Deficiencies per Year
4
3
2
1
0
Moderate
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Deficiencies: 0
Jun 16, 2025
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey.
Findings
The facility, Adams Heritage, was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Annual Recertification and State Licensure survey.
Inspection Report
Renewal
Census: 37
Capacity: 37
Deficiencies: 1
May 21, 2025
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted on May 21, 22, 23, and 27, 2025.
Findings
The facility failed to ensure food items were labeled and dated in the kitchen, with multiple food items found unlabeled or past expiration dates. All 37 residents were served food prepared in the kitchen. A plan of correction was implemented including discarding questionable food, re-education of staff, and ongoing monitoring.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure food items were labeled and dated in the kitchen. | SS=F |
Report Facts
Census: 37
Total Capacity: 37
Survey Dates: 4
Medicare Residents: 2
Medicaid Residents: 24
Other Payor Residents: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Natasha Graves | Administrator | Signed the report and involved in administrative oversight |
| Dietary Manager | Interviewed regarding food labeling and storage practices | |
| Director of Nursing | Interviewed confirming all residents were served food prepared in the kitchen |
Inspection Report
Complaint Investigation
Census: 44
Capacity: 44
Deficiencies: 0
Apr 15, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00455517.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00455517 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 44
Total Capacity: 44
Medicare Census: 7
Medicaid Census: 25
Other Payor Census: 12
Inspection Report
Complaint Investigation
Census: 40
Capacity: 40
Deficiencies: 0
Mar 13, 2025
Visit Reason
This visit was conducted for the investigation of complaints IN00454822 and IN00455370.
Findings
No deficiencies related to the allegations in complaints IN00454822 and IN00455370 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of Complaints IN00454822 and IN00455370 found no deficiencies related to the allegations.
Report Facts
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 25
Census Payor Type - Other: 12
Inspection Report
Re-Inspection
Census: 37
Capacity: 61
Deficiencies: 0
Nov 12, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey that exited on 08/20/24 was conducted by the Indiana Department of Health in accordance with 42 CFR Subpart 483.90(a).
Findings
At this Life Safety Code Survey, Adams Heritage was found in compliance with the Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 483.90(a). The facility is a one-story, fully sprinklered building with a fire alarm system and smoke detectors.
Report Facts
Certified beds: 61
Census: 37
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 27, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey conducted on August 27, 2024.
Findings
Adams Heritage was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Inspection Report
Life Safety
Census: 45
Capacity: 61
Deficiencies: 1
Aug 20, 2024
Visit Reason
The survey was conducted as a Life Safety Code Recertification and State Licensure Survey by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The facility was found not in compliance with Life Safety Code requirements due to failure to ensure a full hydrostatic flush was performed on the automatic sprinkler piping system as required by NFPA 25, 2011 edition. The internal inspection revealed contamination but no obstructions preventing system function. The sprinkler system was never out of service and corrective actions were scheduled and completed shortly after the survey.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure a full hydrostatic flush was performed on the automatic sprinkler piping system as required by NFPA 25, 2011 edition. | SS=F |
Report Facts
Facility capacity: 61
Census: 45
Deficiencies cited: 1
Completion date: Sep 4, 2024
Flush service dates: Sep 3, 2024
Flush service dates: Sep 4, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Technician | Interviewed regarding sprinkler system inspection findings | |
| Facilities Manager | Interviewed regarding sprinkler system inspection findings and corrective action scheduling | |
| Life Safety Coordinator | Interviewed regarding sprinkler system inspection findings | |
| Quality Assurance (QA) nurse | Present at exit conference reviewing findings | |
| Director of Nursing | Present at exit conference reviewing findings | |
| Administrator | Present at exit conference reviewing findings |
Inspection Report
Renewal
Census: 40
Capacity: 40
Deficiencies: 1
Jul 30, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted on July 24, 25, 26, and 30, 2024.
Findings
The facility failed to separate oral medications from external medications in one medication cart affecting one resident. The facility policy requires internal medications to be stored together and separated by resident. The nurse involved was educated and corrective actions were implemented including routine education and audits to prevent recurrence.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to separate oral medications from external medications for 1 of 1 medication cart reviewed affecting 1 resident. | SS=D |
Report Facts
Census: 40
Total Capacity: 40
Medicare Census: 4
Medicaid Census: 25
Other Payor Census: 11
Deficiency Completion Date: Aug 12, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN 2 | Registered Nurse | Named in medication storage deficiency and interview |
| Director of Nursing | DON | Interviewed regarding medication storage and nurse's compliance |
Inspection Report
Complaint Investigation
Census: 40
Capacity: 40
Deficiencies: 0
May 23, 2024
Visit Reason
This visit was conducted for the investigation of complaint IN00433146.
Findings
No deficiencies related to the allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the complaint investigation.
Complaint Details
Complaint IN00433146 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 23
Census Payor Type - Other: 13
Inspection Report
Complaint Investigation
Census: 42
Capacity: 42
Deficiencies: 0
Apr 5, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00430925.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00430925 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 42
Census Payor Type - Medicare: 6
Census Payor Type - Medicaid: 23
Census Payor Type - Other: 13
Inspection Report
Complaint Investigation
Census: 40
Capacity: 40
Deficiencies: 0
Mar 6, 2024
Visit Reason
This visit was conducted for the investigation of Complaints IN00426750 and IN00427072.
Findings
No deficiencies related to the allegations in Complaints IN00426750 and IN00427072 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Investigation of Complaints IN00426750 and IN00427072 found no deficiencies related to the allegations.
Report Facts
Census: 40
Total Capacity: 40
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 26
Census Payor Type - Other: 12
Inspection Report
Complaint Investigation
Census: 41
Capacity: 41
Deficiencies: 0
Jan 11, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00423625 and IN00424139.
Findings
No deficiencies related to the allegations in complaints IN00423625 and IN00424139 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of Complaints IN00423625 and IN00424139 found no deficiencies related to the allegations; both complaints were not substantiated.
Report Facts
Census Bed Type: 41
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 29
Census Payor Type - Other: 10
Inspection Report
Complaint Investigation
Census: 41
Capacity: 41
Deficiencies: 0
Nov 14, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00419826.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00419826 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 3
Medicaid census: 26
Other payor census: 12
Inspection Report
Life Safety
Census: 45
Capacity: 61
Deficiencies: 1
Oct 13, 2023
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with 42 CFR 483.73 and 42 CFR 483.90(a) respectively.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was found not in compliance with Life Safety Code requirements due to 10 sprinkler heads in the kitchen being loaded, corroded, or covered with foreign material, which could affect staff and up to 25 residents in one smoke compartment.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure 10 of 10 sprinkler heads in the kitchen were not loaded, corroded, or covered with foreign material in accordance with LSC 9.7.5 and NFPA 25. | SS=E |
Report Facts
Facility capacity: 61
Census: 45
Sprinkler heads deficient: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Natasha Graves | Administrator | Named as Administrator during the survey and exit conference |
| Maintenance Director | Interviewed and confirmed sprinkler heads were loaded and/or corroded |
Inspection Report
Life Safety
Deficiencies: 0
Oct 13, 2023
Visit Reason
Paper compliance to the Life Safety Code Recertification and State Licensure Survey conducted on 10/13/23.
Findings
Adams Heritage was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Complaint Investigation
Census: 46
Capacity: 46
Deficiencies: 0
Oct 3, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00416660.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaint IN00416660 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 46
Total Capacity: 46
Medicare Census: 4
Medicaid Census: 24
Other Payor Census: 18
Inspection Report
Renewal
Census: 42
Capacity: 42
Deficiencies: 0
Sep 5, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted over multiple days from August 29 to September 5, 2023.
Findings
Adams Heritage was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the Recertification and State Licensure Survey.
Report Facts
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 24
Census Payor Type - Other: 15
Inspection Report
Complaint Investigation
Census: 45
Capacity: 45
Deficiencies: 0
Mar 9, 2023
Visit Reason
This visit was for the Investigation of Complaint IN00402699.
Findings
No deficiencies related to the allegations are cited. Adams Heritage was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the Investigation of Complaint IN00402699.
Complaint Details
Complaint IN00402699 - No deficiencies related to the allegations are cited.
Report Facts
Census Bed Type: 45
Census Payor Type: 5
Census Payor Type: 24
Census Payor Type: 16
Inspection Report
Life Safety
Census: 43
Capacity: 61
Deficiencies: 0
Jan 23, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 12/06/22 by the Indiana Department of Health.
Findings
At this Life Safety Code Survey, Adams Heritage was found in compliance with Requirements for Medicare and Medicaid Participating Providers and Suppliers, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC) and 410 IAC 16.2.
Inspection Report
Life Safety
Census: 40
Capacity: 61
Deficiencies: 4
Dec 6, 2022
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with federal regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but not in compliance with Life Safety Code requirements. Deficiencies were identified related to hazardous area protection, sprinkler system maintenance, fire safety plan completeness, gas equipment storage, and evacuation planning.
Severity Breakdown
SS=E: 3
SS=D: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 1 storage rooms with large amounts of combustible storage and greater than 50 square feet was protected as a hazardous area; corridor door was not self-closing or automatic closing. | SS=E |
| Failed to ensure 1 of 1 sprinkler systems were provided with spare sprinklers in secured slots in the cabinet. | SS=D |
| Failed to provide a written fire safety plan that addressed all required components including relocation of wheeled equipment during a fire or similar emergency. | SS=E |
| Failed to ensure empty oxygen cylinders are segregated from full cylinders and marked to avoid confusion. | SS=E |
Report Facts
Facility capacity: 61
Census: 40
Storage room size: 50
Storage racks length: 20
Spare sprinkler heads: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Natasha Graves | Administrator | Named during exit conference and report signature |
| Lead Maintenance Mechanic | Interviewed and involved in observations related to deficiencies |
Inspection Report
Annual Inspection
Deficiencies: 0
Nov 22, 2022
Visit Reason
Paper compliance review to the Annual Recertification and State Licensure survey completed on October 31, 2022.
Findings
Adams Heritage was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper review for the Recertification and State Licensure survey.
Inspection Report
Renewal
Census: 42
Capacity: 42
Deficiencies: 1
Oct 31, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from October 25 to October 31, 2022.
Findings
The facility failed to ensure medications were administered without errors for 2 of 12 residents reviewed during 2 of 30 medications observed, involving improper handling and administration of medications by agency staff.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure medications were administered without errors for 2 of 12 residents reviewed; during 2 of 30 medications observed (Resident 15 and Resident 7). | SS=D |
Report Facts
Residents reviewed: 12
Medications observed: 30
Census: 42
Total capacity: 42
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Natasha Graves | Administrator | Signed the report as facility administrator |
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