Deficiencies per Year
8
6
4
2
0
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 167
Deficiencies: 0
Jun 25, 2025
Visit Reason
This visit was conducted for the investigation of two complaints, IN00460760 and IN00461508.
Findings
No deficiencies related to the allegations in either complaint were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of Complaint IN00460760 and IN00461508 found no deficiencies related to the allegations.
Report Facts
Census SNF/NF beds: 112
Census Residential beds: 55
Total Census: 167
Medicare residents: 14
Medicaid residents: 60
Other payor residents: 93
Inspection Report
Complaint Investigation
Census: 55
Capacity: 163
Deficiencies: 2
May 30, 2025
Visit Reason
This visit was conducted for the investigation of Nursing Home Complaint IN00458302 and Residential Complaint IN00460127.
Findings
No deficiencies were cited related to Nursing Home Complaint IN00458302. Deficiencies related to Residential Complaint IN00460127 were cited at R215 and R240, involving failure to update assessments and inaccurate physician order documentation for one resident (Resident B).
Complaint Details
Complaint IN00458302 was not substantiated with deficiencies. Complaint IN00460127 was substantiated with deficiencies cited at R215 and R240 related to Resident B's care.
Deficiencies (2)
| Description |
|---|
| Failed to ensure assessments were updated for 1 of 6 residents reviewed (Resident B). |
| Failed to ensure physician order documentation was accurate for 1 of 6 residents reviewed (Resident B). |
Report Facts
Census: 55
Total Capacity: 163
Residents reviewed: 6
Completion date for corrective actions: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dzejna McKenzie | Director of Assisted Living | Interviewed and provided information regarding Resident B's code alert bracelet and assessments. |
Inspection Report
Complaint Investigation
Census: 124
Capacity: 124
Deficiencies: 0
Jan 22, 2025
Visit Reason
This visit was for the Investigation of Complaint IN00450027.
Findings
No deficiencies related to the allegations were cited. Adams Woodcrest 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 IN00450027.
Complaint Details
Investigation of Complaint IN00450027 found no deficiencies related to the allegations.
Report Facts
Census SNF/NF: 124
Total Capacity: 124
Census Payor Type - Medicare: 19
Census Payor Type - Medicaid: 46
Census Payor Type - Other: 59
Inspection Report
Life Safety
Deficiencies: 0
Dec 31, 2024
Visit Reason
The visit was a Life Safety Code Recertification and State Licensure Survey completed on 12/31/2024.
Findings
Adams Woodcrest was found in compliance with Medicare/Medicaid participation requirements, the Life Safety from Fire regulations, and the 2012 Edition of the NFPA 101 Life Safety Code, Chapter 18 for New Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Life Safety
Census: 114
Capacity: 143
Deficiencies: 3
Dec 13, 2024
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code (LSC) Recertification and State Licensure Survey were conducted by the Indiana Department of Health on 12/13/2024 to assess compliance with federal and state regulations including fire safety and emergency preparedness.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included fire doors in a two-hour fire rated horizontal exit that were not self-closing and latching, incorrect exit signage by the Director of Nursing office, and use of flexible cords as substitutes for fixed wiring in resident rooms and common areas.
Severity Breakdown
SS=E: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 1 doors in a two hour fire rated horizontal exit in B-wing were self-closing and latching. | SS=E |
| Failed to ensure 1 of 1 exits by the Director of Nursing (DON) office contained the correct signage; sliding glass doors marked as exit but led to enclosed courtyard with no access to common way. | SS=E |
| Failed to ensure 3 of 3 flexible cords were not used as a substitute for fixed wiring in resident rooms and nurses' station. | SS=E |
Report Facts
Residents affected: 40
Residents affected: 50
Deficiency completion date: Jan 3, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Ahmetovic | Executive Director | Signed the report. |
| Administrator | Participated in observations and interviews related to deficiencies. | |
| LSC Coordinator | Participated in observations and interviews related to deficiencies and responsible for monitoring corrective actions. | |
| Maintenance Lead | Participated in observations and interviews related to deficiencies and performed corrective actions on fire doors and electrical cords. |
Inspection Report
Annual Inspection
Census: 107
Capacity: 107
Deficiencies: 2
Nov 27, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, including the Investigation of Healthcare Complaints IN00447309, IN00447325, and Assisted Living Complaint IN00447049, as well as a State Residential Licensure Survey.
Findings
The facility was found to have deficiencies related to failure to ensure non-pharmacologic interventions were utilized prior to administering anti-anxiety medication to one resident, and failure to ensure sanitation of an ice machine and proper labeling, dating, and removal of expired food items in the kitchen and unit pantries. Complaints IN00447309, IN00447325, and IN00447049 had no deficiencies related to the allegations cited.
Complaint Details
Complaint IN00447309 and IN00447325 - No deficiencies related to the allegations are cited. Complaint IN00447049 - No deficiencies related to the allegations are cited.
Severity Breakdown
SS=D: 1
SS=E: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure non-pharmacologic interventions were utilized prior to giving anti-anxiety medication to 1 of 6 residents reviewed (Resident 4). | SS=D |
| Failed to ensure sanitation of an ice machine; labeling, dating and removal of expired food items in the kitchen and unit pantries. | SS=E |
Report Facts
Survey dates: 5
Residents receiving food prepared in facility kitchen: 110
Resident census: 53
Residents reviewed for psychotropic medication: 6
Residents with PRN psychotropic medication orders: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Ahmetovic | Executive Director | Signed the report and plan of correction. |
| RN 3 | Registered Nurse | Interviewed regarding Resident 4's behaviors and medication administration. |
| Nutrition Services Manager | Interviewed about food safety, labeling, and sanitation issues. | |
| Dietary Manager | Interviewed about food expiration and labeling. | |
| Qualified Medicine Aide 5 | Interviewed about expired food items in pantry. | |
| Licensed Practical Nurse 6 | Interviewed about ice machine sanitation and food expiration. | |
| CNA 7 | Certified Nurse Aide | Observed and commented on ice cream container labeling. |
| Administrator | Interviewed regarding staff use of deescalating techniques and documentation. |
Inspection Report
Annual Inspection
Deficiencies: 0
Nov 27, 2024
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Adams Woodcrest 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
Complaint Investigation
Census: 115
Capacity: 115
Deficiencies: 0
Jun 21, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00435326, IN00435686, and IN00436944.
Findings
No deficiencies related to the allegations in complaints IN00435326, IN00435686, and IN00436944 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
Complaints IN00435326, IN00435686, and IN00436944 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Census SNF/NF: 115
Total Capacity: 115
Census Payor Type Medicare: 12
Census Payor Type Medicaid: 56
Census Payor Type Other: 47
Inspection Report
Re-Inspection
Census: 99
Capacity: 143
Deficiencies: 0
Apr 9, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 01/19/24 was performed to verify compliance with previous deficiencies.
Findings
At this PSR survey, Adams Woodcrest 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). The facility was fully sprinklered and had appropriate fire alarm and smoke detection systems.
Report Facts
Facility capacity: 143
Census: 99
Inspection Report
Complaint Investigation
Census: 107
Capacity: 107
Deficiencies: 0
Jan 19, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00425934.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00425934 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 15
Medicaid census: 48
Other payor census: 44
Inspection Report
Annual Inspection
Census: 107
Capacity: 143
Deficiencies: 4
Jan 19, 2024
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code (LSC) Recertification and State Licensure Survey were conducted by the Indiana Department of Health on 01/19/2024.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was found not in compliance with Life Safety Code requirements, including deficiencies related to hazardous area enclosure, corridor door closures, electrical panel access, and power strip usage in patient care areas.
Severity Breakdown
SS=E: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure hazardous area (ISO storeroom) was enclosed with a 1-hour fire-rated barrier and 3/4-hour fire-rated doors without windows; fire rating tags were missing on double doors. | SS=E |
| Failed to ensure corridor door to room 905 had a means suitable for keeping the door closed; door was tied open with a rope. | SS=E |
| Failed to ensure access and working space was maintained for 2 of 2 electrical panels; medical equipment blocked access. | SS=E |
| Failed to ensure flexible cord power strip in patient care area (therapy gym) met required UL rating of 1363A or 60601-1. | SS=E |
Report Facts
Facility capacity: 143
Census: 107
Residents potentially affected: 50
Residents potentially affected: 25
Residents potentially affected: 35
Residents potentially affected: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Ahmetovic | Executive Director | Signed the report |
| Maintenance Technician | Involved in observations and corrective actions for deficiencies | |
| Life Safety Coordinator | Involved in observations and corrective actions for deficiencies | |
| Administrator | Involved in observations and corrective actions for deficiencies |
Inspection Report
Recertification
Census: 128
Deficiencies: 0
Dec 21, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, including Investigation of Complaints IN00423586, IN00422838, IN00422872, and IN00423590, as well as a State Residential Licensure Survey.
Findings
No deficiencies related to the allegations in the complaints were cited. Adams Woodcrest was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaints IN00423586, IN00422838, IN00422872, and IN00423590 were investigated with no deficiencies related to the allegations cited.
Report Facts
Census Bed Type - SNF/NF: 109
Census Bed Type - Residential: 19
Census Bed Type - Total: 128
Census Payor Type - Medicare: 9
Census Payor Type - Medicaid: 52
Census Payor Type - Other: 48
Census Payor Type - Total: 109
Inspection Report
Complaint Investigation
Census: 101
Capacity: 101
Deficiencies: 0
Oct 3, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00418478.
Findings
No deficiencies related to the allegations in Complaint IN00418478 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00418478 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare residents: 7
Medicaid residents: 49
Other payor residents: 45
Inspection Report
Complaint Investigation
Census: 102
Capacity: 102
Deficiencies: 0
Sep 5, 2023
Visit Reason
This visit was for the Investigation of Complaint IN00416257 and a COVID-19 Focused Infection Control Survey.
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 regarding the complaint investigation and COVID-19 survey.
Complaint Details
Complaint IN00416257 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census SNF/NF beds: 102
Total census: 102
Census Payor Type - Medicare: 7
Census Payor Type - Medicaid: 50
Census Payor Type - Other: 45
Inspection Report
Complaint Investigation
Census: 104
Capacity: 104
Deficiencies: 0
Aug 15, 2023
Visit Reason
This visit was for the investigation of Complaint IN00414433.
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.
Complaint Details
Investigation of Complaint IN00414433 found no deficiencies related to the allegations.
Report Facts
Census: 104
Total Capacity: 104
Medicare Census: 7
Medicaid Census: 49
Other Payor Census: 48
Inspection Report
Re-Inspection
Census: 99
Capacity: 143
Deficiencies: 0
Mar 22, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 02/13/23 was performed to verify compliance with previous deficiencies.
Findings
At this PSR survey, Adams Woodcrest 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). The facility had been remodeled in 2022 and was fully sprinklered with a fire alarm system and smoke detection.
Report Facts
Facility capacity: 143
Census: 99
Inspection Report
Life Safety
Census: 97
Capacity: 143
Deficiencies: 5
Feb 13, 2023
Visit Reason
A Life Safety Code (LSC) Recertification and State Licensure Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The facility was found not in compliance with several Life Safety Code requirements including delayed egress locking arrangements, hazardous area enclosure, sprinkler system testing, corridor door latching, and emergency generator battery backup light testing.
Severity Breakdown
SS=E: 2
SS=F: 1
SS=D: 1
SS=C: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to ensure 2 of 9 delayed egress locking arrangements released the lock within required time and conditions. | SS=E |
| Failed to ensure 1 PPE storage room with large combustible storage was protected as a hazardous area with proper self-closing doors. | SS=E |
| Failed to conduct required testing for dry sprinkler system trip test and air leakage test every 3 years. | SS=F |
| Failed to ensure 1 of 30 resident room corridor doors on A wing had proper latching to resist passage of smoke. | SS=D |
| Failed to ensure emergency generator battery backup light was tested monthly and annually as required. | SS=C |
Report Facts
Facility capacity: 143
Census: 97
Delayed egress locking arrangements: 2
Residents potentially affected: 35
Residents potentially affected: 20
Resident rooms affected: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Ahmetovic | Executive Director | Signed the report |
| Maintenance Director | Named in findings related to delayed egress locks, hazardous area enclosure, sprinkler testing, corridor door latching, and emergency generator light testing | |
| Maintenance Tech | Named in findings related to delayed egress locks, hazardous area enclosure, sprinkler testing, corridor door latching, and emergency generator light testing | |
| Maintenance Manager | Named in findings related to delayed egress locks, hazardous area enclosure, sprinkler testing, corridor door latching, and emergency generator light testing | |
| Administrator | Named in findings review and exit conference |
Inspection Report
Recertification
Census: 91
Capacity: 91
Deficiencies: 2
Feb 3, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, including investigation of two complaints (IN00399973 and IN00399813) and a State Residential Licensure Survey.
Findings
The facility was found to have deficiencies related to failure to follow physician orders for medication administration for 2 of 8 residents, and failure to ensure proper hand hygiene during food delivery. Complaint IN00399973 was substantiated with no deficiencies cited related to allegations, and complaint IN00399813 was unsubstantiated due to lack of evidence. The facility was found in compliance with State Residential Licensure Survey requirements.
Complaint Details
Complaint IN00399973 was substantiated with no deficiencies related to allegations cited. Complaint IN00399813 was unsubstantiated due to lack of evidence.
Severity Breakdown
SS=D: 1
SS=E: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure physician orders were followed for 2 of 8 residents reviewed, including improper holding and dosage adjustments of medications propranolol and metoprolol. | SS=D |
| Failure to ensure hand hygiene was observed during food delivery; server observed not performing hand hygiene appropriately during meal service to 16 residents. | SS=E |
Report Facts
Census: 91
Total Capacity: 91
Residents reviewed for medication orders: 8
Residents present in dining room: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Ahmetovic | Executive Director | Named as Executive Director and involved in follow-up and education related to medication order deficiencies |
| Director of Nursing (DON) | Provided education to QMA and followed up on medication order corrections | |
| Qualified Medication Aide (QMA 3) | Involved in medication administration errors related to propranolol | |
| Nurse Practitioner (NP) | Prescribing provider involved in medication order clarifications and corrections | |
| Dietary Manager | Provided hand hygiene education to food service staff and responsible for monitoring compliance | |
| Server 2 | Observed failing to perform proper hand hygiene during meal service |
Inspection Report
Annual Inspection
Deficiencies: 0
Feb 3, 2023
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Adams Woodcrest 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
Follow-Up
Deficiencies: 0
Oct 14, 2022
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Preoccupancy Survey conducted on 07/07/22 was conducted by the Indiana Department of Health in accordance with 42 CFR Subpart 483.90(a).
Findings
At this PSR Survey, Adams Woodcrest was found in compliance with Requirements for Participation in Medicare/Medicaid, 42 CFR Subpart 483.90(a), 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. The new sections of the building consisting of Physical Therapy suite in B wing, kitchen and dining room in A and C wings, and Activity Room in the common area were found compliant.
Inspection Report
Complaint Investigation
Census: 82
Capacity: 106
Deficiencies: 0
Aug 29, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00388332.
Findings
The complaint was substantiated, but no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00388332 was substantiated. No deficiencies related to the allegations were cited.
Report Facts
SNF/NF Census: 82
Residential Census: 24
Total Capacity: 106
Medicare Census: 10
Medicaid Census: 39
Other Payor Census: 33
Inspection Report
Complaint Investigation
Census: 80
Capacity: 103
Deficiencies: 0
Aug 17, 2022
Visit Reason
This visit was conducted for the investigation of two complaints, IN00386390 and IN00387697.
Findings
Both complaints were substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00386390 - Substantiated with no deficiencies cited. Complaint IN00387697 - Substantiated with no deficiencies cited.
Report Facts
Census SNF/NF beds: 80
Census Residential beds: 23
Total Capacity: 103
Medicare census: 10
Medicaid census: 38
Other payor census: 32
Total census: 80
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