Deficiencies (last 5 years)
Deficiencies (over 5 years)
6.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
48% worse than Indiana average
Indiana average: 4.2 deficiencies/year
Deficiencies per year
16
12
8
4
0
Occupancy
Latest occupancy rate
45% occupied
Based on a May 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jan 29, 2026
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to timely report an allegation of resident abuse involving Resident B.
Complaint Details
The complaint investigation substantiated that the facility did not report the abuse allegation until several days after the incident, violating the facility's Abuse and Neglect Procedural Guidelines and state reporting requirements.
Findings
The facility failed to report an allegation of resident abuse to the State Agency in a timely manner. Resident B reported being groped and kissed by a staff member, but the facility only became aware of the allegation after police contact and reported it late.
Deficiencies (1)
F 0609: The facility failed to timely report suspected abuse of Resident B to the State Agency as required by policy and regulations.
Report Facts
Residents affected: 1
Date of incident: Jan 23, 2026
Date survey completed: Jan 29, 2026
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 1
Date: May 20, 2025
Visit Reason
This visit was conducted for the investigations of Complaints IN00459472 and IN00458770. Both complaints resulted in no deficiencies related to the allegations, but unrelated deficiencies were cited.
Complaint Details
Complaint IN00459472 and Complaint IN00458770 were investigated with no deficiencies related to the allegations cited.
Findings
The facility failed to ensure service plans were completed and signed by the resident or resident representatives on admission for 3 of 5 residents reviewed (Residents B, D, and E). A house-wide audit and education were implemented to ensure compliance with service plan completion and signatures.
Deficiencies (1)
Failed to ensure service plans were completed and signed by the resident or resident representatives on admission for 3 of 5 residents reviewed (Residents B, D, and E).
Report Facts
Residential Census: 60
Residents reviewed for service plans: 5
Residents affected: 3
Audit frequency: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Snyder | Executive Director | Signed the report |
| Assistant Director of Nursing (ADON) | Interviewed regarding service plan completion and policy |
Inspection Report
Complaint Investigation
Census: 111
Deficiencies: 0
Date: Feb 20, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00453818.
Complaint Details
Complaint IN00453818 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 Total: 111
Census Bed Type SNF/NF: 35
Census Bed Type SNF: 20
Census Bed Type Residential: 56
Census Payor Type Medicare: 20
Census Payor Type Medicaid: 19
Census Payor Type Other: 16
Census Payor Type Total: 55
Inspection Report
Complaint Investigation
Census: 114
Deficiencies: 0
Date: Feb 6, 2025
Visit Reason
This visit was conducted for the investigation of Nursing Home Complaint IN00450698 and Residential Complaint IN00451658.
Complaint Details
Complaint IN00450698 and Complaint IN00451658 were investigated with no deficiencies cited related to the allegations.
Findings
No deficiencies related to the allegations were cited for either complaint. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type Total: 114
Census Bed Type SNF/NF: 26
Census Bed Type SNF: 32
Census Bed Type Residential: 56
Census Payor Type Medicare: 20
Census Payor Type Medicaid: 19
Census Payor Type Other: 19
Census Payor Type Total: 58
Inspection Report
Re-Inspection
Census: 57
Capacity: 61
Deficiencies: 0
Date: Feb 4, 2025
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
Prairie Lakes Health Campus 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. The facility was fully sprinklered with a fire alarm system and smoke detection throughout.
Report Facts
Facility capacity: 61
Census: 57
Inspection Report
Complaint Investigation
Census: 59
Capacity: 116
Deficiencies: 0
Date: Jan 21, 2025
Visit Reason
This visit was for the investigation of Complaint IN00451411.
Complaint Details
Complaint IN00451411 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations of Complaint IN00451411 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: 27
Census Bed Type: 32
Census Bed Type: 57
Total Capacity: 116
Census Payor Type: 21
Census Payor Type: 19
Census Payor Type: 19
Current Census: 59
Inspection Report
Complaint Investigation
Census: 56
Capacity: 111
Deficiencies: 0
Date: Jan 9, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00449470.
Complaint Details
Complaint IN00449470 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00449470 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type Total: 111
Census Payor Type Total: 56
Census by Payor Type: 18
Census by Payor Type: 20
Census by Payor Type: 18
Inspection Report
Life Safety
Census: 60
Capacity: 61
Deficiencies: 1
Date: Dec 23, 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 on 12/23/2024.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was found not in compliance with Life Safety Code requirements due to failure to conduct required maintenance and maintain documentation of inspections for Patient Care Related Electrical Equipment (PCREE).
Deficiencies (1)
Facility failed to maintain the record of inspection on the patient care related electrical equipment affecting six of six smoke compartments, staff and all residents.
Report Facts
Certified beds: 61
Census: 60
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Snyder | Executive Director | Signed report and involved in plan of correction |
| Director of Plant Operations | Responsible for inspection, testing, documentation, and education regarding PCREE | |
| Senior Director of Plant Operations | Interviewed during survey and acknowledged findings | |
| Corporate Support Representative | Interviewed during survey and acknowledged findings |
Inspection Report
Deficiencies: 3
Date: Dec 9, 2024
Visit Reason
The inspection was conducted to evaluate compliance with pharmaceutical services regulations, specifically to ensure shift-to-shift narcotic reconciliation was completed for medication storage carts.
Findings
The facility failed to ensure shift-to-shift narcotic reconciliation was completed for 3 of 3 medication carts reviewed. Multiple dates were identified where narcotic counts were not properly documented during shift changes, increasing the risk of drug diversion.
Deficiencies (3)
F 0755: The facility failed to ensure shift-to-shift narcotic reconciliation was completed for the Pioneer front medication cart on multiple dates in November and December 2024. This failure was observed during medication storage review on 12/5/24.
F 0755: The facility failed to ensure shift-to-shift narcotic reconciliation was completed for the Pioneer back medication cart on multiple dates in November 2024. This failure was observed during medication storage review on 12/5/24.
F 0755: The facility failed to ensure shift-to-shift narcotic reconciliation was completed for the Noble Hall medication cart on multiple dates in November 2024. This failure was observed during medication storage review on 12/5/24.
Report Facts
Dates lacking shift to shift reconciliation: 27
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN 6 | Registered Nurse | Accompanied surveyor during medication storage observations and provided interview regarding narcotic count procedures. |
| LPN 7 | Licensed Practical Nurse | Accompanied surveyor during medication storage observation of Noble Hall medication cart. |
| DON | Director of Nursing | Provided interview explaining narcotic count procedures and facility policy on 12/5/24 and 12/9/24. |
Inspection Report
Renewal
Census: 114
Deficiencies: 2
Date: Dec 9, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, including a State Residential Licensure Survey conducted on December 2, 3, 4, 5, 6, and 9, 2024.
Findings
The facility was found deficient in ensuring shift-to-shift narcotic reconciliation for medication carts and in ensuring qualified medication assistants obtained authorization from a licensed nurse or physician prior to administering PRN medications. Immediate corrective actions were taken, education provided, and ongoing audits planned to ensure compliance.
Deficiencies (2)
Failed to ensure shift to shift narcotic reconciliation was completed for 3 of 3 medication carts reviewed.
Failed to ensure the qualified medication assistant obtained authorization from a licensed nurse or physician prior to administering a PRN medication for 1 of 7 sampled residents.
Report Facts
Census Bed Type Total: 114
Narcotic reconciliation missing dates: 27
Residents sampled for PRN medication authorization: 7
PRN medication administration incidents without authorization: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Holly Snyder | HFA | Facility representative signing the report |
| RN 6 | Accompanied medication cart observations and provided information about narcotic count procedures | |
| LPN 7 | Accompanied medication cart observation for Noble Hall cart | |
| QMA 3 | Qualified Medication Assistant | Administered PRN medications without documented nurse or physician authorization |
| QMA 4 | Qualified Medication Assistant | Administered PRN medication without documented nurse or physician authorization |
| QMA 5 | Qualified Medication Assistant | Provided interview about PRN medication administration process |
| DON | Director of Nursing | Provided interviews regarding narcotic count procedures and PRN medication authorization |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Dec 9, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure Survey.
Findings
Prairie Lakes Health Campus 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 of the Recertification and State Licensure survey.
Inspection Report
Complaint Investigation
Census: 59
Capacity: 117
Deficiencies: 0
Date: Nov 7, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00446892 and IN00446526.
Complaint Details
Investigation of Complaints IN00446892 and IN00446526 found no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00446892 and IN00446526 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 these complaints.
Report Facts
Census Bed Type - SNF/NF: 39
Census Bed Type - SNF: 20
Census Bed Type - Residential: 58
Total Capacity: 117
Census Payor Type - Medicare: 20
Census Payor Type - Medicaid: 23
Census Payor Type - Other: 16
Total Census: 59
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 0
Date: Aug 7, 2024
Visit Reason
This visit was for the Investigation of Complaint IN00439313.
Complaint Details
Complaint IN00439313 - No deficiencies related to the allegations are cited.
Findings
No deficiencies related to the allegations are cited. Prairie Lakes Health Campus was found to be in compliance with 410 IAC 16.2-5 in regard to the Investigation of Complaint IN00439313.
Inspection Report
Complaint Investigation
Census: 54
Capacity: 113
Deficiencies: 0
Date: May 21, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00433564.
Complaint Details
Investigation of Complaint IN00433564 found no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00433564 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type Total: 113
Census Payor Type Total: 54
Census by Bed Type: 26
Census by Bed Type: 28
Census by Bed Type: 59
Census Payor Type: 18
Census Payor Type: 25
Census Payor Type: 11
Inspection Report
Complaint Investigation
Census: 62
Deficiencies: 0
Date: Apr 26, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00432037.
Complaint Details
Complaint IN00432037 was investigated and found to have no deficiencies related to the allegations.
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.
Inspection Report
Complaint Investigation
Census: 59
Capacity: 119
Deficiencies: 0
Date: Mar 5, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00429136 and IN00427746.
Complaint Details
Complaint IN00429136 and Complaint IN00427746 were investigated with no deficiencies related to the allegations cited.
Findings
No deficiencies related to the allegations in complaints IN00429136 and IN00427746 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type - SNF/NF: 24
Census Bed Type - SNF: 35
Census Bed Type - Residential: 60
Total Capacity: 119
Census Payor Type - Medicare: 19
Census Payor Type - Medicaid: 23
Census Payor Type - Other: 17
Total Census: 59
Inspection Report
Complaint Investigation
Census: 61
Capacity: 118
Deficiencies: 0
Date: Feb 12, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00427496.
Complaint Details
Investigation of Complaint IN00427496 found 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 - SNF/NF: 26
Census Bed Type - SNF: 35
Census Bed Type - Residential: 57
Total Capacity: 118
Census Payor Type - Medicare: 19
Census Payor Type - Medicaid: 26
Census Payor Type - Other: 16
Total Census: 61
Inspection Report
Life Safety
Census: 61
Capacity: 61
Deficiencies: 0
Date: Jan 11, 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).
Findings
The facility was found in compliance with Emergency Preparedness Requirements and Life Safety Code requirements. The facility is a one-story, fully sprinklered Type V (111) construction with a fire alarm system including smoke detection in corridors and resident sleeping rooms.
Report Facts
Certified beds: 61
Census: 61
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Dec 18, 2023
Visit Reason
The inspection was conducted based on complaints regarding failure to follow physician orders for fluid restriction and insulin administration, narcotic reconciliation, and pharmacy recommendation follow-up.
Complaint Details
The investigation was complaint-driven, focusing on medication administration errors, narcotic reconciliation failures, and lack of response to pharmacy recommendations. The complaints were substantiated with findings of minimal harm and few or some residents affected.
Findings
The facility failed to follow physician orders for fluid restriction and insulin administration parameters for two residents. Narcotics were not reconciled per facility policy across multiple medication carts. Pharmacy recommendations for gradual dosage reduction and medication adjustments were not reviewed or acted upon for two residents.
Deficiencies (3)
F 0684: The facility failed to follow a physician's order for fluid restriction for Resident 5 and failed to follow insulin administration parameters for Resident 36, including lack of physician notification for high blood sugar readings.
F 0755: The facility failed to ensure narcotics were reconciled per facility policy for 4 medication carts, with multiple dates and shifts lacking reconciliation documentation.
F 0756: The facility failed to ensure pharmacy recommendations for gradual dosage reduction and medication adjustments were reviewed and acted upon for Residents 15 and 2, with no documented physician responses or contraindications.
Report Facts
Fluid intake measurements: 2880
Blood sugar readings: 480
Dates and shifts lacking narcotic reconciliation: 40
Pharmacy recommendations: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | DON | Interviewed regarding fluid restriction education, insulin administration, narcotic reconciliation expectations, and pharmacy recommendation follow-up. |
| RN 6 | Registered Nurse | Accompanied medication storage observations for Pioneer back and front carts. |
| RN 8 | Registered Nurse | Accompanied medication storage observation for Noble hall cart. |
| Corporate Nurse Consultant | Consultant | Interviewed regarding facility policies on pharmacy recommendations. |
| IDT Social Services Director | Social Services Director | Interviewed regarding documentation of pharmacy recommendations and interdisciplinary team reviews. |
Inspection Report
Renewal
Census: 58
Capacity: 58
Deficiencies: 5
Date: Dec 18, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, including a State Residential Licensure Survey conducted from December 11 to 18, 2023.
Findings
The facility was found deficient in multiple areas including failure to follow physician orders for fluid restriction and insulin administration, failure to reconcile narcotics per policy, failure to act on pharmacy recommendations for unnecessary medications, failure to provide supervision for a resident with elopement risk, and failure to ensure service plans were signed by residents or representatives.
Deficiencies (5)
Failed to follow physician's order for fluid restriction for Resident 5 and insulin administration parameters for Resident 36.
Failed to ensure narcotics were reconciled per facility policy for 4 medication carts.
Failed to ensure pharmacy recommendations were reviewed by the physician and acted upon for unnecessary medications for Residents 15 and 2.
Failed to provide supervision for a newly admitted resident with a history of elopement, resulting in the resident leaving the secured dementia unit and being found outside.
Failed to ensure service plans were signed by residents or resident representatives for Residents 19, 30, and 101.
Report Facts
Survey dates: 6
Census Bed Type: 58
Fluid intake amounts: 2880
Blood sugar readings: 447
Narcotic count reconciliation missing shifts: 50
Distance resident traveled: 360
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Rebeccah Garza | RN Clinical Support | Signed the report |
| DON | Director of Nursing | Provided interviews regarding fluid restriction, insulin administration, narcotic reconciliation, pharmacy recommendations, and elopement incident |
| Environmental Services Director | Witnessed resident elopement and completed statement of witness form | |
| Corporate Nurse Consultant | Interviewed regarding facility policy on pharmacy recommendations | |
| Dementia Unit Director | Interviewed about patio door alarm and courtyard gate | |
| Resident 56's spouse | Provided information about resident's history of elopement | |
| IDT Social Services Director | Interviewed regarding pharmacy recommendation documentation |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Dec 18, 2023
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Prairie Lakes Health Campus 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
Complaint Investigation
Census: 59
Deficiencies: 0
Date: Oct 11, 2023
Visit Reason
This visit was for the Investigation of Complaint IN00417750.
Complaint Details
Complaint IN00417750 - 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 in regard to the complaint investigation.
Report Facts
Census Bed Type Total: 59
Census Bed Type SNF/NF: 26
Census Bed Type SNF: 33
Census Payor Type Medicare: 19
Census Payor Type Medicaid: 22
Census Payor Type Other: 18
Inspection Report
Complaint Investigation
Census: 104
Deficiencies: 0
Date: Jul 7, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00411649.
Complaint Details
Complaint IN00411649 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00411649 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type Total: 104
Census Payor Type Total: 46
SNF/NF Beds: 26
SNF Beds: 20
Residential Beds: 58
Medicare Residents: 13
Medicaid Residents: 17
Other Payor Residents: 16
Inspection Report
Complaint Investigation
Census: 112
Deficiencies: 0
Date: Jun 1, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00406817.
Complaint Details
Complaint IN00406817 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 regarding the complaint investigation.
Report Facts
Census Bed Type Total: 112
Census Bed Type SNF/NF: 28
Census Bed Type SNF: 25
Census Bed Type Residential: 59
Census Payor Type Medicare: 20
Census Payor Type Medicaid: 18
Census Payor Type Other: 15
Census Payor Type Total: 53
Inspection Report
Life Safety
Census: 54
Capacity: 61
Deficiencies: 0
Date: Jan 9, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 11/17/22 by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
Prairie Lakes Health Campus 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 (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2. The facility was fully sprinklered with a fire alarm system and smoke detectors in all required areas.
Report Facts
Facility capacity: 61
Census: 54
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 21, 2022
Visit Reason
Paper compliance review to the Investigation of Complaint IN00394537 completed on November 21, 2022.
Complaint Details
Investigation of Complaint IN00394537 completed with compliance found.
Findings
Prairie Lakes Health Campus 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 Complaint Investigation.
Inspection Report
Complaint Investigation
Census: 128
Capacity: 128
Deficiencies: 1
Date: Nov 21, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00394537, which was substantiated with a related federal/state deficiency cited at F689.
Complaint Details
Complaint IN00394537 was substantiated. The deficiency related to unsafe transfer practices leading to a resident injury was cited.
Findings
The facility failed to ensure safe transfer of a physically impaired resident (Resident B), resulting in the resident sliding to the floor and sustaining a head injury. The resident required two-person assistance for transfers, but staff did not follow this protocol. The facility updated the resident's care plan and educated staff on proper transfer procedures.
Deficiencies (1)
Failure to ensure staff provided safe transfer of a physically impaired resident requiring two-person assistance, resulting in injury.
Report Facts
Census: 128
Licensed capacity: 128
Residents requiring extensive assistance: 1
Staples to laceration: 3
Audit frequency: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Stacy Mevzek | Executive Director | Signed the report |
| CNA 1 | Certified Nursing Aide | Named in deficiency for transferring resident without assistance |
| RN 2 | Registered Nurse | Interviewed regarding CNA 1 not following proper transfer protocol |
| RN 3 | Registered Nurse | Interviewed regarding resident's fearfulness and transfer requirements |
Inspection Report
Life Safety
Census: 58
Capacity: 61
Deficiencies: 2
Date: Nov 17, 2022
Visit Reason
A Life Safety Code Recertification and State Licensure Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a) and NFPA 101 standards.
Findings
The facility was found not in compliance with Life Safety Code requirements related to egress door locking and sprinkler system installation. Deficiencies included a magnetically locked courtyard exit gate without posted exit code and improperly stored spare sprinkler heads.
Deficiencies (2)
The exit gate from the Courtyard was magnetically locked and the exit code was not posted, restricting egress for residents without clinical security needs.
The sprinkler system did not meet NFPA 13 requirements as spare sprinklers were stored loosely and not secured in a designated slot.
Report Facts
Facility certified beds: 61
Census: 58
Number of spare sprinklers stored loosely: 6
Number of spare sprinklers stored on top of box: 2
Number of staff and visitors potentially affected by egress door deficiency: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Stacy Mevzek | Executive Director | Signed report and involved in exit conference |
| Plant Operations Director | Acknowledged deficiencies related to egress door and sprinkler system | |
| Assistant Plant Operations Director | Acknowledged deficiencies related to egress door and sprinkler system | |
| Corporate Facilities Management Support Representative | Acknowledged deficiencies related to egress door and sprinkler system |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Nov 15, 2022
Visit Reason
The inspection was conducted as a paper compliance review for the Annual Recertification and State Licensure survey, which also included an Investigation of Complaint IN00389656 completed on October 25, 2022.
Complaint Details
Investigation of Complaint IN00389656 was included and found to be in compliance.
Findings
Prairie Lakes Health Campus 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 of the Recertification and State Licensure survey and the Investigation of Complaint IN00389656.
Inspection Report
Complaint Investigation
Deficiencies: 5
Date: Oct 25, 2022
Visit Reason
The inspection was conducted as a complaint investigation related to concerns about individualized services, activities, medication use, staffing adequacy, and infection control during a COVID-19 outbreak at the facility.
Complaint Details
The complaint investigation focused on concerns about individualized care for residents with developmental disabilities, adequacy of activities, appropriate use of psychotropic medications, staffing sufficiency, and infection control practices during a COVID-19 outbreak.
Findings
The facility failed to provide individualized services and activities to meet resident needs, ensure appropriate use and monitoring of psychotropic medications, maintain adequate staffing levels to meet resident care needs, and implement proper infection prevention and control measures during a COVID-19 outbreak.
Deficiencies (5)
F 0675: The facility failed to ensure a resident with developmental disabilities received individualized services to maintain or improve quality of life, including socialization and feeding assistance.
F 0679: The facility failed to provide individualized activities to meet resident needs, resulting in limited engagement and socialization for a resident.
F 0725: The facility failed to provide enough nursing staff daily to meet resident needs, resulting in delayed call light responses, insufficient assistance with activities of daily living, and inadequate supervision during meals.
F 0758: The facility failed to ensure residents receiving antipsychotic medications had documented medical indications, appropriate diagnoses, and gradual dose reductions or contraindications for reductions.
F 0880: The facility failed to implement proper infection prevention and control measures during a COVID-19 outbreak, including improper use of PPE and inadequate cleaning of medication containers.
Report Facts
Resident census on skilled care units: 57
Residents incontinent of bladder: 45
Residents incontinent of bowel: 48
Residents requiring assistance for bathing, dressing, transferring: 55
Residents with dementia diagnosis: 31
Residents requiring staff assistance for eating: 10
Staffing counts on night shifts: 2
Staffing counts on night shifts: 4
COVID-19 positive residents: 23
Resident D activity attendance: 9
Resident D shower dates: 5
Inspection Report
Recertification
Census: 69
Capacity: 126
Deficiencies: 7
Date: Oct 25, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey, including investigation of Complaints IN00389656 and IN00392544.
Complaint Details
Complaint IN00389656 was substantiated with related Federal/State deficiencies cited at F725. Complaint IN00392544 was substantiated with no deficiencies related to the allegations cited.
Findings
The facility was found deficient in multiple areas including quality of life and individualized activities for residents with developmental disabilities, sufficient nursing staff to meet resident needs, appropriate use and documentation of psychotropic medications, infection prevention and control practices during a COVID-19 outbreak, and staff competency in CPR and First Aid certifications.
Deficiencies (7)
Failed to ensure a resident with developmental disabilities received individualized services to maintain or improve quality of life.
Failed to provide individualized activities to meet resident needs for 1 of 1 resident reviewed.
Failed to provide sufficient nursing staff to ensure individual resident needs were met regarding call light responses, stimulation, supervision during dining, ADL assistance, and timely medication administration.
Failed to ensure residents receiving antipsychotic medications had documented medical indications, appropriate diagnoses, and gradual dose reductions or contraindications.
Failed to ensure proper infection prevention and control strategies to mitigate the spread of COVID-19 during a facility outbreak and high community transmission for multiple residents.
Failed to ensure staff competency in First Aid and CPR certifications for 5 of 7 days reviewed.
Failed to establish and maintain an infection prevention and control program including surveillance, education, reporting, and isolation procedures.
Report Facts
Resident census: 69
Total capacity: 126
Residents occasionally or frequently incontinent of bladder: 45
Residents occasionally or frequently incontinent of bowel: 48
Residents requiring assistance for bathing, dressing, transferring: 55
Residents with dementia: 31
Residents requiring assistance for eating: 10
Staffing levels night shift: 3
Staffing levels night shift: 4
Staffing levels night shift: 2
Residents positive for COVID-19: 23
Residents positive for COVID-19: 6
Residents positive for COVID-19: 10
Residents positive for COVID-19: 16
Staffing shifts without CPR/First Aid certified staff: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jenny McCurdy | RN, Clinical support nurse | Signed report |
| LPN 7 | Observed entering isolation room with improper PPE use | |
| Housekeeper 8 | Observed wearing N95 over surgical mask in isolation room | |
| QMA 9 | Qualified Medication Aide | Observed improper handling of eye drop medication in isolation room |
| RN 3 | Registered Nurse | Observed improper mask use entering isolation room |
| NP Student 4 | Nurse Practitioner Student | Observed improper mask use entering isolation room |
| CNA 6 | Certified Nurse's Aide | Reported staffing shortages and shower delays |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 112
Deficiencies: 0
Date: Aug 30, 2022
Visit Reason
This visit was for the investigation of Complaint IN00386373.
Complaint Details
Complaint IN00386373 - Substantiated. No deficiencies related to the allegations were cited.
Findings
The complaint IN00386373 was substantiated, but no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census Bed Type - SNF/NF: 27
Census Bed Type - SNF: 31
Census Bed Type - Residential: 54
Census Bed Type - Total: 112
Census Payor Type - Medicare: 15
Census Payor Type - Medicaid: 21
Census Payor Type - Other: 22
Census Payor Type - Total: 58
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