Inspection Reports for Chapters Living of South Bend
955 Hickory Rd, South Bend, IN 46615, United States, IN, 46615
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Inspection Report
Follow-Up
Census: 15
Deficiencies: 0
Jul 2, 2025
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaints IN00457398 and IN00458551 completed on 2025-05-01, conducted in conjunction with a Recertification and State Licensure Survey and Investigation of Complaint IN00459606 completed on 2025-07-02.
Findings
The facility was found to be in compliance with 410 IAC 16.2-5 regarding the PSR to the Investigations of Complaints IN00457398 and IN00458551. Both complaints IN00457398 and IN00458551 were corrected.
Complaint Details
Complaint IN00457398 and Complaint IN00458551 were investigated and found to be corrected. Complaint IN00459606 was also investigated during this visit.
Report Facts
Facility number: 16149
Residential Census: 15
Inspection Report
Complaint Investigation
Census: 16
Deficiencies: 2
May 1, 2025
Visit Reason
This visit was for the investigation of complaints IN00457398 and IN00458551 concerning allegations of failure to report incidents and abuse in a timely manner.
Findings
The facility failed to implement policies related to reporting falls with major injury, elopements, and allegations of abuse timely for 3 residents. Deficiencies included lack of injury assessment before moving residents after falls, inadequate supervision leading to falls and elopements, and physical abuse or involuntary seclusion of residents with cognitive impairment.
Complaint Details
The investigation was triggered by complaints IN00457398 and IN00458551. The complaints were substantiated with findings of failure to report incidents timely and abuse substantiated against staff. Specific incidents involved Resident B's fall and injury, Resident C's abuse by QMA 11, and Resident D's fall, elopement, and abuse by staff QMA 6 and QMA 9.
Deficiencies (2)
| Description |
|---|
| Failure to report a fall with major injury to the State Agency, failure to investigate and report an elopement to the State Agency in a timely manner, and failure to report two allegations of abuse to the State Agency in a timely manner for 3 residents. |
| Failure to ensure residents' rights were honored, including lack of injury assessment before moving residents after falls, inadequate supervision resulting in falls and elopements, and physical abuse or involuntary seclusion of residents. |
Report Facts
Residents on site: 16
Staffing ratio: 3.3
Incident dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Sieplinga | CEO | Signed report as facility representative |
| QMA 11 | Qualified Medication Aide | Named in abuse incident involving Resident C, placed on administrative leave and terminated after substantiation |
| QMA 6 | Qualified Medication Aide | Involved in resident altercation with Resident D, placed on administrative leave and terminated |
| QMA 9 | Qualified Medication Aide | Involved in resident altercation with Resident D, placed on administrative leave and terminated |
| CNA 10 | Certified Nursing Assistant | Involved in resident altercation with Resident D, placed on administrative leave and returned to work |
Inspection Report
Re-Inspection
Census: 7
Deficiencies: 0
Oct 8, 2024
Visit Reason
This visit was for a Post Survey Revisit (PSR) to the State Residential Licensure Survey completed on 2024-08-13.
Findings
Chapters Living of South Bend was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to the State Residential Licensure Survey.
Inspection Report
Original Licensing
Census: 5
Deficiencies: 7
Aug 13, 2024
Visit Reason
This visit was for an Initial State Residential Licensure Survey conducted on August 13, 2024.
Findings
The facility was found deficient in multiple areas including lack of CPR and First Aid certified staff on each shift, failure to conduct pre-admission evaluations by a nurse for residents, absence of admission weights documentation, missing signed service plans for residents, lack of qualified dietary manager or dietician oversight, and failure to ensure required tuberculosis health assessments and skin tests for admitted residents.
Deficiencies (7)
| Description |
|---|
| Failed to ensure at least one staff member had CPR and First Aid certification on each shift. |
| Failed to ensure 4 of 5 residents had a pre-admission evaluation by a nurse to determine needs. |
| Failed to ensure admission weight was documented for 5 of 5 admitted residents. |
| Failed to ensure resident and/or family member signed a plan of service for 5 of 5 residents. |
| Failed to ensure a qualified Dietary Manager and/or Dietician was overseeing dietary services. |
| Failed to ensure 5 of 5 residents had a physician health assessment with statement of no evidence of infectious tuberculosis. |
| Failed to ensure 5 of 5 admitted residents had a negative tuberculin skin test prior to or upon admission. |
Report Facts
Residents reviewed: 5
Deficiency completion dates: Sep 30, 2024
Deficiency completion dates: Aug 29, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bobbi Bradford | Director of Health and Wellness | Signed the report as Laboratory Director or Provider/Supplier Representative. |
| Director of Nursing (DON) | Mentioned in relation to findings about resident diagnoses, lack of pre-admission evaluations, and facility policies. | |
| Administrator | Mentioned in relation to facility policies and staffing. | |
| Cook 5 | Mentioned in relation to dietary service deficiencies. | |
| Health Service Director | Responsible for re-education and audits related to deficiencies. |
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