Inspection Reports for Sumter County Retirement Village
2124 U.S. 280 W, Plains, GA 31780, United States, GA, 31780
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Inspection Report
Complaint Investigation
Deficiencies: 2
Aug 25, 2025
Visit Reason
The visit was conducted to perform a compliance inspection and investigate intake #GA50004973. The inspection included an unannounced visit on 8/25/2025 and was completed on 8/27/2025.
Findings
The facility was found to have deficiencies related to workforce qualifications and training, including failure to provide required training and documentation for staff. Additionally, the facility failed to maintain and make available a resident file with a physician medical evaluation for one sampled resident.
Complaint Details
The inspection was triggered by intake #GA50004973. Rule violations were cited as a result of the complaint investigation.
Severity Breakdown
SS= D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure staff received required training within the first sixty days of hire, including CPR, first aid, physical examination, tuberculosis test, and infection control for 2 of 3 sampled staff. | SS= D |
| Failure to maintain and make available the resident file with physician medical evaluation for 1 of 3 sampled residents. | SS= D |
Inspection Report
Monitoring
Capacity: 24
Deficiencies: 0
Apr 11, 2025
Visit Reason
The purpose of this visit was to conduct a monitoring inspection for a decrease in capacity from 48 to 24.
Findings
No rule violations were cited as a result of this inspection.
Report Facts
Capacity decrease: 24
Inspection Report
Complaint Investigation
Deficiencies: 4
Feb 18, 2025
Visit Reason
The purpose of this visit was to investigate intake # GA50001198 with an onsite visit conducted from 2/18/2025 to 2/20/2025.
Findings
The facility failed to obtain satisfactory criminal background checks for 2 of 3 sampled staff, failed to supervise 2 of 3 sampled residents consistent with their needs, had medication administration record discrepancies for 1 resident, and failed to properly notify a resident's representative after a fall incident.
Complaint Details
The visit was complaint-related, investigating intake # GA50001198. The complaint involved issues with staff background checks, resident supervision, medication administration, and failure to notify a resident's representative after an incident.
Severity Breakdown
SS= D: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure satisfactory criminal history background checks for 2 of 3 sampled staff (Staff C and Staff D) prior to employment. | SS= D |
| Failed to ensure residents were supervised consistent with their needs for 2 of 3 sampled residents (Resident #1 and Resident #3), including neglect of Resident #3 found in soiled clothing for over 24 hours. | SS= D |
| Medication Administration Record (MAR) did not accurately reflect medications for Resident #3, including missing medications and medications listed that were not prescribed. | SS= D |
| Failed to notify the representative or legal surrogate in a timely manner after Resident #1 fell and was found soaked in urine and incoherent; notification was delayed until a routine visit. | SS= D |
Report Facts
Sampled staff: 3
Staff without satisfactory background checks: 2
Sampled residents: 3
Residents with supervision deficiencies: 2
Residents with medication record deficiencies: 1
Incident report date: Feb 19, 2025
Resident #1 admission date: Jun 5, 2025
Resident #3 admission date: Jan 18, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Provided information about background checks, resident supervision, and medication administration issues | |
| Staff C | Failed to have satisfactory background check and was removed from schedule due to resident supervision failure | |
| Staff D | Failed to notify resident representative after Resident #1 fall incident | |
| GG | Reported observations of Resident #3 in soiled clothing | |
| FF | Reported Resident #3 receiving hospice services and medication concerns | |
| EE | Resident representative not notified timely after Resident #1 fall |
Inspection Report
Complaint Investigation
Deficiencies: 0
Nov 12, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00251558 through an unannounced inspection.
Findings
No rule violations were cited as a result of this inspection and investigation.
Complaint Details
Investigation of intake #GA00251558 with no rule violations found.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jun 18, 2024
Visit Reason
The visit was conducted to perform a compliance inspection and to investigate intake #GA00247507.
Findings
No rule violations were cited as a result of this inspection and investigation.
Complaint Details
Investigation of intake #GA00247507 was completed with no rule violations found.
Inspection Report
Complaint Investigation
Deficiencies: 0
Feb 21, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00242738 with an onsite visit made on 2/21/24 and the investigation completed on 2/23/24.
Findings
No rule violations were cited as a result of this investigation.
Complaint Details
Investigation of intake #GA00242738 found no rule violations.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jan 5, 2024
Visit Reason
The purpose of this visit was to investigate intake #GA00241730.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 3
Dec 5, 2023
Visit Reason
The purpose of this visit was to investigate intake # GA0024038 with an onsite visit made to the facility on 12/5/2023 and the investigation completed on 12/8/2023.
Findings
The facility failed to ensure that staff received required work-related training including current certification in emergency first aid, failed to obtain satisfactory criminal background checks for employees prior to hire, and failed to update the Medication Assistance Record (MAR) each time medication was offered or taken for three sampled residents.
Complaint Details
The visit was complaint-related, investigating intake # GA0024038. The complaint included concerns about staff training, background checks, and medication administration records.
Severity Breakdown
D: 2
E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility failed to ensure any person working received work-related training within the first sixty days of employment including current certification in emergency first aid for 1 of 3 sampled staff (Staff B). | D |
| Facility failed to obtain a satisfactory criminal history background check prior to employment for 1 of 3 sampled staff (Staff C). | E |
| Facility staff failed to ensure the Medication Assistance Record (MAR) was updated each time medication was offered or taken for 3 of 3 sampled residents. | D |
Report Facts
Number of sampled staff with training deficiency: 1
Number of sampled staff with background check deficiency: 1
Number of sampled residents with MAR documentation issues: 3
Dates of missing MAR signatures: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in deficiency for lack of emergency first aid certification and awareness of missing MAR signatures | |
| Staff C | Named in deficiency for lack of background check and responsible for missing MAR signatures | |
| Staff A | Interviewed regarding staff training and MAR signature issues |
Inspection Report
Complaint Investigation
Deficiencies: 2
Oct 24, 2023
Visit Reason
The purpose of this visit was to investigate intake # GA00239560, with an on-site visit made on 10/24/2023 and the investigation completed on 10/26/2023.
Findings
The facility failed to obtain satisfactory fingerprint records checks for 3 of 5 sampled staff and failed to store medications under lock and key, leaving the medication room unsecured with narcotics accessible.
Complaint Details
Investigation was initiated based on intake # GA00239560. The complaint was substantiated by findings of missing fingerprint background checks and unsecured medication storage.
Severity Breakdown
SS= D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to obtain a satisfactory fingerprint records check determination for 3 of 5 sampled staff (Staff B, Staff C, and Staff D). | SS= D |
| Failed to store medications under lock and key, leaving the medication room open and unsecured with the narcotics lock box key left on the table. | SS= D |
Report Facts
Number of sampled staff without fingerprint records check: 3
Number of sampled staff reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in deficiency for missing fingerprint records check and medication room unsecured | |
| Staff C | Named in deficiency for missing fingerprint records check and medication room unsecured | |
| Staff D | Named in deficiency for missing fingerprint records check | |
| Staff A | Unable to present documentation of fingerprint records check during onsite visit |
Inspection Report
Complaint Investigation
Deficiencies: 3
Oct 3, 2023
Visit Reason
The purpose of this visit was to conduct a compliance inspection and investigate intake #GA00238406, with the investigation starting on 10/3/2023 and completing on 10/6/2023.
Findings
The facility failed to obtain satisfactory fingerprint background checks for 2 of 3 sampled staff, did not comply with fire safety rules regarding fire drills with no drills documented for 2022, and failed to provide sufficient activities to promote residents' physical, mental, and social well-being as evidenced by incomplete activity calendars and resident interviews.
Complaint Details
Investigation was initiated based on intake #GA00238406. The complaint was substantiated as deficiencies were found in criminal background checks, fire drill compliance, and resident activities.
Severity Breakdown
SS= D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to obtain a satisfactory fingerprint records check determination for 2 of 3 sampled staff (Staff B and Staff C). | SS= D |
| Failed to be in compliance with fire and safety rules regarding fire drills; no documentation of fire drills for 2022 calendar year. | SS= D |
| Failed to provide sufficient activities to promote the physical, mental, and social well-being of each resident. | SS= D |
Report Facts
Number of sampled staff missing fingerprint checks: 2
Year with no documented fire drills: 2022
Dates of documented activities: Morning moves on 9/29/2023, snack bingo on 9/30/2023, morning moves and snack bingo on 10/2/2023.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Named in deficiency for missing fingerprint background check. | |
| Staff C | Named in deficiency for missing fingerprint background check. | |
| Staff A | Interviewed regarding lack of awareness of fingerprint check rule and fire drills, and staffing for resident activities. |
Inspection Report
Complaint Investigation
Deficiencies: 0
May 25, 2023
Visit Reason
The purpose of this visit was to investigate intakes# GA00233506 and GA00233449.
Findings
No rule violations were cited as a result of this investigation.
Complaint Details
Investigation of intakes# GA00233506 and GA00233449 with no rule violations cited.
Inspection Report
Complaint Investigation
Deficiencies: 0
Apr 8, 2021
Visit Reason
The purpose of this inspection was to investigate intake #GA00212940 and conduct the compliance inspection.
Findings
The investigation began on 2021-04-05 and was completed on 2021-04-08. No rule violations were cited as a result of this inspection.
Complaint Details
Investigation of intake #GA00212940 with no rule violations cited.
Inspection Report
Complaint Investigation
Deficiencies: 0
Sep 21, 2020
Visit Reason
The purpose of this inspection was to investigate intake #GA00208040.
Findings
No rule violations were cited as a result of this investigation.
Complaint Details
Investigation of intake #GA00208040 with no rule violations cited.
Inspection Report
Monitoring
Deficiencies: 0
Apr 6, 2020
Visit Reason
The purpose of this review is to monitor COVID-19 cases and assess infection control process.
Findings
No specific findings or deficiencies are detailed in the report beyond the stated purpose to monitor COVID-19 cases and infection control.
Inspection Report
Routine
Deficiencies: 0
Jan 29, 2020
Visit Reason
The purpose of this visit was to conduct a compliance inspection.
Findings
No rule violations were cited as a result of this inspection.
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 27, 2019
Visit Reason
The purpose of this visit was to investigate complaint # GA00198892.
Findings
No rules violations were cited as a result of this investigation.
Complaint Details
Investigation of complaint # GA00198892 with no violations found.
Inspection Report
Follow-Up
Deficiencies: 1
Apr 9, 2019
Visit Reason
The purpose of this visit was to conduct a follow-up to the 11/6/18 complaint investigation.
Findings
The facility failed to ensure that only ambulatory residents capable of self-preservation with minimal assistance were admitted and retained, as evidenced by Resident #2 who was incapable of self-preservation and had no waiver on file.
Complaint Details
This visit was a follow-up to a complaint investigation conducted on 11/6/18.
Severity Breakdown
E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The home admitted and retained a resident (Resident #2) who was not ambulatory and incapable of self-preservation without a waiver. | E |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A was interviewed and stated there was a waiver in process for Resident #2 but Resident #2 was still incapable of self-preservation. |
Inspection Report
Follow-Up
Deficiencies: 1
Apr 9, 2019
Visit Reason
The purpose of this visit was to conduct a follow-up to the 1/8/19 follow-up inspection.
Findings
The facility failed to ensure that staff updated the Medication Administration Record (MAR) each time medication was offered or taken, specifically for Resident #3's Finger Stick Blood Sugar (FSBS) monitoring, with missing initials on multiple dates in March and April 2019.
Severity Breakdown
F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to update the MAR each time medication was offered or taken, as evidenced by missing initials on the FSBS Flowsheet for Resident #3 on multiple dates. | F |
Report Facts
Dates with missing documentation: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A interviewed on 4/9/19 who was unaware that staff had not been documenting Resident #3's FSBS as ordered. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 25, 2019
Visit Reason
The purpose of this visit was to investigate complaint #GA00195357.
Findings
No rule violation was cited as a result of this investigation.
Complaint Details
Investigation of complaint #GA00195357 resulted in no rule violations.
Inspection Report
Follow-Up
Deficiencies: 1
Jan 8, 2019
Visit Reason
The purpose of this visit was to conduct a follow-up to the 9/3/18 compliance inspection.
Findings
The facility failed to update the Medication Assistance Record (MAR) each time the medication was offered to or taken by a resident (Resident #3). Specifically, there was no documentation that Finger Stick Blood Sugar (FSBS) checks were done twice on several specified days.
Severity Breakdown
E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to update the Medication Assistance Record (MAR) each time medication was offered or taken for Resident #3. | E |
Report Facts
Dates missing FSBS documentation: 8
Inspection Report
Complaint Investigation
Deficiencies: 4
Nov 6, 2018
Visit Reason
The purpose of this visit was to investigate complaint #GA00192450.
Findings
The facility failed to obtain a satisfactory fingerprint records check for the Administrator prior to employment, admitted and retained a resident incapable of self-preservation, failed to properly assist with medication self-administration for a resident, and did not maintain a central file for resident incident reports.
Complaint Details
The visit was complaint-related, investigating complaint #GA00192450.
Severity Breakdown
D: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to obtain a satisfactory fingerprint records check determination prior to employment for the Administrator. | D |
| Admitted and retained a resident incapable of self-preservation with minimal assistance. | D |
| Failed to ensure staff properly assisted with self-administration of medications, including crushing medications without an order. | D |
| Failed to maintain a central file for resident incident reports. | D |
Report Facts
Hire date: Sep 4, 2018
Resident #2 admit date: Apr 30, 2018
Resident #1 admit date: May 30, 2014
Medications for Resident #1: 5
Time of interview: 1245
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Named in findings related to fingerprint check, resident self-preservation, medication administration, and incident report file | |
| Staff B | Named in medication administration finding |
Inspection Report
Routine
Deficiencies: 6
Sep 3, 2018
Visit Reason
The purpose of this visit was to conduct the compliance inspection.
Findings
The facility was found to have multiple deficiencies including failure to ensure employees received required physical examinations and tuberculosis screenings prior to employment, failure to update Medication Administration Records (MAR) properly, lack of physician orders for nutritional supplements, incomplete resident personal item inventories, inadequate care related to resident weight loss, and failure to complete annual competency checklists for proxy caregivers.
Severity Breakdown
SS= D: 6
Deficiencies (6)
| Description | Severity |
|---|---|
| Failure to ensure each employee received a physical examination and TB screening within 12 months prior to employment for 1 of 3 sampled staff (Staff B). | SS= D |
| Failure to update the Medication Administration Record (MAR) each time medication was offered or taken for 2 of 3 sampled residents (Resident #2 and Resident #3). | SS= D |
| Medication Administration Record (MAR) did not contain information for a nutritional supplement for 1 of 3 sampled residents (Resident #2). | SS= D |
| Resident file did not contain an updated inventory list of all personal items brought to the home for 1 of 3 sampled residents (Resident #3). | SS= D |
| Failure to ensure each resident received adequate and appropriate care, including addressing weight loss and physician visits for Resident #2. | SS= D |
| Failure to ensure a proxy caregiver completed an annual skills competency checklist for 1 of 4 sampled staff (Staff C). | SS= D |
Report Facts
Sampled staff: 3
Sampled residents: 3
Sampled staff: 4
Weight measurements: 117
Weight measurements: 115
Weight measurements: 113
Weight measurements: 110
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff B | Failed to have physical examination and TB screening prior to employment | |
| Staff A | Interviewed regarding Staff B's employment status, medication administration, resident care, and proxy caregiver competency | |
| Staff D | Interviewed regarding medication administration and MAR updates | |
| Staff C | Proxy caregiver who failed to complete annual skills competency checklist |
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