Inspection Report Summary
The most recent inspection on June 12, 2025, found the facility in compliance with life safety code requirements and Medicare/Medicaid participation, with no deficiencies cited. Prior inspections showed a mixed record, including multiple deficiencies related to resident care, medication management, and life safety issues such as fire safety and emergency preparedness. Complaint investigations were mostly unsubstantiated, though some substantiated complaints resulted in deficiencies concerning hydration monitoring, incontinent care, medication administration, and resident dignity. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility’s inspection history shows some improvement in life safety compliance in the most recent survey following earlier citations, but resident care and medication management issues have recurred over time.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
35.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
752% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
81% occupied
Based on a June 2025 inspection.
Census over time
Inspection Report
Routine
Deficiencies: 1
Date: Jul 1, 2025
Visit Reason
The inspection was conducted to assess the facility's compliance with regulations regarding residents' ability to self-administer medications and treatments, focusing on whether the interdisciplinary team timely determined and documented clinical appropriateness for self-administration.
Findings
The facility failed to timely have the interdisciplinary team determine and document that self-administration of medications and treatments was clinically appropriate for two residents. Observations and interviews revealed medications left at bedside without nurse supervision, lack of proper self-administration assessments, and inconsistent documentation of residents' ability to self-administer medications.
Deficiencies (1)
Facility failed to timely have the interdisciplinary team determine and document self-administration of medications and treatments were clinically appropriate for 2 residents.
Report Facts
Residents affected: 2
Physician orders: 6
Physician orders: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 1 | Registered Nurse | Resident 10's nurse who observed medication left at bedside and spoke with Resident 20 about medication refusal |
| Director of Nursing | Director of Nursing | Provided information on self-administration assessments and facility policy |
Inspection Report
Life Safety
Census: 122
Capacity: 150
Deficiencies: 0
Date: Jun 12, 2025
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey was conducted to verify compliance with fire safety and life safety code requirements.
Findings
The facility was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 Edition of the National Fire Protection Association (NFPA) 101 Life Safety Code. The facility is fully sprinklered except for a detached storage and repair shed.
Report Facts
Resident sleeping rooms with battery operated smoke detectors: 59
Resident sleeping rooms with hard wired smoke detectors: 23
Facility capacity: 150
Census: 122
Inspection Report
Complaint Investigation
Census: 119
Capacity: 119
Deficiencies: 0
Date: May 22, 2025
Visit Reason
This visit was conducted for the investigation of complaints IN00456216 and IN00459209 at the facility.
Complaint Details
Investigation of Complaints IN00456216 and IN00459209 found no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00456216 and IN00459209 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census SNF/NF beds: 119
Census total residents: 119
Census Medicare residents: 4
Census Medicaid residents: 75
Census other payor residents: 40
Inspection Report
Complaint Investigation
Census: 181
Deficiencies: 0
Date: Mar 24, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00455337.
Complaint Details
Complaint IN00455337 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00455337 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type - SNF/NF: 130
Census Bed Type - Residential: 51
Census Total: 181
Census Payor Type - Medicare: 6
Census Payor Type - Medicaid: 80
Census Payor Type - Other: 44
Census Payor Type - Total: 130
Inspection Report
Life Safety
Census: 123
Capacity: 150
Deficiencies: 5
Date: Mar 11, 2025
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health on 03/11/2025 to assess compliance with emergency preparedness and life safety requirements.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but not in compliance with Life Safety Code requirements. Deficiencies included failure to ensure hazardous areas were properly enclosed with self-closing doors, sprinkler heads covered with lint, smoke barrier doors obstructed or not closing properly, failure to conduct fire drills at varied times, and soiled linen and trash containers exceeding allowed capacity in corridors.
Deficiencies (5)
Failed to ensure 1 of 9 hazardous areas such as a soiled linen or laundry rooms were separated by smoke resistant partitions and doors that are self-closing or automatic closing.
Failed to ensure 1 of 1 sprinkler heads behind the Laundry room dryers covered with lint were replaced or cleaned in accordance with NFPA 25.
Failed to ensure 1 of 5 sets of smoke barrier doors would restrict the movement of smoke for at least 20 minutes; doors were obstructed by a food cart and could not fully close.
Failed to conduct quarterly fire drills at unexpected times under varying conditions on the second shift for 4 of 4 quarters.
Failed to ensure 4 of 4 soiled linen or trash receptacles in the corridor did not exceed 32 gallons in capacity within a 64 square foot area.
Report Facts
Certified beds: 150
Census: 123
Hazardous areas: 9
Sprinkler heads: 1
Smoke barrier doors: 5
Fire drills: 4
Soiled linen/trash receptacles: 4
Receptacle capacity: 40
Allowed receptacle capacity: 32
Allowed area: 64
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed report and involved in education and corrective action oversight |
| Maintenance Director | Acknowledged deficiencies related to hazardous area doors, sprinkler heads, smoke barrier doors, and fire drills; involved in corrective actions | |
| Field Maintenance Supervisor | Participated in exit conference and review of findings |
Inspection Report
Renewal
Deficiencies: 0
Date: Feb 25, 2025
Visit Reason
The inspection was conducted as a paper compliance review for the Recertification and State Licensure Survey, including a Residential Survey completed on February 25, 2025.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the Recertification and State Licensure Survey. Quality review was completed on March 24, 2025.
Inspection Report
Annual Inspection
Deficiencies: 8
Date: Feb 25, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, medication management, infection control, and social services at the nursing facility.
Findings
The facility was found deficient in multiple areas including inaccurate Minimum Data Set (MDS) assessments, failure to develop timely and complete care plans, medication administration errors, inadequate application of prescribed splints, lack of appropriate behavior management plans for dementia patients, insufficient social services follow-up related to abuse allegations, improper medication labeling and storage, and failure to follow infection prevention protocols during wound care.
Deficiencies (8)
Failed to accurately complete Minimum Data Set (MDS) assessments for dental services, Preadmission Screening and Resident Review (PASRR), and skin conditions for multiple residents.
Failed to develop a person-centered care plan timely for refusal to change clothes for a resident.
Failed to ensure lidocaine patches were administered as ordered and to obtain weights and notify physician as ordered for residents.
Failed to apply splints as care-planned for a resident with limited range of motion.
Failed to timely develop a person-centered behavior management care plan with individualized interventions for a resident with dementia exhibiting behaviors.
Failed to ensure appropriate social services follow-up related to a previous allegation of abuse by a family member for a resident with dementia.
Failed to remove discontinued medications, refrigerate medications requiring refrigeration, and label open medications in medication carts.
Failed to ensure staff donned personal protective equipment (PPE) prior to wound dressing for a resident on Enhanced Barrier Precautions.
Report Facts
Medication administration missed doses: 11
Weight gain: 5.2
Residents reviewed for ADL care: 9
Residents affected: 1
Residents affected: 1
Residents affected: 1
Medication carts observed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 4 | Licensed Practical Nurse | Named in medication labeling and refrigeration deficiency |
| LPN 2 | Licensed Practical Nurse | Named in medication labeling deficiency |
| LPN 21 | Licensed Practical Nurse | Named in infection control deficiency for wound care |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple deficiencies including care plans, medication administration, social services, and infection control |
| Certified Nurse Aide 7 | Certified Nurse Aide | Interviewed regarding resident refusal to change clothes |
| Unit Manager 3 | Unit Manager | Interviewed regarding weight monitoring and physician notification |
| Memory Care Support Specialist | Memory Care Support Specialist | Interviewed regarding resident behavior and supervision |
| Social Services Director | Social Services Director | Interviewed regarding social services follow-up on abuse allegation |
| Registered Nurse 25 | Registered Nurse | Interviewed regarding resident behavior and tearfulness |
| Registered Nurse 26 | Registered Nurse | Documented resident behavior observations |
Inspection Report
Recertification
Census: 178
Deficiencies: 9
Date: Feb 18, 2025
Visit Reason
This visit was for a Recertification and State Licensure Survey and Investigation of Nursing Home Complaints IN00451302 and IN00452379, and a State Residential Licensure Survey and Investigation of Residential Complaint IN00450714.
Complaint Details
Complaint IN00451302 and IN00452379 - No deficiencies related to the allegations are cited. Complaint IN00450714 - No deficiencies related to the allegations are cited.
Findings
The facility had multiple deficiencies including inaccurate Minimum Data Set assessments, failure to develop timely person-centered care plans, medication administration errors, failure to apply splints as care planned, inadequate social services follow-up related to abuse allegations, improper medication storage, and failure to use personal protective equipment during wound care.
Deficiencies (9)
Failed to accurately complete Minimum Data Set assessments for residents related to dental services, Preadmission Screening and Resident Review, and skin conditions.
Failed to develop a person-centered care plan timely for refusal to change clothes for a resident.
Failed to ensure lidocaine patches were administered as ordered and to obtain weights three times weekly and inform the physician of weight changes as ordered.
Failed to apply splints as care planned for a resident with limited range of motion.
Failed to timely develop a person-centered behavior management care plan with individualized interventions and document approaches to care for a resident with dementia exhibiting behaviors.
Failed to ensure appropriate social services follow-up related to a previous allegation of abuse of a resident by a family member.
Failed to remove discontinued resident medications, refrigerate medication requiring refrigeration, and label open medications in medication carts.
Failed to ensure staff donned personal protective equipment prior to wound dressing for a resident on Enhanced Barrier Precautions.
Failed to ensure residents with medications stored in their apartment were assessed for ability to self-administer medications and failed to assess a resident who used an electronic cigarette for appropriate utilization.
Report Facts
Survey dates: February 18, 19, 20, 21, 24, and 25, 2025
Census SNF/NF: 128
Census Residential: 50
Total Census: 178
Medicare Census: 9
Medicaid Census: 81
Other Payor Census: 38
Medication administration missed doses: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report and involved in interviews |
| LPN 21 | Licensed Practical Nurse | Observed providing wound care without full PPE and unaware of Enhanced Barrier Precautions |
| LPN 4 | Licensed Practical Nurse | Observed medication cart with unlabeled and improperly stored medications |
| LPN 2 | Licensed Practical Nurse | Observed medication cart with unlabeled medications |
| LPN 20 | Licensed Practical Nurse | Observed medication administration without supervision of resident self-administration |
| Director of Nursing | Director of Nursing | Provided policies, interviews, and observations related to multiple deficiencies |
| Memory Care Support Specialist | Memory Care Support Specialist | Provided interviews related to resident behaviors and abuse concerns |
| Social Services Director | Social Services Director | Provided interview regarding abuse allegations and supervision of visits |
| Hospice Staff 1 | Provided interview regarding visitation supervision | |
| Hospice Staff 2 | Provided interview regarding visitation supervision and abuse concerns |
Inspection Report
Complaint Investigation
Census: 122
Capacity: 165
Deficiencies: 0
Date: Dec 2, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00446848, IN00444433, and IN00443133.
Complaint Details
Complaints IN00446848, IN00444433, and IN00443133 were investigated with no deficiencies found related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00446848, IN00444433, and IN00443133 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census SNF/NF beds: 122
Census Residential beds: 43
Total licensed capacity: 165
Census Medicare residents: 5
Census Medicaid residents: 77
Census Other payor residents: 40
Total census residents: 122
Inspection Report
Complaint Investigation
Census: 165
Deficiencies: 0
Date: Aug 6, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00437191, IN00438066, IN00439017, and IN00440159 at the facility.
Complaint Details
Complaints IN00437191, IN00438066, IN00439017, and IN00440159 were investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in any of the complaints were cited. The facility 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 the complaints.
Report Facts
Census Bed Type - SNF/NF: 122
Census Bed Type - Residential: 43
Total Census: 165
Census Payor Type - Medicare: 6
Census Payor Type - Medicaid: 73
Census Payor Type - Other: 43
Total Census Payor: 122
Inspection Report
Complaint Investigation
Census: 123
Capacity: 166
Deficiencies: 0
Date: Jun 17, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00435825 and IN00429787.
Complaint Details
Complaint IN00435825 and Complaint IN00429787 were investigated with no deficiencies cited related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00435825 and IN00429787 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
SNF/NF census: 123
Residential census: 43
Total capacity: 166
Medicare census: 6
Medicaid census: 68
Other payor census: 49
Total census: 123
Inspection Report
Follow-Up
Census: 120
Capacity: 150
Deficiencies: 0
Date: Mar 26, 2024
Visit Reason
A Post Survey Revisit (PSR) was conducted to follow up on the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey that exited on 02/02/24.
Findings
At this PSR Emergency Preparedness survey, American Village was found in compliance with Emergency Preparedness Requirements. At the PSR Life Safety Code survey, the facility was found in compliance with Life Safety Code requirements, including fire safety and sprinkler systems.
Report Facts
Certified beds: 150
Census: 120
Resident sleeping rooms with battery operated smoke detectors: 59
Resident sleeping rooms with hard wired smoke detectors: 23
Resident sleeping rooms total: 82
Inspection Report
Renewal
Deficiencies: 0
Date: Mar 6, 2024
Visit Reason
The inspection was conducted as a paper compliance review related to the Recertification, State Licensure, and Complaint Survey, including a Residential Survey completed on January 10, 2024.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding paper compliance to the Recertification, State Licensure, and Complaint Survey.
Inspection Report
Life Safety
Census: 120
Capacity: 150
Deficiencies: 20
Date: Feb 2, 2024
Visit Reason
An Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey were conducted to assess compliance with federal and state regulations including fire safety, emergency preparedness, and facility maintenance.
Findings
The facility was found substantially compliant with emergency preparedness requirements but had multiple deficiencies related to life safety code including fire hazards, door latching issues, obstructed egress, sprinkler system maintenance, smoke barrier integrity, electrical safety, smoking policy violations, and improper use of portable heaters and power strips.
Deficiencies (20)
Emergency preparedness communication plan lacked specific contact information for the State Long Term Care Ombudsman.
Electric range in therapy area had combustible materials on burners creating fire hazard.
Smoke barrier doors failed to latch properly.
Exit discharge sidewalk was obstructed by crates and charcoal grill.
Two exterior exit doors were not readily accessible or failed to open on first try.
Delayed egress locking arrangements were not installed or functioning properly on multiple exit doors.
Battery operated smoke detectors in resident rooms lacked documentation of maintenance and battery replacement.
400 Hall linen closet door had holes compromising smoke resistance.
Electric range in therapy area lacked accessible shutoff switch.
Fire alarm control panel displayed incorrect date.
Canvas canopy outside 100 Hall East Exit was not sprinkled and lacked documentation of fire retardant material.
Portable fire extinguisher in therapy area was unsecured and sitting on floor.
Several corridor doors failed to latch properly or were propped open.
Smoke barrier walls had holes and unsealed penetrations allowing passage of smoke.
Electrical junction box above ceiling near service hall entrance lacked cover and exposed wiring.
Smoking policy was not enforced; cigarette smoke odor detected in facility and cigarette butts found in designated smoking area near entrance.
Annual inspection and testing of oxygen transfilling room fire door assembly was not completed.
Portable space heater was in use in therapy office contrary to facility policy.
Power strips in resident rooms lacked required UL rating of 1363A or 60601-1.
Oxygen transfilling room ceiling had a hole compromising fire-resistive construction.
Report Facts
Certified beds: 150
Census: 120
Deficiencies cited: 20
Battery operated smoke detectors: 59
Resident sleeping rooms: 82
Canvas canopy size: 240
Hole size: 4
Hole size: 400
Hole size: 1
Spare sprinklers: 5
Inspection Report
Recertification
Census: 37
Capacity: 37
Deficiencies: 17
Date: Jan 10, 2024
Visit Reason
This visit was for a State Residential Licensure Survey including a Recertification and Investigation of Complaints IN00422553, IN00425026 and IN00420608.
Complaint Details
Complaint investigations IN00422553, IN00425026, and IN00420608 were included in this survey. Deficiencies were cited related to dignity and respect, medication administration, ADL care, medication management, infection control, hospice notification, staffing, and sanitation.
Findings
The facility was found to have multiple deficiencies including failure to provide care in a manner that promotes dignity and respect, failure to timely assess and document medication self-administration, failure to provide care consistent with resident preferences, failure to provide timely assistance with ADLs, failure to administer medications as ordered, failure to maintain infection control practices, failure to maintain medication storage and labeling standards, failure to ensure sufficient staffing, failure to notify hospice timely of resident falls, and failure to maintain sanitation and safety standards including proper garbage disposal and food storage.
Deficiencies (17)
Failure to provide care services in a manner that promoted privacy, respect, and dignity for 11 of 12 residents reviewed for dignity.
Failure to timely have the interdisciplinary team determine and document that self-administration of medications was clinically appropriate for 2 residents.
Failure to ensure residents got out of bed and showered as preference for 2 residents.
Failure to provide timely assistance with eating, incontinent care, grooming, and personal hygiene for 8 residents.
Failure to administer medications as ordered for 7 residents and failure to follow physician orders for elevation of bilateral lower extremities and pressure relief boots for 1 resident.
Failure to provide proper foot care and treatment for 1 resident.
Failure to ensure wheelchair had 2 functioning anti-tippers and fall interventions in place for 3 residents.
Failure to ensure residents with urinary catheters had physician orders, monitoring and documentation of urinary output, and timely notification of decreased output and leakage for 2 residents.
Failure to assure weights were obtained accurately for 1 resident.
Failure to administer oxygen as ordered and ensure accuracy of oxygen orders for 1 resident.
Failure to provide sufficient nursing staff with appropriate competencies and skill sets to provide ADL care and medication administration in accordance with plans of care for multiple residents.
Failure to ensure medication labels were not altered, expired supplies were removed, medications for discharged residents were returned to pharmacy, and medication carts were locked during administration.
Failure to ensure appropriate justification and follow-up for continued use of antipsychotic medication and abnormal AIMS assessment for 1 resident.
Failure to timely notify hospice of resident falls for 1 resident.
Failure to maintain infection control by not ensuring gloves were changed and hand hygiene was completed appropriately during incontinent care, dining assistance, and medication pass for multiple residents.
Failure to ensure trash was contained in receptacles and dumpsters were properly maintained and covered.
Failure to properly store food in refrigerator and ensure dishwasher detergent system was functioning properly.
Report Facts
Residents reviewed for ADL care: 12
Residents reviewed for medication administration: 14
Residents reviewed for infection control: 12
Residents reviewed for hospice notification: 1
Residents reviewed for sanitation: 124
Residents reviewed for food storage: 37
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the Statement of Deficiencies |
| LPN 15 | Licensed Practical Nurse | Observed and interviewed regarding medication administration and oxygen therapy |
| CNA 24 | Certified Nursing Assistant | Observed and interviewed regarding incontinent care and infection control |
| LPN 26 | Licensed Practical Nurse | Interviewed regarding medication administration system issues |
| Resident Rights policy | Policy | Referenced multiple times regarding resident dignity and care |
| Director of Nursing | Director of Nursing | Interviewed multiple times regarding various care and policy issues |
| Hospice RN 13 | Hospice Registered Nurse | Interviewed regarding hospice notification failures |
| Unit Manager 23 | Unit Manager | Observed weights and interviewed regarding weight discrepancies |
| Dietary Manager | Dietary Manager | Interviewed regarding food storage and dishwasher issues |
Inspection Report
Complaint Investigation
Deficiencies: 17
Date: Jan 10, 2024
Visit Reason
The inspection was conducted based on complaints alleging inadequate care, including disrespectful staff behavior, failure to assist residents timely with meals and hygiene, medication administration issues, and infection control concerns.
Complaint Details
The complaint investigation included allegations of inadequate care, disrespectful staff behavior, medication errors, infection control breaches, and failure to notify hospice of falls. Multiple interviews with residents, family members, and staff confirmed these concerns.
Findings
The facility failed to ensure residents were treated with dignity and respect, timely assisted with activities of daily living including feeding and incontinent care, medications were administered as ordered, infection control practices were followed, and hospice was notified timely of resident falls. Multiple residents experienced delayed care, disrespectful staff interactions, and improper medication and treatment management.
Deficiencies (17)
Failure to honor residents' rights to dignity, respect, and to express grievances without fear of reprisal.
Failure to allow residents to self-administer medications with timely interdisciplinary team assessment and documentation.
Failure to promote and facilitate resident self-determination through support of resident choice, including showering and getting out of bed.
Failure to provide timely assistance with eating, nail care, incontinent care, and ensure residents needing incontinent care were provided one brief at a time.
Failure to administer medications as ordered, follow physician orders for elevation of bilateral lower extremities, and apply pressure relief boots as ordered.
Failure to provide necessary foot care, including timely podiatry services for a resident with thick, long toenails.
Failure to ensure residents' wheelchairs had two functioning anti-tippers and fall interventions were in place.
Failure to have physician orders for urinary catheters, monitor and document urinary output in milliliters, and timely notify physician of decreased output and urine leakage.
Failure to obtain accurate resident weights as ordered.
Failure to administer oxygen as ordered and ensure accuracy of oxygen orders in clinical record.
Failure to provide sufficient nursing staff with appropriate competencies to meet resident care needs and administer medications as ordered.
Failure to ensure medication labels were not altered, expired medical supplies were removed, medications for discharged or expired residents were disposed timely, and home medications were stored appropriately.
Failure to ensure medication carts were locked during medication administration and medications were stored with proper labeling and expiration dates.
Failure to ensure trash was contained in receptacles throughout the facility.
Failure to timely notify hospice of a resident's falls.
Failure to maintain infection control by ensuring gloves were changed and hand hygiene was completed appropriately during incontinent care, while assisting residents to eat, and while passing medications.
Failure to ensure appropriate justification for continued use of antipsychotic medication, follow up with family on side effects, and follow up on abnormal involuntary movement scale assessment.
Report Facts
Residents requiring verbal cues with eating: 22
Residents requiring mechanical lift for transfers: 5
Residents requiring mechanical lift for transfers: 3
Residents requiring mechanical lift for transfers: 9
Medication doses not administered: 15
Residents reviewed for ADL care: 12
Residents reviewed for medication administration and treatments: 14
Residents reviewed for urinary catheters: 3
Residents reviewed for nutrition: 4
Residents reviewed for respiratory care: 4
Residents reviewed for infection control: 12
Residents reviewed for hospice services: 1
Residents reviewed for medication storage: 6
Residents reviewed for medication rooms: 2
Residents in facility: 124
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 15 | Licensed Practical Nurse | Noted Resident G's toenails were very long and thick and trimmed some toenails; also involved in Resident F's oxygen care |
| LPN 26 | Licensed Practical Nurse | Nurse on duty evening and night shift for Residents 40, 44, 83 and 118; reported issues with medication charting system |
| LPN 31 | Licensed Practical Nurse | Observed leaving medication cart unlocked during medication pass |
| LPN 32 | Licensed Practical Nurse | Observed not performing hand hygiene during medication pass |
| CNA 24 | Certified Nursing Assistant | Observed not changing gloves or performing hand hygiene during incontinent care |
| CNA 7 | Certified Nursing Assistant | Observed assisting Resident SS with breakfast in bed without knocking or introducing herself |
| QMA 2 | Qualified Medication Assistant | Observed assisting multiple residents with meals without hand hygiene between residents |
| Hospice RN 13 | Registered Nurse | Reported hospice was not notified of Resident F's falls |
| Hospice Aide 17 | Hospice Aide | Observed Resident F's oxygen tank empty and not flowing |
| DON | Director of Nursing | Provided multiple policy documents and interviews regarding care deficiencies |
| Administrator | Provided information on staffing and trash issues | |
| Unit Manager 23 | Observed weight of Resident BB and provided staffing information |
Inspection Report
Complaint Investigation
Deficiencies: 5
Date: Jan 10, 2024
Visit Reason
The inspection was conducted based on complaints regarding failure to provide timely assistance with activities of daily living (ADLs), medication administration, respiratory care, and hospice notification.
Complaint Details
The complaint involved issues with failure to provide timely assistance with ADLs, medication administration errors, inadequate respiratory care, and failure to notify hospice of falls for multiple residents.
Findings
The facility failed to provide adequate assistance with eating, incontinent care, nail care, and transfers for multiple residents. There were issues with inaccurate weight documentation, improper oxygen administration, and failure to notify hospice of resident falls. Staffing shortages and inadequate supervision contributed to these deficiencies.
Deficiencies (5)
Failure to provide care and assistance to perform activities of daily living for residents unable to do so, including feeding, incontinent care, and transfers.
Failure to provide enough food/fluids to maintain a resident's health, including inaccurate weight measurements.
Failure to provide safe and appropriate respiratory care, including administering oxygen as ordered and maintaining accurate oxygen orders.
Failure to provide enough nursing staff with appropriate competencies to meet residents' needs for ADL care and medication administration.
Failure to timely notify hospice of a resident's falls.
Report Facts
Residents requiring mechanical lift for transfers: 17
Residents requiring verbal cues with eating: 22
Resident BB weight measurements: 141
Resident BB weight measurements: 142
Resident BB weight measurements: 143
Resident BB weight measurements: 144
Resident BB weight measurements: 134.8
Staffing ratio: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 7 | Certified Nursing Assistant | Assisted Resident SS with breakfast and involved in feeding deficiencies |
| CNA 9 | Certified Nursing Assistant | Provided incontinent care to Resident B and reported skin tear |
| LPN 15 | Licensed Practical Nurse | Managed Resident F's oxygen orders and identified discrepancies |
| Hospice RN 13 | Registered Nurse | Reported failure to notify hospice of Resident F's falls |
| UM 23 | Unit Manager | Observed Resident BB's weight and managed oxygen settings for Resident F |
| DON | Director of Nursing | Interviewed regarding staffing, care deficiencies, and policies |
Inspection Report
Complaint Investigation
Census: 163
Deficiencies: 0
Date: Oct 5, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00418780.
Complaint Details
Complaint IN00418780 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00418780 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type - SNF/NF: 124
Census Bed Type - Residential: 39
Census Bed Type - Total: 163
Census Payor Type - Medicare: 5
Census Payor Type - Medicaid: 77
Census Payor Type - Other: 42
Census Payor Type - Total: 124
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 25, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to a Complaint Survey IN00415131 completed on August 29, 2023.
Complaint Details
The visit was complaint-related, specifically a paper compliance review of Complaint Survey IN00415131. The facility was found to be in compliance.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance to the Complaint Survey.
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Aug 29, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to concerns about the facility's failure to monitor and record fluid intake and urine output accurately, and failure to timely obtain labs as ordered by the physician for Resident B.
Complaint Details
This Federal tag relates to complaint IN00415131.
Findings
The facility failed to accurately monitor and record fluid intake and urinary output for Resident B, with missing documentation on multiple days. Additionally, the facility failed to timely obtain ordered laboratory tests, resulting in delayed diagnosis and treatment of acute renal failure. Several physician orders for labs were not completed or reattempted, and lab samples were mishandled or not properly labeled.
Deficiencies (2)
Failed to monitor and record fluid intake and urine output from a urinary catheter accurately for Resident B.
Failed to timely obtain labs as ordered by the physician for Resident B.
Report Facts
Days with missing oral intake documentation: 11
Residents reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) 2 | Interviewed regarding Resident B's eating and fluid intake. | |
| Director of Nursing | Interviewed about physician's order entry error and provided facility policies. | |
| Nurse Consultant | Provided urinary catheter care policy. | |
| Lab Representative (LB) 3 | Interviewed regarding lab sample labeling issues. | |
| Nurse Practitioner (NP) 4 | Interviewed about lab draw expectations and treatment plans. |
Inspection Report
Complaint Investigation
Census: 125
Capacity: 125
Deficiencies: 2
Date: Aug 29, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00415131 and IN00416297. Complaint IN00415131 resulted in federal/state deficiencies being cited, while Complaint IN00416297 had no deficiencies cited.
Complaint Details
Complaint IN00415131 was substantiated with federal/state deficiencies cited at F0692 and F0770 related to hydration status maintenance and laboratory services. Complaint IN00416297 had no federal/state deficiencies cited.
Findings
The facility was found deficient in monitoring and recording fluid intake and urinary output accurately for one resident with a urinary catheter, and in timely obtaining laboratory tests as ordered by the physician for the same resident. These deficiencies were related to hydration status maintenance and laboratory services.
Deficiencies (2)
Failed to monitor and record fluid intake and urine output from a urinary catheter accurately for 1 of 3 residents reviewed for hospitalization (Resident B).
Failed to timely obtain labs, as ordered by the physician for 1 of 3 residents reviewed for hospitalization (Resident B).
Report Facts
Census: 125
Total Capacity: 125
Medicare Census: 8
Medicaid Census: 77
Other Payor Census: 40
Fluid need estimate: 1510
Fluid need estimate: 1760
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report |
| Director of Nursing | Interviewed regarding urinary output recording and lab order issues related to Resident B | |
| LPN 2 | Licensed Practical Nurse | Interviewed about assistance with Resident B's meals and fluids |
| Nurse Consultant | Provided urinary catheter care policy | |
| LB 3 | Lab Representative | Interviewed about lab specimen issues |
| NP 4 | Nurse Practitioner | Interviewed about lab draws and treatment plans for Resident B |
Inspection Report
Complaint Investigation
Census: 167
Deficiencies: 0
Date: Aug 7, 2023
Visit Reason
This visit was conducted to investigate complaints IN00412785, IN00414340, and IN00414681 at the facility.
Complaint Details
Complaints IN00412785, IN00414340, and IN00414681 were investigated and no deficiencies related to the allegations were found.
Findings
No deficiencies related to the allegations in complaints IN00412785, IN00414340, and IN00414681 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
SNF/NF Census: 130
Residential Census: 37
Total Census: 167
Medicare Census: 13
Medicaid Census: 74
Other Payor Census: 29
Total Payor Census: 130
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jun 20, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to a complaint survey completed on June 20, 2023.
Complaint Details
Paper compliance to the Complaint Survey IN00410705 completed on June 20, 2023; facility found in compliance.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance to the Complaint Survey.
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Jun 20, 2023
Visit Reason
The inspection was conducted based on complaint IN00410705 to investigate concerns related to inadequate toileting and incontinent care on night shift for several residents and lack of physician orders for oxygen therapy for a resident.
Complaint Details
Complaint IN00410705 triggered the investigation. The complaint involved concerns about inadequate toileting and incontinent care on night shift and lack of physician orders for oxygen therapy.
Findings
The facility failed to ensure appropriate toileting and incontinent care was provided on night shift for 4 of 14 residents reviewed, resulting in residents being left in incontinent states for extended periods. Additionally, the facility failed to have physician orders for oxygen therapy for one resident using oxygen. Interviews with residents and staff confirmed these care deficiencies.
Deficiencies (2)
Failed to provide appropriate toileting and incontinent care on night shift for 4 residents (Residents J, K, M, and N).
Failed to ensure a resident utilizing oxygen therapy had physician orders for oxygen (Resident B).
Report Facts
Residents reviewed for toileting and incontinent care: 14
Residents affected by toileting/incontinence deficiency: 4
Residents reviewed for oxygen therapy: 3
Residents affected by oxygen therapy deficiency: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 1 | Licensed Practical Nurse | Reported resident concerns about night shift care to Director of Nursing |
| Director of Nursing | Interviewed regarding awareness of night shift care concerns and oxygen order deficiency | |
| CNA 2 | Certified Nursing Assistant | Reported observations of Resident N saturated with urine and night shift care issues |
| CNA 3 | Certified Nursing Assistant | Reported observations of Resident N saturated with urine and night shift care issues |
Inspection Report
Complaint Investigation
Census: 122
Capacity: 122
Deficiencies: 2
Date: Jun 19, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00410705 and IN00409482. Complaint IN00410705 resulted in federal/state deficiencies cited, while no deficiencies were found related to complaint IN00409482.
Complaint Details
Complaint IN00410705 was substantiated with federal/state deficiencies cited at F684 (Quality of Care) and F695 (Respiratory/Tracheostomy Care and Suctioning). Complaint IN00409482 had no deficiencies related to the allegations.
Findings
The facility failed to ensure adequate toileting and incontinent care on night shift for 4 of 14 residents reviewed, and failed to ensure a resident utilizing oxygen therapy had physician orders for oxygen. Resident and staff interviews, record reviews, and observations confirmed these deficiencies.
Deficiencies (2)
Failed to ensure residents' needs were met on night shift with toileting and incontinent care for 4 residents (Residents J, K, M, and N).
Failed to ensure a resident utilizing oxygen therapy had physician orders for oxygen (Resident B).
Report Facts
Residents reviewed for care needs with Activities of Daily Living: 14
Residents affected by toileting/incontinence deficiency: 4
Census: 122
Total licensed capacity: 122
Residents using oxygen therapy reviewed: 3
Dates oxygen saturation documented: 19
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report and involved in oversight |
| LPN 1 | Licensed Practical Nurse | Received report of night shift care concerns from Resident J |
| CNA 2 | Certified Nursing Assistant | Reported Resident N was found saturated with urine on multiple occasions |
| CNA 3 | Certified Nursing Assistant | Reported lack of night shift report and observed Resident N saturated with urine |
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Apr 26, 2023
Visit Reason
Paper compliance review to the Complaint Survey IN00403574 completed on March 28, 2023.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance to the Complaint Survey.
Inspection Report
Complaint Investigation
Census: 159
Deficiencies: 3
Date: Mar 28, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00403574 and IN00404205. Complaint IN00403574 resulted in federal/state deficiencies cited, while complaint IN00404205 had no deficiencies related to the allegations.
Complaint Details
Complaint IN00403574 resulted in federal/state deficiencies cited at F557 related to dignity and respect. Complaint IN00404205 had no deficiencies related to the allegations.
Findings
The facility was found deficient in promoting resident dignity and respect, including failure to ensure residents' clothing was dry and catheter dignity bags were used. Additionally, call lights were not within reach for some residents, and there were incomplete documentation issues with weekly skin assessments and medication administration records.
Deficiencies (3)
Failure to promote dignity by not assuring a resident's clothing was dry and not assuring a resident with an indwelling catheter had a dignity bag.
Failure to ensure call lights were in reach for residents.
Failure to ensure complete documentation of weekly skin assessments and electronic medication administration records.
Report Facts
Census SNF/NF beds: 113
Census Residential beds: 46
Total Census: 159
Census Medicare: 16
Census Medicaid: 85
Census Other payor: 12
Medication administration record holes: 7
Weekly skin assessments missing: 2
Wait time for assistance: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report and identified as facility representative |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Mar 27, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to concerns about resident dignity, accommodation of needs, and documentation of care at American Village nursing home.
Complaint Details
This Federal tag relates to Complaint IN00403574.
Findings
The facility failed to promote resident dignity by not ensuring clothing was dry and dignity bags were used for catheterized residents, failed to ensure call lights were within reach for some residents, and failed to maintain complete documentation of weekly skin assessments and medication administration records for several residents.
Deficiencies (3)
Failed to promote dignity by not assuring a resident's clothing didn't have the appearance of wetness and not assuring a resident with an indwelling catheter had a dignity bag for 2 of 5 residents reviewed.
Failed to ensure call lights were in reach for 2 of 5 residents reviewed for accommodation of needs.
Failed to ensure complete documentation of weekly skin assessments and electronic medication administration records for 3 of 7 residents reviewed.
Report Facts
Residents reviewed for dignity: 5
Residents reviewed for accommodation of needs: 5
Residents records reviewed for documentation: 7
Holes in medication administration record: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Corporate Nurse 2 | Provided Resident Rights policy and interviewed regarding call light expectations |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 21, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to Complaint Surveys IN00398923 and IN00401490 completed on February 15, 2023.
Complaint Details
The visit was complaint-related, reviewing paper compliance for Complaint Surveys IN00398923 and IN00401490. The facility was found to be in compliance.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding paper compliance to the Complaint Survey.
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Feb 15, 2023
Visit Reason
The inspection was conducted as an annual survey to assess compliance with health and safety regulations at the facility.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Feb 15, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to concerns about skin impairment and medication administration at the facility.
Complaint Details
This Federal tag relates to Complaint IN00401490 for skin impairment and Complaint IN00398923 for medication administration.
Findings
The facility failed to ensure appropriate treatment and care for residents, including failure to ensure bilateral boots were in place for a resident with an arterial ulcer and failure to obtain and administer a prescribed medication for another resident. Policies related to skin management and medication orders were reviewed and related to the complaints.
Deficiencies (2)
Failed to ensure bilateral boots were in place for a resident with an arterial ulcer (Resident H).
Failed to ensure a medication (Aranesp) was obtained and administered for a resident (Resident G).
Report Facts
Residents reviewed for skin impairment: 3
Residents reviewed for medication administration: 3
Hemoglobin level: 6.8
Medication dosage: 40
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed regarding residents' care and medication issues. |
Inspection Report
Complaint Investigation
Census: 172
Deficiencies: 2
Date: Feb 13, 2023
Visit Reason
This visit was for the investigation of multiple nursing home complaints and a COVID-19 Focused Infection Control Survey, including an investigation of a residential complaint.
Complaint Details
Multiple complaints were investigated: IN00391300 (unsubstantiated), IN00394673 (substantiated, no deficiencies), IN00397247 (substantiated, no deficiencies), IN00398169 (substantiated, no deficiencies), IN00398408 (unsubstantiated), IN00398923 (substantiated with deficiencies cited at F755), IN00400811 (substantiated, no deficiencies), IN00401490 (substantiated with deficiencies cited at F684), and IN00395699 (residential complaint, unsubstantiated).
Findings
The facility was found to have deficiencies related to substantiated complaints involving failure to ensure bilateral boots were in place for a resident with an arterial ulcer and failure to ensure a medication was obtained and administered for another resident. Some complaints were unsubstantiated or substantiated with no deficiencies cited.
Deficiencies (2)
Failed to ensure bilateral boots were in place for a resident with an arterial ulcer (Resident H).
Failed to ensure a medication (Aranesp) was obtained and administered for a resident (Resident G).
Report Facts
Census bed type: 123
Census bed type: 49
Total census beds: 172
Census payor type: 10
Census payor type: 83
Census payor type: 30
Total census payor: 123
Hemoglobin level: 6.8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report and referenced in quality assurance oversight |
| Director of Nursing | Director of Nursing | Interviewed regarding Resident H's refusal to wear boots and medication issues for Resident G |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Feb 10, 2023
Visit Reason
Paper compliance review related to the Complaint Survey IN00399028 completed on January 18, 2023.
Complaint Details
Complaint Survey IN00399028 was reviewed and found to be in compliance.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding paper compliance to the Complaint Survey.
Inspection Report
Complaint Investigation
Census: 128
Capacity: 128
Deficiencies: 1
Date: Jan 17, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00399028, which was substantiated with a federal/state deficiency cited.
Complaint Details
Complaint IN00399028 was substantiated. The deficiency related to inaccurate cognitive coding in MDS assessments for Resident B.
Findings
The facility failed to accurately code the cognitive abilities of one resident (Resident B) in the Minimum Data Set (MDS) assessments, incorrectly listing her as in a persistent vegetative state when she had shown cognitive improvement.
Deficiencies (1)
Failed to accurately code the cognitive abilities of Resident B in MDS assessments.
Report Facts
Census: 128
Total Capacity: 128
Medicare Census: 14
Medicaid Census: 78
Other Payor Census: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the report |
| Director of Nursing | Interviewed regarding Resident B's condition and MDS assessments | |
| MDS Coordinator | Interviewed regarding MDS assessments and leave status during Resident B's assessments |
Inspection Report
Re-Inspection
Census: 113
Capacity: 150
Deficiencies: 0
Date: Dec 8, 2022
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 10/18/22 was performed to verify compliance with fire safety and licensure requirements.
Findings
The facility was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 NFPA 101 Life Safety Code. The building is fully sprinklered except for a detached storage and repair shed.
Report Facts
Resident census: 113
Total capacity: 150
Resident sleeping rooms with battery operated smoke detectors: 59
Resident sleeping rooms with hard wired smoke detectors: 23
Total resident sleeping rooms: 82
Inspection Report
Complaint Investigation
Census: 114
Capacity: 114
Deficiencies: 0
Date: Dec 6, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00395877.
Complaint Details
Complaint IN00395877 was substantiated, but no deficiencies related to the allegations were cited.
Findings
The complaint was substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type: 114
Census Payor Type - Medicare: 6
Census Payor Type - Medicaid: 74
Census Payor Type - Other: 34
Inspection Report
Re-Inspection
Census: 160
Deficiencies: 0
Date: Nov 10, 2022
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Recertification and State Licensure Survey completed on September 28, 2022, including a PSR to the Investigation of Complaints IN00390169 and IN00389737 and the Residential survey completed on September 28, 2022.
Complaint Details
Complaint IN00390169 and Complaint IN00389737 were investigated and found to be corrected.
Findings
American Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the PSR to the Recertification and State Licensure Survey and the PSR to the Investigation of Complaints IN00390169 and IN00389737.
Report Facts
Census Bed Type - SNF/NF: 109
Census Bed Type - Residential: 51
Census Bed Type - Total: 160
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 73
Census Payor Type - Other: 32
Census Payor Type - Total: 109
Inspection Report
Life Safety
Census: 113
Capacity: 150
Deficiencies: 5
Date: Oct 18, 2022
Visit Reason
The Indiana Department of Health conducted a Life Safety Code Recertification and State Licensure Survey on 10/18/2022 to assess compliance with 42 CFR 483.90(a) and NFPA 101 standards.
Findings
The facility was found not in compliance with several Life Safety Code requirements including emergency lighting testing, preventative maintenance of battery-operated smoke alarms, obstruction of portable fire extinguishers, inspection and maintenance of fire dampers, and use of prohibited portable space heaters. Corrective actions and plans of correction were submitted for each deficiency.
Deficiencies (5)
Failed to ensure 14 of 14 battery backup emergency lights were tested monthly for 30 seconds as required.
Failed to ensure documentation for preventative maintenance of 59 of 59 battery operated smoke alarms in resident rooms was complete.
Failed to ensure 1 of 1 portable fire extinguishers in the lobby was installed and accessible in accordance with NFPA 10; extinguisher was obstructed by a walker and relocation chair.
Failed to ensure 7 of 7 fire dampers were inspected and maintained at least every four years as required by NFPA 90A.
Failed to ensure 1 of 1 portable space heater was not used within the facility, violating prohibition of portable space heaters in health care occupancies.
Report Facts
Certified beds: 150
Census: 113
Battery backup emergency lights: 14
Battery operated smoke alarms: 59
Portable fire extinguishers: 1
Fire dampers: 7
Portable space heaters: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gina Couch | Executive Director | Signed the inspection report and participated in exit conference |
| Maintenance Director | Outgoing and incoming Maintenance Directors acknowledged deficiencies and corrective actions related to emergency lighting, smoke alarms, fire extinguishers, fire dampers, and space heaters | |
| Facility Administrator | Participated in exit conference and discussions regarding deficiencies and corrective actions |
Inspection Report
Routine
Deficiencies: 17
Date: Sep 28, 2022
Visit Reason
The inspection was conducted as a routine survey of the American Village nursing home to assess compliance with regulatory requirements related to resident care, safety, medication management, and facility environment.
Findings
The facility was found deficient in multiple areas including failure to ensure residents' dignity, medication self-administration oversight, call light accessibility, environmental cleanliness and repair, investigation of reportable incidents, transfer documentation, assistance with activities of daily living, medication administration, pressure ulcer care, water temperature safety, catheter care, IV fluid management, dialysis care, behavioral health care, pharmaceutical services, psychotropic medication management, and medication labeling and storage.
Deficiencies (17)
Failed to promote dignity by not assuring cognitively impaired residents were fully dressed when in the common area for 2 of 3 residents reviewed.
Failed to ensure a resident was determined clinically appropriate by the interdisciplinary team to self-administer medications for 1 of 1 residents observed with medications left at bedside.
Failed to assure a call light was within reach of a resident for 1 of 2 residents reviewed for call lights in reach.
Failed to provide a clean, sanitary, and homelike environment by not maintaining walls in good repair and in clean condition for 5 of 8 residents reviewed for environmental concerns and failed to provide clean linen for 1 of 1 residents reviewed for catheter care.
Failed to provide evidence of a thoroughly investigated reportable incident for 1 of 2 reportable incidents reviewed related to missing narcotics.
Failed to provide a transfer form to the receiving facility for 1 of 1 resident reviewed for hospitalization.
Failed to provide necessary services to maintain good grooming, oral care, personal hygiene, and timely assistance with dressing for 5 of 6 residents reviewed for activities of daily living and 1 of 1 residents reviewed for tube feeding.
Failed to timely schedule a neurology appointment and administer medications as ordered for 1 of 1 residents reviewed for ADL decline and 3 of 6 residents reviewed for unnecessary medications.
Failed to provide care consistent with professional standards to prevent a stage II pressure ulcer from developing and failed to administer Vitamin C and Zinc as ordered to 2 of 2 residents reviewed for pressure ulcers.
Failed to assure hot water temperatures were at safe levels at point of use with potential to affect 15 cognitively impaired and ambulatory residents.
Failed to ensure staff provided catheter care, monitored outputs, and timely obtained a culture and sensitivity urinalysis as ordered for 1 of 1 residents reviewed for catheter.
Failed to ensure assessment, flushing, and dressing change to a resident's PICC for 1 of 1 resident reviewed for death.
Failed to administer a resident's medication as ordered to 1 of 1 resident reviewed for dialysis.
Failed to monitor and track behaviors, timely initiate care plans and interventions for behavioral symptoms for 1 of 1 resident reviewed for behaviors and 1 of 5 residents reviewed for unnecessary medications; failed to administer psychotropic medication as ordered and obtain psychological evaluation as ordered for 1 of 1 resident reviewed for dialysis.
Failed to ensure accurate and complete reconciliation of controlled medications for 1 of 2 reportable incidents reviewed.
Failed to assure medications stored in medication carts were labeled with residents' names, dated with open dates, not expired, and discharged residents' medications removed for 1 of 3 medication carts observed.
Failed to assure a bathroom call light was functional for 2 of 8 residents reviewed for environmental concerns.
Report Facts
Medication administrations missed: 7
Medication administrations missed: 4
Medication administrations missed: 26
Medication administrations missed: 4
Medication administrations missed: 7
Medication administrations missed: 15
Medication administrations missed: 3
Medication administrations missed: 5
Medication administrations missed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 4 | Certified Nursing Assistant | Named in dignity deficiency for Resident 50 |
| QMA 2 | Qualified Medication Aide | Mentioned in dignity and medication self-administration deficiencies |
| CNA 12 | Certified Nursing Assistant | Named in catheter care and grooming deficiencies |
| LPN 14 | Licensed Practical Nurse | Named in narcotic medication investigation deficiency |
| DON | Director of Nursing | Multiple interviews and findings related to medication, care, and investigations |
| UM 7 | Unit Manager | Interviewed regarding medication administration and dialysis care |
| QMA 15 | Qualified Medication Aide | Named in narcotic medication investigation deficiency |
| QMA 24 | Qualified Medication Aide | Named in narcotic medication investigation deficiency |
| LPN 3 | Licensed Practical Nurse | Named in medication administration and pressure ulcer care deficiencies |
| SSD | Social Services Director | Named in behavioral health care deficiency |
| CNA 6 | Certified Nursing Assistant | Named in mobility and fall risk deficiency |
| LPN 1 | Licensed Practical Nurse | Named in behavioral health care deficiency |
Inspection Report
Routine
Census: 50
Deficiencies: 20
Date: Sep 28, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey and Investigation of Complaints IN00390169 and IN00389737. This visit included a State Residential Licensure Survey.
Complaint Details
Complaint IN00390169 - Substantiated. Federal/State deficiencies related to the allegations are cited at F686 and F694. Complaint IN00389737 - Unsubstantiated due to lack of evidence.
Findings
The facility was found deficient in multiple areas including resident dignity, medication administration, call light functionality, environmental conditions, infection control, behavioral health services, and regulatory compliance related to transfers and medication management.
Deficiencies (20)
Failed to promote dignity by not assuring cognitively impaired residents were fully dressed when in the common area for 2 of 3 residents reviewed for dignity.
Failed to ensure a resident was determined clinically appropriate by the interdisciplinary team to self-administer medications for 1 of 1 residents observed with medications left at bedside.
Failed to assure a call light was within reach of a resident for 1 of 2 residents reviewed for call lights in reach.
Failed to provide a clean, sanitary, and homelike environment by not maintaining walls in good repair and in clean condition for 5 of 8 residents reviewed for environmental concerns and failed to provide clean linen for 1 of 1 residents reviewed for catheter care.
Failed to provide evidence of a thoroughly investigated reportable incident for 1 of 2 reportable incidents reviewed.
Failed to provide a transfer form to the receiving facility for 1 of 1 resident reviewed for hospitalization.
Failed to provide the necessary services to maintain good grooming, oral care, personal hygiene, and providing timely assistance with dressing in street clothes for residents who are unable to carry out activities of daily living for 5 of 6 residents reviewed for ADL and 1 of 1 residents reviewed for tube feeding.
Failed to ensure residents who are bedfast or chairfast have their body position changed every 2 hours as ordered for 3 of 3 residents reviewed for positioning/mobility; failed to timely schedule a neurology appointment and administer medications, as ordered, by the physician for 1 of 1 residents reviewed for ADL decline and 3 of 6 residents reviewed for unnecessary medications.
Failed to provide care, consistent with professional standards of practice, to prevent a stage II pressure ulcer from developing and failed to administer Vitamin C and Zinc, as ordered, to 2 of 2 residents reviewed for pressure ulcers.
Failed to assure hot water temperatures were at safe levels, at point of use, with the potential to affect 15 cognitively impaired and ambulatory residents of the 91 residents who reside in the 200, 300, and 400 halls at the facility.
Failed to ensure staff provided catheter care, monitored of outputs and timely obtained a culture and sensitivity urinalysis as ordered for 1 of 1 residents reviewed for catheter.
Failed to ensure assessment, flushing, and dressing change to a resident's PICC for 1 of 1 resident reviewed for death.
Failed to administer a resident's medication, as ordered, to 1 of 1 resident reviewed for dialysis.
Failed to ensure accurate and complete reconciliation of controlled medications for 1 of 2 reportable incidents reviewed.
Failed to timely act upon a pharmacist's recommendation on the monthly medication regimen review for 1 of 6 residents reviewed for unnecessary medications.
Failed to attempt non-pharmacological interventions prior to initiating an anti-psychotic medication for 1 of 1 resident reviewed for behaviors.
Failed to ensure medications stored in the medication carts were labeled with the residents' names, dated with open dates, not expired, and discharged residents' medications removed for 1 of 3 medications carts observed.
Failed to assure a bathroom call light was functional for 2 of 8 residents reviewed for environmental concerns.
Failed to ensure a resident/resident representative was given a written notification of an intrafacility transfer at least two days before her relocation nor did the facility ensure a copy of the notice was in the resident's clinical record for 1 of 2 residents reviewed for transfer/discharge rights.
Failed to properly prevent and/or contain COVID-19 by not ensuring staff members were screened prior to entry to the facility for symptoms, test results, and exposure to COVID-19.
Report Facts
Survey dates: 7
Census: 50
Residents on medication refusal: 7
Residents with hot water temperature above 120F: 3
Residents observed not turned every 2 hours: 3
Residents with missing catheter care: 1
Residents with medication reconciliation issues: 1
Residents with delayed psychiatric evaluation: 1
Residents with non-functional call light: 2
Residents with missing transfer notice: 1
Staff missing COVID-19 screening: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 4 | Certified Nursing Assistant | Assisted Resident 50 who was not fully dressed |
| QMA 2 | Qualified Medication Aide | Observed Resident 50 and Resident 264 clothing issues |
| Director of Nursing | Provided multiple interviews and policies related to deficiencies | |
| LPN 14 | Licensed Practical Nurse | Named in medication diversion investigation |
| QMA 15 | Qualified Medication Aide | Named in medication diversion investigation |
| Maintenance Supervisor | Checked water temperatures and repaired call lights | |
| CNA 12 | Certified Nursing Assistant | Provided catheter care and shaving assistance |
| UM 7 | Unit Manager | Provided interviews related to medication administration and dialysis |
| SSD | Social Services Director | Provided interviews related to behavioral health and transfers |
| RN 28 | Registered Nurse | Interviewed about medication cart storage |
| LPN 27 | Licensed Practical Nurse | Interviewed about medication cart storage |
Inspection Report
Complaint Investigation
Census: 111
Capacity: 111
Deficiencies: 0
Date: Aug 18, 2022
Visit Reason
This visit was conducted for the investigation of three complaints: IN00386621, IN00387363, and IN00387395.
Complaint Details
Complaint IN00386621 - Substantiated with no deficiencies cited. Complaint IN00387363 - Substantiated with no deficiencies cited. Complaint IN00387395 - Substantiated with no deficiencies cited.
Findings
All three complaints were substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Medicare census: 6
Medicaid census: 66
Other payor census: 39
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