Inspection Reports for Coventry Meadows Assisted Living
7833 W Jefferson Blvd, Fort Wayne, IN 46804, United States, IN, 46804
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Inspection Report
Complaint Investigation
Census: 127
Deficiencies: 0
May 12, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00456422.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00456422 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 127
Census Bed Type - SNF: 33
Census Bed Type - SNF/NF: 94
Census Payor Type - Medicare: 34
Census Payor Type - Medicaid: 67
Census Payor Type - Other: 26
Inspection Report
Complaint Investigation
Census: 124
Deficiencies: 0
Mar 25, 2025
Visit Reason
This visit was conducted for the investigation of Complaints IN00454462 and IN00455240.
Findings
No deficiencies related to the allegations in Complaints IN00454462 and IN00455240 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Investigation of Complaints IN00454462 and IN00455240 found no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF: 27
Census Bed Type - SNF/NF: 97
Total Census: 124
Census Payor Type - Medicare: 10
Census Payor Type - Medicaid: 68
Census Payor Type - Other: 46
Inspection Report
Complaint Investigation
Census: 125
Deficiencies: 0
Feb 19, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00452008.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00452008 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF: 29
Census Bed Type - SNF/NF: 96
Total Census: 125
Census Payor Type - Medicare: 9
Census Payor Type - Medicaid: 63
Census Payor Type - Other: 53
Inspection Report
Complaint Investigation
Census: 129
Deficiencies: 0
Dec 20, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00446920.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00446920 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 99
Census Bed Type - SNF: 30
Census Total: 129
Census Payor Type - Medicare: 30
Census Payor Type - Medicaid: 76
Census Payor Type - Other: 23
Inspection Report
Re-Inspection
Census: 112
Capacity: 150
Deficiencies: 0
Nov 12, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey that exited on 09/30/24 was conducted by the Indiana Department of Health in accordance with 42 CFR Subpart 483.90(a).
Findings
At this Life Safety Code Survey, Coventry Meadows was found in compliance with the Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 483.90(a).
Inspection Report
Complaint Investigation
Census: 100
Deficiencies: 1
Nov 6, 2024
Visit Reason
This visit was conducted as an investigation of Complaint IN00445849 regarding allegations of abuse at the facility.
Findings
The facility was found to have failed to ensure a resident's right to be free from physical abuse for one resident. The incident involved a Certified Nurse Aid striking a resident who had been combative. The deficient practice was corrected prior to the survey with the termination of the employee and staff re-education.
Complaint Details
Complaint IN00445849 was substantiated with federal and state deficiencies cited related to the allegations of abuse. The incident involved CNA 5 striking Resident B, who was combative. The facility conducted a thorough investigation, suspended and terminated CNA 5, assessed the resident for injury, and re-educated staff.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure a resident's right to be free from physical abuse. | SS=D |
Report Facts
Census Bed Type - Total Residents: 100
Census Bed Type - SNF/NF: 87
Census Bed Type - SNF: 13
Census Payor Type - Medicare: 13
Census Payor Type - Medicaid: 67
Census Payor Type - Other: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CNA 5 | Certified Nurse Aid | Named in physical abuse finding; suspended and terminated following incident |
| Administrator | Interviewed regarding the abuse incident and investigation |
Inspection Report
Life Safety
Census: 115
Capacity: 150
Deficiencies: 4
Sep 30, 2024
Visit Reason
The survey was conducted as a Life Safety Code Recertification and State Licensure Survey by the Indiana Department of Health in accordance with 42 CFR 483.90(a) and an Emergency Preparedness Survey in accordance with 42 CFR 483.73.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included failure to maintain annual inspection of portable fire extinguishers, lack of current inspection certificates for fuel fired water heaters, failure to ensure annual inspection and testing of the oxygen storage room fire door assembly, and improper use of flexible cords and surge protectors in offices.
Severity Breakdown
SS=E: 3
SS=F: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 16 portable fire extinguishers was given maintenance at periods not more than one year apart. | SS=E |
| Failed to ensure 3 of 3 fuel fired water heaters had current inspection certificates to ensure safe operating condition. | SS=F |
| Failed to ensure annual inspection and testing of 1 oxygen storage room fire door assembly was completed. | SS=E |
| Failed to ensure 1 Housekeeping Manager's office and 1 Maintenance Director's office flexible cords were not used as a substitute for fixed wiring (surge protectors plugged into each other). | SS=E |
Report Facts
Facility capacity: 150
Census: 115
Portable fire extinguishers inspected: 16
Fuel fired water heaters: 3
Oxygen storage room fire door assemblies: 1
Surge protectors observed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Hardy | Executive Director | Named in relation to findings and exit conference |
Inspection Report
Renewal
Census: 117
Capacity: 117
Deficiencies: 0
Sep 13, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey and included the Investigation of Complaint IN00442779.
Findings
Coventry Meadows 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 and Complaint IN00442779. No deficiencies related to the complaint allegations were cited.
Complaint Details
Complaint IN00442779 was investigated and no deficiencies related to the allegations were cited.
Report Facts
Census SNF/NF beds: 96
Census SNF beds: 21
Total census: 117
Medicare residents: 25
Medicaid residents: 68
Other payor residents: 24
Inspection Report
Complaint Investigation
Census: 112
Deficiencies: 0
Jun 24, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00435061.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00435061 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 112
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 67
Census Payor Type - Other: 41
Inspection Report
Complaint Investigation
Census: 125
Deficiencies: 0
Mar 8, 2024
Visit Reason
This visit was for the Investigation of Complaint IN00429779.
Findings
No deficiencies related to the allegations are cited. Coventry Meadows was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the Investigation of Complaint IN00429779.
Complaint Details
Complaint IN00429779 - No deficiencies related to the allegations are cited.
Report Facts
Census: 125
Census Bed Type - SNF: 29
Census Bed Type - SNF/NF: 96
Census Payor Type - Medicare: 9
Census Payor Type - Medicaid: 63
Census Payor Type - Other: 53
Inspection Report
Complaint Investigation
Census: 129
Deficiencies: 0
Feb 28, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00427104.
Findings
No deficiencies related to the allegations in Complaint IN00427104 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00427104 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF: 25
Census Bed Type - SNF/NF: 104
Total Census: 129
Census Payor Type - Medicare: 27
Census Payor Type - Medicaid: 76
Census Payor Type - Other: 26
Inspection Report
Complaint Investigation
Census: 124
Deficiencies: 0
Jan 24, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00426813.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00426813 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 124
Census Payor Type - Medicare: 7
Census Payor Type - Medicaid: 71
Census Payor Type - Other: 46
Inspection Report
Complaint Investigation
Census: 128
Deficiencies: 0
Jan 16, 2024
Visit Reason
This visit was for the investigation of complaints IN00424257, IN00424846, and IN00425647 at Coventry Meadows.
Findings
No deficiencies related to the allegations in complaints IN00424257, IN00424846, and IN00425647 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaints IN00424257, IN00424846, and IN00425647 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type: 128
Census Payor Type - Medicare: 30
Census Payor Type - Medicaid: 75
Census Payor Type - Other: 23
Census Bed Type - SNF/NF: 104
Census Bed Type - SNF: 24
Inspection Report
Re-Inspection
Census: 120
Capacity: 150
Deficiencies: 0
Nov 3, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 09/25/23 by the Indiana Department of Health.
Findings
Coventry Meadows was found in compliance with Requirements for Participation in Medicare/Medicaid, 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
Complaint Investigation
Census: 116
Deficiencies: 0
Oct 23, 2023
Visit Reason
This visit was for the Investigation of Complaints IN00418393 and IN00419138.
Findings
No deficiencies related to the allegations in complaints IN00418393 and IN00419138 were cited. Coventry Meadows was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the investigation.
Complaint Details
Investigation of Complaints IN00418393 and IN00419138 found no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 95
Census Bed Type - SNF: 21
Total Census: 116
Census Payor Type - Medicare: 25
Census Payor Type - Medicaid: 73
Census Payor Type - Other: 18
Inspection Report
Complaint Investigation
Census: 117
Deficiencies: 0
Sep 26, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00417485 and IN00417504.
Findings
No deficiencies related to the allegations in either complaint were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00417485 and Complaint IN00417504 were investigated; no deficiencies related to the allegations were cited.
Report Facts
Census Bed Type - SNF/NF: 97
Census Bed Type - SNF: 20
Census Total: 117
Census Payor Type - Medicare: 22
Census Payor Type - Medicaid: 72
Census Payor Type - Other: 23
Inspection Report
Life Safety
Census: 122
Capacity: 150
Deficiencies: 5
Sep 25, 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 federal regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was found not in compliance with Life Safety Code requirements. Deficiencies included failure to maintain latching hardware on smoke barrier doors, unsealed penetrations in smoke barriers, lack of annual inspection of fire door assemblies, and improper use and installation of power cords and power strips.
Severity Breakdown
SS=E: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to maintain latching hardware on 1 of 1 smoke barrier doors in the 300-hall. | SS=E |
| Failed to ensure penetrations through 1 of 5 smoke barriers were protected to maintain smoke resistance. | SS=E |
| Failed to ensure annual inspection and testing of 1 of 8 fire door assemblies, specifically the oxygen storage/transfilling room door. | SS=E |
| Failed to ensure 1 of 1 flexible cords were installed properly and used in a safe manner; power strip was dangling and not secured. | SS=E |
| Failed to ensure 2 of 2 power strips were not used as a substitute for fixed wiring to provide power to high current draw equipment. | SS=E |
Report Facts
Facility capacity: 150
Census: 122
Number of smoke barrier doors inspected: 1
Number of smoke barriers inspected: 5
Number of fire door assemblies: 8
Number of power strips improperly used: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Hardy | Executive Director | Signed the report |
| Maintenance Assistant | Interviewed and acknowledged deficiencies related to smoke barrier doors, penetrations, fire door inspections, and power strip usage | |
| Maintenance Director | Interviewed and involved in corrective actions and exit conference |
Inspection Report
Annual Inspection
Deficiencies: 0
Sep 12, 2023
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Coventry Meadows was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Inspection Report
Complaint Investigation
Census: 113
Deficiencies: 0
Aug 29, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00416131.
Findings
No deficiencies related to the complaint allegations were cited. Coventry Meadows was found to be in compliance with relevant regulations regarding the complaint.
Complaint Details
Complaint IN00416131 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF: 14
Census Bed Type - NF: 99
Total Census: 113
Census Payor Type - Medicare: 14
Census Payor Type - Medicaid: 80
Census Payor Type - Private: 19
Inspection Report
Annual Inspection
Census: 121
Capacity: 121
Deficiencies: 2
Aug 25, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, which included the Investigation of Complaint IN00414817. No deficiencies related to the complaint allegations were cited.
Findings
The facility was found deficient in ensuring dignity during dining for 2 residents on the memory care unit and in implementing an effective pain management regimen for 1 resident. Observations revealed issues with meal timing, resident assistance, and pain management practices.
Complaint Details
Complaint IN00414817 was investigated during the survey and no deficiencies related to the allegations were cited.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure dignity with dining for 2 of 8 residents reviewed (Residents 14 and 51) on the memory care unit, including late meal trays, inadequate assistance, and inappropriate handling of residents' drinks and food. | SS=D |
| Failed to implement an effective pain management regimen for 1 of 4 residents reviewed for pain (Resident 20), including lack of non-pharmacological interventions and incomplete pain assessments. | SS=D |
Report Facts
Census SNF/NF beds: 104
Census SNF beds: 17
Total census: 121
Medicare census: 18
Medicaid census: 83
Other payor census: 20
Non-pharmacological interventions not offered: 7
Non-pharmacological interventions attempted: 33
Pain medication refusals: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Hardy | Executive Director | Signed the inspection report |
| CNA 2 | Certified Nurse Aide | Interviewed regarding care and assistance provided to Residents 14 and 51 during dining |
| Director of Nursing | Director of Nursing | Provided policies and interviewed regarding pain management practices |
Inspection Report
Complaint Investigation
Census: 113
Deficiencies: 0
May 31, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00409399.
Findings
No deficiencies related to the allegations were cited. Coventry Meadows was found to be in compliance with applicable regulations regarding the complaint investigation.
Complaint Details
Complaint IN00409399 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type Total: 113
Census Payor Type Medicare: 19
Census Payor Type Medicaid: 76
Census Payor Type Other: 18
Inspection Report
Complaint Investigation
Census: 119
Deficiencies: 0
May 23, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00407709 and IN00408404.
Findings
No deficiencies related to the allegations in complaints IN00407709 and IN00408404 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Investigation of Complaints IN00407709 and IN00408404 found no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 99
Census Bed Type - SNF: 20
Census Total: 119
Census Payor Type - Medicare: 21
Census Payor Type - Medicaid: 78
Census Payor Type - Other: 20
Census Payor Type - Total: 119
Inspection Report
Complaint Investigation
Census: 118
Capacity: 118
Deficiencies: 0
Apr 19, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00406121 and IN00406487.
Findings
No deficiencies related to the allegations in either complaint were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00406121 and Complaint IN00406487 were investigated with no deficiencies cited related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 97
Census Bed Type - SNF: 21
Total Census: 118
Census Payor Type - Medicare: 23
Census Payor Type - Medicaid: 75
Census Payor Type - Other: 20
Inspection Report
Complaint Investigation
Census: 114
Deficiencies: 0
Apr 4, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00404840.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00404840 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 94
Census Bed Type - SNF: 20
Census Total: 114
Census Payor Type - Medicare: 20
Census Payor Type - Medicaid: 67
Census Payor Type - Other: 27
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 21, 2023
Visit Reason
The visit was a paper compliance review related to the Investigation of Complaint IN00402413 completed on March 1, 2023.
Findings
Coventry Meadows 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 of the complaint investigation.
Complaint Details
Investigation of Complaint IN00402413 completed on March 1, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 116
Capacity: 116
Deficiencies: 1
Mar 1, 2023
Visit Reason
This visit was conducted for the investigation of four complaints (IN00402403, IN00402413, IN00402445, and IN00402580) and included a COVID-19 Focused Infection Control Survey.
Findings
The facility was found to have failed to ensure showers or bed baths were offered twice weekly and nail care was provided for 3 of 4 residents reviewed for activities of daily living. Deficiencies related to complaint IN00402413 were cited at F677, while other complaints were substantiated but had no deficiencies cited.
Complaint Details
Complaint IN00402403 - Substantiated with no deficiencies cited. Complaint IN00402413 - Substantiated with federal/state deficiencies cited at F677. Complaint IN00402445 - Substantiated with no deficiencies cited. Complaint IN00402580 - Substantiated with no deficiencies cited.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure showers or bed baths were offered twice weekly and nail care was provided for 3 of 4 residents reviewed for activities of daily living. | SS=E |
Report Facts
Census: 116
Total Capacity: 116
Medicare Census: 23
Medicaid Census: 71
Other Payor Census: 22
Inspection Report
Complaint Investigation
Census: 125
Deficiencies: 0
Jan 18, 2023
Visit Reason
This visit was conducted for the investigation of three complaints: IN00398252, IN00398492, and IN00399269.
Findings
All three complaints were found to be unsubstantiated due to lack of evidence, and no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00398252 - Unsubstantiated due to lack of evidence. No deficiencies related to the allegations are cited. Complaint IN00398492 - Unsubstantiated due to lack of evidence. No deficiencies related to the allegations are cited. Complaint IN00399269 - Unsubstantiated due to lack of evidence. No deficiencies related to the allegations are cited.
Report Facts
Census Bed Type - SNF/NF: 99
Census Bed Type - SNF: 26
Census Total: 125
Census Payor Type - Medicare: 26
Census Payor Type - Medicaid: 99
Census Payor Type - Other: 0
Inspection Report
Complaint Investigation
Census: 114
Capacity: 114
Deficiencies: 0
Dec 8, 2022
Visit Reason
This visit was conducted for the investigation of two complaints, IN00393592 and IN00393604.
Findings
Both complaints were substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00393592 - Substantiated with no deficiencies cited. Complaint IN00393604 - Substantiated with no deficiencies cited.
Report Facts
Census Bed Type: 114
Census Payor Type: 114
Medicare residents: 27
Medicaid residents: 66
Other residents: 21
Inspection Report
Annual Inspection
Census: 110
Capacity: 150
Deficiencies: 2
Nov 21, 2022
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 found not in compliance with Life Safety Code requirements. Deficiencies included an exit discharge gate obstructed by a zip-tie, and use of power strips in resident care areas that did not meet required UL ratings.
Severity Breakdown
SS=E: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to maintain 1 of 1 exit discharge gates free of impediments to full instant use in case of fire or emergency, affecting 25 residents using the 100-hall exit. | SS=E |
| Failed to ensure 2 of 2 flexible cords power strips in patient care locations met the required UL rating of 1363A or 60601-1, affecting four residents. | SS=E |
Report Facts
Facility capacity: 150
Census: 110
Residents affected by exit gate deficiency: 25
Residents affected by power strip deficiency: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Hardy | Executive Director | Signed the report and involved in exit conference |
| Maintenance Director | Interviewed regarding exit gate and power strip deficiencies | |
| Administrator | Interviewed and involved in exit conference |
Inspection Report
Life Safety
Deficiencies: 0
Nov 21, 2022
Visit Reason
Paper compliance to the Life Safety Code Recertification and State Licensure Survey conducted on 11/21/22.
Findings
Coventry Meadows was found in compliance with Requirements for Participation in Medicare/Medicaid, 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
Annual Inspection
Deficiencies: 0
Oct 25, 2022
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey, and also included an Investigation of Complaint IN00391151 completed on October 7, 2022.
Findings
Coventry Meadows was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review of the Recertification and State Licensure survey and the complaint investigation.
Complaint Details
Investigation of Complaint IN00391151 was completed on October 7, 2022 and found to be in compliance.
Inspection Report
Annual Inspection
Census: 121
Capacity: 121
Deficiencies: 2
Oct 7, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey, which included the Investigation of Complaint IN00391151.
Findings
The facility was found deficient in providing engaging activities for residents on the secured memory care unit and failed to ensure proper food temperature monitoring and documentation. Complaint IN00391151 was substantiated with related deficiencies cited. The facility lacked proper activity engagement for 4 residents and had incomplete food temperature logs and no thermometer in the walk-in refrigerator.
Complaint Details
Complaint IN00391151 was substantiated with federal/state deficiencies related to the allegations cited at F679 (activities deficiency).
Severity Breakdown
SS=E: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure engaging activities were provided for 4 of 4 residents reviewed on the secured memory care unit. | SS=E |
| Failed to ensure proper temperature of food with missing temperature logs and no thermometer observed in the walk-in refrigerator. | SS=E |
Report Facts
Residents present: 121
Licensed capacity: 121
Residents reviewed for activities deficiency: 4
Residents in facility: 124
Inspection Report
Complaint Investigation
Census: 122
Deficiencies: 0
Sep 23, 2022
Visit Reason
This visit was conducted for the investigation of complaints IN00390214 and IN00390571.
Findings
Both complaints IN00390214 and IN00390571 were found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00390214 - Unsubstantiated due to lack of evidence. Complaint IN00390571 - Unsubstantiated due to lack of evidence.
Report Facts
Census Bed Type: 122
Census Payor Type: 122
Inspection Report
Complaint Investigation
Census: 122
Deficiencies: 0
Sep 9, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00387816.
Findings
The complaint IN00387816 was found to be unsubstantiated due to lack of evidence. Coventry Meadows was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the complaint investigation.
Complaint Details
Complaint IN00387816 was investigated and found unsubstantiated due to lack of evidence.
Report Facts
Census Bed Type - SNF/NF: 100
Census Bed Type - SNF: 22
Total Census: 122
Census Payor Type - Medicare: 9
Census Payor Type - Medicaid: 66
Census Payor Type - Other: 47
Total Census Payor: 122
Inspection Report
Complaint Investigation
Census: 114
Deficiencies: 0
Jul 28, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00385157.
Findings
The complaint was substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00385157 was substantiated, but no deficiencies related to the allegations were cited.
Report Facts
Census Bed Type Total: 114
Census Payor Type Total: 114
SNF/NF Beds: 94
SNF Beds: 20
Medicare Residents: 12
Medicaid Residents: 64
Other Residents: 38
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