9/5/2019 - COMPLAINT HEALTH SURVEY - GLEN AT LAKE OCONEE VILLAGE, THEPRINTED: 10/15/2019
FORM APPROVED State of GA, Healthcare Facility Regulation Division
State of GA Inspection Report
STATE FORM 6899 Q9MV11 If continuation sheet Page 1 of 1
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
ALC000233
(X2) MULTIPLE CONSTRUCTION
A.BUILDING
B.WING
(X3) DATE SURVEY
COMPLETED
09/05/2019
NAME OF PROVIDER OR SUPPLIER
GLEN AT LAKE OCONEE VILLAGE, THE
STREET ADDRESS, CITY, STATE, ZIP CODE
1070 OLD SALEM ROAD
GREENSBORO, GA 30642
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
{L 000} Initial Comments.
The purpose of this visit was to investigate #GA00199029. No rule violations were cited as a
result of this inspection.