The most recent inspection on June 18, 2025, found no deficiencies. Earlier inspections showed a pattern of deficiencies related mainly to staffing issues, including inadequate nurse presence in the memory care unit and insufficient trained caregiver coverage, as well as failures in incident reporting and infection control practices. Complaint investigations mostly resulted in unsubstantiated findings, except for a citation regarding failure to report a serious incident within 24 hours and some staffing and supervision concerns. Enforcement actions such as fines or license suspensions were not listed in the available reports. The trend suggests improvement over time, with the most recent inspections showing no deficiencies after a period of multiple citations.
Deficiencies (last 5 years)
Deficiencies (over 5 years)1.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
63% better than Georgia average
Georgia average: 4.9 deficiencies/year
Deficiencies per year
86420
2020
2021
2023
2024
2025
Inspection Report Original LicensingDeficiencies: 0Jun 18, 2025
Visit Reason
The purpose of this visit was to conduct a change of ownership (CHOW) inspection at the facility.
Findings
The inspection began on 2025-06-18 and ended on 2025-06-25. No rule violations were cited as a result of this inspection.
The purpose of this visit was to investigate intake #GA00237540 regarding allegations of verbal and physical abuse of Resident #1 by staff.
Findings
The facility failed to report a serious incident involving Resident #1 within 24 hours as required. Allegations included that Resident #1 was yelled at and beaten by an agency staff member on 7/23/2023, but no law enforcement was notified. Interviews revealed conflicting statements among staff about the abuse and reporting.
Complaint Details
The investigation was triggered by intake #GA00237540 alleging that Resident #1 was verbally and physically abused by an agency staff member. The complaint was not substantiated as staff gave conflicting accounts, and no law enforcement was notified.
Severity Breakdown
SS= D: 1
Deficiencies (1)
Description
Severity
Failure to report to the Department within 24 hours a serious incident involving a resident as required by regulation.
SS= D
Report Facts
Incident date: Jul 23, 2023Report date: Oct 4, 2023Number of sampled residents: 4
The purpose of this visit was to investigate complaint intakes GA00219873 and GA00220094 with an on-site visit conducted on 12/29/2021.
Findings
The facility failed to ensure that one registered professional nurse, licensed practical nurse, or certified medication aide was on-site at all times in the memory care unit. Observations and interviews revealed that on 12/29/21, no qualified nurse or medication aide was present in the memory care unit during the inspection.
Complaint Details
The visit was complaint-related, investigating intakes GA00219873 and GA00220094. The investigation was closed on 01/04/2022.
Severity Breakdown
D: 1
Deficiencies (1)
Description
Severity
Facility failed to ensure one registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times in the memory care unit.
D
Employees Mentioned
Name
Title
Context
Staff D
Certified Medication Aide (CMA)
Interviewed and observed working on 1st floor Assisted Living Unit and going back and forth between AL and Memory Care unit.
Staff E
Licensed Practical Nurse (LPN)
Interviewed and stated helping to cover 1st floor Assisted Living Unit and noted Staff C was not a CMA or licensed caregiver.
The purpose of this visit was to investigate intake GA00218939 and conduct the compliance inspection at the assisted living facility.
Findings
The facility failed to ensure adequate staffing with trained caregivers on each occupied floor, lacked a memory care certificate for the memory care unit, did not have proper physician physical examination reports reflecting dementia diagnosis for residents, failed to involve residents' families in care plan development, and did not secure quarterly pharmacist reviews for certified medication aides.
Complaint Details
The visit was complaint-related, investigating intake GA00218939. The investigation was completed on 11/18/2021.
Severity Breakdown
D: 5
Deficiencies (5)
Description
Severity
Failed to ensure at least two trained staff present at all times with one on each occupied floor.
D
Failed to obtain and display a memory care certificate for the memory care unit.
D
Failed to ensure residents have a physician's physical examination report completed within 30 days prior to admission reflecting dementia diagnosis.
D
Failed to ensure resident's family participated in the development of the resident's written care plan.
D
Failed to secure quarterly pharmacist reviews of drug regimens for certified medication aides.
D
Report Facts
Residents on first floor: 6Residents on second floor: 5Residents in memory care unit: 7Sampled residents with care plan issues: 2Sampled staff without quarterly pharmacist review: 2
Employees Mentioned
Name
Title
Context
Staff A
Interviewed regarding staffing, care plans, memory care certificate, and pharmacist reviews
Staff C
Caregiver on first floor and certified medication aide without quarterly pharmacist review
Staff D
Assigned to second floor but was on lunch break during inspection
Staff F
Certified medication aide without quarterly pharmacist review
The purpose of this visit was to investigate complaint intakes #GA00216959 and GA00216833 with an onsite visit conducted on 09/15/2021.
Findings
The facility failed to ensure adequate supervision of residents consistent with their needs, resulting in the elopement of Resident #1 from the memory care unit. Additionally, the facility failed to ensure staff demonstrated proper infection control practices, as one staff member was observed not wearing a mask while providing care.
Complaint Details
The investigation was initiated due to complaint intakes #GA00216959 and GA00216833 regarding inadequate supervision leading to Resident #1's elopement and improper infection control practices by staff.
Severity Breakdown
SS= D: 2
Deficiencies (2)
Description
Severity
Failure to supervise residents consistent with their needs, resulting in Resident #1 eloping from the memory care unit.
SS= D
Failure to ensure staff demonstrated understanding and use of proper infection control practices; Staff D was observed not wearing a mask while providing care.
SS= D
Report Facts
Sampled residents: 6Sampled staff: 10Time of Resident #1 elopement: 1252
Employees Mentioned
Name
Title
Context
Staff C
Observed Resident #1 outside the neighboring library and provided interview details about the elopement
Staff F
Held the door open allowing Resident #1 to exit the memory care unit; was new and unaware of the incident
Staff D
Observed not wearing a mask while providing care to residents, violating infection control policies
Staff I
Reviewed security camera footage of the elopement incident
Staff B
Provided information about Staff F and the elopement incident
Staff A
Provided interview regarding video footage and facility mask policy
Staff G
On-duty staff at the memory care unit during the elopement incident