Inspection Reports for Five Star Residences of Clearwater
4519 E 82nd St, Indianapolis, IN 46250, United States, IN, 46250
Back to Facility ProfileDeficiencies per Year
12
9
6
3
0
Unclassified
Census Over Time
Inspection Report
Complaint Investigation
Census: 61
Deficiencies: 11
Jul 2, 2024
Visit Reason
This visit was for a State Residential Licensure Survey which included the Investigation of Complaint IN00420876.
Findings
The facility was found to have multiple deficiencies including failure to obtain resident weights per policy, lack of CPR and First Aid certified staff on every shift, incomplete annual training for staff, unclean kitchen equipment and improper food storage, unsigned resident service plans, failure to administer insulin as ordered, lack of proper authorization for PRN medication administration, failure to send transfer forms with residents transferred to acute care, failure to maintain infection control practices in food service, and incomplete new hire employee records for the Director of Nursing.
Complaint Details
Complaint IN00420876 was investigated with no deficiencies related to the allegations cited.
Deficiencies (11)
| Description |
|---|
| Failed to ensure weights were obtained per policy for 1 of 6 resident records reviewed (Resident 34). |
| Failed to ensure a staff person on every shift was certified in CPR and First Aid, potentially affecting all 61 residents. |
| Failed to assure a staff member had Resident Rights and Dementia annual training for 1 of 5 staff members reviewed (Home Health Aide 2). |
| Failed to keep kitchen equipment maintained and in good repair; ice machine not cleaned/sanitized every 6 months, ice buildup on freezer door seals, missing protective handle guard on freezer. |
| Failed to ensure residents' service plans were signed by the resident and/or representatives for 5 of 6 residents reviewed (Residents 1, 22, 34, 62, 73). |
| Failed to administer insulin as ordered by the physician for 1 of 5 records reviewed (Resident 1). |
| Failed to ensure appropriate authorization for administration of PRN medication by a Qualified Medication Aide for 1 of 6 records reviewed (Resident 62). |
| Failed to ensure food was stored and prepared under sanitary conditions including unclean meat slicer, unlabeled and undated opened food items, improper stacking of clean trays and bowls, and food left open to air. |
| Failed to ensure a transfer form was sent for a resident transferred to an acute care hospital (Resident 61). |
| Failed to maintain an infection control program by not changing gloves after touching potentially contaminated surfaces and then touching food with the same gloves during food service. |
| Failed to maintain new hire employee records for 1 of 3 staff members reviewed (Director of Nursing). |
Report Facts
Residents present: 61
Dates of missing weights: Resident 34 missing weights in March and May 2024
Dates of CPR/First Aid certification lapses: Multiple days from 6/23/24 to 6/29/24 with no certified staff on shifts
Dates of missing insulin administration: 6
Dates of unauthorized PRN medication administration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shane Patterson | Executive Director | Signed report and provided policy documents |
| Qualified Medication Aide 1 | Interviewed regarding weight policy and transfer forms | |
| Director of Nursing | Director of Nursing | Interviewed regarding weights, CPR certification, service plans, medication administration, and transfer forms |
| Business Office Manager | Interviewed regarding staff training records and employee files | |
| Dietary Manager | Conducted kitchen tour and provided observations | |
| Kitchen Staff 4 | Observed during food service with infection control violations |
Inspection Report
Renewal
Census: 50
Deficiencies: 8
Apr 26, 2023
Visit Reason
This visit was for a State Residential Licensure Survey conducted on April 24, 25, and 26, 2023.
Findings
The facility was found noncompliant in several areas including failure to post residents' rights and advocacy contact information in publicly accessible areas, incomplete fire drills with lack of fire alarm transmission, improper hot water temperature control, unauthorized administration of PRN medications by a QMA, food safety and sanitation violations, improper insulin administration technique, and failure to dispose of expired or discontinued medications.
Deficiencies (8)
| Description |
|---|
| Failed to ensure residents' rights were available in a publicly accessible area for all residents. |
| Failed to post advocacy addresses and telephone numbers in an accessible area for all residents. |
| Failed to conduct 12 fire drills per year including transmission of fire alarm signal and simulation of emergency fire conditions. |
| Failed to maintain water temperatures between 100 and 120 degrees Fahrenheit for bathing and hand washing facilities. |
| Failed to ensure PRN medications administered by a QMA were authorized by a licensed nurse prior to administration. |
| Failed to store food properly, including uncovered trash bins, improper storage of clean pots and pans, uncovered dry food items, and kitchen staff not wearing hair/beard covers. |
| Failed to administer insulin from an insulin pen according to manufacturer's instructions (failed to prime needle before dialing dose). |
| Failed to dispose of expired and/or discontinued medications in accordance with regulations and facility policy. |
Report Facts
Residents: 50
Fire drills conducted: 8
Expired medication vials: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shane Patterson | Executive Director | Signed the report |
| Maintenance Director | Interviewed regarding fire drills, water temperatures, and residents' rights postings | |
| Business Office Manager | Interviewed regarding residents' rights postings and advocacy information | |
| Director of Nursing | Director of Nursing | Interviewed regarding medication administration and infection control |
| Dietary Manager | Interviewed regarding kitchen sanitation and staff illness | |
| LPN 3 | Licensed Practical Nurse | Observed administering insulin and medication storage |
Inspection Report
Complaint Investigation
Census: 51
Deficiencies: 1
Mar 15, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00393398 at Five Star Residences of Clearwater.
Findings
The facility failed to ensure food stored in the refrigerator was covered and dated, and that foods stored in the freezer were stored in a manner to prevent overcrowding, potentially affecting all 51 residents.
Complaint Details
Investigation of Complaint IN00393398. The deficiency related to food storage and sanitation was substantiated.
Deficiencies (1)
| Description |
|---|
| Food stored in the refrigerator was not covered and dated; freezer storage was overcrowded without shelves, limiting air circulation. |
Report Facts
Residential Census: 51
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shane Patterson | Executive Director | Named in relation to corrective actions and plan of correction |
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