Inspection Reports for
Harrison Terrace

The facility had multiple deficiencies including failure to provide adequate personal care and hygiene, medication administration errors, inadequate fall prevention interventions, inaccurate urinary output documentation, delayed behavioral care planning for dementia residents, improper infection control practices, insufficient privacy measures, and environmental cleanliness and maintenance issues.

The facility was found not in compliance with several Life Safety Code requirements including illegible fire resistance rating labels on cross corridor doors, failure of doors to self-close and latch, inadequate separation of hazardous areas, impediments to corridor door closing, incomplete electrical receptacle testing documentation, unsecured emergency power supply overcurrent devices, incomplete emergency generator load testing, and use of non-fused multiplug adapters as substitutes for fixed wiring.

Complaint IN00436961 was investigated during this visit with Federal/State deficiencies cited related to the allegations.

The facility was cited for multiple deficiencies including failure to notify medical providers of abnormal blood sugar levels, incomplete orthostatic blood pressure monitoring, inadequate bowel management, failure to provide therapeutic diets as ordered, unsanitary kitchen conditions including dirty floors, vents, and ice machines, improper trash containment, and presence of flying insects in the kitchen.

This citation relates to Complaint IN00436961.

The facility was found deficient in notifying medical providers of abnormal blood sugar readings, incomplete orthostatic blood pressure monitoring, inadequate constipation management, failure to provide therapeutic diet as ordered, unsanitary kitchen conditions including dirty flooring, ceiling vents, and ice machine, improper trash containment, and presence of flying insects in the kitchen.

The facility was found in compliance with Emergency Preparedness Requirements but had multiple deficiencies related to Life Safety Code including fire door self-closing failures, missing exit signage, outdated smoke alarms, hazardous area door issues, fire alarm system labeling, sprinkler system maintenance, smoke barrier penetrations, and non-hospital grade electrical receptacles.

This Federal tag relates to Complaint IN00409906.

The facility failed to complete an admission assessment and monitor blood pressure for one resident readmitted to the facility. The facility also failed to assess pain location and intensity and provide nonpharmacological interventions for one resident. Additionally, the facility failed to provide adequate supervision to prevent two residents with dementia from wandering into other residents' rooms, leading to intrusive wandering and potential resident-to-resident altercations.

Complaint IN00409906 was investigated with Federal/State deficiencies related to the allegations cited at F744 regarding intrusive wandering and supervision of residents with dementia.

The facility was found deficient in completing admission assessments and monitoring blood pressure for a resident readmitted after hospitalization, assessing and documenting pain appropriately for a resident receiving PRN pain medication, and providing appropriate supervision and interventions for residents with dementia exhibiting intrusive wandering behaviors.

Complaint IN00389336 was substantiated. The investigation found that Resident B, who had a history of inappropriate sexual behavior, touched Resident C's private parts on 8/26/22. The facility failed to implement interventions per the care plan and did not remove Resident C from Resident B's room in a timely manner. Immediate Jeopardy was identified on 8/26/22 and removed on 8/30/22 after corrective actions including staff training and room changes.

The facility failed to prevent resident to resident sexual abuse involving Resident B and Resident C. Interventions were not implemented per the plan of care, resulting in Resident B touching Resident C's private parts. Immediate Jeopardy was identified but removed prior to the survey after staff training and corrective actions were completed.