Inspection Reports for
Clark Rehabilitation and Skilled Nursing Center
517 N LITTLE LEAGUE BLVD, CLARKSVILLE, IN, 47129
Back to Facility ProfileDeficiencies (last 5 years)
Deficiencies (over 5 years)
8.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
100% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
28
21
14
7
0
Occupancy
Latest occupancy rate
82% occupied
Based on a June 2025 inspection.
Occupancy rate over time
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jan 22, 2026
Visit Reason
The inspection was conducted to investigate a complaint regarding the facility's failure to ensure accurate medication administration records for residents.
Complaint Details
The visit was complaint-related, investigating Intake 2708150. The complaint involved missing documentation of medication administration for multiple residents. The deficiency was substantiated.
Findings
The facility failed to ensure medication administration records reflected medications administered for 4 of 4 residents reviewed. Documentation was missing for multiple medications on various dates and times in January 2026.
Deficiencies (1)
F 0842: The facility failed to safeguard resident-identifiable information and maintain medical records in accordance with accepted professional standards. Medication administration records lacked documentation for multiple medications for Residents B, C, D, and E on various dates in January 2026.
Report Facts
Dates with missing medication documentation: 6
Dates with missing medication documentation: 3
Dates with missing medication documentation: 5
Dates with missing medication documentation: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) 5 | Interviewed regarding medication administration documentation. | |
| Director of Nursing | Provided current policy titled General Dose Preparation and Medication Administration. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Oct 29, 2025
Visit Reason
The inspection was conducted due to complaints regarding misappropriation of residents' property and failure to follow the scope of practice for certified nursing assistants.
Complaint Details
The complaint investigation substantiated that narcotic pain medications were not administered as documented for Residents B, C, and D, and that a certified nursing assistant administered medication outside their scope of practice. The facility corrected the deficiencies by implementing audits, staff education, drug testing, and policy reinforcement.
Findings
The facility failed to prevent misappropriation of residents' property related to narcotic pain medications for 3 residents and failed to ensure that certified nursing assistants adhered to their scope of practice by administering medications.
Deficiencies (2)
F 0602: The facility failed to protect residents from misappropriation of property by documenting medication administration that did not occur and allowing a nurse to sign out narcotic medications without administering them.
F 0658: The facility failed to ensure a certified nursing assistant followed the scope of practice by administering medication to a resident, which is outside their authorized duties.
Report Facts
Residents affected: 3
Dates of medication administration discrepancies: 4
Date of plan correction completion: Oct 15, 2025
Date of CNA education completion: Oct 14, 2025
Drug testing date: Oct 10, 2025
Pharmacy audit duration: 90
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 10 | Licensed Practical Nurse | Named in findings related to failure to administer narcotic medications and improper delegation to CNA. |
| CNA 11 | Certified Nursing Assistant | Named in findings related to administering medication outside scope of practice. |
| Executive Director | Provided timeline and documentation related to the investigation. | |
| Regional Nurse Consultant | Reviewed video footage and provided expert opinion on medication administration discrepancies. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Jul 1, 2025
Visit Reason
The inspection was conducted due to a complaint investigation related to medication administration and pharmaceutical services at Clark Rehabilitation and Skilled Nursing Center.
Complaint Details
This citation relates to Complaint IN00462112.
Findings
The facility failed to ensure a physician's order was in place for an additional dose of narcotic pain medication for one resident and failed to administer scheduled medications to a resident on dialysis days. Additionally, medication administration records did not accurately reflect the administration of controlled substances for four residents reviewed.
Deficiencies (2)
F 0755: The facility failed to ensure a physician's order was in place for an additional dose of Oxycodone given to Resident B on 5/31/25 at 12:00 a.m. and failed to administer scheduled medications to Resident C on dialysis days for 2 of 4 residents reviewed.
F 0842: The facility failed to ensure medication administration records accurately reflected the administration of controlled substances for Residents B, C, D, and E, with multiple instances of missing documentation for administered medications in June 2025.
Report Facts
Medication administration missing documentation: 4
Medication error rate policy: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 4 | Licensed Practical Nurse | Named in medication error finding for signing out two doses of Oxycodone at 12:00 a.m. on 5/31/25. |
| RN 3 | Registered Nurse | Indicated medications could not be administered without a physician's order. |
| Executive Director | Provided statements and documentation related to medication administration policies and findings. | |
| Assistant Director of Nursing | Provided statements and documentation related to medication administration policies and findings. |
Inspection Report
Life Safety
Census: 68
Capacity: 83
Deficiencies: 1
Date: Jun 12, 2025
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health on 06/12/2025.
Findings
The facility was found in compliance with Emergency Preparedness Requirements. However, the Life Safety Code survey identified a deficiency where 2 of over 50 corridor doors failed to latch properly, potentially affecting 6 staff and 15 residents. The doors were repaired and corrective actions were implemented to prevent recurrence.
Deficiencies (1)
Failed to ensure 2 of over 50 corridor doors had no impediment to closing and latching into the door frame, resisting the passage of smoke.
Report Facts
Certified beds: 83
Census: 68
Corridor doors inspected: 50
Deficient corridor doors: 2
Staff potentially affected: 6
Residents potentially affected: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Bricker | Executive Director | Signed report and present at exit conference |
| Maintenance Director | Interviewed during survey and acknowledged door deficiencies |
Inspection Report
Life Safety
Deficiencies: 0
Date: Jun 12, 2025
Visit Reason
The visit was a Life Safety Code Recertification and State Licensure Survey conducted on 06/12/2025.
Findings
Clark Rehabilitation and Skilled Nursing Center was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 Edition of the National Fire Protection Association (NFPA) 101, Life Safety Code, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Renewal
Census: 67
Deficiencies: 0
Date: May 19, 2025
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted over May 13, 14, 15, 16, and 19, 2025.
Findings
Clark Rehabilitation and Skilled Nursing Center was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the Recertification and State Licensure survey.
Report Facts
Census Bed Type: 67
Census Payor Type Medicaid: 54
Census Payor Type Other: 13
Inspection Report
Annual Inspection
Deficiencies: 0
Date: May 19, 2025
Visit Reason
Annual survey inspection of Clark Rehabilitation and Skilled Nursing Center to assess compliance with health and safety regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Complaint Investigation
Census: 72
Deficiencies: 0
Date: Apr 29, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00455660.
Complaint Details
Investigation of Complaint IN00455660 found no deficiencies related to the allegation.
Findings
No deficiencies related to the complaint allegation were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census: 72
Census Bed Type: 63
Census Bed Type: 9
Census Payor Type: 5
Census Payor Type: 43
Census Payor Type: 24
Inspection Report
Life Safety
Census: 67
Capacity: 83
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification survey which exited on 04/30/2024 was conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
Clark Rehabilitation and Skilled Nursing Center was found in compliance with Requirements for Participation in Medicare/Medicaid, 42 CFR Subpart 483.90(a), 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. The facility was fully sprinklered with appropriate fire alarm systems.
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: May 29, 2024
Visit Reason
Paper compliance review to the Investigation of Complaint IN00405571 completed on April 5, 2024.
Complaint Details
Investigation of Complaint IN00405571 completed on April 5, 2024; facility found in compliance.
Findings
Clark Rehabilitation and Skilled Nursing 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.
Inspection Report
Complaint Investigation
Census: 70
Capacity: 70
Deficiencies: 0
Date: May 16, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00432338.
Complaint Details
Complaint IN00432338 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type - SNF/NF: 64
Census Bed Type - SNF: 6
Total Census: 70
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 48
Census Payor Type - Other: 18
Inspection Report
Annual Inspection
Census: 73
Capacity: 83
Deficiencies: 4
Date: Apr 30, 2024
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with federal regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements, with deficiencies noted in corridor width clearance, sprinkler system obstructions, door latching, and smoke barrier penetrations.
Deficiencies (4)
Failed to meet clear width requirements for 1 of 1 corridor near the staff lounge which could affect staff only.
Failed to ensure the spray pattern for sprinkler heads were not obstructed in 1 mop closet, 1 dry storage room, and 1 office supply storage room which could affect staff, visitors, and residents.
Failed to ensure 1 of 1 Dutch doors to resident sleeping rooms on the ground floor fully latched into the door frame which could affect up to 2 residents, staff and visitors.
Failed to ensure 2 of 4 smoke barrier walls were protected to maintain the smoke resistance of the smoke barrier which could affect over 20 residents, staff, and visitors.
Report Facts
Certified beds: 83
Census: 73
Corridor width deficiency count: 1
Sprinkler obstruction deficiency count: 3
Dutch door deficiency count: 1
Smoke barrier deficiency count: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Bricker | Executive Director | Signed report and referenced in exit conference |
| Maintenance Director | Interviewed and involved in observations related to deficiencies |
Inspection Report
Annual Inspection
Census: 68
Deficiencies: 2
Date: Apr 5, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, which included the Investigation of Complaint IN00429725.
Complaint Details
Complaint IN00429725 was investigated and no deficiencies related to the allegations were cited.
Findings
The facility was found deficient in ensuring consistent shower provision for dependent residents and in providing splint devices to prevent decrease in range of motion for a resident. No deficiencies were cited related to the complaint investigation. Corrective actions and monitoring plans were outlined for the identified deficiencies.
Deficiencies (2)
Facility failed to ensure showers were provided consistently for 2 of 4 residents reviewed for Activities of Daily Living care (Residents 19 and 67).
Facility failed to ensure a splint device was provided to prevent a decrease in range of motion for 1 of 3 residents reviewed for range of motion (Resident 40).
Report Facts
Census: 68
SNF/NF beds: 7
SNF beds: 61
Medicare residents: 7
Medicaid residents: 47
Other payor residents: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Bricker | Executive Director | Signed the inspection report |
| LPN 5 | Licensed Practical Nurse | Interviewed regarding shower provision and splint application |
| CNA 8 | Certified Nurse Aide | Interviewed regarding shower schedule and resident care |
| CNA 9 | Certified Nurse Aide | Interviewed regarding shower schedule and resident care |
| Occupational Therapist 4 | Occupational Therapist | Interviewed regarding splint use and therapy |
| CNA 3 | Certified Nurse Aide | Interviewed regarding resident brace use |
| LPN 6 | Licensed Practical Nurse | Interviewed regarding facility policy on splints or braces |
| Corporate MDS Coordinator | Interviewed regarding restorative nursing and splint orders |
Inspection Report
Routine
Deficiencies: 2
Date: Apr 5, 2024
Visit Reason
The inspection was conducted to evaluate the facility's compliance with care standards related to activities of daily living, including bathing and range of motion care for residents.
Findings
The facility failed to ensure consistent shower provision for 2 of 4 residents reviewed and failed to ensure a splint device was provided to prevent decreased range of motion for 1 of 3 residents reviewed. The facility also lacked policies for Activities of Daily Living and for applying splints or braces.
Deficiencies (2)
F 0677: The facility failed to provide showers consistently for 2 of 4 residents reviewed for Activities of Daily Living. Resident 19 did not receive showers as scheduled in January, February, and March 2024. Resident 67 did not receive showers in February and March 2024 despite care plans requiring two showers per week.
F 0688: The facility failed to ensure a splint device was provided to prevent decreased range of motion for 1 of 3 residents reviewed. Resident 40 was not wearing the prescribed hand splint for the required hours, and staff lacked a policy for applying splints or braces.
Report Facts
Residents reviewed for ADL care: 4
Residents reviewed for range of motion: 3
Showers scheduled per week: 2
Splint wear time: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 5 | Interviewed regarding shower schedule and splint application. | |
| CNA 8 | Interviewed about shower schedule for Resident 67. | |
| CNA 9 | Interviewed about shower completion and refusals. | |
| Occupational Therapist 4 | Interviewed about Resident 40's splint and therapy status. | |
| CNA 3 | Interviewed about Resident 40's brace use. | |
| LPN 6 | Interviewed about facility policy on splints and braces. | |
| Corporate MDS Coordinator | Interviewed about restorative and splinting programs. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jan 31, 2024
Visit Reason
The inspection was conducted in response to a complaint (IN00424151) regarding the facility's failure to provide timely radiology results for a resident.
Complaint Details
This citation relates to Complaint IN00424151. The deficient practice began on 10/9/23 and was corrected by 12/31/23 after the facility implemented a systemic plan including staff education and audits to ensure follow-up on lab and diagnostic orders.
Findings
The facility failed to ensure radiology results were obtained in a timely manner for 1 of 3 residents reviewed. The resident had a subacute clavicle fracture identified by CT scan, but the facility did not follow up appropriately with the results until corrective actions were implemented.
Deficiencies (1)
F 0776: The facility failed to provide timely, approved x-ray services or have an agreement with an approved provider to obtain them. Radiology results for one resident were not followed up in a timely manner despite multiple imaging orders and reports.
Report Facts
Residents reviewed for radiology services: 3
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Provided interview details about the resident's imaging and follow-up process. |
Inspection Report
Complaint Investigation
Census: 71
Deficiencies: 1
Date: Jan 31, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00424151 regarding allegations related to radiology and diagnostic services at the facility.
Complaint Details
Complaint IN00424151 was substantiated with a Federal/State deficiency cited as F776 related to radiology and diagnostic services.
Findings
The facility failed to ensure radiology results were obtained in a timely manner for 1 of 3 residents reviewed (Resident B). The resident had a delayed follow-up on a CT scan result from 10/9/23, which was not acted upon by the facility despite being faxed to the primary care physician and uploaded to the resident's record. The deficiency was corrected by 12/31/23 after staff education and a 90-day audit.
Deficiencies (1)
Facility failed to ensure radiology results were obtained in a timely manner for 1 of 3 residents reviewed (Resident B).
Report Facts
Census total residents: 71
Census SNF beds: 10
Census SNF/NF beds: 61
Census Medicare residents: 3
Census Medicaid residents: 50
Census Other payor residents: 18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed regarding the delayed follow-up on radiology results and facility policies |
Inspection Report
Complaint Investigation
Census: 67
Deficiencies: 0
Date: Oct 30, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00419106.
Complaint Details
Complaint IN00419106 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations of Complaint IN00419106 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census: 67
Census Bed Type - SNF/NF: 64
Census Bed Type - SNF: 3
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 50
Census Payor Type - Other: 14
Inspection Report
Complaint Investigation
Census: 65
Deficiencies: 0
Date: Aug 21, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00414566.
Complaint Details
Complaint IN00414566 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type Total: 65
Census Payor Type Total: 65
Medicare Census: 3
Medicaid Census: 53
Other Payor Census: 9
SNF/NF Beds: 60
SNF Beds: 5
Inspection Report
Complaint Investigation
Census: 65
Deficiencies: 0
Date: Jun 5, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00404845.
Complaint Details
Complaint IN00404845 was investigated and found to have no related deficiencies.
Findings
No deficiencies related to the allegations in Complaint IN00404845 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census bed type: 65
Census bed type SNF: 4
Census bed type SNF/NF: 61
Census payor type Medicare: 4
Census payor type Medicaid: 50
Census payor type Other: 11
Inspection Report
Re-Inspection
Census: 67
Capacity: 83
Deficiencies: 0
Date: May 30, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 04/03/23 by the Indiana Department of Health.
Findings
Clark Rehabilitation and Skilled Nursing Center was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101 Life Safety Code, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2. The facility was fully sprinklered with appropriate fire alarm systems.
Inspection Report
Re-Inspection
Census: 67
Capacity: 67
Deficiencies: 0
Date: May 2, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Recertification and State Licensure Survey completed on 2023-03-14.
Findings
Clark Rehabilitation and Skilled Nursing Center 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.
Report Facts
Census by bed type: 67
Census by payor type: 67
Inspection Report
Life Safety
Census: 71
Capacity: 83
Deficiencies: 4
Date: Apr 3, 2023
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with 42 CFR 483.73 and 42 CFR 483.90(a) respectively.
Findings
The facility was found in compliance with Emergency Preparedness Requirements. However, deficiencies were identified in life safety code compliance including corridor doors not closing and latching properly, unprotected smoke barrier walls, lack of GFCI protection in a wet location, and unsecured nonflammable gas cylinders.
Deficiencies (4)
Failed to ensure 1 of 45 resident room corridor doors would close completely and latch into their door frames, potentially affecting at least 15 residents, staff and visitors.
Failed to ensure 2 of 4 smoke barrier walls were protected to maintain the smoke resistance of the smoke barrier, potentially affecting over 20 residents, staff and visitors.
Failed to ensure 1 of over 20 wet locations were provided with ground fault circuit interrupter (GFCI) protection against electric shock.
Failed to ensure cylinders of nonflammable gases such as oxygen were properly secured from falling in 1 of 5 smoke compartments.
Report Facts
Certified beds: 83
Census: 71
Resident room corridor doors inspected: 45
Smoke barrier walls inspected: 4
Wet locations inspected: 20
Smoke compartments inspected: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Bricker | Executive Director | Signed report and participated in exit conference |
| Maintenance Director | Interviewed regarding deficiencies and corrective actions | |
| Senior Maintenance Supervisor | Interviewed regarding deficiencies and corrective actions |
Inspection Report
Annual Inspection
Census: 67
Capacity: 67
Deficiencies: 11
Date: Mar 14, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey. This visit included the Investigation of Complaints IN00400507 and IN00402331.
Complaint Details
Complaint IN00400507 and IN00402331 were investigated with no deficiencies related to the allegations cited.
Findings
The facility was found deficient in multiple areas including resident dignity, notification of changes, abuse investigation, vision care, pressure ulcer care, fall prevention, urinary catheter management, respiratory care, medication administration, kitchen sanitation, and COVID-19 testing. Several residents were affected by these deficiencies, and corrective actions were initiated.
Deficiencies (11)
Failed to respect the dignity of a resident with a Foley catheter by ensuring the urine side of the bag was not in sight.
Failed to notify the physician when a resident's blood pressure was elevated and when staff withheld medication.
Failed to ensure an investigation was initiated and completed related to a resident's complaint of mistreatment.
Failed to ensure a resident who had a referral for an evaluation by an ophthalmologist received proper treatment to maintain vision.
Failed to ensure residents' Weekly Skin Assessments were completed and accurate, interventions were implemented, and treatment and monitoring was completed to prevent worsening of pressure ulcers.
Failed to ensure appropriate intervention to prevent a fall for a resident which resulted in broken bones, bruising, and skin tears.
Failed to ensure a resident with a history of UTIs was provided proper management of the urinary catheter drainage system by maintaining the drainage system off the floor.
Failed to ensure oxygen concentrator filters were applied and maintained for residents reviewed for respiratory care.
Failed to ensure accurate documentation in the Controlled Substances Record sheet of administered narcotics and expired medications in medication storage.
Failed to ensure the kitchen, dry storage room and equipment were clean and in good repair during kitchen observations.
Failed to ensure residents were COVID-19 tested in accordance with facility policy.
Report Facts
Census: 67
Total Capacity: 67
Deficiencies cited: 11
Severity SS=D: 7
Severity SS=G: 2
Severity SS=E: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 6 | Licensed Practical Nurse | Named in medication administration deficiency and oxygen concentrator filter observation |
| LPN 5 | Licensed Practical Nurse | Named in medication administration deficiency |
| LPN 4 | Licensed Practical Nurse | Named in medication administration deficiency |
| LPN 3 | Licensed Practical Nurse | Named in medication administration deficiency |
| CNA 12 | Certified Nurse Aide | Named in fall incident observation |
| CNA 19 | Certified Nurse Aide | Named in fall incident observation |
| DON | Director of Nursing | Named in multiple interviews related to deficiencies |
| Executive Director | Named as facility representative signing report and in interviews | |
| Physical Therapist 17 | Physical Therapist | Named in pressure ulcer observation and interview |
| LPN 11 | Licensed Practical Nurse | Named in pressure ulcer care observation |
| CNA 21 | Certified Nurse Aide | Named in catheter care observation |
| CNA 22 | Certified Nurse Aide | Named in catheter care observation |
| Corporate Dietary Manager | Named in kitchen sanitation interview | |
| Dietary Cook | Named in kitchen sanitation interview | |
| LPN 25 | Licensed Practical Nurse | Named in kitchen sanitation interview |
Inspection Report
Routine
Deficiencies: 11
Date: Mar 14, 2023
Visit Reason
Routine inspection of Clark Rehabilitation and Skilled Nursing Center to assess compliance with healthcare regulations including resident care, safety, medication management, infection control, and facility conditions.
Findings
The facility had multiple deficiencies including failure to respect resident dignity, inadequate notification of physician for changes in condition, failure to investigate abuse complaints, inadequate vision service follow-up, pressure ulcer care deficiencies, fall prevention failures, improper catheter care, missing oxygen concentrator filters, medication record inaccuracies, and poor kitchen sanitation.
Deficiencies (11)
F 0550: The facility failed to respect the dignity of a resident with a Foley catheter by ensuring the urine side of the bag was not visible from the hallway.
F 0580: The facility failed to notify the physician when a resident's blood pressure was elevated and when medication was withheld.
F 0610: The facility failed to initiate and complete an investigation related to a resident's complaint of mistreatment.
F 0685: The facility failed to ensure a resident with a referral for ophthalmology received proper treatment to maintain vision.
F 0686: The facility failed to provide appropriate pressure ulcer care and prevent new ulcers from developing for 3 residents.
F 0689: The facility failed to ensure appropriate intervention to prevent a fall resulting in fractures and bruising for a resident.
F 0690: The facility failed to ensure a resident's urinary catheter drainage system was maintained off the floor.
F 0695: The facility failed to ensure oxygen concentrator filters were applied and maintained for 6 residents.
F 0755: The facility failed to ensure accurate documentation in the Controlled Substances Record sheet of administered narcotics and expired medication for 8 residents.
F 0812: The facility failed to ensure the kitchen, dry storage room, and equipment were clean and in good repair during 3 kitchen observations.
F 0886: The facility failed to ensure residents were COVID-19 tested in accordance with policy for 1 resident.
Report Facts
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 3
Residents affected: 1
Residents affected: 1
Residents affected: 6
Residents affected: 8
Residents affected: 66
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 6 | Licensed Practical Nurse | Named in medication administration and signing discrepancy for narcotics |
| LPN 5 | Licensed Practical Nurse | Named in medication administration and signing discrepancy for narcotics |
| LPN 4 | Licensed Practical Nurse | Named in medication administration and signing discrepancy for narcotics |
| CNA 12 | Certified Nurse Aide | Involved in fall incident leading to resident injury |
| Physical Therapist 17 | Physical Therapist | Identified pressure wound on Resident 62 |
| DON | Director of Nursing | Provided policy and interview responses on multiple findings |
| Corporate Dietary Manager | Interviewed regarding kitchen sanitation issues |
Inspection Report
Complaint Investigation
Census: 66
Deficiencies: 0
Date: Jan 24, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00396410, IN00397139, IN00397947, and IN00399062 at Clark Rehabilitation and Skilled Nursing Center.
Complaint Details
Complaint IN00396410 was unsubstantiated due to lack of sufficient evidence. Complaint IN00397139 was substantiated with no deficiencies cited. Complaint IN00397947 was unsubstantiated due to lack of sufficient evidence. Complaint IN00399062 was substantiated with no deficiencies cited.
Findings
Complaints IN00397139 and IN00399062 were substantiated but no deficiencies related to the allegations were cited. Complaints IN00396410 and IN00397947 were unsubstantiated due to lack of sufficient evidence. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type - SNF/NF: 65
Census Bed Type - SNF: 1
Total Census: 66
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 53
Census Payor Type - Other: 11
Total Census Payor: 66
Inspection Report
Complaint Investigation
Census: 66
Deficiencies: 0
Date: Nov 1, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00387819.
Complaint Details
Complaint IN00387819 was investigated and found unsubstantiated due to lack of evidence.
Findings
The complaint IN00387819 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with applicable regulations related to the complaint.
Report Facts
Census Bed Type - SNF/NF: 59
Census Bed Type - SNF: 7
Total Census: 66
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 47
Census Payor Type - Other: 15
Total Census Payor: 66
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