Inspection Report
Census: 66
Deficiencies: 2
May 29, 2025
Visit Reason
This visit was for a State Residential Licensure Survey conducted by the Indiana State Department of Health on May 28 and 29, 2025.
Findings
The facility was found noncompliant for failing to ensure new employees received a health screen separate from a tuberculosis test for 3 of 5 new hires, and for failing to obtain signatures of residents and/or family representatives on service plans for 4 of 7 residents reviewed. The facility submitted plans of correction requesting paper compliance.
Deficiencies (2)
| Description |
|---|
| Failed to ensure new employees received a health screen separate from tuberculosis test for 3 of 5 newly hired employees. |
| Failed to obtain signatures of the resident and/or family representative on their service plans for 4 of 7 residents reviewed. |
Report Facts
New employee records reviewed: 5
Residents reviewed: 7
Residents with unsigned service plans: 4
New hires missing health screening separate from TB: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Named in relation to the inspection and plan of correction. |
| Suzanne Williams | Director of Division Long Term Care | Addressee of the plan of correction letter. |
Inspection Report
Complaint Investigation
Census: 76
Deficiencies: 0
Feb 20, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00452382.
Findings
No deficiencies related to the allegations in Complaint IN00452382 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00452382 was investigated and found to have no related deficiencies.
Inspection Report
Complaint Investigation
Census: 84
Deficiencies: 2
Sep 19, 2024
Visit Reason
This visit was conducted for the investigation of four complaints (IN00434279, IN00435806, IN00442138, and IN00442472) regarding alleged deficiencies at Independence Village of Avon.
Findings
The investigation found no deficiencies related to complaints IN00434279 and IN00435806. Deficiencies related to complaints IN00442138 and IN00442472 were cited. Key findings included failure to ensure a resident was free from verbal abuse, and failure to provide neurological assessments and hospital evaluations for residents with unwitnessed falls as required by facility policy.
Complaint Details
Complaint IN00434279 - No deficiencies related to the allegations are cited. Complaint IN00435806 - No deficiencies related to the allegations are cited. Complaint IN00442138 - State deficiencies related to the allegations are cited at R0053. Complaint IN00442472 - State deficiencies related to the allegations are cited at R0217.
Deficiencies (2)
| Description |
|---|
| Facility failed to ensure a resident was free from verbal abuse for 1 of 3 residents reviewed for abuse. |
| Facility failed to provide neurological assessments on residents who had unwitnessed falls with dementia and did not send residents to the hospital for evaluation as their policy states for 2 of 4 residents reviewed. |
Report Facts
Residential Census: 84
Date of compliance: Nov 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Buroker | Director of Division Long Term Care | Recipient of the Plan of Correction letter. |
| Romeo Behl | Submitted the Plan of Correction letter on behalf of the facility. | |
| QMA 27 | Qualified Medication Aide | Named in verbal abuse incident and subsequent suspension. |
| QMA 28 | Qualified Medication Aide | Named in verbal abuse incident. |
| Nurse 30 | Triage Nurse | Involved in resident care during verbal abuse incident. |
| Director of Nursing | Director of Nursing | Interviewed regarding staff complaints and facility policies. |
| Executive Director | Executive Director | Provided facility investigation and policies. |
| Wellness Director | Wellness Director | Provided information on fall policies and neurological assessments. |
Inspection Report
Complaint Investigation
Census: 82
Deficiencies: 7
Apr 25, 2024
Visit Reason
This visit was for a State Residential Licensure Survey including the Investigation of Complaint IN00429183 regarding allegations of misappropriation of residents' property and other regulatory compliance issues.
Findings
The facility was found deficient in ensuring residents were free from misappropriation of property, accurate medical record keeping for self-administration of medications, proper monitoring and follow-up after falls, observation for medication side effects, proper labeling and disposal of medications, and adequate transfer documentation for discharged residents.
Complaint Details
Complaint IN00429183 was investigated, with state deficiencies cited related to allegations of misappropriation of residents' property and failure to properly report and investigate grievances.
Deficiencies (7)
| Description |
|---|
| Failed to ensure residents were free from misappropriation of their property and failed to ensure an effective in-service/education program for grievances for all staff. |
| Failed to ensure a resident's medical record was accurate and a true reflection of her ability to self-administer medications. |
| Failed to ensure a resident received monitoring and/or supervision after a fall. |
| Failed to ensure residents on high-risk medications were observed for undesirable effects and failed to provide medically appropriate diagnoses for black box medications. |
| Failed to ensure over-the-counter and prescription medications were appropriately labeled and dated after opening, and failed to remove expired medications. |
| Failed to ensure resident medications were destroyed upon removal from the facility. |
| Failed to ensure transfer documentation was created for a resident transferred to another facility. |
Report Facts
Residents present: 82
Survey dates: April 25 and 26, 2024
Deficiency completion date: Plan of correction completion date May 26, 2024
Fall risk assessment date: Feb 6, 2024
Medication expiration dates: Multiple medications expired or undated as observed on April 25, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Named in relation to grievance reporting and plan of correction |
| Brenda Buroker | Director of Division Long Term Care | Recipient of survey letter and plan of correction |
| QMA 53 | Qualified Medication Aide | Observed medication cart and refrigerator labeling issues |
| Wellness Director | Interviewed regarding grievances, medication self-administration, fall follow-up, medication disposal, and transfer documentation | |
| Maintenance Director | Interviewed regarding resident grievances about missing property |
Inspection Report
Complaint Investigation
Census: 92
Deficiencies: 1
Nov 27, 2023
Visit Reason
The visit was conducted as a complaint survey related to complaint IN00421978 concerning allegations about resident care.
Findings
The facility failed to ensure a resident (Resident B) was sent to the hospital promptly after receiving a physician's order, causing a delay in treatment. The resident was eventually hospitalized with pneumonia and treated with IV antibiotics and a chest tube.
Complaint Details
Complaint IN00421978 was substantiated with state deficiencies cited at R0033 related to the delay in hospital transfer for Resident B after a physician's order was given.
Deficiencies (1)
| Description |
|---|
| Failure to send Resident B to the hospital immediately after a physician's order, causing delay in treatment. |
Report Facts
Residential Census: 92
Date of compliance: Dec 27, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Signed the report and plan of correction |
| Brenda Buroker | Director of Division Long Term Care | Addressee of the complaint survey report |
Inspection Report
Complaint Investigation
Census: 94
Deficiencies: 0
Sep 14, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00415627 and IN00417009.
Findings
No deficiencies related to the allegations in complaints IN00415627 and IN00417009 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Investigation of Complaints IN00415627 and IN00417009 found no deficiencies related to the allegations; facility was compliant.
Report Facts
Residential Census: 94
Inspection Report
Complaint Investigation
Census: 98
Deficiencies: 1
Aug 22, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00415606 regarding State Residential Findings related to personnel training and competency.
Findings
The facility failed to ensure personnel were trained and demonstrated competency in the use of a mechanical lift prior to providing care to one resident (Resident B). Staff turnover and lack of proper training were noted, with the facility relying on hospice agency training rather than providing their own.
Complaint Details
Complaint IN00415606 was substantiated with State Residential Findings related to personnel training and competency in mechanical lift use.
Deficiencies (1)
| Description |
|---|
| Facility failed to ensure personnel were trained and demonstrated competency in the use of a mechanical lift prior to providing care to Resident B. |
Report Facts
Residential Census: 98
Plan of Correction Completion Date: Sep 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Signed the report and Plan of Correction |
| Brenda Buroker | Director of Division Long Term Care | Recipient of the complaint survey letter |
Inspection Report
Complaint Investigation
Census: 98
Deficiencies: 1
Aug 11, 2023
Visit Reason
This visit was conducted for the investigation of four complaints (IN00414265, IN00414512, IN00414863, and IN00414933) at Independence Village of Avon.
Findings
The investigation found no deficiencies related to three of the complaints, but cited state residential findings related to complaint IN00414512 regarding insufficient licensed nursing staff availability to timely address a resident's dislodged urinary catheter.
Complaint Details
Complaint IN00414512 was substantiated with state residential findings cited. Complaints IN00414265, IN00414863, and IN00414933 had no deficiencies related to the allegations cited.
Deficiencies (1)
| Description |
|---|
| Failed to ensure licensed nursing staff were available to address a resident's dislodged indwelling urinary catheter in a timely manner. |
Report Facts
Residential Census: 98
Survey Dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Signed the report and submitted the Plan of Correction. |
| Brenda Buroker | Director of Division Long Term Care | Addressee of the complaint survey report. |
Inspection Report
Complaint Investigation
Census: 93
Deficiencies: 6
Jul 21, 2023
Visit Reason
This visit was for the investigation of complaints IN00412406 and IN00413370 involving allegations of resident abuse, neglect, and failure to report incidents.
Findings
The facility failed to prevent resident-to-resident and staff-to-resident abuse, failed to report incidents of abuse and falls with injury to the state, failed to monitor and document neurological assessments after incidents, and failed to update service plans to reflect residents' behavioral and medical needs. Specific failures included inadequate supervision of aggressive residents, failure to ensure resident safety regarding possession of weapons, and failure to monitor effects of diabetic medications.
Complaint Details
Complaint IN00412406 cited deficiencies related to resident abuse, neglect, and failure to report incidents. Complaint IN00413370 cited deficiencies related to abuse and neglect.
Deficiencies (6)
| Description |
|---|
| Failed to prevent resident-to-resident physical abuse and staff-to-resident abuse, including failure to monitor and document aggressive behaviors and incidents. |
| Failed to ensure a resident with a pocketknife did not carry it on the premises, violating safety policies. |
| Failed to report abuse, injuries of unknown origin, and falls with significant injury to the state licensing agency as required. |
| Failed to ensure sufficient staffing to complete appropriate assessments after potential head injuries and falls. |
| Failed to maintain personalized service plan agreements reflecting residents' behavioral needs and changes. |
| Failed to assess, document, and monitor effects of diabetic medications and elevated blood sugar levels for a resident. |
Report Facts
Residential Census: 93
Dates of Survey: July 19, 20, and 21, 2023
Severity Counts: 0
Blood Sugar Level: 530
Blood Sugar Level: 321
Fall Risk Score: 41
Fall Risk Score: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Romeo Behl | Executive Director | Signed the report and plan of correction. |
| Brenda Buroker | Director of Division Long Term Care | Recipient of the complaint survey report. |
| LPN 8 | Licensed Practical Nurse | Charge nurse involved in care and interviews related to Resident C and Resident F. |
| CNA 18 | Certified Nurse Aide | Observed assisting residents and involved in behavioral observations of Resident C. |
| CNA 20 | Certified Nurse Aide | Observed assisting Resident C during activity and behavioral incidents. |
| QMA 21 | Qualified Medication Aide | Provided medications to Resident M and involved in interviews. |
Inspection Report
Complaint Investigation
Census: 92
Deficiencies: 0
Jun 14, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00409953.
Findings
No deficiencies related to the allegations in Complaint IN00409953 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00409953 was investigated and found to have no related deficiencies; the complaint was not substantiated.
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