewed about medication administration delays and resident condition | |
| DD | Interviewed about past medication errors | |
| EE | Interviewed about observations of Resident #1's care and brief changing |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: May 23, 2022
Visit Reason
The purpose of this visit was to investigate intake GA0023683.
Complaint Details
Investigation of intake GA0023683; no rule violations cited.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Feb 11, 2022
Visit Reason
The purpose of this visit was to investigate intake GA00221278 with an onsite visit made to the facility on 2/11/2022.
Complaint Details
The visit was complaint-related, investigating intake GA00221278. The investigation started on 2/7/2022 and included an onsite visit on 2/11/2022.
Findings
The facility failed to maintain daily Medication Assistance Records (MAR) for 2 of 4 sampled residents, failed to ensure timely refills of prescribed medications for 1 resident, and failed to properly label and handle medications in accordance with regulations for 2 residents.
Deficiencies (3)
Failed to maintain a daily Medication Assistance Record (MAR) for Resident #1 and Resident #3.
Failed to ensure timely refills of prescribed medications for Resident #1, resulting in missing medications.
Failed to ensure medications were properly labeled and handled according to physician's instructions and regulations for Resident #1 and Resident #3.
Report Facts
Sampled residents: 4
Residents with MAR deficiencies: 2
Residents with medication refill issues: 1
Medications missing for Resident #1: 3
Medications in bottles for Resident #1: 6
Medications in bottles for Resident #3: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Interviewed regarding missing MAR for Resident #3 and medication repacking | |
| Staff C | Interviewed regarding checking missing medications for Resident #1 |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jan 14, 2022
Visit Reason
The purpose of this visit was to conduct the compliance inspection and investigate intake #GA00220417. An onsite visit was made on 2022-01-13 and the investigation was completed on 2022-01-14.
Complaint Details
Investigation of intake #GA00220417 was completed with no rule violations cited.
Findings
No rule violations were cited during the investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 6, 2020
Visit Reason
The purpose of this visit was to investigate intake #GA00207164.
Complaint Details
Investigation of intake #GA00207164 found no rule violations.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 1, 2020
Visit Reason
The inspection was conducted to investigate complaint intakes #GA00204763 and #GA00204284, which were initiated on 2020-05-08 and completed on 2020-06-01.
Complaint Details
Investigation of complaint intakes #GA00204763 and #GA00204284 resulted in no rule violations.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 20, 2020
Visit Reason
The purpose of this visit was to investigate intake #GA00203905, which was also investigated under GA00203535 and GA00203616.
Complaint Details
Investigation of intake #GA00203905 with no rule violations found.
Findings
No rule violations were cited as a result of this investigation.
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Apr 14, 2020
Visit Reason
The purpose of this visit was to investigate complaints GA00203553 and GA00203616 regarding an incident involving resident safety and security.
Complaint Details
The investigation was triggered by complaints GA00203553 and GA00203616. Resident #1 was assaulted by Resident #2 on 03/04/20, resulting in a large hematoma and bruising on Resident #1's face. Resident #2 was known for wandering and irritating other residents. Resident #1 was transported to the hospital and treated for facial contusions. The incident was not reported to the Department until 03/24/20, beyond the required 24-hour timeframe.
Findings
The facility failed to ensure safety and security precautions to protect residents from harm by other residents, resulting in Resident #1 being assaulted by Resident #2. Resident #1 sustained facial injuries and was hospitalized. The facility also failed to provide adequate supervision consistent with residents' needs and failed to report the serious injury to the Department within 24 hours.
Deficiencies (3)
Failed to ensure safety and security precautions to protect residents from harm by other residents.
Failed to provide supervision consistent with residents' needs.
Failed to report serious injury to the Department within 24 hours.
Report Facts
Incident time: 230
Incident report delay: 20
Resident #2 monitoring frequency: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| BB | Witnessed incident on 03/04/20 night shift, called police and notified Resident #1's family | |
| CC | Witnessed incident on 03/04/20 night shift, called police and notified Resident #1's family | |
| DD | Familiar with Resident #2, re-directed Resident #2 to own room before incident | |
| EE | Resident #2's caregiver in memory care unit, described Resident #2's wandering behavior | |
| Staff A | Confirmed incident and Resident #2's behavior, stated Resident #2 moved to memory care unit |
Inspection Report
Monitoring
Deficiencies: 0
Date: Apr 6, 2020
Visit Reason
The purpose of this review was to monitor COVID-19 cases and assess infection control processes.
Findings
The report focused on monitoring COVID-19 cases and evaluating the facility's infection control measures.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 4, 2019
Visit Reason
The purpose of this visit was to investigate intake #GA00199997 and intake #GA199956.
Complaint Details
Investigation of intake #GA00199997 and intake #GA199956 with no rule violations cited.
Findings
No rule violations were cited as a result of this visit.
Inspection Report
Complaint Investigation
Census: 66
Deficiencies: 1
Date: Sep 23, 2019
Visit Reason
The purpose of this visit was to investigate complaint #GA00199380.
Complaint Details
The visit was complaint-related to investigate #GA00199380.
Findings
The facility failed to obtain a valid license from the Department before operating as an adult day center. Observations included 66 residents and 6 Veterans Administration adult daycare participants present, with activities and meals provided as described by staff and participants.
Deficiencies (1)
Facility failed to obtain a valid license from the Department before operating as an adult day center.
Report Facts
Residents observed: 66
VA adult daycare participants observed: 6
VA daycare participants drop-in: 7
VA daycare participants drop-in: 8
VA daycare participants present on day of visit: 5
VA daycare program hours: 10
Meals provided daily: 3
Snacks provided daily: 2
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 11, 2019
Visit Reason
The purpose of this visit was to conduct the compliance inspection and to investigate intake #GA00194382.
Complaint Details
Investigation of intake #GA00194382 with no violations found.
Findings
No violations were cited as a result of this inspection.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Feb 26, 2018
Visit Reason
The purpose of this visit was to conduct the annual inspection and investigate complaint #GA00185309.
Complaint Details
Complaint #GA00185309 was investigated during this visit; no violations were found.
Findings
No violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 13, 2017
Visit Reason
The purpose of this visit was to investigate complaint #GA00175739. An on-site visit was made to the community on 6/13/17 and the investigations were completed on 7/6/17.
Complaint Details
Complaint #GA00175739 was investigated and found to have no violations.
Findings
No violations were cited as a result of the inspections.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: May 3, 2017
Visit Reason
The purpose of this visit was to conduct the annual inspection of the facility.
Findings
No violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 27, 2017
Visit Reason
The purpose of this visit was to investigate complaint #GA00171850.
Complaint Details
Complaint #GA00171850 was investigated and found to have no violations.
Findings
No violations were cited as a result of this inspection.
Viewing
Loading inspection reports...
