Deficiencies per Year
8
6
4
2
0
Unclassified
Census Over Time
Inspection Report
Census: 56
Deficiencies: 1
Apr 30, 2025
Visit Reason
This visit was for a State Residential Licensure Survey conducted on April 28, 29, and 30, 2025.
Findings
The facility failed to maintain safe and sanitary kitchens due to a build-up of grease on ovens and stoves, food and liquid spills inside refrigerators, outdated cooking liquids, and improper storage of scoops inside dry food bins in two kitchens. These deficiencies had the potential to affect all 56 residents receiving meals from the Assisted Living and Memory Care kitchens.
Deficiencies (1)
| Description |
|---|
| Failure to maintain safe and sanitary kitchens related to build-up of grease on ovens and stoves, spills inside refrigerators, outdated cooking liquids, and scoops stored inside dry food bins. |
Report Facts
Residents affected: 56
Survey dates: 3
Plan of Correction completion date: Jun 20, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith M Sipich | Executive Director | Signed the report and mentioned as Executive Director overseeing compliance |
| Cook 1 | Interviewed during Assisted Living Kitchen tour regarding kitchen cleanliness | |
| Cook 2 | Interviewed during Memory Care Unit Kitchen/Kitchenette tour regarding kitchen cleanliness | |
| Dining Service Manager | Responsible for cleaning schedules, staff re-inservice, and monitoring kitchen compliance | |
| Memory Care Program Coordinator | Responsible for checking kitchenette refrigerator and freezer cleanliness weekly |
Inspection Report
Complaint Investigation
Census: 61
Deficiencies: 0
Dec 23, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00449289.
Findings
No deficiencies related to the allegations in Complaint IN00449289 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint.
Complaint Details
Complaint IN00449289 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Renewal
Census: 57
Deficiencies: 5
Mar 12, 2024
Visit Reason
This visit was for a State Residential Licensure Survey conducted on March 12 and 13, 2024, to assess compliance with state regulations for the facility.
Findings
The facility was found deficient in several areas including failure to complete discharge/transfer papers for a resident transferred to the hospital, incomplete fire drills each shift per quarter and lack of fire department participation, unsecured personal medications on the dementia care unit, improperly prepared pureed food, and inadequate infection control related to COVID-19 positive staff returning to work prematurely.
Deficiencies (5)
| Description |
|---|
| Failure to ensure discharge/transfer papers were completed for a resident transferred to the hospital. |
| Failure to conduct fire drills each shift per quarter and failure to invite the fire department to participate every six months. |
| Failure to keep personal medications secure on the dementia care unit, resulting in a resident gaining access. |
| Failure to ensure food was prepared in form to meet individual needs, related to incorrectly made pureed food. |
| Failure to ensure infection control guidelines were implemented, including COVID-19 positive staff not restricted from work for the required quarantine period. |
Report Facts
Residents affected: 57
Residents affected: 34
Residents affected: 7
Staff with COVID-19 positive tests: 3
Days staff returned to work after positive COVID-19 test: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judy Sipich | Executive Director | Signed report and mentioned in plan of correction |
| Health and Wellness Director | Interviewed regarding discharge papers, medication security, and infection control policies | |
| Maintenance Director | Interviewed regarding fire drills and fire department participation | |
| Administrator | Interviewed regarding personal items policy and medication security | |
| Memory Care Director | Interviewed regarding resident observations and COVID-19 policies | |
| CNA 4 | Mentioned in medication security incident and COVID-19 positive staff | |
| CNA 5 | Mentioned as COVID-19 positive staff | |
| CNA 6 | Mentioned in medication security incident and COVID-19 positive staff | |
| Cook 1 | Observed preparing pureed food incorrectly | |
| LPN 1 | Received medication bottles found on resident |
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 0
Sep 11, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00414038.
Findings
No deficiencies related to the allegations in Complaint IN00414038 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00414038 was investigated and found to have no related deficiencies; the complaint was not substantiated.
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