The most recent inspection on April 28, 2025, found no deficiencies related to the complaint investigated. Earlier inspections showed a mixed record, with several complaint investigations resulting in no deficiencies, but some prior surveys cited issues. Deficiencies primarily involved medication administration and storage, as well as resident care and infection control, including a prior finding related to a pressure ulcer and kitchen sanitation. Complaint investigations were mostly unsubstantiated or found no related deficiencies, with one substantiated complaint that did not result in citations. The facility’s inspection history suggests some improvement in recent months following earlier citations.
Deficiencies (last 4 years)
Deficiencies (over 4 years)1.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
69% better than Indiana average
Indiana average: 4.2 deficiencies/year
Deficiencies per year
43210
2022
2023
2024
2025
Census
Latest occupancy rate35 residents
Based on a April 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
This visit was for the Investigation of Complaints IN00447322, IN00447080, and IN00445705.
Findings
No deficiencies related to the allegations were cited for any of the three complaints. The facility was found to be in compliance with the State Residential Licensure Survey and the Investigation of Complaints.
Complaint Details
Complaints IN00447322, IN00447080, and IN00445705 were investigated and found to have no deficiencies related to the allegations.
This visit was for the investigation of Complaint IN00440216, which triggered state deficiencies related to the allegations cited at R0036 and R0305.
Findings
The facility failed to follow a physician's order timely for obtaining a urine specimen for one resident, failed to store medications securely on one medication cart, and failed to provide antibiotics in a timely manner for another resident. Additional findings included improper medication administration timing and lack of a medication storage policy.
Complaint Details
Complaint IN00440216 was investigated with state deficiencies cited related to the allegations. The complaint involved issues with medication administration and resident care.
Deficiencies (3)
Description
Failed to follow the physician's order in a timely manner related to obtaining a urine specimen for Resident B.
Failed to store medications in a safe and secure manner for one of three medication carts reviewed; medication cart was unlocked with loose pills accessible.
Failed to provide a resident's medication in a timely manner related to antibiotics for Resident C.
Report Facts
Residential Census: 38Medication carts reviewed: 3Medication administration timing: 3.1Antibiotic delay: 3Completion date for corrective actions: Sep 21, 2024
Employees Mentioned
Name
Title
Context
Heather Angel
Executive Director
Signed the report as the Laboratory Director's or Provider/Supplier Representative.
This visit was for the Investigation of Complaint IN00438297.
Findings
No deficiencies related to the allegations were cited. Keepsake Village of Columbus was found to be in compliance with 410 IAC 16.2-5 in regard to the Investigation of Complaint IN00438297.
Complaint Details
Complaint IN00438297 - No deficiencies related to the allegations are cited.
Inspection Report Original LicensingCensus: 31Deficiencies: 0Dec 19, 2023
Visit Reason
This visit was for a State Residential Licensure Survey conducted on December 18 and 19, 2023.
Findings
Keepsake Village of Columbus was found to be in compliance with 410 IAC 16.2-5 in regard to the State Residential Licensure Survey.
This visit was conducted for the investigation of Complaint IN00401126.
Findings
The complaint IN00401126 was substantiated; however, 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 IN00401126 was substantiated but no deficiencies related to the allegations were cited.
This visit was for a State Residential Licensure Survey conducted on October 25 and 26, 2022, to assess compliance with state residential care regulations.
Findings
The facility failed to provide appropriate professional staff to provide comprehensive nursing care for a resident with a self-limiting condition, resulting in a Stage 4 pressure ulcer. Additionally, infection control deficiencies were found in the kitchen related to storage and sanitation practices.
Deficiencies (2)
Description
Failure to provide appropriate professional staff to identify and manage a pressure ulcer for a resident on hospice, resulting in a Stage 4 pressure ulcer.
Failure to follow infection control guidelines in the kitchen related to storage areas, including dirty carts, contaminated dishes, and improper thermometer maintenance.
This visit was for the Investigation of Complaint IN00380315.
Findings
Complaint IN00380315 was found to be unsubstantiated due to lack of evidence. Keepsake Village of Columbus was found to be in compliance with 410 IAC 16.2-5 in regard to the complaint investigation.
Complaint Details
Complaint IN00380315 - Unsubstantiated due to lack of evidence.
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