Deficiencies per Year
4
3
2
1
0
Unclassified
Census Over Time
Inspection Report
Census: 37
Deficiencies: 2
Feb 21, 2025
Visit Reason
This visit was for a State Residential Licensure Survey conducted on February 20 and 21, 2025.
Findings
The facility was found noncompliant for failing to ensure weights were taken on admission for one resident and for failing to maintain kitchen cleanliness, including improper food storage and incomplete cleaning documentation.
Deficiencies (2)
| Description |
|---|
| Failed to ensure weights were taken on admission for 1 of 7 residents reviewed (Resident 2). |
| Failed to ensure kitchen cleanliness was maintained; multiple items observed on the floor, wet aluminum pans, crumbs in utensil drawers, and improperly stored food without closures or open dates. |
Report Facts
Residents reviewed for admission weights: 7
Residents affected: 1
Residents in facility: 37
Days with no cleaning tasks documented: 4
Cleaning audit frequency: 1
Food storage audit frequency: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Amber Hardy | Executive Director | Signed the report |
| Director of Nursing | Interviewed regarding admission weights and facility policies | |
| Dietary Worker 2 | Interviewed regarding kitchen cleanliness and food storage | |
| Dietary Manager | Responsible for auditing cleaning and food storage checklists |
Inspection Report
Complaint Investigation
Census: 40
Deficiencies: 0
Dec 10, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00446809.
Findings
No deficiencies related to the allegations were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00446809 - No deficiencies related to the allegations are cited.
Inspection Report
Complaint Investigation
Census: 40
Deficiencies: 0
Oct 28, 2024
Visit Reason
This visit was conducted for the investigation of Residential Complaints IN00445075 and IN00445522.
Findings
No deficiencies related to the allegations in complaints IN00445075 and IN00445522 were cited. The facility was found to be in compliance with applicable regulations regarding these complaints.
Complaint Details
Investigation of Residential Complaints IN00445075 and IN00445522 found no deficiencies related to the allegations; facility was compliant.
Inspection Report
Complaint Investigation
Census: 43
Deficiencies: 0
Jul 3, 2024
Visit Reason
This visit was for the Investigation of Complaint IN00436699.
Findings
No deficiencies related to the allegations are cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00436699 - No deficiencies related to the allegations are cited.
Report Facts
Facility number: 3273
Inspection Report
Complaint Investigation
Census: 46
Deficiencies: 0
Apr 30, 2024
Visit Reason
This visit was conducted for the Investigation of Complaint IN00432344.
Findings
No deficiencies related to the allegations in Complaint IN00432344 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00432344 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Renewal
Census: 49
Deficiencies: 3
Mar 19, 2024
Visit Reason
This visit was for a State Residential Licensure Survey conducted on March 18th and 19th, 2024 to assess compliance with state regulations.
Findings
The facility was found deficient in maintaining a clean and sanitary environment for food preparation, including uncovered trash cans and incomplete temperature logs. Additionally, the facility failed to ensure adequate documentation during resident transfers to acute care facilities.
Deficiencies (3)
| Description |
|---|
| Failed to ensure a clean and sanitary environment for food preparation, including uncovered trash cans and uncovered, unlabeled, and undated food items. |
| Failed to complete required refrigerator and freezer temperature logs for March 2024. |
| Failed to ensure adequate documentation at the time of transfer for 1 of 2 residents reviewed, including missing transfer destination, resident's functional abilities, nursing care, and other required information. |
Report Facts
Residents present: 49
Temperature log missing entries: 26
Residents reviewed for transfer documentation: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonya Bollin | HWD | Signed as Laboratory Director or Provider/Supplier Representative |
| Director of Nursing | Director of Nursing | Interviewed regarding transfer documentation and facility procedures |
| Dining Service Coordinator | Interviewed regarding food service procedures and trash can coverage | |
| Dining Assistant 5 | Interviewed regarding food storage and sanitation practices | |
| Administrator | Administrator | Interviewed regarding awareness of transfer documentation requirements |
Inspection Report
Complaint Investigation
Census: 46
Deficiencies: 1
Jan 18, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00423902 regarding allegations of unlicensed staff providing assistance with activities of daily living.
Findings
The facility failed to ensure that assistance with activities of daily living was provided by qualified staff for 1 of 3 residents reviewed. A cook, who was not certified, assisted a resident with dressing, which is outside the scope of their job description. The cook was suspended and subsequently terminated.
Complaint Details
Complaint IN00423902 was substantiated with deficiencies cited related to unlicensed staff providing personal care. The cook was terminated and staff were re-educated on job descriptions and care boundaries.
Deficiencies (1)
| Description |
|---|
| Any unlicensed employee providing more than limited assistance with activities of daily living must be either a certified nurse aide or a home health aide. The facility failed to ensure this for Resident B. |
Report Facts
Residential Census: 46
Deficiency completion date: Feb 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonya Bollin | Health & Wellness Director | Named as the Health & Wellness Director involved in interviews and re-education of staff |
| Cook 3 | Unlicensed employee who provided personal care to Resident B and was terminated |
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 3
Oct 24, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00419400 regarding allegations of failure to notify physicians of significant changes in resident conditions and medication errors.
Findings
The facility failed to notify the physician of significant changes in condition for 2 of 3 residents reviewed (Resident H and Resident K), failed to notify the physician of a medication error for Resident H, and failed to have a licensed nurse available to complete an admission for Resident H. Multiple deficiencies related to residents' rights and health services were cited.
Complaint Details
Complaint IN00419400 was substantiated with deficiencies cited related to failure to notify physicians of significant changes in resident conditions and medication errors.
Deficiencies (3)
| Description |
|---|
| Failed to notify the physician of a significant change in condition for 2 of 3 residents reviewed (Resident H and Resident K). |
| Failed to notify the physician of a medication error for 1 of 3 residents reviewed (Resident H). |
| Failed to have a licensed nurse available to complete an admission for 1 of 3 residents reviewed (Resident H). |
Report Facts
Residential Census: 50
Medication administration overlap days: 5
Medication doses: 2.5
Medication doses: 0.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonya Bollin | Health & Wellness Director | Named in relation to findings and plans of correction regarding notification failures and medication errors |
| QMA 3 | Qualified Medication Aid | Interviewed regarding lack of licensed nurse availability and admission order transcription |
Inspection Report
Renewal
Census: 35
Deficiencies: 0
Mar 17, 2023
Visit Reason
This visit was for a State Residential Licensure Survey conducted on March 16 and 17, 2023.
Findings
Brookdale Fort Wayne was found to be in compliance with 410 IAC 16.2-5 in regard to the State Residential Licensure Survey.
Report Facts
Residential Census: 35
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 1
Mar 7, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00402513 regarding allegations related to the facility's administration and management.
Findings
The facility failed to employ a licensed Administrator from 12/30/2022 to 2/27/2023. Residents reported worsened call light response times and concerns about medication administration delays. The Operation Specialist was acting as Administrator without a license, and the facility had not properly reported incidents to the Indiana Department of Health.
Complaint Details
Complaint IN00402513 was substantiated with state deficiencies cited related to the allegations of not having a licensed Administrator and failure to report incidents properly.
Deficiencies (1)
| Description |
|---|
| Failed to employ a licensed Administrator as required by state regulations. |
Report Facts
Residential Census: 34
Dates without licensed Administrator: From 12/30/2022 to 2/27/2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristine Lundquist | Executive Director | Signed the report |
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