Inspection Report
Complaint Investigation
Census: 46
Deficiencies: 0
Apr 10, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00456875.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00456875 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 46
Medicare residents: 6
Medicaid residents: 31
Other payor residents: 9
Inspection Report
Plan of Correction
Deficiencies: 0
Feb 26, 2025
Visit Reason
Paper compliance review to the Investigation of Complaints IN00449796 and IN00451233 completed on February 4, 2025.
Findings
Pulaski Health Care Center 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.
Complaint Details
The visit was related to complaint investigations IN00449796 and IN00451233, with compliance found upon paper review.
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 2
Feb 3, 2025
Visit Reason
This visit was conducted for the investigation of Complaints IN00449796 and IN00451233 related to pressure ulcer care and infection control practices.
Findings
The facility failed to ensure a resident with pressure ulcers received necessary treatment and services to promote healing, and failed to ensure correct Personal Protective Equipment (PPE) was used by staff when providing care to residents under Enhanced Barrier Precautions.
Complaint Details
The investigation was triggered by Complaints IN00449796 and IN00451233. Both complaints resulted in deficiencies related to pressure ulcer care and infection control cited at F686.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure a resident with pressure ulcers received necessary treatment and services to promote healing, related to treatments not completed as ordered for 1 of 3 residents reviewed for pressure ulcers (Resident D). | SS=D |
| Failure to ensure correct Personal Protective Equipment (PPE) was used by staff members when providing care to residents in Enhanced Barrier Precautions (Residents G and D). | SS=D |
Report Facts
Census Bed Type - SNF/NF: 45
Census Bed Type - SNF: 5
Total Census: 50
Census Payor Type - Medicare: 5
Census Payor Type - Medicaid: 34
Census Payor Type - Other: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thelma Jean Fort | Administrator | Signed as Laboratory Director's or Provider/Supplier Representative |
| R. G | Resident affected by pressure ulcer treatment deficiency | |
| E 1 | Staff member reeducated on proper notification and wound prevention | |
| CNA 1 | Certified Nursing Assistant | Observed providing care without proper PPE |
| CNA 2 | Certified Nursing Assistant | Observed providing care without proper PPE and dressing care |
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding care and PPE practices |
Inspection Report
Complaint Investigation
Census: 51
Deficiencies: 0
Dec 10, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00445725 at Pulaski Health Care Center.
Findings
No deficiencies related to the allegations in Complaint IN00445725 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00445725 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type - SNF/NF: 47
Census Bed Type - SNF: 4
Census Total: 51
Census Payor Type - Medicare: 4
Census Payor Type - Medicaid: 36
Census Payor Type - Other: 11
Inspection Report
Re-Inspection
Census: 54
Capacity: 58
Deficiencies: 0
Sep 26, 2024
Visit Reason
A Post Survey Revisit (PSR) was conducted to follow up on the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey originally conducted on 08/13/2024.
Findings
At this PSR survey, Pulaski Health Care Center was found in compliance with Emergency Preparedness Requirements and Life Safety Code Requirements. The facility was fully sprinklered except for one detached equipment shed, and had a fire alarm system with smoke detection in required areas.
Report Facts
Certified beds: 58
Census: 54
Inspection Report
Complaint Investigation
Census: 57
Capacity: 57
Deficiencies: 1
Aug 21, 2024
Visit Reason
This visit was conducted for the investigation of Complaints IN00440025 and IN00440943. Complaint IN00440025 resulted in federal/state deficiencies related to privacy violations, while Complaint IN00440943 had no deficiencies cited.
Findings
The facility failed to ensure a resident's privacy was respected when a terminated employee used her private cell phone to take a video of a resident without approval. The video was shared on a staff group messaging page but not on social media. The incident was investigated, resulting in termination and disciplinary actions, and staff were re-educated on confidentiality policies.
Complaint Details
Complaint IN00440025 was substantiated with federal/state deficiencies cited. Complaint IN00440943 was not substantiated with any deficiencies.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure a resident's privacy was respected related to a terminated employee taking a video of a resident without approval. | SS=D |
Report Facts
Census: 57
Total Capacity: 57
Medicare Census: 4
Medicaid Census: 38
Other Payor Census: 15
Survey Dates: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Terminated Employee 1 | Employee who took unauthorized video of resident and was terminated | |
| CNA 2 | Certified Nursing Assistant | Employee present during video recording, disciplined with written warning |
| CNA 3 | Certified Nursing Assistant | Employee who notified Administrator about the video |
| Social Service Director | Interviewed and aware of the incident involving the video | |
| Administrator | Conducted full investigation and provided video evidence |
Inspection Report
Life Safety
Census: 58
Capacity: 58
Deficiencies: 5
Aug 13, 2024
Visit Reason
An Emergency Preparedness Survey and Life Safety Code Recertification and State Licensure Survey were conducted by the Indiana Department of Health in accordance with federal regulations.
Findings
The facility was found in substantial compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included failure to develop and implement facility-specific emergency preparedness policies, failure to maintain fire alarm system inspections, failure to conduct quarterly fire drills on each shift, failure to conduct annual fire door inspections, and improper storage of oxygen cylinders.
Severity Breakdown
SS=C: 1
SS=F: 3
SS=E: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to develop and implement emergency preparedness policies and procedures that are facility specific and reviewed at least annually. | SS=C |
| Failed to maintain fire alarm system with required semi-annual visual inspections. | SS=F |
| Failed to conduct quarterly fire drills on each shift for one quarter. | SS=F |
| Failed to ensure annual inspection and testing of 6 fire door assemblies. | SS=F |
| Failed to properly secure 11 of 30 oxygen cylinders from falling. | SS=E |
Report Facts
Certified beds: 58
Census: 58
Fire door assemblies: 6
Oxygen cylinders improperly secured: 11
Oxygen cylinders total: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thelma Jean Fort | Administrator | Named in report signature and involved in exit conference and corrective actions |
| Maintenance Director | Interviewed regarding deficiencies and responsible for corrective actions |
Inspection Report
Annual Inspection
Census: 57
Deficiencies: 4
Jul 26, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, which included the Investigation of Complaint IN00435619.
Findings
The facility was found deficient in several areas including inaccurate Minimum Data Set (MDS) assessments related to antiplatelet medication use, lack of comprehensive care plans for anticoagulant and antiplatelet medication use, failure to provide necessary treatment to prevent contractures and decreased range of motion, and inadequate monitoring for residents receiving scheduled opioid medications. No deficiencies were cited related to the complaint investigation.
Complaint Details
Complaint IN00435619 was investigated and no deficiencies related to the allegations were cited.
Severity Breakdown
SS=A: 1
SS=D: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure Minimum Data Set (MDS) comprehensive assessments were accurately completed related to antiplatelet medication use for 2 of 18 MDS assessments reviewed. | SS=A |
| Failed to ensure a comprehensive care plan was developed and in place for anticoagulant and antiplatelet medication use for 1 of 18 resident care plans reviewed. | SS=D |
| Failed to ensure residents received necessary treatment to prevent contractures or decreased range of motion related to passive range of motion not completed as recommended and splinting device not in place as ordered for 2 of 2 residents reviewed. | SS=D |
| Failed to ensure adequate monitoring was in place for a resident receiving scheduled opioid medication for 1 of 5 residents reviewed for unnecessary medications. | SS=D |
Report Facts
Census Bed Type: 57
SNF Beds: 6
SNF/NF Beds: 51
Medicare Census: 5
Medicaid Census: 39
Other Payor Census: 13
MDS Assessments Reviewed: 18
Residents Reviewed for ROM: 2
Residents Reviewed for Unnecessary Drugs: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jean Fort | Administrator | Signed the report |
| MDS Coordinator | Interviewed regarding MDS coding errors for antiplatelet medications | |
| Director of Nursing | Interviewed regarding MDS coding, care plans, ROM documentation, and opioid monitoring | |
| QMA 1 | Interviewed regarding ROM services | |
| PT Aide 1 | Interviewed regarding therapy recommendations for ROM | |
| CNA 1 | Interviewed regarding splinting device use |
Inspection Report
Renewal
Deficiencies: 0
Jul 26, 2024
Visit Reason
The visit was a paper compliance review related to the Recertification and State Licensure Survey.
Findings
Pulaski Health Care Center 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 Recertification and State Licensure Survey.
Inspection Report
Complaint Investigation
Census: 54
Deficiencies: 0
Feb 22, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00428186.
Findings
No deficiencies related to the allegations in Complaint IN00428186 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00428186 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Bed Type Total: 54
Census Payor Type Total: 54
Medicare Census: 5
Medicaid Census: 36
Other Payor Census: 13
Inspection Report
Complaint Investigation
Deficiencies: 0
Feb 19, 2024
Visit Reason
The visit was a paper compliance review related to the investigation of Complaint IN00425189 completed on January 17, 2024.
Findings
Pulaski Health Care Center 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.
Complaint Details
Investigation of Complaint IN00425189 completed on January 17, 2024; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 51
Deficiencies: 1
Jan 17, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00425189 regarding allegations of abuse at Pulaski Health Care Center.
Findings
The facility failed to report an allegation of abuse involving one resident to the State Agency as required. The investigation did not substantiate the allegation, but the facility did not report it because the resident was discharged. The facility's policy requires reporting all allegations regardless of resident status.
Complaint Details
Complaint IN00425189 was investigated. The allegation involved a nurse aide being rough with a discharged resident during shower care. The allegation was not substantiated, and the facility did not report it because the resident was no longer in the facility.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to report an allegation of abuse to the State Agency for one resident. | SS=D |
Report Facts
Census: 51
Medicare residents: 5
Medicaid residents: 33
Other residents: 13
Skilled Nursing Facility/Nursing Facility beds: 45
Skilled Nursing Facility beds: 6
Inspection Report
Re-Inspection
Census: 51
Capacity: 58
Deficiencies: 0
Nov 8, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 09/06/23 was performed to verify compliance with fire safety and licensure requirements.
Findings
Pulaski Health Care Center was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and applicable state and national fire safety codes. The facility was fully sprinklered except for one detached equipment shed.
Inspection Report
Life Safety
Census: 50
Capacity: 58
Deficiencies: 4
Sep 6, 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 in accordance with federal regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements, including issues with exit door locking arrangements, exit signage, fire alarm system maintenance, and documentation of fire drills.
Severity Breakdown
SS=F: 3
SS=E: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure the means of egress through 4 of 6 exits were readily accessible; exit doors were magnetically locked and required a four-digit code not posted at the exit. | SS=F |
| Failed to ensure 1 of 3 doors to the outside was not mistaken as a facility exit; the Northeast wing door to a secured courtyard lacked 'NO EXIT' signage. | SS=E |
| Failed to ensure 1 of 1 heat detector was accessible for testing and maintained according to NFPA 72; the heat detector above the nurse's station was not inspected in consecutive years. | SS=F |
| Failed to document quarterly fire drills for 3 of 4 quarters; times of drills were missing on the front of the fire drill report forms. | SS=F |
Report Facts
Certified beds: 58
Census: 50
Exits with deficient locking: 4
Fire drills missing documented times: 3
Inspection Report
Renewal
Census: 50
Capacity: 50
Deficiencies: 5
Aug 24, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from August 21 to 24, 2023.
Findings
The facility was found deficient in multiple areas including failure to apply protective arm sleeves as ordered, failure to initiate neurological checks after a fall, improper oxygen administration flow rate, failure to monitor vital signs before administering blood pressure medication, and failure to follow infection control protocols related to PPE use in isolation rooms.
Severity Breakdown
SS=D: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Failure to ensure a resident's protective arm sleeves were applied as ordered and discolorations were assessed and monitored for 2 of 3 residents reviewed for non-pressure skin condition. | SS=D |
| Failure to ensure neurological checks were initiated following a fall for 1 of 2 residents reviewed for falls. | SS=D |
| Failure to ensure oxygen was administered at the correct flow rate for 1 of 1 residents reviewed for oxygen. | SS=D |
| Failure to ensure each resident's drug regimen was managed and monitored to promote or maintain the resident's highest practicable well-being, related to not monitoring blood pressure and pulse before a blood pressure medication was administered for 1 of 5 residents. | SS=D |
| Failure to ensure infection control guidelines were in place and implemented, including staff not using personal protective equipment while in a transmission based precautions room. | SS=D |
Report Facts
Census: 50
Total Capacity: 50
Residents with tubigrip orders: 4
Audit frequency: 3
Audit frequency: 1
Audit frequency: 6
Audit frequency: 12
Audit frequency: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thelma Jean Fort | Administrator | Signed the report |
Inspection Report
Renewal
Deficiencies: 0
Aug 24, 2023
Visit Reason
Paper compliance review to the Recertification and State Licensure Survey completed on August 24, 2023.
Findings
Pulaski Health Care 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.
Inspection Report
Plan of Correction
Deficiencies: 0
Nov 1, 2022
Visit Reason
The document reports on paper compliance for the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey conducted on 10/04/22 and completed on 11/01/22.
Findings
Pulaski Health Care Center was found in compliance with the Emergency Preparedness Requirements and Life Safety Code requirements for Medicare and Medicaid participating providers and suppliers.
Inspection Report
Life Safety
Census: 39
Capacity: 58
Deficiencies: 5
Oct 4, 2022
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 federal regulations and state law.
Findings
The facility was found not in compliance with Emergency Preparedness Requirements and Life Safety Code requirements including failure to maintain documentation of monthly generator testing, failure to test battery backup lights annually for 90 minutes, improper installation of a portable fire extinguisher, and use of an unapproved power strip in a non-resident area.
Severity Breakdown
SS=F: 3
SS=E: 2
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to implement emergency power system inspection, testing, and maintenance requirements; no documentation of monthly generator testing available for the last 12 months. | SS=F |
| Failed to ensure 1 of 1 battery backup lights were tested annually for 90 minutes and maintain written records of visual inspections and tests. | SS=F |
| Failed to ensure 1 of 1 portable fire extinguishers in the laundry room was installed in accordance with NFPA 10; extinguisher was sitting on the floor. | SS=E |
| Failed to maintain complete written record of monthly generator load testing for 12 of the last 12 months. | SS=F |
| Failed to ensure flexible cords were not used as a substitute for fixed wiring in 1 of 1 conference room; unapproved power strip used. | SS=E |
Report Facts
Certified beds: 58
Census: 39
Deficiencies cited: 5
Load test frequency: 36
Battery backup light test duration: 90
Fire extinguisher audit frequency: 8
Fire extinguisher audit frequency: 4
Extension cord audit frequency: 8
Extension cord audit frequency: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Thelma Jean Fort | Administrator | Named in relation to interview and exit conference regarding findings |
Inspection Report
Annual Inspection
Census: 36
Deficiencies: 9
Sep 23, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from September 19 to 23, 2022.
Findings
The facility was found deficient in multiple areas including failure to inform residents of diagnostic results, failure to document and act on grievances, inaccurate Minimum Data Set assessments, incomplete care plans, inadequate personal care, improper pressure ulcer staging, incomplete nurse staffing postings, unsanitary food storage, and lapses in infection control practices.
Severity Breakdown
SS=D: 6
SS=C: 1
SS=E: 1
SS=A: 1
Deficiencies (9)
| Description | Severity |
|---|---|
| Failed to ensure a resident or their representative was informed of diagnostic results for 1 of 1 residents reviewed for care planning. | SS=D |
| Failed to ensure a resident's grievance was documented and acted upon for 1 of 1 residents reviewed for grievances. | SS=D |
| Failed to ensure Minimum Data Set assessments were accurately completed related to medications for 1 of 15 MDS assessments reviewed. | SS=A |
| Failed to develop and implement a care plan for an anticoagulant medication for 1 of 16 resident care plans reviewed. | SS=D |
| Failed to ensure necessary care and services were provided to a dependent resident related to unclean and untrimmed fingernails for 1 of 4 residents reviewed for activities of daily living. | SS=D |
| Failed to ensure a resident with a pressure ulcer received necessary treatment and services to promote healing, related to inaccurate staging of a pressure ulcer for 1 of 2 residents reviewed. | SS=D |
| Failed to have completed daily nurse staffing postings including facility census for review, potentially affecting all residents. | SS=C |
| Failed to maintain a sanitary kitchen related to boxes of food stored on the floor in dry storage and freezer, boxes stacked to the ceiling and around the fan in the freezer, and a dirty vent above the food preparation counter. | SS=E |
| Failed to ensure infection control guidelines were implemented, including hand hygiene after contact with contaminated surfaces and proper use of PPE when entering isolation rooms. | SS=D |
Report Facts
Survey dates: 5
Resident census: 36
Residents reviewed for MDS assessments: 15
Residents reviewed for care plans: 16
Residents reviewed for ADL care: 4
Residents reviewed for pressure ulcers: 2
Audit duration for nail care: 6
Audit duration for nurse staffing forms: 24
Audit duration for dietary storage monitoring: 15
Audit duration for infection control practices: 6
Inspection Report
Renewal
Deficiencies: 0
Sep 23, 2022
Visit Reason
Paper compliance review to the Recertification and State Licensure Survey.
Findings
Pulaski Health Care 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.
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