Inspection Reports for Independence Village of Zionsville West (Anson)
IN, 46077
Back to Facility ProfileDeficiencies per Year
12
9
6
3
0
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Renewal
Census: 57
Deficiencies: 9
Apr 16, 2025
Visit Reason
This visit was for a State Residential Licensure Survey conducted on April 15 and 16, 2025, to assess compliance with state residential rules and regulations.
Findings
The facility was found deficient in multiple areas including staffing certifications for CPR and first aid, employee health screenings, orientation documentation, food labeling and dating, medication self-administration assessments, blood pressure monitoring, medication labeling, infection control tracking, and hand hygiene practices during dining service.
Deficiencies (9)
| Description |
|---|
| Failed to ensure minimum staffing requirements for first aide and CPR coverage with only two staff members certified in CPR and none in first aide. |
| Failed to ensure new employees received a health screen separate from tuberculosis testing for 5 of 5 new hires reviewed. |
| Failed to ensure new employees completed general and job-specific orientation for 2 of 5 new hires reviewed. |
| Failed to label and date foods as they were opened in the kitchen observation. |
| Failed to ensure residents had current self-administration of medication assessments for 2 of 5 residents reviewed. |
| Failed to obtain blood pressure as ordered for 1 of 2 residents reviewed. |
| Failed to label and date medications in medication carts and rooms for multiple residents. |
| Failed to implement an infection control program that included tracking and surveillance of known infectious symptoms for all residents. |
| Failed to ensure appropriate hand hygiene was conducted by dietary aides during dining service, including failure to remove gloves and perform hand hygiene between tasks. |
Report Facts
Residential Census: 57
New employee records reviewed: 5
Residents reviewed for self-administration of medication: 5
Residents observed in dining room: 20
Inspection Report
Complaint Investigation
Census: 47
Deficiencies: 0
Dec 8, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00416136.
Findings
No deficiencies related to the allegations were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00416136 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Follow-Up
Census: 45
Deficiencies: 0
Aug 31, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00411530 completed on June 30, 2023.
Findings
Independence Village Zionsville West was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to Investigation of Complaint IN00411530.
Complaint Details
Complaint IN00411530 was corrected.
Inspection Report
Complaint Investigation
Census: 44
Capacity: 44
Deficiencies: 0
Aug 16, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00415104.
Findings
No deficiencies related to the complaint allegation were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00415104 was investigated and found to have no deficiencies related to the allegation.
Report Facts
Census Residential: 44
Total Capacity: 44
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 2
Jun 29, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00411530 regarding allegations of staff to resident abuse.
Findings
The facility failed to assess, document, and conduct a thorough investigation of a staff to resident abuse allegation involving Resident B. The incident of abuse by CNA 9 was not reported timely to the state and the investigation lacked documentation of interviews or assessments of other potentially affected residents or staff.
Complaint Details
Complaint IN00411530 involved allegations of physical and sexual abuse by CNA 9 towards Resident B and female staff. CNA 9 was suspended on 6/13/23 and terminated on 6/22/23. The facility delayed reporting the abuse to the state until 6/22/23. The investigation lacked documentation of interviews with other residents or staff and failed to notify the Executive Director timely due to miscommunication.
Deficiencies (2)
| Description |
|---|
| Failed to assess, document, and conduct a thorough investigation of a staff to resident abuse allegation for Resident B. |
| Failed to timely report staff to resident abuse within 2 hours for Resident B. |
Report Facts
Residential Census: 38
Survey date: Jun 29, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jim Gepp | Executive Director | Named in relation to the abuse investigation and reporting |
| CNA 9 | Certified Nursing Assistant | Alleged perpetrator of abuse and sexual harassment |
| QMA 11 | Qualified Medication Aide | Reported sexual harassment allegations to HR |
| QMA 13 | Qualified Medication Aide | Reported sexual harassment to Executive Director |
| Wellness Director | Involved in handling abuse allegations and communication | |
| Regional Wellness Director | Provided guidance on follow-up and reporting of abuse allegations | |
| Memory Care Coordinator | Witnessed some interactions and involved in investigation | |
| HR representative | Handled sexual harassment investigation and communication |
Inspection Report
Complaint Investigation
Census: 43
Deficiencies: 2
May 3, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00406922 and IN00407166, regarding alleged deficiencies at Independence Village of West Zionsville.
Findings
The facility failed to appoint a licensed administrator as required by state regulation, potentially affecting all 43 residents. Additionally, the facility failed to revise a resident's service plan to reflect her mental and physical decline related to frontal lobe dementia.
Complaint Details
Complaint IN00406922 related to failure to revise resident service plans; Complaint IN00407166 related to failure to appoint a licensed administrator. Both complaints resulted in state deficiencies.
Deficiencies (2)
| Description |
|---|
| Failure to appoint a licensed administrator for the facility as required by state regulation. |
| Failure to revise a resident's service plan to reflect changes in mental and physical condition. |
Report Facts
Residents affected: 43
Residents reviewed for service plans: 3
Resident B evaluation date: May 4, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jim Gepp | Laboratory Director or Provider/Supplier Representative | Signed the report |
| ED 5 | Executive Director's Preceptor | Preceptor whose certification expired and was no longer qualified |
Inspection Report
Complaint Investigation
Census: 41
Deficiencies: 0
Mar 7, 2023
Visit Reason
This visit was for the Investigation of Complaint IN00395953.
Findings
No deficiencies related to the allegations are cited. Independence Village of West Zionsville was found to be in compliance with 410 IAC 16.2-5 in regard to the Investigation of Complaint IN00395953.
Complaint Details
Complaint IN00395953 - No deficiencies related to the allegations are cited.
Inspection Report
Complaint Investigation
Census: 42
Deficiencies: 0
Sep 29, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00390478.
Findings
The complaint IN00390478 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with relevant regulations regarding the complaint.
Complaint Details
Complaint IN00390478 was investigated and found unsubstantiated due to lack of evidence.
Report Facts
Residential Census: 42
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