Inspection Reports for Aperion Care Kokomo
3518 S Lafountain St, Kokomo, IN 46902, United States, IN, 46902
Back to Facility ProfileDeficiencies per Year
28
21
14
7
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 52
Capacity: 52
Deficiencies: 0
Jul 2, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00462418.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00462418 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 4
Medicaid census: 41
Other payor census: 7
Inspection Report
Complaint Investigation
Census: 54
Capacity: 54
Deficiencies: 0
Jun 24, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00461708 at Aperion Care Kokomo.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00461708 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 4
Medicaid census: 43
Other payor census: 7
Inspection Report
Complaint Investigation
Census: 47
Capacity: 47
Deficiencies: 0
May 6, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00458123 at Aperion Care Kokomo.
Findings
No deficiencies related to the allegations in Complaint IN00458123 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00458123 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 47
Total Capacity: 47
Medicare Census: 1
Medicaid Census: 35
Other Payor Census: 11
Inspection Report
Plan of Correction
Deficiencies: 0
Jan 9, 2025
Visit Reason
Paper compliance review related to the Investigation of Complaint IN00447825 and unrelated deficiencies completed on December 3, 2024.
Findings
Aperion Care Kokomo 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 of the complaint investigation and unrelated deficiencies.
Complaint Details
Investigation of Complaint IN00447825 was reviewed and found to be in compliance.
Inspection Report
Complaint Investigation
Census: 55
Capacity: 55
Deficiencies: 3
Dec 3, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00447825, which included federal and state deficiencies related to the allegations as well as unrelated deficiencies.
Findings
The facility was found deficient in multiple areas including failure to ensure a resident's specialized wheelchair was treated with respect and was not located after discharge, failure to complete an accurate admission assessment of a pressure ulcer by a licensed nurse, and failure to properly anchor an indwelling catheter causing trauma to the resident's urinary tube.
Complaint Details
Complaint IN00447825 was substantiated with federal and state deficiencies cited at F557, F686, and F690 related to the allegations of mishandling of personal property, inadequate pressure ulcer assessment, and improper catheter placement.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure a resident's specialized wheelchair was treated with respect and was unable to be located after discharge. | SS=D |
| Failed to ensure staff completed an accurate admission assessment of a resident's pressure ulcer by a licensed nurse qualified to assess pressure wounds. | SS=D |
| Failed to ensure staff anchored an indwelling catheter with proper placement into a resident's bladder, causing trauma. | SS=D |
Report Facts
Census: 55
Total Capacity: 55
Medicare Census: 4
Medicaid Census: 36
Other Payor Census: 15
Pressure ulcer wound measurements: 9
Pressure ulcer wound measurements: 5.5
Pressure ulcer wound measurements: 0.2
Pressure ulcer wound measurements: 2.5
Pressure ulcer wound measurements: 5
Pressure ulcer wound measurements: 4.2
Pressure ulcer wound measurements: 1
Pressure ulcer wound measurements: 5
Pressure ulcer wound measurements: 4
Pressure ulcer wound measurements: 3.5
Indwelling catheter size: 16
Indwelling catheter size: 12
Balloon size: 10
Balloon size: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sherry Morgan | RN | Laboratory Director's or Provider/Supplier Representative's signature on report |
| LPN 12 | Licensed Practical Nurse | Nurse who admitted Resident B to the facility on 7/12/24 |
| Executive Director | Interviewed regarding wheelchair and facility policies | |
| Assistant Director of Nursing | Interviewed regarding Resident B's admission and call light | |
| Director of Nursing | Interviewed regarding wound care and staff changes | |
| Regional Vice President of Operations | Interviewed regarding catheter placement and facility operations |
Inspection Report
Follow-Up
Census: 55
Capacity: 105
Deficiencies: 2
Dec 2, 2024
Visit Reason
This was a Post Survey Revisit (PSR) to the Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey conducted on 10/01/24, to verify correction of previously cited deficiencies.
Findings
The facility was found in substantial compliance with Emergency Preparedness Requirements and Life Safety Code. However, deficiencies were cited for failure to ensure staff demonstrated knowledge of emergency preparedness policies and procedures, and failure to provide a complete written Fire Safety Plan addressing all required elements.
Severity Breakdown
SS=C: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure staff were trained and could demonstrate knowledge of emergency preparedness policies and procedures. | SS=C |
| Failed to provide a complete written Fire Safety Plan according to LSC 19.7, missing evacuation of smoke compartments and preparation of floors/buildings for evacuation. | SS=C |
Report Facts
Certified beds: 105
Census: 55
Date of compliance: Dec 16, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Markia Baker | Administrator | Named in relation to findings and exit conference |
Inspection Report
Routine
Census: 55
Capacity: 105
Deficiencies: 18
Oct 1, 2024
Visit Reason
Routine Emergency Preparedness and Life Safety Code Recertification survey conducted by the Indiana Department of Health in accordance with 42 CFR 483.73 and 42 CFR 483.90(a).
Findings
The facility was found not in compliance with Emergency Preparedness requirements including failure to maintain a complete Emergency Preparedness Plan, conduct annual training, maintain documentation of drills, and maintain emergency power system testing. Life Safety Code deficiencies included obstructed egress corridors, uneven exit discharge walkways, hazardous storage areas, lack of access to cooktop shutoff, corroded sprinkler heads, unsealed smoke barrier penetrations, missing fire safety plan, incomplete fire drills, improper smoking area maintenance, missing smoke door inspections, untested electrical receptacles, and improper use of power strips.
Severity Breakdown
SS=F: 10
SS=E: 6
SS=C: 1
Deficiencies (18)
| Description | Severity |
|---|---|
| Failed to maintain an Emergency Preparedness Plan based on all-hazards risk assessment. | SS=F |
| Failed to conduct annual Emergency Preparedness Program training for all staff. | SS=F |
| Failed to analyze and document Emergency Preparedness drills and exercises. | SS=C |
| Failed to implement emergency power system testing and maintenance per NFPA 110 and Life Safety Code. | SS=F |
| Failed to maintain means of egress corridors free of obstructions. | SS=F |
| Exit discharge walkway was uneven and not unobstructed. | SS=E |
| Hazardous storage areas not protected by self-closing or latching doors. | SS=E |
| Staff lacked access to cooktop shutoff switch; kitchen cooking equipment not maintained per fire extinguishing system requirements. | SS=E |
| Failed to maintain sprinkler system including missing monthly inspections and corroded sprinkler heads. | SS=F |
| Unsealed penetrations in smoke barrier walls compromising smoke resistance. | SS=E |
| Failed to maintain electrical terminals and main power switches in safe condition; exposed copper terminals due to missing light bulbs. | SS=E |
| Failed to provide and maintain written Fire Safety Plan available to supervisory personnel; plan lacked specific facility information. | SS=F |
| Failed to conduct quarterly fire drills on each shift for multiple quarters. | SS=F |
| Smoking area not maintained with proper disposal containers; cigarette butts found on ground. | SS=E |
| Failed to routinely inspect and maintain smoke barrier doors and oxygen room fire door. | SS=E |
| Failed to test non-hospital grade electrical receptacles in resident rooms annually. | SS=F |
| Power strip used as substitute for fixed wiring to power high current equipment. | SS=E |
| Failed to ensure emergency generator had reliable fuel source and conducted required weekly and monthly testing. | SS=F |
Report Facts
Certified beds: 105
Census: 55
Fire drills missing: 5
Resident sleeping rooms: 45
Smoke barrier doors: 11
Sprinkler heads corroded: 2
Unsealed smoke barrier penetrations: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deana Jordan Collins | Regional Nurse Consultant | Signed report and participated in exit conference |
| Maintenance Director | Interviewed multiple times regarding deficiencies and corrective actions | |
| Director of Nursing | Interviewed multiple times regarding deficiencies and corrective actions | |
| Assistant Director of Nursing | Interviewed multiple times regarding deficiencies and corrective actions | |
| Administrator | Participated in exit conference and corrective action planning | |
| Dietary Manager | Interviewed regarding kitchen equipment maintenance |
Inspection Report
Annual Inspection
Census: 52
Capacity: 52
Deficiencies: 7
Sep 23, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, including the Investigation of Complaint IN00443390.
Findings
The facility was found deficient in several areas including management of personal funds, care plan revisions, oxygen administration, RN staffing coverage, medication availability, medication storage, and food service quality. Complaint allegations were not substantiated.
Complaint Details
Complaint IN00443390 was investigated and no deficiencies related to the allegations were cited.
Severity Breakdown
SS=D: 7
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to ensure a resident was able to receive personal funds when requested. | SS=D |
| Failed to ensure a care plan was reviewed and revised as appropriate for a resident. | SS=D |
| Failed to administer oxygen at the correct flow rate as ordered by the physician for 2 residents. | SS=D |
| Failed to ensure a Registered Nurse was in the facility at least 8 consecutive hours a day, 7 days a week for 5 days reviewed. | SS=D |
| Failed to ensure medications were available and a resident received scheduled medication as ordered. | SS=D |
| Failed to ensure eye drops were dated when opened and medication drawers were free of loose unidentified medications. | SS=D |
| Failed to ensure food was served at the proper temperature, menus were followed, substitutions honored, and puree recipes followed. | SS=D |
Report Facts
Census: 52
Total Capacity: 52
Survey Dates: 2024-09-16 to 2024-09-23
Oxygen flow rate ordered: 3
Oxygen flow rate observed: 2
Medication missed days: 7
Eye drops count: 2
Loose medications: 6
Food temperature: 118.9
Food temperature required: 145
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Markia Baker | Administrator | Named as facility administrator on report |
| Corporate Business Office Manager | Involved in personal funds management deficiency | |
| Director of Nursing | Director of Nursing | Interviewed regarding care plan and oxygen administration deficiencies |
| Assistant Director of Nursing | Assistant Director of Nursing | Interviewed regarding oxygen administration deficiency |
| Scheduler | Interviewed regarding RN staffing deficiency | |
| Qualified Medication Assistant 3 | Interviewed regarding medication availability and storage deficiencies | |
| Dietary Manager | Dietary Manager | Interviewed regarding food service deficiencies |
| Cook 4 | Named in food preparation deficiency | |
| Cook 5 | Named in food preparation deficiency | |
| LPN 6 | Interviewed regarding oxygen administration deficiency |
Inspection Report
Renewal
Deficiencies: 0
Sep 23, 2024
Visit Reason
The inspection was conducted as a paper compliance review for the Recertification and State Licensure survey.
Findings
Aperion Care Kokomo 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: 51
Capacity: 51
Deficiencies: 0
Jun 25, 2024
Visit Reason
This visit was for the Investigation of Complaint IN00436059.
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 in regard to the complaint investigation.
Complaint Details
Complaint IN00436059 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 51
Medicare Census: 5
Medicaid Census: 35
Other Payor Census: 11
Inspection Report
Complaint Investigation
Census: 44
Capacity: 44
Deficiencies: 0
Apr 17, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00428969 and IN00432351.
Findings
No deficiencies related to the allegations in complaints IN00428969 and IN00432351 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of complaints IN00428969 and IN00432351 found no deficiencies related to the allegations; both complaints were not substantiated.
Report Facts
Census: 44
Total Capacity: 44
Medicare Census: 3
Medicaid Census: 32
Other Payor Census: 9
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 5, 2024
Visit Reason
Paper compliance review to the Investigation of Complaint IN00425889 completed on January 24, 2024.
Findings
Aperion Care Kokomo was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Complaint Details
Investigation of Complaint IN00425889 completed on January 24, 2024; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 42
Deficiencies: 2
Jan 24, 2024
Visit Reason
The visit was conducted for the investigation of Complaint IN00425889 regarding allegations of resident rights violations and misappropriation of property.
Findings
The facility was found to have failed to ensure residents were treated with respect and dignity by a staff member, and failed to protect residents from misappropriation of property by staff. Several incidents involving staff verbal abuse, profanity, and theft of resident money were substantiated, resulting in staff terminations and corrective actions.
Complaint Details
Complaint IN00425889 was substantiated with findings of verbal abuse, use of profanity, and disrespectful treatment by LPN 2 towards residents, as well as substantiated theft by CNA 3 involving resident funds. LPN 2 was terminated for misconduct and CNA 3 was terminated for misappropriation of resident money.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure residents were treated with respect and dignity by a staff member for 4 of 8 residents reviewed. | SS=D |
| Failure to ensure a resident was free from theft related to a staff member not returning change after picking up food for her. | SS=D |
Report Facts
Census: 42
Medicare residents: 4
Medicaid residents: 29
Other residents: 9
Residents reviewed for respect and dignity: 8
Residents involved in respect and dignity deficiency: 4
Residents reviewed for misappropriation: 2
Amount of money involved in theft: 10
Amount reimbursed to resident: 10
Number of residents interviewed for monitoring: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN 2 | Licensed Practical Nurse | Named in multiple findings of verbal abuse, disrespect, and use of profanity towards residents; terminated for misconduct |
| CNA 3 | Certified Nursing Assistant | Named in findings of misappropriation of resident money; terminated for violating company policy |
| Jeff Attinger | RVP of Operations | Signed the report |
Inspection Report
Re-Inspection
Census: 48
Capacity: 48
Deficiencies: 0
Nov 27, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00418301 completed on September 29, 2023, conducted in conjunction with the PSR to the Recertification and State Licensure survey completed on July 28, 2023.
Findings
Aperion Care Kokomo 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 IN00418301, which was corrected.
Complaint Details
Complaint IN00418301 was investigated and found to be corrected.
Report Facts
Census: 48
Total Capacity: 48
Medicare Census: 4
Medicaid Census: 33
Other Payor Census: 11
Inspection Report
Re-Inspection
Census: 48
Capacity: 48
Deficiencies: 0
Nov 27, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Recertification and State Licensure survey completed on July 28, 2023, conducted in conjunction with the PSR to the Investigation of Complaint IN00418301 completed on September 29, 2023.
Findings
Aperion Care Kokomo 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. The complaint IN00418301 was corrected.
Complaint Details
Complaint IN00418301 was investigated and found to be corrected.
Report Facts
Census SNF/NF: 48
Total Capacity: 48
Census Payor Type Medicare: 4
Census Payor Type Medicaid: 33
Census Payor Type Other: 11
Inspection Report
Complaint Investigation
Census: 50
Capacity: 50
Deficiencies: 0
Oct 20, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00418807.
Findings
No deficiencies related to the allegations in Complaint IN00418807 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00418807 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 3
Medicaid census: 35
Other payor census: 12
Inspection Report
Plan of Correction
Deficiencies: 0
Oct 19, 2023
Visit Reason
The document reports on paper compliance to the Post Survey Revisit (PSR) conducted on 09/25/23 for the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey conducted on 08/18/23.
Findings
Aperion Care Kokomo was found in compliance with Medicare/Medicaid Emergency Preparedness Requirements and Life Safety Code from Fire requirements, including the 2012 Edition of the NFPA 101 Life Safety Code, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Complaint Investigation
Census: 48
Capacity: 48
Deficiencies: 2
Sep 29, 2023
Visit Reason
Investigation of Complaints IN00416939 and IN00418301. Complaint IN00416939 found no deficiencies; Complaint IN00418301 cited federal/state deficiencies related to abuse and improper discharge.
Findings
The facility failed to ensure a resident was free from mental and verbal abuse and intimidation by the previous Executive Director (ED), who also improperly instructed the resident to leave the facility. The resident was verbally abused, intimidated, and discharged against her will but returned the next day with no adverse outcomes. The previous ED was terminated due to these actions.
Complaint Details
Complaint IN00418301 substantiated with federal/state deficiencies cited at F600 (abuse) and F622 (transfer and discharge). Complaint IN00416939 found no deficiencies related to allegations.
Severity Breakdown
SS=G: 1
SS=D: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure a resident was free from mental and verbal abuse and intimidation by the Executive Director, and failed to provide 72-hour psychosocial follow-up after abuse. | SS=G |
| Failed to ensure facility-initiated transfer or discharge was in alignment with resident's goals and preferences; resident was told to leave by the Executive Director. | SS=D |
Report Facts
Census SNF/NF beds: 48
Census Medicare residents: 5
Census Medicaid residents: 35
Census Other residents: 8
Deficiency completion date: Oct 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeff Attinger | RVP of Operations | Signed report as provider/supplier representative |
| Previous Executive Director | Named in findings for verbal and mental abuse, intimidation, and improper discharge of Resident B | |
| Interim Executive Director | Spoke with Resident B and offered return to facility; provided plan of correction information | |
| CNA 7 | Certified Nursing Assistant | Witnessed verbal abuse incident and reported intimidation by previous ED |
| CNA 8 | Certified Nursing Assistant | Witnessed verbal abuse incident and assisted resident with packing belongings |
| CNA 10 | Certified Nursing Assistant | Witnessed verbal abuse incident and reported previous ED's aggressive behavior |
| ADON | Assistant Director of Nursing | Witnessed verbal abuse and aggressive behavior by previous ED |
| DON | Director of Nursing | Witnessed verbal abuse and aggressive behavior by previous ED |
| Social Service Director | Involved in post-incident resident interview and noted lack of psychosocial assessment | |
| Qualified Medication Aide 6 | Reported previous ED delivering boxes to resident's room | |
| Floor Tech 12 | Observed previous ED instructing staff to get boxes for resident |
Inspection Report
Re-Inspection
Census: 48
Capacity: 105
Deficiencies: 3
Sep 25, 2023
Visit Reason
A Post Survey Revisit (PSR) was conducted to the Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey originally conducted on 08/16/23 to verify correction of previous deficiencies.
Findings
The facility was found not in compliance with Emergency Preparedness Requirements, Life Safety Code requirements including evacuation and relocation plan, fire safety plan adherence, and oxygen transfilling signage. Deficiencies included incomplete staff training on emergency preparedness and fire safety plans, failure to immediately contact fire department during fire conditions, and lack of proper signage in the oxygen storage/transfer room.
Severity Breakdown
SS=F: 2
SS=E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to conduct annual training for the Emergency Preparedness Program; incomplete staff training sign-in sheet with only 29 of 63 employees trained by completion date. | SS=F |
| Failed to follow written fire safety plan including immediate contact of fire department upon fire condition; incomplete staff training on fire safety plan by completion date. | SS=F |
| Failed to provide proper signage indicating oxygen transfilling is occurring in the oxygen storage/transfer room. | SS=E |
Report Facts
Certified beds: 105
Census: 48
Employees listed on EPP training sign-in sheet: 63
Employees signed on EPP training sign-in sheet: 29
Residents potentially affected by oxygen signage deficiency: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeff Attinger | RVP of Operations | Signed report as provider/supplier representative |
| Director of Nursing | Interviewed regarding incomplete emergency preparedness training and fire safety plan training | |
| Maintenance Director | Interviewed regarding incomplete emergency preparedness training and fire safety plan training; involved in oxygen room signage observation | |
| Maintenance Supervisor | Interviewed regarding oxygen storage/transfer room signage |
Inspection Report
Life Safety
Census: 73
Capacity: 105
Deficiencies: 25
Aug 18, 2023
Visit Reason
An Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey were conducted due to regulatory compliance and an Immediate Jeopardy related to fire safety.
Findings
The facility was found not in compliance with Emergency Preparedness Requirements and Life Safety Code standards, including deficiencies in emergency preparedness plan updates, fire safety plan execution, fire alarm system maintenance, fire drills, combustible decorations, corridor door integrity, electrical safety, generator testing, and oxygen storage.
Severity Breakdown
Level F: 8
Level C: 3
Level D: 1
Level E: 6
Level L: 2
Deficiencies (25)
| Description | Severity |
|---|---|
| Failed to review and update the Emergency Preparedness Plan (EPP) at least annually. | Level F |
| Failed to review and update the Emergency Preparedness Plan (EPP) Policies and Procedures at least annually. | Level F |
| Failed to ensure Emergency Preparedness Plan (EPP) subsistence needs policies and procedures did not have conflicting policies. | Level F |
| Failed to ensure Emergency Preparedness Plan (EPP) include non-conflicting information for safe evacuation from the LTC facility. | Level F |
| Failed to review and update the Emergency Preparedness Plan (EPP) Communication program at least annually. | Level F |
| Failed to review and update the Emergency Preparedness Plan (EPP) Training and Testing program at least annually. | Level F |
| Failed to implement emergency power system inspection, testing, and maintenance requirements; generator missing monthly load testing documentation and natural gas reliability letter. | Level F |
| Failed to maintain latching hardware on 3 of 8 smoke barrier doors. | — |
| Failed to ensure at least 50 of 50 Packaged Terminal Air Conditioner (PTAC) units were maintained in a safe operational condition; dirty or clogged air filters. | — |
| Failed to ensure 2 of 10 delayed egress locking arrangements were installed in accordance with code requirements. | — |
| Failed to ensure 139 DEG 'Bell Style' heat detectors were removed from the fire alarm system. | — |
| Failed to ensure staff were instructed in the use of the UL 300 hood system in the kitchen. | — |
| Failed to maintain fire alarm system in accordance with NFPA 70 and NFPA 72; presence of non-tied heat detectors. | — |
| Failed to provide complete fire watch policy including notification to Indiana Department of Health. | Level C |
| Failed to inspect 2 of over 20 portable fire extinguishers monthly. | Level D |
| Failed to ensure corridor doors resist passage of smoke and close properly; holes in doors and privacy curtains blocking doors. | Level E |
| Failed to ensure access and working space was maintained in 1 of 1 electrical panel in the mechanical room; storage blocking panel. | Level E |
| Failed to ensure hospital-grade electrical receptacles testing form showed each receptacle was tested and results documented. | Level C |
| Failed to maintain natural gas emergency generator testing documentation for 36-month continuous run and fuel reliability letter. | Level F |
| Failed to segregate and mark empty oxygen cylinders from full cylinders in storage. | Level E |
| Failed to post sign indicating oxygen transfilling is occurring in liquid oxygen storage/transfer room. | Level F |
| Failed to follow written fire safety plan during actual fire resulting in Immediate Jeopardy due to delayed fire alarm activation and resident evacuation. | Level L |
| Failed to provide complete and non-conflicting written emergency fire safety plan incorporating all required elements. | Level L |
| Failed to ensure fire drills included simulation of emergency fire conditions. | Level C |
| Failed to maintain smoking areas by disposing cigarette butts in metal or noncombustible containers with self-closing covers. | Level E |
Report Facts
Certified beds: 105
Census: 73
Deficiencies cited: 29
Fire drills missing emergency simulation: 12
Smoke barrier doors with faulty latching: 3
PTAC units inspected: 50
Delayed egress locks deficient: 2
Battery operated smoke alarms tested monthly: 50
Corridor doors with holes: 4
Corridor doors blocked by privacy curtains: 3
Electrical receptacles with exposed wiring: 2
Fire extinguishers missed monthly inspection: 2
Oxygen cylinders improperly segregated: 15
Cigarette butts improperly disposed: 30
Inspection Report
Annual Inspection
Census: 46
Capacity: 46
Deficiencies: 14
Jul 28, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from July 23 to July 28, 2023.
Findings
The facility was found deficient in multiple areas including Medicare beneficiary notification, transfer/discharge notifications, care plan meetings, medication administration, nutrition monitoring, pain management, dialysis monitoring, drug regimen review, medication storage, dental services, arbitration agreements, immunization consents, environmental conditions, and employee health screenings.
Severity Breakdown
SS=D: 11
SS=E: 2
Deficiencies (14)
| Description | Severity |
|---|---|
| Failed to ensure residents with Medicare Part A services ending were issued Skilled Nursing Facility Advance Beneficiary Notices of Non-coverage (SNF ABNs). | SS=D |
| Failed to notify family and Ombudsman for a resident hospitalized and transferred to another facility. | SS=D |
| Failed to ensure an initial care plan meeting was held for a cognitively intact resident. | SS=D |
| Failed to ensure residents were given anti-anxiety medication as scheduled. | SS=D |
| Failed to recognize and notify the physician of significant weight gain or loss for residents. | SS=E |
| Failed to ensure a resident's PRN pain medication was available and physician notified when unavailable. | SS=D |
| Failed to ensure residents on dialysis were monitored for fluid restriction. | SS=D |
| Failed to ensure pharmacy recommendations were addressed by the physician. | SS=D |
| Failed to ensure medications were stored properly in medication rooms. | SS=D |
| Failed to ensure a resident's preference for dental services was assessed and dental services arranged. | SS=D |
| Failed to ensure residents understood arbitration agreements and that electronic signatures were only obtained if agreement was given. | SS=D |
| Failed to ensure residents who received influenza vaccines signed consents and education forms. | SS=D |
| Failed to maintain a safe, functional, sanitary, and comfortable environment including repair of walls, ceilings, floors, and removal of hazardous chemicals. | SS=E |
| Failed to ensure new employees received required physical exams, TB testing, and annual risk assessments. | SS=D |
Report Facts
Census: 46
Total Capacity: 46
Survey Dates: 2023-07-23 to 2023-07-28
Weight Gain Resident 40: 25.22
Weight Gain Resident 48: 34.87
Weight Loss Resident 8: 6.1
Weight Loss Resident 9: 7.6
Brown Stains on Ceiling Tiles: 11
Days without oxycodone: 3
Audit Frequency: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Paula Carroll | Administrator | Signed report and involved in interviews |
| Business Office Manager | Mentioned in relation to Medicare beneficiary notification deficiency and arbitration agreement | |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple deficiencies including medication administration, care plans, and pharmacy recommendations |
| Social Services Director | Social Services Director | Interviewed regarding care plan meetings, transfer notifications, and dental services |
| Admissions Director | Admissions Director | Interviewed regarding arbitration agreements and dental consents |
| Maintenance Director | Maintenance Director | Interviewed regarding environmental deficiencies |
| LPN 3 | Licensed Practical Nurse | Mentioned in relation to medication administration and employee health screening deficiencies |
| LPN 4 | Licensed Practical Nurse | Mentioned in relation to employee health screening deficiencies |
| CNA 5 | Certified Nursing Assistant | Mentioned in relation to employee health screening deficiencies |
| LPN 6 | Licensed Practical Nurse | Mentioned in relation to employee health screening deficiencies |
| CNA 7 | Certified Nursing Assistant | Mentioned in relation to employee health screening deficiencies |
| CNA 8 | Certified Nursing Assistant | Mentioned in relation to employee health screening deficiencies |
| CNA 9 | Certified Nursing Assistant | Mentioned in relation to employee health screening deficiencies |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 52
Deficiencies: 0
Jun 27, 2023
Visit Reason
This visit was for the investigation of Complaint IN00410606.
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 IN00410606 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 52
Total Capacity: 52
Payor Type Census: 1
Payor Type Census: 43
Payor Type Census: 8
Inspection Report
Complaint Investigation
Census: 53
Capacity: 53
Deficiencies: 0
May 4, 2023
Visit Reason
This visit was conducted for the investigation of multiple complaints identified as IN00402872, IN00402962, IN00403648, IN00404808, and IN00406824.
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.
Complaint Details
Complaints IN00402872, IN00402962, IN00403648, IN00404808, and IN00406824 were investigated and no deficiencies related to the allegations were found.
Report Facts
Census SNF/NF beds: 53
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 42
Census Payor Type - Other: 9
Inspection Report
Complaint Investigation
Census: 62
Capacity: 62
Deficiencies: 0
Jan 30, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00399827.
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 IN00399827 was substantiated; however, no deficiencies related to the allegations were cited.
Report Facts
Census bed type: 62
Medicare census: 11
Medicaid census: 36
Other payor census: 15
Inspection Report
Complaint Investigation
Census: 61
Capacity: 61
Deficiencies: 0
Jan 4, 2023
Visit Reason
This visit was conducted for the investigation of three complaints: IN00395301, IN00396855, and IN00397824.
Findings
Two complaints (IN00395301 and IN00396855) were unsubstantiated due to lack of evidence, while the third complaint (IN00397824) 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 IN00395301 - Unsubstantiated due to lack of evidence. Complaint IN00396855 - Unsubstantiated due to lack of evidence. Complaint IN00397824 - Substantiated. No deficiencies related to the allegations were cited.
Report Facts
Census SNF/NF beds: 61
Total census: 61
Medicare census: 9
Medicaid census: 39
Other payor census: 13
Inspection Report
Follow-Up
Census: 57
Capacity: 105
Deficiencies: 0
Oct 17, 2022
Visit Reason
A Post Survey Revisit (PSR) was conducted to the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey originally conducted on 08/23/22 by the Indiana Department of Health.
Findings
At this Post Survey Revisit, Aperion Care Kokomo was found in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 483.73, and 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), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Report Facts
Certified beds: 105
Census: 57
Inspection Report
Complaint Investigation
Census: 59
Capacity: 59
Deficiencies: 0
Oct 7, 2022
Visit Reason
This visit was for the Investigation of Complaint IN00390231.
Findings
Complaint IN00390231 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 IN00390231 - Substantiated. No deficiencies related to the allegations were cited.
Report Facts
Census bed type: 59
Census payor type - Medicare: 3
Census payor type - Medicaid: 44
Census payor type - Other: 12
Inspection Report
Complaint Investigation
Census: 55
Capacity: 55
Deficiencies: 0
Sep 7, 2022
Visit Reason
This visit was conducted for the investigation of complaints IN00386507 and IN00386859.
Findings
Both complaints IN00386507 and IN00386859 were substantiated, but no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00386507 - Substantiated with no deficiencies cited. Complaint IN00386859 - Substantiated with no deficiencies cited.
Report Facts
Census SNF/NF beds: 55
Census total beds: 55
Census Medicare residents: 2
Census Medicaid residents: 39
Census other payor residents: 14
Census total residents: 55
Inspection Report
Plan of Correction
Deficiencies: 0
Aug 29, 2022
Visit Reason
Paper compliance review to the Recertification and State Licensure Survey completed on July 13, 2022.
Findings
Aperion Care Kokomo was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review to the Recertification and State Licensure Survey.
Inspection Report
Routine
Census: 57
Capacity: 105
Deficiencies: 20
Aug 23, 2022
Visit Reason
Routine Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey conducted by the Indiana Department of Health in accordance with federal regulations.
Findings
The facility was found in substantial compliance with Emergency Preparedness Requirements but had multiple deficiencies related to emergency preparedness plan review, life safety code violations including door latch issues, corridor obstructions, fire alarm and sprinkler system maintenance, portable fire extinguisher inspections, electrical receptacle testing, improper use of power strips, oxygen cylinder storage, and smoking area maintenance.
Severity Breakdown
SS=C: 4
SS=E: 10
SS=F: 5
Deficiencies (20)
| Description | Severity |
|---|---|
| Failed to develop and maintain an emergency preparedness plan reviewed and updated at least annually. | SS=C |
| Failed to develop and maintain emergency preparedness policies and procedures reviewed and updated at least annually. | SS=C |
| Failed to develop and maintain an emergency preparedness communication plan reviewed and updated at least annually. | SS=C |
| Failed to develop and maintain an emergency preparedness training and testing program reviewed and updated at least annually. | SS=C |
| Kitchen door had an independent deadbolt in addition to door handle latch, requiring more than one operation to open. | SS=E |
| Corridor obstruction by non-wheeled equipment (3-drawer chest) reducing clear corridor width below required minimum. | SS=E |
| Means of egress obstructed by a scale in corridor. | SS=E |
| Exit door near resident room #129 was magnetically locked with keypad code not posted. | SS=E |
| Exterior overhang at main entrance constructed of wood and not sprinkled underneath. | SS=E |
| Corridor door to hazardous storage room lacked self-closing device. | SS=E |
| Fire alarm system sensitivity testing documentation not available. | SS=F |
| Sprinkler system internal pipe inspection documentation not available. | SS=F |
| Fire hydrant inspection failed due to frozen valve; no documentation of repair provided. | SS=F |
| Portable fire extinguishers missing monthly inspection tags for July 2022. | SS=F |
| Resident room doors (9 of 49) failed to fully close and latch into the frame. | SS=E |
| Barrier doors (3 of 6) failed to fully close leaving gaps allowing smoke passage. | SS=E |
| Smoking area container was not an approved metal container with self-closing cover device. | SS=E |
| Small oxygen cylinder was not properly secured in the nurses station medication room. | SS=E |
| Nonhospital-grade electrical receptacles at resident rooms were not fully tested for polarity and retention. | SS=F |
| Power strip used improperly in Harmony Hall nurses station. | SS=E |
Report Facts
Certified beds: 105
Current census: 57
Residents affected by corridor obstruction: 12
Residents affected by door latch issues: 40
Residents affected by barrier door gaps: 32
Residents affected by oxygen cylinder storage: 24
Residents affected by power strip misuse: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeff Attinger | RVP of Operations | Named as facility representative signing report |
| Maintenance Director | Interviewed and acknowledged multiple deficiencies including door latch issues, corridor obstructions, fire alarm and sprinkler system maintenance, oxygen storage, and power strip misuse | |
| Administrator-in-Training | Interviewed and acknowledged multiple deficiencies and participated in exit conference |
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