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Inspection Reports for Bloom at German Church

IN, 46229

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Inspection Report Complaint Investigation Census: 54 Deficiencies: 8 Jun 26, 2024
Visit Reason
This visit was for a State Residential Licensure Survey which included the Investigation of Complaint IN00421227.
Findings
The facility was found deficient in multiple areas including failure to provide written transfer/discharge notices, maintain hot water temperatures within required range, maintain kitchen sanitation and food safety, timely administration of prescribed antibiotics, documentation of medication disposition, completeness of resident transfer forms, infection control practices related to insulin needle recapping, and administration of tuberculin skin tests prior to admission.
Complaint Details
Complaint IN00421227 was investigated during this survey. State deficiencies related to the allegations are cited at R0045.
Deficiencies (8)
Description
Failure to provide written notice of transfer or discharge and place a copy in the resident's clinical record for 2 of 2 records reviewed.
Failed to maintain hot water temperatures between 100 and 120 degrees Fahrenheit at point of use for 3 of 3 rooms observed.
Facility kitchen food preparation and serving areas were not free of personal staff items, hair nets were not utilized, food was not properly dated, expired food was not disposed of, dish machine temperatures were inadequate, and kitchen was not maintained clean and sanitary.
Failed to ensure a resident requiring an antibiotic received the prescribed medication in a timely manner.
Failed to document disposition of released, returned, or destroyed medications in the resident's clinical record for 1 of 2 residents reviewed.
Failed to ensure transfer forms included all required information for 2 of 2 residents reviewed.
Failed to ensure used insulin needles were not recapped for 2 of 2 injections randomly observed.
Failed to ensure tuberculin skin tests were administered prior to or at the time of admission for 1 of 5 records reviewed.
Report Facts
Residents present: 54 Hot water temperature: 131 Hot water temperature: 124 Hot water temperature: 128 Dishwasher wash temperature: 116 Dishwasher rinse temperature: 119 Missed antibiotic doses: 5
Employees Mentioned
NameTitleContext
Kim LingleExecutive DirectorSigned the report
Director of NursingDirector of NursingInterviewed regarding transfer forms, medication administration, and infection control practices
QMA 4Qualified Medication AideObserved administering insulin and recapping needles
Dietary ManagerDietary ManagerInterviewed during kitchen inspection regarding sanitation and food safety
Director of Plant OperationsDirector of Plant OperationsInterviewed regarding hot water temperatures and kitchen observations
Inspection Report Follow-Up Census: 53 Deficiencies: 0 Jun 9, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the State Residential Licensure Survey and a PSR to Investigations of Complaints IN00406175 and IN00406078 completed on April 20, 2023.
Findings
Bloom at German Church was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to the State Residential Licensure Survey and PSR to Investigation of Complaints IN00406175 and IN00406078.
Complaint Details
Complaints IN00406175 and IN00406078 were investigated and found to be corrected.
Report Facts
Residential Census: 53
Inspection Report Complaint Investigation Census: 57 Deficiencies: 15 Apr 20, 2023
Visit Reason
This visit was for a State Residential Licensure Survey including the Investigation of Complaints IN00406175 and IN00406078.
Findings
The facility was found deficient in multiple areas including failure to protect residents from sexual and mental abuse, failure to develop a clear abuse policy, incomplete health screenings for employees, incomplete resident evaluations and care plans, improper medication administration, inadequate food service and infection control practices.
Complaint Details
Complaint IN00406175 - State deficiencies related to the allegations are cited at R268, R406. Complaint IN00406078 - State deficiencies related to the allegations are cited at R268, R269, R273, and R272.
Deficiencies (15)
Description
Failed to protect residents from sexual and mental abuse by not determining capacity to consent to sexual activity and not developing a plan to address sexual activity and psychological harassment for 2 residents.
Failed to develop an abuse policy that clearly states assurance that all residents are free of abuse.
Did not assure a 2-step tuberculin skin test was completed for 2 of 5 employee records reviewed.
Failed to ensure resident's semiannual weights were included in evaluation of needs for 1 of 5 residents reviewed.
Failed to revise a resident's service plan as needs changed related to frequent falls for 1 of 5 residents.
Failed to assess a resident for ability to self-administer medications for 1 of 5 residents reviewed.
Failed to ensure as needed (PRN) medications administered by Qualified Medication Assistants were authorized by licensed nursing personnel for 2 of 5 residents reviewed.
Failed to provide meals that provided a balanced distribution of daily nutritional requirements for all residents.
Failed to ensure meals and/or substitutions were approved by a registered dietician for all residents.
Failed to ensure food was served at safe and appropriate temperatures for 9 residents receiving room trays and 1 resident with puree diet.
Failed to maintain kitchen equipment in good working order; reach-in freezer condenser leaking onto foods, expired food items, unlabeled and undated opened food items, and kitchen staff not wearing beard/mustache restraints.
Failed to maintain complete medical record including emergency contact information for 1 of 5 residents reviewed.
Failed to ensure resident death record included notification of physician for 1 of 2 closed records reviewed.
Failed to develop a comprehensive care plan in cooperation with mental health service provider for 1 of 5 residents reviewed.
Failed to properly prevent and/or contain COVID-19 and ensure infection control by staff not donning/doffing appropriate PPE for a resident in droplet transmission and not performing hand hygiene between lunch tray deliveries.
Report Facts
Residents affected: 57 Employees missing 2-step TB test: 2 Residents reviewed for evaluation: 5 Residents receiving room trays with temperature issues: 9 Residents reviewed for medication administration: 5 Residents reviewed for infection control: 2
Employees Mentioned
NameTitleContext
Kim LingleExecutive DirectorSigned report and provided interviews regarding abuse policy and infection control.
Cheryl DitltzerNPProvided follow-up orders and care plan updates for Resident N.
Tiffini SmithNPProvided follow-up orders and care plan updates for Resident N.
LPN 1Licensed Practical NurseInterviewed regarding sexual activity and education of residents.
LPN 2Licensed Practical NurseInterviewed regarding sexual activity and resident interactions.
LPN 3Licensed Practical NurseReported resident statements about sexual activity and abuse.
LPN 4Licensed Practical NurseInterviewed regarding PPE use and resident care.
QMA 10Qualified Medication AssistantAdministered PRN medications without nurse authorization.
QMA 11Qualified Medication AssistantMissing 2-step tuberculin skin test documentation.
QMA 12Qualified Medication AssistantMissing 2-step tuberculin skin test documentation.
WDWellness DirectorInterviewed regarding employee health screenings and PRN medication authorization.
DONDirector of NursingProvided multiple interviews regarding care plans, infection control, medication administration, and record completeness.
DMDietary ManagerInterviewed regarding menu planning, food preparation, and kitchen sanitation.
CNA 2Certified Nursing AssistantObserved and interviewed regarding PPE use and resident care.
HHA 17Home Health AideObserved delivering lunch trays and PPE use.
KS 2Kitchen StaffObserved preparing pureed meals and kitchen sanitation issues.
KS 22Kitchen StaffObserved not wearing beard restraint during food preparation.

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