Inspection Reports for
Greenwood Healthcare Center

Complaint IN00458484 was substantiated with federal/state deficiencies cited at F689 related to inadequate supervision leading to resident elopement. Other complaints were not substantiated.

The facility failed to provide adequate one-to-one supervision to a resident (Resident B) on a secured memory care unit, resulting in the resident exiting the facility through a window and being found approximately 2 miles away. The Immediate Jeopardy was identified but removed prior to the survey after corrective actions were implemented.

Complaint IN00452252 was not substantiated with deficiencies. Complaint IN00451897 was substantiated with a finding of physical abuse by a staff member against a resident.

The facility was found to have no deficiencies related to complaint IN00452252. However, for complaint IN00451897, the facility failed to protect a resident from physical abuse by a staff member who held down the resident's arms during care. The issue was corrected with staff education and ongoing monitoring.

The facility was found not in compliance with Life Safety Code requirements including issues with exit discharge ramps lacking curbs or railings, and improper use of extension cords and power strips as substitutes for fixed wiring in resident rooms.

The survey included investigation of complaints IN00440493, IN00440410, IN00438453, and IN00437947. No deficiencies related to the allegations of these complaints were cited.

The facility was found deficient in several areas including failure to ensure clinical appropriateness of resident self-administration of medication, failure to provide required written notices before resident transfers or discharges, failure to provide written notice of the bed-hold policy upon transfer, and failure to maintain a safe, functional, sanitary, and homelike environment on a secured unit.

Complaint IN00429421 was substantiated with federal/state deficiencies cited. Other complaints investigated had no deficiencies related to the allegations.

The facility failed to ensure accurate reconciliation and accounting for narcotics during 2 of 3 shifts reviewed, specifically involving missing oxycodone tablets. No residents were found to be affected by the deficient practice, and the facility implemented corrective actions including audits and staff education.

The facility was found not in compliance with Medicare/Medicaid participation requirements related to Life Safety from Fire and the 2012 NFPA 101 Life Safety Code. Deficiencies were identified in battery-operated smoke alarms, hazardous area door closures, kitchen range hood drip pans, sprinkler system escutcheons, and use of extension cords in patient care areas.

Complaint IN00411214 was investigated with no deficiencies related to the allegations cited.

The facility was found deficient in medication administration practices, accuracy of Minimum Data Set (MDS) assessments, and development of comprehensive care plans. No deficiencies were related to the complaint investigation.