Inspection Report Summary
The most recent inspection on June 17, 2025, found Auburn Village to be in compliance with all applicable federal and state regulations, with no deficiencies cited. Prior inspections showed a mixed history with several deficiencies related mainly to Life Safety Code compliance, resident care, and infection control, including issues such as failure to maintain sprinkler system inspections, improper resident care practices, and food safety violations. Complaint investigations over time were predominantly unsubstantiated, with a few substantiated cases involving resident self-determination, injury investigations, and infection prevention that prompted corrective actions. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility appears to have improved recently, resolving earlier Life Safety Code and care-related deficiencies as reflected in the clean findings of the latest inspection.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
10.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
150% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
100% occupied
Based on a April 2025 inspection.
Census over time
Inspection Report
Annual Inspection
Deficiencies: 0
Jun 17, 2025
Visit Reason
The inspection was a paper compliance review related to the Annual Recertification and State Licensure Survey completed on June 17, 2025.
Findings
Auburn Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Annual Recertification and State Licensure Survey.
Inspection Report
Complaint Investigation
Census: 83
Capacity: 83
Deficiencies: 0
Apr 7, 2025
Visit Reason
This visit was conducted for the investigation of three complaints: IN00456074, IN00456810, and IN00456832.
Findings
No deficiencies related to the allegations in any of the three complaints were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaints IN00456074, IN00456810, and IN00456832 were investigated and no deficiencies related to the allegations were found.
Report Facts
Census SNF/NF: 83
Total Capacity: 83
Census Payor Type - Medicare: 12
Census Payor Type - Medicaid: 56
Census Payor Type - Other: 15
Inspection Report
Complaint Investigation
Census: 84
Capacity: 84
Deficiencies: 0
Mar 21, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00454531.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00454531 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Payor Type - Medicare: 16
Census Payor Type - Medicaid: 55
Census Payor Type - Other: 13
Inspection Report
Complaint Investigation
Census: 79
Capacity: 79
Deficiencies: 0
Feb 10, 2025
Visit Reason
This visit was conducted for the investigation of complaints IN00451495 and IN00452826.
Findings
No deficiencies related to the allegations in complaints IN00451495 and IN00452826 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Investigation of complaints IN00451495 and IN00452826 found no deficiencies related to the allegations.
Report Facts
Census SNF/NF beds: 79
Census Medicare residents: 12
Census Medicaid residents: 53
Census Other residents: 14
Inspection Report
Complaint Investigation
Census: 83
Capacity: 83
Deficiencies: 0
Dec 19, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00448050.
Findings
No deficiencies related to the allegations in Complaint IN00448050 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00448050 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 15
Medicaid census: 56
Other payor census: 12
Inspection Report
Complaint Investigation
Census: 88
Capacity: 88
Deficiencies: 0
Nov 22, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00446331.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00446331 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 88
Total Capacity: 88
Medicare Census: 13
Medicaid Census: 64
Other Payor Census: 11
Inspection Report
Complaint Investigation
Census: 77
Capacity: 77
Deficiencies: 0
Oct 9, 2024
Visit Reason
This visit was conducted to investigate Complaints IN00444294 and IN00444475 at Auburn Village.
Findings
No deficiencies related to the allegations in Complaints IN00444294 and IN00444475 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of Complaints IN00444294 and IN00444475 found no deficiencies related to the allegations.
Report Facts
Medicare residents: 15
Medicaid residents: 54
Other residents: 8
Inspection Report
Complaint Investigation
Census: 67
Capacity: 67
Deficiencies: 0
Sep 27, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00443120, IN00443406, IN00443857, and IN00443884.
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.
Complaint Details
Complaints IN00443120, IN00443406, IN00443857, and IN00443884 were investigated and no deficiencies related to the allegations were cited.
Report Facts
Census SNF/NF: 67
Total Capacity: 67
Census Payor Type - Medicare: 10
Census Payor Type - Medicaid: 51
Census Payor Type - Other: 6
Inspection Report
Complaint Investigation
Census: 74
Capacity: 74
Deficiencies: 0
Aug 27, 2024
Visit Reason
This visit was conducted for the investigation of three complaints: IN00440387, IN00440889, and IN00441267.
Findings
No deficiencies related to the allegations in any of the three complaints were cited. The facility was found to be in compliance with relevant federal and state regulations.
Complaint Details
Complaints IN00440387, IN00440889, and IN00441267 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 74
Census Payor Type - Medicare: 13
Census Payor Type - Medicaid: 53
Census Payor Type - Other: 8
Inspection Report
Re-Inspection
Census: 76
Capacity: 111
Deficiencies: 0
Aug 26, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Emergency Preparedness Survey conducted on 07/30/24 by the Indiana Department of Health in accordance with 42 CFR 483.73.
Findings
At this PSR survey, Auburn Village was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Re-Inspection
Census: 68
Capacity: 68
Deficiencies: 0
Aug 5, 2024
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Recertification and State Licensure Survey completed on July 2, 2024, and included the PSR to Investigation of Complaint IN00437399 completed on July 2, 2024.
Findings
Auburn 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 Investigation of Complaint IN00437399. The complaint was corrected.
Complaint Details
Complaint IN00437399 was investigated and found to be corrected.
Report Facts
Census SNF/NF: 68
Census Medicare: 14
Census Medicaid: 47
Census Other: 7
Inspection Report
Life Safety
Census: 70
Capacity: 111
Deficiencies: 4
Jul 30, 2024
Visit Reason
The Indiana Department of Health conducted an Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey on 07/30/2024 to assess compliance with federal and state regulations including 42 CFR 483.73 and 42 CFR 483.90(a).
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included failure to maintain sprinkler system inspections, corridor doors propped open preventing smoke resistance, staff smoking in non-designated areas, and improper use of extension cords as substitutes for fixed wiring.
Severity Breakdown
SS=F: 1
SS=E: 2
SS=D: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to maintain sprinkler system inspection; last internal pipe inspection was past due since 5/30/18. | SS=F |
| Two resident corridor doors on the 100-hall were propped open with a trashcan, preventing proper closing and smoke resistance. | SS=E |
| Failed to enforce smoking policy; staff observed smoking in a non-smoking area outside service and housekeeping exit doors. | SS=E |
| Use of an extension cord in resident room 306 as a substitute for fixed wiring, which is prohibited. | SS=D |
Report Facts
Deficiencies cited: 4
Residents affected by corridor door deficiency: 10
Facility capacity: 111
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Named in relation to review of findings during exit conference. |
| Maintenance Director | Interviewed and acknowledged deficiencies related to sprinkler inspection, corridor doors, smoking policy, and extension cord use. |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 71
Deficiencies: 0
Jul 11, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00438244.
Findings
No deficiencies related to the allegations in Complaint IN00438244 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaint IN00438244 - No deficiencies related to the allegations are cited.
Report Facts
Census SNF/NF beds: 71
Census Payor Type - Medicare: 11
Census Payor Type - Medicaid: 49
Census Payor Type - Other: 11
Inspection Report
Annual Inspection
Census: 68
Capacity: 68
Deficiencies: 2
Jul 2, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, including investigation of three complaints (IN00437399, IN00436510, IN00436296).
Findings
The facility was cited for deficiencies related to mental/psychosocial treatment of a trauma survivor resident and infection prevention and control, specifically failure to follow public health recommendations during a Legionella outbreak investigation. Complaint IN00437399 was substantiated with a severity level E deficiency (F880). No deficiencies were found related to the other complaints.
Complaint Details
Complaint IN00437399 was substantiated with a deficiency related to infection prevention and control (F880). Complaints IN00436510 and IN00436296 had no deficiencies related to the allegations.
Severity Breakdown
SS=D: 1
SS=E: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to identify, assess, and determine underlying cause of specific expressions of distress of a trauma survivor resident (Resident 3). | SS=D |
| Failure to ensure education about and follow public health authority recommendations during investigation of a Legionella outbreak affecting residents. | SS=E |
Report Facts
Census: 68
Total Capacity: 68
Medicare Census: 9
Medicaid Census: 51
Other Payor Census: 8
Water samples positive for Legionella: 12
Water samples tested: 35
Water flushing frequency: 3
Water flushing duration: 10
Number of private rooms with bathrooms/showers: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Facility Administrator signing the report and interviewed regarding Legionella outbreak and infection control. |
| Social Service Director | Interviewed regarding Resident 3's behavioral issues and trauma-informed care. | |
| Director of Nursing | Interviewed regarding Resident 3's trauma triggers and infection control measures. | |
| Maintenance Director | Interviewed regarding water management program and Legionella remediation efforts. | |
| Infection Preventionist | Interviewed regarding infection control investigation and Legionella outbreak response. |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 77
Deficiencies: 0
Apr 9, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00431381.
Findings
No deficiencies related to the allegations in Complaint IN00431381 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00431381 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 11
Medicaid census: 54
Other payor census: 12
Inspection Report
Complaint Investigation
Census: 77
Capacity: 77
Deficiencies: 0
Mar 20, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00429498.
Findings
No deficiencies related to the allegations in Complaint IN00429498 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaint IN00429498 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census SNF/NF: 77
Census Payor Type Medicare: 14
Census Payor Type Medicaid: 53
Census Payor Type Other: 10
Inspection Report
Complaint Investigation
Census: 88
Capacity: 88
Deficiencies: 0
Feb 26, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00427792, IN00427841, IN00428862, and IN00429241.
Findings
No deficiencies related to the allegations were cited for any of the complaints investigated. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaints IN00427792, IN00427841, IN00428862, and IN00429241 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Census SNF/NF: 88
Total Capacity: 88
Medicare Census: 20
Medicaid Census: 56
Other Payor Census: 12
Inspection Report
Complaint Investigation
Census: 73
Capacity: 73
Deficiencies: 1
Jan 10, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00423600 and IN00425572. Complaint IN00423600 had no deficiencies related to the allegations, while Complaint IN00425572 resulted in federal/state deficiencies related to the allegations cited at F610.
Findings
The facility failed to conduct a thorough investigation of injuries of unknown origin for one resident (Resident B). Multiple bruises in various stages of healing were observed on Resident B, and the investigation lacked documentation regarding the cause, characteristics, and potential involvement of other residents. The facility implemented corrective actions including reeducation of staff on abuse policies and investigation procedures, and monitoring through random skin observations.
Complaint Details
Complaint IN00425572 was substantiated with federal/state deficiencies cited at F610. The investigation revealed multiple bruises on Resident B with no thorough investigation or documentation of cause, and failure to review video footage mentioned in the police report. The facility ruled out abuse and implemented corrective actions.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to conduct a thorough investigation of injuries of unknown origin for 1 of 2 residents reviewed (Resident B). | SS=D |
Report Facts
Census: 73
Total Capacity: 73
Medicare Census: 9
Medicaid Census: 52
Other Payor Census: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Signed the report and provided facility investigation information |
| Nurse 3 | Reported bruises to the Director of Nursing and participated in resident assessment | |
| Nurse 5 | Attended Resident B during observation and examination | |
| CNA 7 | Certified Nurse Aide | Provided direct care to Resident B and reported no bruises on 1/3/24 |
| CNA 8 | Observed and reported multiple bruises on Resident B on 1/5/24 |
Inspection Report
Complaint Investigation
Deficiencies: 0
Jan 10, 2024
Visit Reason
The inspection was conducted as a paper compliance review related to the Investigation of Complaint IN00425572.
Findings
Auburn 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 review of the complaint investigation.
Complaint Details
Investigation of Complaint IN00425572 completed on January 10, 2024; facility found in compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
Nov 13, 2023
Visit Reason
Paper compliance review to the Investigation of Complaint IN00419195 completed on October 26, 2023.
Findings
Auburn 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 review to the Complaint Investigation.
Complaint Details
Investigation of Complaint IN00419195 completed on October 26, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 78
Capacity: 78
Deficiencies: 1
Oct 26, 2023
Visit Reason
This visit was for the investigation of Complaint IN00419195 regarding allegations related to resident self-determination and choice.
Findings
The facility failed to ensure a resident's choice of bedtime for 1 of 3 residents reviewed (Resident P). The resident was put to bed against her wishes after wandering, contrary to her care plan and rights.
Complaint Details
Complaint IN00419195 was substantiated with federal/state deficiencies cited at F561 related to resident self-determination and choice of bedtime.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure a resident's choice of bedtime was honored, resulting in the resident being put to bed against her wishes. | SS=D |
Report Facts
Census: 78
Total Capacity: 78
Medicare Census: 13
Medicaid Census: 52
Other Payor Census: 13
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Signed the report |
Inspection Report
Follow-Up
Census: 77
Capacity: 111
Deficiencies: 0
Sep 26, 2023
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 08/09/23.
Findings
At this PSR survey, Auburn Village 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 Life Safety Code.
Report Facts
Facility capacity: 111
Census: 77
Generator power: 200
Inspection Report
Life Safety
Census: 73
Capacity: 111
Deficiencies: 18
Aug 9, 2023
Visit Reason
Life Safety Code Recertification and State Licensure Survey conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The facility was found not in compliance with multiple Life Safety Code requirements including emergency preparedness policies, egress door locking, hazardous area enclosures, fire alarm system maintenance, sprinkler system maintenance, electrical safety, fire drills, and gas equipment storage.
Severity Breakdown
SS=E: 8
SS=F: 6
: 5
SS=D: 1
Deficiencies (18)
| Description | Severity |
|---|---|
| Failed to develop and implement emergency preparedness policies and procedures based on a facility and community-based risk assessment including IT outage/cyber-attack. | — |
| Failed to ensure emergency preparedness policies include provision of subsistence needs for staff and residents. | — |
| Failed to ensure emergency preparedness policies include safe evacuation procedures addressing residents on life support ventilators and evacuation locations. | — |
| Failed to maintain updated arrangements with other facilities to receive residents in event of limitations or cessation of operations. | — |
| Failed to ensure means of egress doors were readily accessible; exit doors #3 and #5 were magnetically locked without posted access codes. | SS=E |
| Failed to ensure hazardous areas, specifically sprinkler riser room, were properly enclosed with sealed penetrations. | SS=E |
| Failed to ensure staff were instructed in the use of the UL 300 hood system in the kitchen. | SS=E |
| Failed to maintain fire alarm system visual inspections semi-annually as required. | SS=F |
| Failed to maintain monitoring of sprinkler system supervisory attachments; low air check monitoring device not connected to fire system. | SS=F |
| Failed to ensure sprinkler heads in kitchen and attic were free of dirt, grease, and insulation. | SS=E |
| Failed to ensure resident room door 107 resisted passage of smoke and fire for at least 20 minutes; 1/2 inch gap at top of door. | SS=D |
| Failed to maintain electrical junction boxes in attic with covers; two boxes had exposed wiring. | SS=E |
| Failed to ensure fire damper systems were inspected and maintained after first year and every four years thereafter. | SS=F |
| Failed to conduct fire drills on each shift for one quarter; missing third shift drill for fourth quarter 2022. | SS=F |
| Failed to maintain access and working space for electrical panels; items stored blocking panels in maintenance office and room M-1. | SS=E |
| Failed to ensure hospital-grade electrical receptacles testing forms fully documented pass/fail status for each receptacle. | SS=F |
| Failed to ensure power strips and multi-plug adapters were not used as substitutes for fixed wiring for high current draw equipment. | SS=E |
| Failed to ensure minimum 5-foot separation between combustible materials and liquid oxygen tanks and secure storage of oxygen cylinders with proper signage. | SS=E |
Report Facts
Deficiencies cited: 20
Facility capacity: 111
Census: 73
Residents potentially affected: 55
Residents potentially affected: 40
Residents potentially affected: 30
Residents potentially affected: 20
Residents potentially affected: 5
Residents potentially affected: 2
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 8, 2023
Visit Reason
The visit was conducted as a paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Auburn Village 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
Renewal
Census: 73
Capacity: 73
Deficiencies: 1
Jul 31, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from July 24 to July 28, 2023.
Findings
The facility was found deficient in food safety requirements, specifically failing to ensure proper hand hygiene procedures during meal service in one of three observations. Dietary staff were observed not following proper glove use and hand hygiene protocols.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure hand hygiene procedures were performed during meal service, including improper glove use by Dietary Aide 3. | SS=D |
Report Facts
Residents observed during meal service: 14
Census: 73
Total licensed capacity: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Signed as Laboratory Director's or Provider/Supplier Representative |
| Dietary Aide 3 | Named in deficiency for improper hand hygiene and glove use during meal service |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 79
Deficiencies: 0
May 25, 2023
Visit Reason
This visit was conducted for the investigation of three complaints: IN00407854, IN00408659, and IN00409247.
Findings
No deficiencies related to the allegations in any of the three complaints were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaints IN00407854, IN00408659, and IN00409247 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 79
Census Payor Type - Medicare: 11
Census Payor Type - Medicaid: 55
Census Payor Type - Other: 13
Inspection Report
Complaint Investigation
Census: 76
Capacity: 76
Deficiencies: 0
Apr 3, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00404442 and IN00405268.
Findings
No deficiencies related to the allegations in complaints IN00404442 and IN00405268 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Investigation of complaints IN00404442 and IN00405268 found no deficiencies related to the allegations.
Report Facts
Census: 76
Total Capacity: 76
Medicare Census: 16
Medicaid Census: 45
Other Payor Census: 15
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 21, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to the investigation of Complaint IN00400506 completed on February 14, 2023.
Findings
Auburn 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 review of the complaint investigation.
Complaint Details
Investigation of Complaint IN00400506 completed on February 14, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 82
Capacity: 82
Deficiencies: 0
Mar 16, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00403593.
Findings
No deficiencies related to the allegations in Complaint IN00403593 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00403593 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 82
Census Payor Type - Medicare: 20
Census Payor Type - Medicaid: 52
Census Payor Type - Other: 10
Inspection Report
Complaint Investigation
Census: 77
Capacity: 77
Deficiencies: 1
Feb 14, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00400506, which was substantiated with federal/state deficiencies cited.
Findings
The facility failed to ensure food was stored, distributed, and served according to safety standards, including issues with dishwasher sanitation, improper food storage temperatures, uncovered and undated food items, and improper use of hair restraints by dietary staff.
Complaint Details
Complaint IN00400506 was substantiated with federal/state deficiencies cited at F812 related to food safety violations.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to procure food from approved sources and ensure food safety requirements including proper storage, preparation, and serving. | SS=E |
Report Facts
Residents provided meals by facility kitchen: 71
Dishwasher wash temperature: 165
Reach-in refrigerator temperature: 48
Walk-in refrigerator temperature: 46
Total census: 77
Total capacity: 77
Medicare census: 8
Medicaid census: 51
Other payor census: 18
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Derek Moss | Administrator | Named as facility administrator and involved in temperature checks and policy enforcement |
| Dietary Manager | Interviewed and observed during kitchen tour; involved in food safety observations and corrective actions | |
| Chef | Observed serving food without checking temperatures and improper serving practices |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 74
Deficiencies: 0
Jan 27, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00400126.
Findings
The complaint IN00400126 was found to be unsubstantiated due to lack of evidence. 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.
Complaint Details
Complaint IN00400126 was investigated and found unsubstantiated due to lack of evidence.
Report Facts
Census: 74
Total Capacity: 74
Medicare Residents: 6
Medicaid Residents: 50
Other Payor Residents: 18
Inspection Report
Complaint Investigation
Census: 87
Capacity: 87
Deficiencies: 0
Dec 13, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00396142.
Findings
The complaint IN00396142 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00396142 was investigated and found to be unsubstantiated due to lack of evidence.
Report Facts
Census: 87
Total Capacity: 87
Medicare Census: 6
Medicaid Census: 65
Private Pay Census: 9
Other Pay Census: 7
Inspection Report
Annual Inspection
Deficiencies: 0
Sep 27, 2022
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey completed on August 12, 2022.
Findings
Auburn Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Inspection Report
Life Safety
Census: 78
Capacity: 111
Deficiencies: 4
Sep 20, 2022
Visit Reason
The survey was conducted as a Life Safety Code Recertification and State Licensure Survey by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The facility was found not in compliance with Life Safety Code requirements, including failure to test battery backup emergency lights annually, corridor doors not resisting smoke passage, missing inspection certificates for fuel-fired water heaters, and improper use of power strips for high current draw equipment.
Severity Breakdown
SS=F: 1
SS=E: 2
SS=C: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 19 of 19 battery backup emergency lights were tested annually for 90 minutes. | SS=F |
| Failed to ensure 4 of 15 service corridor doors resist the passage of smoke and are capable of resisting fire for at least 20 minutes. | SS=E |
| Failed to ensure 4 of 4 fuel fired water heaters had current inspection certificates to ensure safe operating condition. | SS=C |
| Failed to ensure 2 of 2 power strips were not used as a substitute for fixed wiring to provide power to equipment with a high current draw. | SS=E |
Report Facts
Deficiencies cited: 4
Battery backup emergency lights: 19
Service corridor doors: 4
Fuel fired water heaters: 4
Power strips: 2
Facility capacity: 111
Census: 78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Interviewed and involved in findings related to emergency lighting, corridor doors, water heater inspections, and power strip usage | |
| Administrator | Present during exit conference and review of findings |
Inspection Report
Life Safety
Deficiencies: 0
Sep 20, 2022
Visit Reason
Paper compliance to the Life Safety Code Recertification and State Licensure Survey conducted on 09/20/22.
Findings
Auburn Village was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Complaint Investigation
Census: 79
Capacity: 79
Deficiencies: 0
Aug 30, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00388318.
Findings
The complaint IN00388318 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00388318 was investigated and found unsubstantiated due to lack of evidence.
Report Facts
Medicare residents: 18
Medicaid residents: 53
Other residents: 8
Inspection Report
Annual Inspection
Census: 74
Capacity: 74
Deficiencies: 10
Aug 12, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted on August 9-12, 2022.
Findings
The facility was found deficient in multiple areas including timely completion of quarterly Minimum Data Set (MDS) assessments, quarterly care plan meetings, provision of necessary ADL care, quality of care related to PICC line management, staple removal, hospice care planning, urinary output documentation for catheterized residents, monitoring of side effects for certain medications, proper garbage disposal, and maintenance of a comfortable environment.
Severity Breakdown
SS=E: 3
SS=D: 7
Deficiencies (10)
| Description | Severity |
|---|---|
| Failed to ensure quarterly Minimum Data Set (MDS) assessments were completed in the required time frame for 4 of 4 residents reviewed. | SS=E |
| Failed to ensure residents had quarterly care plan meetings for 1 of 3 residents reviewed. | SS=D |
| Failed to ensure necessary eating and grooming assistance was provided to 1 of 1 resident reviewed. | SS=D |
| Failed to ensure professional standard of care related to PICC line management for 3 of 3 residents reviewed. | SS=D |
| Failed to ensure staples were properly managed and removed for 1 resident. | SS=D |
| Failed to ensure hospice care plan was in place for resident receiving hospice services. | SS=D |
| Failed to ensure urine output was documented for 1 of 1 resident with catheter. | SS=D |
| Failed to monitor side effects of medications for 5 of 5 residents reviewed. | SS=E |
| Failed to ensure garbage and refuse were contained inside the dumpster. | SS=D |
| Failed to ensure environment was comfortable due to damaged walls in resident room. | SS=D |
Report Facts
Census Bed Type: 74
Survey Dates: August 9, 10, 11, and 12, 2022
Residents with untimely MDS: 4
Residents reviewed for care plan meetings: 3
Residents reviewed for ADL care: 1
Residents reviewed for PICC care: 3
Residents reviewed for medication monitoring: 5
Residents with missing urine output documentation: 1
Dates missing urine output documentation: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN 11 | Registered Nurse | Named in PICC line care and removal deficiencies |
| LPN 15 | Licensed Practical Nurse | Named in staple removal and care plan documentation |
| CNA 8 | Certified Nursing Assistant | Named in catheter urine output documentation |
| Maintenance 3 | Named in dumpster and wall repair observations | |
| Social Service Director | Named in care plan meeting and hospice care plan deficiencies | |
| Director of Nursing | DON | Named in multiple interviews regarding PICC care, care plans, and policies |
| Administrator | Named in dumpster and environment deficiencies |
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