Inspection Report Summary
The most recent inspection on June 6, 2025, found no deficiencies related to the complaint investigated. Earlier inspections showed a pattern of deficiencies primarily involving medication management, resident care planning, and safety practices, including issues with enteral feeding, medication administration, and fall prevention. Complaint investigations were mostly unsubstantiated, though some substantiated complaints led to citations for medication errors, care plan lapses, and safety concerns; no fines or enforcement actions were listed in the available reports. Prior Life Safety Code surveys noted several facility maintenance and safety issues, but recent surveys showed compliance. The overall trend suggests some improvement in compliance with fewer deficiencies cited in the most recent inspections compared to earlier reports.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
20.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
395% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
100% occupied
Based on a June 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy over time
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Sep 16, 2025
Visit Reason
The inspection was conducted as an annual survey to assess compliance with healthcare regulations and quality of care standards at Maple Park Village nursing home.
Findings
The facility was found deficient in multiple areas including failure to hold medications according to physician orders and notify physicians of abnormal blood glucose readings, failure to ensure medications had appropriate supporting diagnoses and stop dates, and failure to properly implement infection prevention and control practices including improper use of PPE and hand hygiene.
Deficiencies (3)
Failed to ensure a medication was held according to ordered parameters and the physician was notified of blood glucose readings as ordered for 2 of 5 residents reviewed.
Failed to ensure physician ordered medications included an appropriate supporting diagnosis and a medication included a stop date for 3 of 5 residents reviewed for unnecessary medications.
Failed to provide and implement an infection prevention and control program, including improper use of PPE, failure to perform hand hygiene, and failure to change gloves during dressing changes for 3 of 7 residents reviewed.
Report Facts
Medication administrations not held as ordered: 18
Blood glucose readings not reported: 2
Residents reviewed for medication issues: 5
Residents reviewed for infection control: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Indicated medication should have been held according to physician's order and facility lacked policy on medication hold parameters and medication stop dates |
| LPN 9 | Licensed Practical Nurse | Indicated nurse responsibility to verify medication hold or physician notification |
| Executive Director | Executive Director | Indicated facility expectations for medication holds and lack of policy on medication hold parameters and stop dates |
| RN 10 | Registered Nurse | Indicated responsibility to ensure short-term diagnosis changed to correct supporting diagnosis and to clarify medication stop dates |
| Infection Preventionist | Infection Preventionist | Indicated diagnosis issues with medications and described infection control expectations |
| CNA 4 | Certified Nursing Assistant | Observed not tying gown as required for isolation precautions |
| CNA 3 | Certified Nursing Assistant | Observed not wearing required eye protection for droplet precautions |
| CNA 6 | Certified Nursing Assistant | Observed not performing hand hygiene prior to donning gloves |
| LPN 7 | Licensed Practical Nurse | Observed not changing gloves or performing hand hygiene during wound dressing change |
Inspection Report
Complaint Investigation
Census: 82
Capacity: 82
Deficiencies: 0
Date: Jun 6, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00460145.
Complaint Details
Complaint IN00460145 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00460145 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Report Facts
Census Bed Type: 82
Census Payor Type: 82
SNF/NF beds: 77
SNF beds: 5
Medicare residents: 5
Medicaid residents: 31
Other residents: 46
Inspection Report
Complaint Investigation
Census: 86
Deficiencies: 0
Date: Apr 10, 2025
Visit Reason
This visit was conducted for the Investigation of Complaint IN00448919.
Complaint Details
Complaint IN00448919 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00448919 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Report Facts
Census: 86
Census Bed Type - SNF/NF: 85
Census Bed Type - SNF: 1
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 36
Census Payor Type - Other: 47
Inspection Report
Census: 83
Capacity: 106
Deficiencies: 0
Date: Nov 7, 2024
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with 42 CFR 483.73 and 42 CFR 483.90(a), respectively.
Findings
At the Emergency Preparedness survey, Maple Park Village was found to be in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. At the Life Safety Code survey, the facility was found in compliance with Requirements for Participation in Medicare/Medicaid and the 2012 edition of the National Fire Protection Association (NFPA) 101 Life Safety Code.
Report Facts
Certified beds: 106
Census: 83
Inspection Report
Complaint Investigation
Census: 83
Deficiencies: 1
Date: Oct 18, 2024
Visit Reason
This visit was for the investigation of Complaint IN00445223 regarding federal and state deficiencies related to enteral feeding practices.
Complaint Details
Complaint IN00445223 was substantiated with federal and state deficiencies cited at F693 related to enteral feeding management and restoration of eating skills.
Findings
The facility failed to ensure a resident with a Jejunostomy tube received the ordered amount of nutrient formula at the correct rate and time frame, resulting in aspiration and respiratory distress leading to hospitalization and death. The deficient practice was corrected prior to the survey date.
Deficiencies (1)
Failure to ensure a resident with continuous feeding through a Jejunostomy tube received the ordered amount of nutrient formula at the correct rate in the ordered time frame.
Report Facts
Census: 83
Residents reviewed for enteral feedings: 2
Ordered feeding rate: 45
Feeding volume received: 1000
Oxygen saturation: 58
Fluid in belly: 200
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 1 | Night Nurse | Administered feeding and medications to Resident B; involved in feeding pump management |
| RN 2 | Registered Nurse | Responded to Resident B's distress, assessed vital signs, and notified provider |
| Physician 4 | Physician | Attended Resident B during emergency and provided medical assessment |
| Executive Director | Provided information about feeding pump and investigation | |
| Director of Nursing | Present during feeding pump assessment | |
| Corporate Support Nurse | Provided information on medication administration policy and facility practices |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 18, 2024
Visit Reason
The inspection was conducted as a complaint investigation related to concerns about the care and feeding of a resident with a Jejunostomy tube (Resident B) at Maple Park Village.
Complaint Details
This citation relates to Complaint IN00445223.
Findings
The facility failed to ensure Resident B received the ordered amount of nutrient formula at the correct rate via J-tube, resulting in aspiration and subsequent hospitalization. The feeding pump malfunctioned, and staff did not adequately monitor the feeding rate, leading to emesis and respiratory distress. The deficient practice was corrected prior to the survey with systemic changes implemented.
Deficiencies (1)
Failed to ensure a resident with continuous feeding through a Jejunostomy tube received the ordered amount of nutrient formula at the correct rate in the ordered time frame.
Report Facts
Feeding rate: 45
Feeding volume: 1000
Feeding pump default rate: 400
Fluid in belly: 200
Oxygen saturation: 58
Glasgow Coma Score: 3
Oxygen liters: 3
Date of physician order: Jul 4, 2024
Date of feeding pump disconnection: Oct 14, 2024
Date of deficient practice correction: Oct 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 1 | Night Shift Nurse | Informed writer about pump failure, administered feeding and medication to Resident B |
| RN 2 | Registered Nurse | Noticed emesis, assessed Resident B, administered breathing treatment and suctioned tracheostomy |
| Physician 4 | Physician | Responded to Resident B during emergency, provided breathing support, and gave medical opinion |
| RN 3 | Registered Nurse | Checked feeding pump, called tech support, replaced pump |
| Executive Director | Provided information about feeding pump and facility policy | |
| Director of Nursing | Present during feeding pump observation | |
| Corporate Support Nurse | Present during feeding pump observation and policy interview |
Inspection Report
Annual Inspection
Census: 84
Capacity: 84
Deficiencies: 4
Date: Oct 11, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, which also included the Investigation of Complaint IN00443865.
Complaint Details
Complaint IN00443865 was investigated with no Federal or State deficiencies related to the allegations cited.
Findings
The facility was found deficient in conducting quarterly care plan meetings for residents, medication administration not following physician's hold parameters, improper medication and food storage, and unsanitary food preparation practices. No deficiencies were cited related to the complaint investigation.
Deficiencies (4)
Failed to conduct care plan meetings at least quarterly for 2 of 2 residents reviewed (Residents 5 and 59).
Failed to ensure medications were held according to physician's ordered hold parameters for 2 of 2 residents reviewed (Residents 36 and 55).
Failed to ensure unlabeled food was not stored in a medication room refrigerator and medications were stored in original containers in 1 of 2 medication rooms and 1 of 3 medication carts reviewed.
Failed to ensure staff prepared pureed food in a sanitary manner for 1 of 1 staff member observed (Cook 6).
Report Facts
Census: 84
Total Capacity: 84
Deficiencies cited: 4
Survey dates: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tony Link | Executive Director | Signed the report and involved in plan of correction |
| Cook 6 | Cook | Observed preparing pureed food unsanitarily |
| Director of Nursing | Director of Nursing | Interviewed regarding medication administration and storage deficiencies |
| Social Service Director | Social Service Director | Interviewed regarding care plan meetings for residents |
| Registered Nurse 3 | Registered Nurse | Interviewed regarding unlabeled food in medication refrigerator |
| RN 5 | Registered Nurse | Interviewed regarding medication cart condition |
Inspection Report
Renewal
Deficiencies: 0
Date: Oct 11, 2024
Visit Reason
The visit was a paper compliance review for the Recertification and State Licensure survey completed on October 11, 2024.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Inspection Report
Routine
Deficiencies: 4
Date: Oct 11, 2024
Visit Reason
The inspection was conducted to assess compliance with federal regulations regarding care planning, medication administration, medication storage, food handling, and overall quality of care at Maple Park Village nursing home.
Findings
The facility failed to conduct quarterly care plan meetings for two residents, administered medications outside physician-ordered hold parameters for two residents, stored medications and food improperly in medication rooms and carts, and failed to ensure sanitary food preparation practices by staff.
Deficiencies (4)
Failed to conduct care plan meetings at least quarterly for 2 of 2 residents reviewed (Resident 5 and 59).
Failed to ensure medications were held according to physician's ordered hold parameters for 2 of 2 residents reviewed (Resident 36 and 55).
Failed to ensure drugs and biologicals were labeled and stored properly; found unlabeled tablets and unlabeled food in medication storage areas.
Failed to ensure staff prepared pureed food in a sanitary manner; observed staff licking pureed food off finger during preparation.
Report Facts
Medication administration dates outside physician's ordered hold parameters: 10
Medication administration dates outside physician's ordered hold parameters: 13
Unlabeled tablets found: 20
Unlabeled cans of Canada Dry: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding medication administration and storage deficiencies. |
| Social Service Director | Social Service Director | Interviewed regarding care plan meeting deficiencies for Residents 5 and 59. |
| RN 5 | Registered Nurse | Interviewed regarding possible medication spill in medication cart. |
| RN 3 | Registered Nurse | Interviewed regarding unlabeled food in medication room refrigerator. |
| Cook 6 | Cook | Observed preparing pureed food unsanitarily by licking food off finger. |
| Corporate Support Nurse | Corporate Support Nurse | Provided facility policy on care plan process. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 17, 2024
Visit Reason
Paper compliance review related to the Investigation of Complaint IN00441461 completed on August 29, 2024.
Complaint Details
Investigation of Complaint IN00441461 completed on August 29, 2024; facility found in compliance.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review for the complaint investigation.
Inspection Report
Complaint Investigation
Census: 88
Deficiencies: 2
Date: Aug 29, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00439443 and IN00441461. Complaint IN00439443 resulted in federal/state deficiencies cited, while Complaint IN00441461 had no deficiencies related to the allegations.
Complaint Details
Complaint IN00439443 was substantiated with federal/state deficiencies cited at F755. Complaint IN00441461 had no deficiencies related to the allegations.
Findings
The facility failed to ensure a narcotic pain patch was administered at the correct time with proper site rotation for one resident and failed to ensure staff signed narcotic count sheets for multiple medication cart narcotic logs. Several missing signatures were found on narcotic count sheets across multiple units.
Deficiencies (2)
Failed to ensure a narcotic pain patch was administered at the correct time and new sites were used for the transdermal patch for 1 of 1 resident reviewed.
Failed to ensure staff were signing the narcotic count sheets for 4 of 6 medication cart narcotic logs reviewed.
Report Facts
Resident census: 88
Narcotic count sheet missing signatures: 3
Narcotic count sheet missing signatures: 7
Narcotic count sheet missing signatures: 1
Narcotic count sheet missing signatures: 2
Narcotic count sheet missing signatures: 4
Narcotic count sheet missing signatures: 4
Narcotic count sheet missing signatures: 2
Narcotic count sheet missing signatures: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tony Link | Executive Director | Provided interviews and facility policies related to narcotic administration and counts |
| RN 1 | Named in findings related to early administration of Fentanyl patch and narcotic count signing | |
| RN 4 | Provided interview regarding narcotic card counts and medication administration | |
| RN 6 | Provided interview regarding medication destruction and narcotic count procedures | |
| LPN 5 | Provided interview regarding medication orders and narcotic counts |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Aug 29, 2024
Visit Reason
The inspection was conducted in response to a complaint (IN00439443) regarding medication administration practices, specifically the timing and site rotation of narcotic pain patches and proper documentation of narcotic counts.
Complaint Details
This Federal tag relates to Complaint IN00439443.
Findings
The facility failed to ensure a narcotic pain patch was administered at the correct time and that new sites were used for transdermal patch administration for one resident. Additionally, staff failed to consistently sign narcotic count sheets across multiple medication carts, with missing signatures noted in several units.
Deficiencies (2)
Failure to administer narcotic pain patch at the correct time and to rotate sites as ordered for Resident B.
Failure to ensure staff signed narcotic count sheets for 4 of 6 medication cart narcotic logs reviewed.
Report Facts
Missing on-coming nurse signatures: 10
Missing off-going nurse signatures: 18
Medication patch administration times: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 1 | Named in medication administration timing deficiency; unable to explain early administration of Fentanyl patch. | |
| LPN 5 | Provided information on medication order checks and narcotic counting procedures. | |
| RN 6 | Described medication destruction procedures and narcotic book signing requirements. | |
| RN 4 | Described narcotic count and medication patch placement procedures. | |
| Executive Director | Interviewed regarding RN 1's early administration of the Fentanyl patch and facility policies. |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 85
Deficiencies: 0
Date: Jul 15, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00431769.
Complaint Details
Complaint IN00431769 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Report Facts
Census Bed Type: 85
Medicare Census: 3
Medicaid Census: 38
Other Payor Census: 44
Inspection Report
Complaint Investigation
Census: 87
Deficiencies: 0
Date: Feb 9, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00427177.
Complaint Details
Complaint IN00427177 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census: 87
Census Bed Type Total: 87
Census Payor Type Total: 87
SNF/NF Beds: 85
SNF Beds: 2
Medicare Residents: 2
Medicaid Residents: 43
Other Payor Residents: 42
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Nov 9, 2023
Visit Reason
Paper compliance review to the Recertification and State Licensure Survey and Investigation of Complaint IN00418152.
Complaint Details
Investigation of Complaint IN00418152 was completed.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review to the Recertification and State Licensure Survey and Investigation of Complaint IN00418152.
Inspection Report
Complaint Investigation
Census: 80
Capacity: 80
Deficiencies: 0
Date: Nov 1, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00420603, IN00420279, IN00419794, and IN00419633 at Maple Park Village.
Complaint Details
Complaints IN00420603, IN00420279, IN00419794, and IN00419633 were investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in any of the complaints were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Report Facts
Census Bed Type: 80
Census Payor Type - Medicare: 14
Census Payor Type - Medicaid: 56
Census Payor Type - Other: 10
Inspection Report
Life Safety
Census: 80
Capacity: 106
Deficiencies: 4
Date: Oct 31, 2023
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health on 10/31/2023.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but not in compliance with Life Safety Code requirements. Deficiencies included obstruction of a portable fire extinguisher, a resident room door failing to close and latch properly, cigarette butts improperly disposed in the staff smoking area, and obstruction of an electrical panel by equipment.
Deficiencies (4)
1 of 25 portable fire extinguishers was obstructed by a Hoyer lift, making it not readily accessible.
1 of 56 resident room doors to the corridor failed to close completely and latch into the door frame.
1 of 1 staff smoking area was not maintained properly; cigarette butts were mixed with dry leaves and not disposed of in approved metal ashtrays.
Access and working space was obstructed in 1 of 7 electrical panel enclosures by a Hoyer lift stored in the corridor.
Report Facts
Certified beds: 106
Census: 80
Portable fire extinguishers inspected: 25
Resident room doors inspected: 56
Electrical panel enclosures inspected: 7
Residents potentially affected: 24
Staff potentially affected: 4
Visitors potentially affected: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Link | Executive Director | Signed the report and participated in observations and interviews |
Inspection Report
Life Safety
Deficiencies: 0
Date: Oct 31, 2023
Visit Reason
Paper compliance to the Life Safety Code Recertification and State Licensure Survey conducted on 10/31/23.
Findings
Maple Park Village was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 Edition of the National Fire Protection Association (NFPA) 101, Life Safety Code, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Annual Inspection
Census: 79
Deficiencies: 10
Date: Oct 12, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, including the Investigation of Complaint IN00418152.
Complaint Details
Complaint IN00418152 was investigated and federal/state deficiencies related to the allegations were cited at F684 for medication administration timeliness.
Findings
The facility was found deficient in multiple areas including resident rights related to use of non-disposable utensils, accuracy of assessments, medication administration timeliness, accident hazards related to wanderguard use, bowel/bladder incontinence care, nutrition and hydration management, respiratory care, psychotropic medication management, medication labeling and storage, and infection prevention and control.
Deficiencies (10)
Failed to ensure residents received non-disposable utensils for meals on the locked dementia unit for 17 of 17 residents.
Failed to ensure Minimum Data Set (MDS) assessment included wanderguard use for 1 of 1 resident reviewed.
Failed to give medications within prescribed time for 6 of 6 residents reviewed.
Failed to ensure a resident with a wanderguard had a physician's order, daily assessment, and care plan for the alarm.
Failed to identify and implement resident specific preventative nursing measures for a resident with multiple repeat urinary tract infections.
Failed to identify significant weight changes, implement timely interventions, and notify provider and family timely for 2 of 4 residents reviewed for nutrition.
Failed to ensure residents' oxygen tubing was dated and replaced as required for 2 of 3 residents reviewed for respiratory care.
Failed to ensure symptom monitoring and gradual dose reduction consideration for antipsychotic medication for 1 of 5 residents reviewed.
Failed to label medications with an open date on medications with shortened expiration date once opened in medication storage and carts.
Failed to ensure catheter bag was not touching the ground for 1 of 1 resident reviewed for infection control related to catheters.
Report Facts
Census: 79
Medication administration late doses: 20
Weight loss percentage: 9.03
Weight gain percentage: 23.71
Oxygen tubing replacement frequency: 7
Psychotropic drug PRN order limit: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Link | Executive Director | Signed the report |
| Director of Nursing Services (DNS) | Interviewed regarding multiple findings including medication administration, wanderguard use, nutrition, and psychotropic medication management | |
| Dementia Unit Manager (UM) | Interviewed regarding resident behaviors and care plans | |
| RN 3 | Interviewed regarding medication labeling and late medication administration | |
| LPN 2 | Interviewed regarding medication labeling and storage | |
| RN 9 | Interviewed regarding oxygen tubing replacement | |
| Assistant Director of Nursing (ADON) | Interviewed regarding catheter bag infection control | |
| Dementia Unit Manager | Provided psychotropic medication management policy |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 12, 2023
Visit Reason
The inspection was conducted as a complaint investigation related to medication administration timeliness at Maple Park Village nursing home.
Complaint Details
This Federal tag relates to Complaint IN00418152.
Findings
The facility failed to administer medications within the prescribed time for 6 of 6 residents reviewed, with multiple instances of late medication administration documented in the Medication Administration Records (MAR) for residents B, C, D, E, F, and G.
Deficiencies (1)
Failure to give medications within the prescribed time for 6 of 6 residents reviewed.
Report Facts
Residents reviewed for medication timeliness: 6
Late medication administrations for Resident B: 15
Late medication administrations for Resident C: 12
Late medication administrations for Resident D: 15
Late medication administrations for Resident E: 2
Late medication administrations for Resident F: 2
Late medication administrations for Resident G: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 3 | Indicated sometimes staff would get sidetracked when passing medication and would have to just chart late during interview on 10/12/23 | |
| LPN 7 | Indicated things came up, you got too busy, or you just did not have time and medications were passed out late during interview on 10/12/23 |
Inspection Report
Complaint Investigation
Deficiencies: 10
Date: Oct 12, 2023
Visit Reason
The inspection was conducted based on a complaint investigation related to multiple concerns including resident rights, medication administration, elopement prevention, infection control, nutrition, respiratory care, and medication labeling at Maple Park Village nursing home.
Complaint Details
This Federal tag relates to Complaint IN00418152.
Findings
The facility was found deficient in several areas including failure to provide non-disposable utensils on the dementia unit, inaccurate Minimum Data Set assessments, late medication administration for multiple residents, lack of physician orders and care plans for wanderguard use, inadequate infection control related to catheter bag placement, failure to identify and intervene on significant weight changes, improper oxygen tubing labeling and replacement, failure to monitor and reduce antipsychotic medications appropriately, and failure to label medications with open dates in medication storage.
Deficiencies (10)
Failed to ensure residents received non-disposable utensils to eat their meals with for 17 of 17 residents on the locked dementia unit.
Failed to ensure the Minimum Data Set (MDS) assessment included the resident had a wanderguard for 1 of 1 resident reviewed for elopement.
Failed to give medications within the prescribed time for 6 of 6 residents reviewed for quality of care.
Failed to ensure a resident with a wanderguard had a physician's order, daily assessment for placement, and a care plan for the alarm for 1 of 1 resident reviewed for elopement.
Failed to identify and implement resident specific preventative nursing measures for a resident with multiple repeat urinary tract infections for 1 of 3 residents reviewed for UTIs.
Failed to identify significant weight changes, implement timely interventions, and notify the provider and family in a timely manner for 2 of 4 residents reviewed for nutrition.
Failed to ensure residents oxygen tubing was dated and replaced for 2 of 3 residents reviewed for respiratory care.
Failed to ensure symptom monitoring was in place for the use of an antipsychotic medication prescribed and a gradual dose reduction was considered for 1 of 5 residents reviewed for unnecessary medications.
Failed to label medications with an open date on medications with a shortened expiration date once opened in 1 of 2 medication storage refrigerators and 2 of 3 medication carts.
Failed to ensure a catheter bag was not touching the ground for 1 of 1 resident reviewed for infection control related to catheters.
Report Facts
Residents affected: 17
Residents affected: 6
Residents affected: 1
Residents affected: 3
Residents affected: 4
Residents affected: 3
Residents affected: 5
Medication doses left: 56
Weight loss percentage: 9.03
Weight loss pounds: 13
Weight gain percentage: 23.71
Body Mass Index: 27.11
Medication doses left: 200
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 8 | Indicated a resident owned a restaurant and would take the silverware | |
| Dementia Unit Manager | Interviewed regarding plasticware use and antipsychotic medication monitoring | |
| Director of Nursing Services | DNS | Interviewed regarding plasticware use, medication administration, weight monitoring, and infection control |
| MDS Coordinator | Interviewed regarding wanderguard use and MDS assessments | |
| RN 3 | Registered Nurse | Interviewed regarding medication administration and medication labeling |
| LPN 7 | Licensed Practical Nurse | Interviewed regarding reasons for late medication administration |
| RN 9 | Registered Nurse | Interviewed regarding oxygen tubing dating and replacement |
| Assistant Director of Nursing | ADON | Interviewed regarding catheter bag placement |
| Executive Director | ED | Provided policies and interviewed regarding oxygen tubing and elopement prevention |
| Dementia Unit Manager | UM | Interviewed regarding documentation of delusions and psychotropic medication monitoring |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 78
Deficiencies: 2
Date: Sep 20, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00417153 and IN00415768, regarding resident safety and care practices.
Complaint Details
Complaint IN00417153 was substantiated with related deficiencies cited. Complaint IN00415768 was substantiated but no deficiencies were cited related to it.
Findings
The facility was found to have failed to protect residents from injury by not ensuring proper supervision and safety precautions, resulting in a resident fall with injury and another incident requiring staff intervention. The deficient practices were corrected prior to the survey.
Deficiencies (2)
Facility failed to protect a resident from injury when left unattended in a bed not in the lowest position and without a fall mat, resulting in a fall with laceration and femoral neck fracture.
Facility failed to ensure staff followed care sheets or electronic records for safety precautions, resulting in another resident needing to be lowered to the floor safely.
Report Facts
Census: 78
Total Capacity: 78
Medicare Residents: 7
Medicaid Residents: 41
Other Residents: 30
Cut size: 3.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 1 | Certified Nursing Assistant | Named in fall incident involving Resident B and disciplined |
| LPN 2 | Licensed Practical Nurse | Provided care sheet information regarding bed position |
| Director of Nursing | Provided interviews about staff responsibilities and care plan policies | |
| Executive Director | Provided multiple statements regarding resident incidents and facility practices | |
| CNA 7 | Certified Nursing Assistant | Involved in assisting Resident C during fall incident |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Sep 20, 2023
Visit Reason
The inspection was conducted following a complaint investigation related to a resident fall incident where the facility allegedly failed to protect a resident from injury due to inadequate supervision and failure to follow safety protocols.
Complaint Details
This Federal Tag relates to Complaint IN00417153. The complaint involved allegations that the facility failed to follow protocols leading to a resident fall and injury, and failure to use safety precautions for residents at risk of falls.
Findings
The facility failed to ensure a resident was protected from injury when left unattended in a bed not in the lowest position and without a fall mat, resulting in a fall causing a laceration and femoral neck fracture. Additionally, staff did not consistently follow care sheets or electronic records for safety precautions, leading to another resident being lowered to the floor to prevent injury. The deficient practice was corrected prior to the survey start date.
Deficiencies (2)
Failure to protect a resident from injury when left unattended in a bed not in the lowest position and without a fall mat, resulting in a fall with injury.
Failure to ensure staff followed care sheets or electronic records for safety precautions, resulting in a resident being lowered to the floor to prevent injury.
Report Facts
Date of fall incident: Sep 8, 2023
Date deficient practice corrected: Sep 12, 2023
Number of residents reviewed for accidents: 3
Cut size: 3.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA 1 | Certified Nursing Assistant | Named in incident involving Resident B fall and disciplinary action |
| Director of Nursing | Provided interviews regarding care sheet usage and policies | |
| Executive Director | Provided statements regarding resident care profiles and incident | |
| LPN 2 | Licensed Practical Nurse | Provided care sheet information |
| LPN 3 | Licensed Practical Nurse | Responded to fall for Resident B and provided bed position information |
| CNA 7 | Certified Nursing Assistant | Involved in lowering Resident C to floor to prevent injury |
Inspection Report
Complaint Investigation
Census: 85
Deficiencies: 0
Date: Aug 9, 2023
Visit Reason
This visit was for the investigation of Complaint IN00414150.
Complaint Details
Complaint IN00414150 - No deficiencies related to the allegations are cited.
Findings
No deficiencies related to the allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the complaint investigation.
Report Facts
Census Bed Type Total: 85
Census Payor Type Medicare: 6
Census Payor Type Medicaid: 47
Census Payor Type Other: 32
Inspection Report
Complaint Investigation
Census: 83
Deficiencies: 0
Date: Jun 14, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00410010.
Complaint Details
Complaint IN00410010 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type Total: 83
Census Bed Type SNF/NF: 76
Census Bed Type SNF: 7
Census Payor Type Medicare: 6
Census Payor Type Medicaid: 57
Census Payor Type Other: 20
Inspection Report
Complaint Investigation
Census: 87
Deficiencies: 0
Date: May 24, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00406718.
Complaint Details
Complaint IN00406718 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census: 87
SNF/NF beds: 83
SNF beds: 4
Medicare residents: 4
Medicaid residents: 48
Other payor residents: 35
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 18, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to the Investigation of Complaint IN00403435 completed on March 22, 2023.
Complaint Details
Investigation of Complaint IN00403435 completed on March 22, 2023; facility found in compliance.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Inspection Report
Complaint Investigation
Census: 85
Deficiencies: 0
Date: Apr 10, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00404838 and IN00405289.
Complaint Details
Complaint IN00404838 and Complaint IN00405289 were investigated with no deficiencies cited related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00404838 and IN00405289 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census: 85
Census Bed Type - SNF: 1
Census Bed Type - SNF/NF: 84
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 49
Census Payor Type - Other: 32
Inspection Report
Complaint Investigation
Census: 85
Deficiencies: 2
Date: Mar 22, 2023
Visit Reason
The visit was conducted for the investigation of Complaints IN00403435 and IN00403818. Complaint IN00403435 resulted in federal/state deficiencies cited, while Complaint IN00403818 had no deficiencies related to the allegations.
Complaint Details
Complaint IN00403435 was substantiated with federal/state deficiencies cited at F755 (Pharmacy Services) and F842 (Resident Records - Identifiable Information). Complaint IN00403818 had no deficiencies related to the allegations.
Findings
The facility failed to ensure prescribed medications were acquired in a timely manner from the pharmacy for one resident and failed to ensure accurate and complete documentation of medication administration for three residents. Deficiencies were related to pharmacy services and resident records identifiable information.
Deficiencies (2)
Facility failed to ensure prescribed medications ordered by a physician were acquired from the facility pharmacy in a timely manner for 1 of 3 residents reviewed for pharmaceutical services (Resident B).
Facility failed to ensure medications were accurately and completely documented on the Electronic Medication Administration Record (EMAR) for 3 of 3 residents reviewed (Residents B, C, and D).
Report Facts
Census: 85
SNF beds: 3
SNF/NF beds: 82
Medicare residents: 5
Medicaid residents: 51
Other payor residents: 29
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Link | Executive Director | Signed report and plan of correction |
| DNS | Director of Nursing Services | Provided documents and interviews related to medication and pharmacy services deficiencies |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Mar 22, 2023
Visit Reason
The inspection was conducted based on Complaint IN00403435 to investigate pharmaceutical services and medication documentation at Maple Park Village.
Complaint Details
Complaint IN00403435 triggered the investigation. The complaint related to pharmaceutical services and medication documentation deficiencies.
Findings
The facility failed to ensure prescribed medications were acquired from the facility pharmacy in a timely manner for 1 of 3 residents reviewed (Resident B). Additionally, the facility failed to ensure medications were accurately and completely documented on the Electronic Medication Administration Record (EMAR) for 3 of 3 residents reviewed (Residents B, C, and D).
Deficiencies (2)
Failure to provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist, resulting in delayed medication availability for Resident B.
Failure to safeguard resident-identifiable information and maintain accurate and complete medical records on the EMAR for Residents B, C, and D.
Report Facts
Residents reviewed for pharmaceutical services: 3
Residents reviewed for medication documentation: 3
Medications not administered due to unavailability: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing Services (DNS) | Provided information about medication availability, special-order medications, and facility policies during interviews on 3/21/23 and 3/22/23. |
Inspection Report
Complaint Investigation
Census: 91
Deficiencies: 0
Date: Jan 24, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00399804 and IN00399974 at Maple Park Village.
Complaint Details
Complaint IN00399804 - Substantiated with no deficiencies cited. Complaint IN00399974 - Unsubstantiated due to lack of evidence.
Findings
Complaint IN00399804 was substantiated but no deficiencies related to the allegations were cited. Complaint IN00399974 was unsubstantiated due to lack of evidence. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type: 91
Census Payor Type: 91
Medicare residents: 5
Medicaid residents: 51
Other residents: 35
Inspection Report
Complaint Investigation
Census: 92
Deficiencies: 0
Date: Jan 19, 2023
Visit Reason
This visit was conducted for the investigation of two complaints, IN00399481 and IN00399147.
Complaint Details
Complaint IN00399481 - Substantiated with no deficiencies cited. Complaint IN00399147 - Substantiated with no deficiencies cited.
Findings
Both complaints were substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type - SNF/NF: 88
Census Bed Type - SNF: 4
Census Total: 92
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 52
Census Payor Type - Other: 36
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Jan 6, 2023
Visit Reason
Paper compliance review to the Investigation of Complaint IN00396664 completed on December 15, 2022.
Complaint Details
Investigation of Complaint IN00396664; paper compliance review completed and found in compliance.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Inspection Report
Plan of Correction
Deficiencies: 0
Date: Jan 6, 2023
Visit Reason
Paper compliance review to the Investigation of Complaint IN00394244 completed on November 21, 2022.
Complaint Details
Investigation of Complaint IN00394244; paper compliance review completed; facility found in compliance.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Inspection Report
Life Safety
Census: 94
Capacity: 106
Deficiencies: 0
Date: Jan 5, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 11/14/22 was performed to verify compliance with Life Safety Code requirements.
Findings
Maple Park Village was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire regulations, and the 2012 edition of the NFPA 101 Life Safety Code. The facility was fully sprinkled and had appropriate fire alarm and smoke detection systems.
Report Facts
Facility capacity: 106
Census: 94
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Dec 15, 2022
Visit Reason
The inspection was conducted based on a complaint investigation related to failure to notify physicians and resident representatives timely about skin injuries and failure to report incidents as required by policy.
Complaint Details
Complaint IN00396664 regarding failure to notify and report skin injuries and burns, and failure to implement appropriate care plans and monitoring.
Findings
The facility failed to notify the physician and resident representative timely for two residents with burns, failed to report incidents according to the Long Term Care Incident Reporting Policy, and failed to develop and implement appropriate care plans and monitoring for a resident with a burn injury.
Deficiencies (4)
Failure to notify physician and resident representative timely for burns sustained by residents.
Failure to follow Long Term Care Incident Reporting Policy for reporting incidents involving burns.
Failure to develop and implement a care plan with interventions to prevent future burns for a resident.
Failure to notify wound nurse and monitor healing process of a burn injury.
Report Facts
Burn size: 12
Burn size: 13
Burn size: 4
Scar size: 0.8
Scar size: 0.6
Audit frequency: 5
Audit duration: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Voss | Executive Director | Interviewed and involved in findings related to notification and reporting failures. |
| RN 4 | Involved in incidents where burns occurred and failed to notify wound nurse or follow skin management program. | |
| DNS | Director of Nursing Services | Interviewed regarding incidents and failures in notification and reporting. |
| LPN 4 | Wound Nurse | Responsible for oversight of skin management program; was not notified timely of burn injury. |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 90
Deficiencies: 2
Date: Nov 21, 2022
Visit Reason
This visit was for the investigation of complaints IN00394244 and IN00393266. Complaint IN00394244 was substantiated with related deficiencies cited, while complaint IN00393266 was unsubstantiated due to lack of evidence.
Complaint Details
Complaint IN00394244 was substantiated with federal/state deficiencies cited at F689 and F692. Complaint IN00393266 was unsubstantiated due to lack of evidence.
Findings
The facility failed to ensure appropriate assistive devices were used to prevent a fall for one resident, and failed to keep accurate fluid intake records for one resident on fluid restriction. Corrective actions and education were planned to address these deficiencies.
Deficiencies (2)
Failed to ensure appropriate assistive devices were used to prevent a fall for 1 of 3 residents reviewed for accidents (Resident C).
Failed to keep accurate fluid intake records for 1 of 1 resident reviewed for a fluid restriction (Resident C).
Report Facts
Census: 90
Total Capacity: 90
Residents reviewed for accidents: 3
Residents reviewed for fluid restriction: 1
Fluid restriction amount: 1.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Voss | Executive Director | Signed the report |
| Director of Nursing | Interviewed regarding staff use of assistive devices and policies | |
| RN 1 | Interviewed regarding fluid intake documentation responsibilities | |
| RN 2 | Interviewed regarding fluid tracking and resident rights |
Inspection Report
Routine
Census: 89
Capacity: 106
Deficiencies: 14
Date: Nov 14, 2022
Visit Reason
Routine Life Safety Code Recertification and Emergency Preparedness Survey conducted by the Indiana Department of Health in accordance with federal regulations.
Findings
The facility was found to be in compliance with Emergency Preparedness requirements but had multiple deficiencies related to Life Safety Code including corridor obstructions, exit discharge issues, exit signage, cooking facility staff training, sprinkler system maintenance, fire department connection signage, corridor door integrity, smoke barrier door functionality, electrical safety, fire drill documentation, smoking area maintenance, and improper use of power strips.
Deficiencies (14)
Corridor width obstruction due to a large table not affixed to wall or floor.
Exit discharge at Breezeway North Exit uneven and obstructed by fence.
Exit signage confusion due to improper placement of 'Not an Exit' signs.
Staff not properly instructed on use of UL 300 hood fire suppression system in kitchen.
Fire department connection (FDC) lacked adequate directional signage.
Sprinkler heads in kitchen were loaded or covered with dust.
Corridor doors had holes and one door failed to latch properly, compromising smoke resistance.
Smoke barrier doors did not close completely and latch.
Electrical panels in corridors were unlocked and exposed wiring found in riser room.
Missing documentation of fire drills for all second quarter shifts.
Smoking areas not maintained; cigarette butts disposed on ground instead of in proper containers.
Power strip used as substitute for fixed wiring to power microwave in Medical Records office.
Power strip in resident room did not meet UL rating and was used for personal and medical equipment.
Electrical outlet receptacle testing documentation not available for past 12 months.
Report Facts
Certified beds: 106
Census: 89
Residents potentially affected by corridor obstruction: 20
Residents potentially affected by exit discharge issue: 25
Residents potentially affected by exit signage issue: 25
Residents potentially affected by sprinkler head loading: 5
Residents potentially affected by corridor door holes: 8
Residents potentially affected by smoke barrier door issue: 24
Residents potentially affected by electrical panel issue: 12
Residents potentially affected by fire drill deficiency: all
Cigarette butts counted: 190
Residents potentially affected by improper power strip use: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Supervisor | Interviewed and acknowledged multiple findings including corridor obstruction, exit discharge, exit signage, sprinkler issues, electrical safety, and fire drill deficiencies. | |
| Executive Director | Present at exit conference and acknowledged findings. | |
| Dietary Manager | Received training on UL 300 hood system use. | |
| Maintenance Director | Responsible for fire drills and electrical testing compliance. |
Inspection Report
Re-Inspection
Census: 92
Deficiencies: 0
Date: Nov 10, 2022
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Recertification and State Licensure Survey completed on October 6, 2022, including a PSR to the Investigation of Complaint IN00388366 completed on October 6, 2022.
Complaint Details
Complaint IN00388366 was investigated and found to be corrected.
Findings
Maple Park Village was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the PSR to the Recertification and State Licensure Survey and to the Investigation of Complaint IN00388366.
Report Facts
Census Bed Type: 92
SNF/NF beds: 85
SNF beds: 7
Census Payor Type: 92
Medicare residents: 5
Medicaid residents: 65
Other payor residents: 22
Inspection Report
Recertification
Census: 89
Deficiencies: 13
Date: Oct 6, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey, including the Investigation of Complaints IN00388366 and IN00390225.
Complaint Details
Complaint IN00388366 was substantiated with federal/state deficiencies cited at F690 and F921. Complaint IN00390225 was unsubstantiated due to lack of evidence.
Findings
Multiple deficiencies were cited including failure to assist residents with dignity during meals, improper medication administration, lack of comprehensive care plans, inadequate ADL assistance, pressure ulcer prevention failures, fall intervention lapses, catheter care issues, improper tube feeding practices, respiratory care deficiencies, medication storage errors, food safety violations, and unsanitary resident environment.
Deficiencies (13)
Residents were assisted to eat in the dining room without dignity when staff stood over them during meals.
Facility failed to ensure interdisciplinary team determined which medications may be self-administered and failed to obtain physician's order for bedside medications.
Facility failed to ensure residents had current comprehensive person-centered care plans for enhanced barrier precautions and respiratory care for CPAP treatments.
Facility failed to provide assistance with activities of daily living related to shaving and nail care.
Facility failed to assess, monitor and implement interventions to prevent pressure ulcers from developing.
Facility failed to ensure staff followed fall interventions for residents at risk for falls and sustained injuries.
Facility failed to ensure residents received treatment and care in accordance with professional standards and notify physician with change of condition for catheter care.
Facility failed to ensure head of bed was properly elevated during infusion of gastrostomy tube feeding and feeding equipment was labeled and dated.
Facility failed to thoroughly assess and document resident's change in respiratory status, notify physician of respiratory distress, ensure BIPAP/CPAP availability and proper infection control measures for tracheostomy care.
Facility failed to ensure medication error rate was less than 5%, with 6 errors out of 30 attempts.
Facility failed to ensure medication carts and medications were secured to prevent resident access.
Facility failed to ensure drinking cups were free of lime build up, meals were covered and protected during transport, and staff did not touch mouthpiece of straws with bare hands.
Facility failed to provide a safe, clean, and comfortable interior environment for a resident's room, including dirty floors, stains, and soiled bedside table.
Report Facts
Census: 89
Medication error rate: 26.67
Falls: 69
Unwitnessed falls: 49
Residents served meals: 87
Medication carts unsecured: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Voss | Executive Director | Signed report and involved in interviews |
| Nurse Practitioner 22 | Nurse Practitioner | Interviewed regarding catheter care and respiratory care |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple care deficiencies and policies |
| Licensed Practical Nurse 25 | LPN | Observed administering medications and involved in respiratory care |
| Registered Nurse 24 | RN | Observed medication administration and respiratory care |
| Certified Nursing Assistant 6 | CNA | Observed touching straw tops during meal service |
| Director of Housekeeping | Director of Housekeeping | Interviewed regarding housekeeping staffing and cleaning |
| Infection Preventionist | Infection Preventionist | Interviewed regarding infection control and respiratory equipment |
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