Deficiencies per Year
4
3
2
1
0
High
Moderate
Census Over Time
Census
Capacity
Inspection Report
Re-Inspection
Census: 88
Capacity: 88
Deficiencies: 0
Jul 1, 2025
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00459934 completed on June 2, 2025.
Findings
Rolling Meadows Health Care Center 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 Investigation of Complaint IN00459934.
Complaint Details
Complaint IN00459934 - Corrected.
Report Facts
Census: 88
Total Capacity: 88
Medicare Census: 4
Medicaid Census: 67
Other Payor Census: 17
Inspection Report
Complaint Investigation
Census: 91
Capacity: 91
Deficiencies: 1
Jun 2, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00459934 regarding federal and state deficiencies related to fall prevention interventions.
Findings
The facility failed to implement immediate interventions to prevent future falls for 2 of 3 residents reviewed (Residents B and C), resulting in Resident B sustaining a right hip fracture after a subsequent fall. Resident C had multiple falls with no immediate interventions implemented to prevent further falls. Documentation and care plan updates were inconsistent and incomplete.
Complaint Details
Complaint IN00459934 was investigated, with federal and state deficiencies cited related to fall prevention.
Severity Breakdown
SS=G: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to implement immediate interventions to prevent future falls for 2 of 3 residents reviewed for falls (Residents B and C). | SS=G |
Report Facts
Census: 91
Total Capacity: 91
Medicare Census: 10
Medicaid Census: 67
Other Payor Census: 14
Fall Risk Assessment Date: Mar 20, 2025
Fall Risk Assessment Date: Dec 5, 2024
MDS Assessment Date: Mar 11, 2025
Fall Incident Date: May 19, 2025
Fall Incident Date: May 25, 2025
Fall Incident Date: Jan 6, 2025
Fall Incident Date: Mar 2, 2025
Fall Incident Date: Mar 21, 2025
Fall Incident Date: Apr 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carmen Morrison | Director of Nursing | Named in relation to facility policy review and staff re-education on fall investigation and risk evaluation |
| RN 3 | Provided risk management forms, fall investigation worksheets, and interviewed regarding fall interventions and documentation | |
| LPN 9 | Interviewed regarding fall interventions and documentation practices | |
| RN 5 | Assessed Resident B after fall and assisted with immediate fall interventions | |
| CNA 7 | Witnessed Resident B's fall and assisted with post-fall care | |
| LPN 10 | Interviewed regarding Resident C's fall risk and interventions | |
| LPN 11 | Interviewed regarding communication of fall interventions during shift reports | |
| LPN 12 | Interviewed regarding care plan updates and communication of fall interventions | |
| LPN 13 | Interviewed regarding fall investigation and documentation | |
| RN 6 | Interviewed regarding immediate interventions after falls | |
| CNA 4 | Interviewed regarding assistance provided to Resident C | |
| QMA 8 | Interviewed regarding fall interventions for Resident C | |
| LPN 30 | Interviewed regarding Resident B's fall circumstances |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 91
Deficiencies: 0
Feb 7, 2025
Visit Reason
This visit was for the Investigation of Complaint IN00452301.
Findings
No deficiencies related to the allegations are 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.
Complaint Details
Investigation of Complaint IN00452301 found no deficiencies related to the allegations.
Report Facts
Census SNF/NF beds: 91
Census total residents: 91
Census Medicare residents: 7
Census Medicaid residents: 68
Census other payor residents: 16
Inspection Report
Life Safety
Census: 71
Capacity: 115
Deficiencies: 0
Dec 19, 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, in conjunction with the Life Safety Code Preoccupancy that exited on 12/19/24.
Findings
Rolling Meadows Health Care Center was found in compliance with Emergency Preparedness Requirements and Life Safety Code Requirements for Participation in Medicare/Medicaid. The facility is a one-story, fully sprinklered Type III (211) construction with a fire alarm system and hard wire smoke detection in resident areas. Three detached sheds used for facility services were not sprinklered.
Report Facts
Facility capacity: 115
Census: 71
Number of detached sheds: 3
Inspection Report
Life Safety
Census: 71
Capacity: 115
Deficiencies: 0
Dec 19, 2024
Visit Reason
A Life Safety Code (LSC) Preoccupancy survey was conducted for the 400-wing repair due to flooding from a watermain break, in conjunction with the Life Safety Code/Emergency Preparedness Recertification Survey.
Findings
The facility was found in compliance with the Requirements for Participation in Medicare/Medicaid, 42 CFR Subpart 483.90(a), Life Safety from Fire, and the 2012 edition of NFPA 101, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2. The facility was fully sprinklered with a fire alarm system and hard wire smoke detection in resident rooms, corridors, and areas open to corridors.
Report Facts
Facility capacity: 115
Census: 71
Inspection Report
Original Licensing
Capacity: 115
Deficiencies: 0
Dec 2, 2024
Visit Reason
An Emergency Preparedness Preoccupancy Survey and a Life Safety Code Preoccupancy Survey were conducted due to a water main break and facility repairs.
Findings
The facility was found in compliance with Emergency Preparedness Requirements and Life Safety Code Requirements. The facility had evacuated 95 residents due to a water main break, and the Loretta Lane memory care unit remained closed for repairs.
Report Facts
Residents evacuated: 95
Inspection Report
Renewal
Census: 95
Capacity: 95
Deficiencies: 2
Oct 30, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted over October 24, 25, 28, 29, and 30, 2024.
Findings
The facility was found deficient in ensuring PASRR submissions for residents with newly diagnosed mental health conditions requiring psychotropic medication, and in timely administration and follow-up of pending physician orders for medications. Specific deficiencies involved two residents (76 and 90) lacking updated PASRR submissions and one resident (70) with delayed medication administration due to pending orders.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure a Preadmission Screening and Resident Review (PASRR) was submitted for residents with newly diagnosed mental health conditions requiring psychotropic medication (Residents 76 and 90). | SS=D |
| Failed to ensure procedures were in place to follow up on pending physician's orders and timely medication administration for Resident 70. | SS=D |
Report Facts
Census: 95
Total Capacity: 95
Survey Dates: 5
Residents reviewed for PASRR: 3
Residents affected by PASRR deficiency: 2
Residents reviewed for unnecessary medications: 5
Residents affected by medication deficiency: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peyton Byrd | HFA | Laboratory Director or Provider/Supplier Representative who signed the report |
| LPN 7 | Licensed Practical Nurse | Provided information about pharmacy interchange and medication order |
| Director of Nursing | Director of Nursing | Interviewed regarding medication administration and follow-up |
| Assistant Director of Nursing | Assistant Director of Nursing | Provided information about PASRR submissions and medication order notifications |
| Social Services Director | Social Services Director | Interviewed about PASRR submission practices |
Inspection Report
Annual Inspection
Deficiencies: 0
Oct 30, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure Survey.
Findings
Rolling Meadows Health Care Center 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: 96
Capacity: 96
Deficiencies: 0
Aug 19, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00440263.
Findings
No deficiencies related to the allegations in Complaint IN00440263 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00440263 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 96
Total Capacity: 96
Medicare Census: 1
Medicaid Census: 71
Other Payor Census: 24
Inspection Report
Complaint Investigation
Census: 96
Capacity: 115
Deficiencies: 0
Jul 26, 2024
Visit Reason
An investigation of Complaint Number IN00439547 was conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The complaint was substantiated but no deficiencies related to the allegation were cited. The facility was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and applicable fire safety codes.
Complaint Details
Complaint Number IN00439547 was substantiated. No deficiencies related to the allegation were cited.
Report Facts
Facility capacity: 115
Census: 96
Inspection Report
Complaint Investigation
Census: 98
Capacity: 98
Deficiencies: 1
Apr 29, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00432566 regarding federal and state deficiencies related to allegations of inadequate nursing staff competency and response.
Findings
The facility failed to provide prompt physical assessment of a resident (Resident C) complaining of a fall and hip pain, resulting in a delay in treatment for a hip fracture. The deficient practice was corrected prior to the survey start date.
Complaint Details
Complaint IN00432566 was substantiated with federal and state deficiencies cited at F726 related to nursing staff competency and failure to promptly assess a resident after a fall.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide prompt physical assessment of a resident complaining of a fall and hip pain, resulting in delayed treatment for a hip fracture. | SS=D |
Report Facts
Census: 98
Total Capacity: 98
Medicare Census: 3
Medicaid Census: 67
Other Payor Census: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN 5 | Licensed Practical Nurse | Named in finding related to failure to assess Resident C promptly |
| RN 13 | Registered Nurse | Named in finding related to delayed assessment of Resident C |
| QMA 3 | Qualified Medication Aide | Involved in reporting Resident C's complaints but did not perform assessment |
| DON | Director of Nursing | Provided interviews and facility policy information related to the deficiency |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 91
Deficiencies: 0
Mar 20, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00430301.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00430301 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Payor Type - Medicare: 1
Census Payor Type - Medicaid: 66
Census Payor Type - Other: 24
Inspection Report
Life Safety
Census: 93
Capacity: 115
Deficiencies: 0
Feb 29, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey was conducted by the Indiana Department of Health.
Findings
The facility was found in compliance with the Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 483.90(a).
Inspection Report
Annual Inspection
Census: 88
Capacity: 115
Deficiencies: 3
Jan 26, 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 federal regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included failure to inspect one portable fire extinguisher monthly, unsealed penetrations in smoke barrier walls, and use of a multi-plug adaptor in a resident room.
Severity Breakdown
SS=D: 2
SS=E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to inspect 1 of over 20 portable fire extinguishers each month as required by NFPA 10. | SS=D |
| Failed to ensure penetrations caused by wire/conduit through 2 of 8 smoke barrier walls were protected to maintain smoke resistance. | SS=E |
| Failed to ensure 1 of over 50 resident rooms did not use multi-plug adaptors as a substitute for fixed wiring, violating NFPA 70. | SS=D |
Report Facts
Facility capacity: 115
Census: 88
Deficient fire extinguishers: 1
Smoke barrier penetrations: 2
Resident rooms with multi-plug adaptor: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peyton Byrd | Health Facility Administrator | Signed the report |
| Executive Director | Participated in observations and interviews related to deficiencies | |
| Maintenance Director | Participated in observations and interviews related to deficiencies and corrective actions |
Inspection Report
Renewal
Census: 88
Capacity: 88
Deficiencies: 2
Jan 8, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from January 2 to January 8, 2024.
Findings
The facility was found deficient in infection prevention and control practices, specifically failing to properly sanitize a multi-use blood glucose meter and failing to ensure proper hand hygiene during medication administration.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to sanitize a multi-use blood glucose meter according to manufacturer's instructions. | SS=D |
| Failed to ensure staff handled medications in a sanitary manner and performed hand hygiene during medication administration. | SS=D |
Report Facts
Census: 88
Total Capacity: 88
Medicare Residents: 6
Medicaid Residents: 59
Other Payor Residents: 23
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Sevier | RN, RDQA | Laboratory Director's or Provider/Supplier Representative's signature on report |
| LPN 2 | Observed failing to properly sanitize blood glucose meter | |
| LPN 4 | Observed failing to perform hand hygiene during medication administration | |
| Director of Nursing | DON | Provided interviews and oversaw re-inservicing of nursing staff on infection control policies |
Inspection Report
Annual Inspection
Deficiencies: 0
Jan 8, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Rolling Meadows Health Care Center 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: 87
Capacity: 87
Deficiencies: 0
Dec 20, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00423192.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00423192 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare census: 5
Medicaid census: 61
Other payor census: 21
Inspection Report
Complaint Investigation
Census: 91
Capacity: 91
Deficiencies: 0
Jul 6, 2023
Visit Reason
This visit was for the Investigation of Complaint IN00409168.
Findings
No deficiencies related to the allegations are 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.
Complaint Details
Complaint IN00409168 - No deficiencies related to the allegations are cited.
Report Facts
Census: 91
Total Capacity: 91
Medicare Census: 2
Medicaid Census: 69
Other Payor Census: 20
Inspection Report
Complaint Investigation
Census: 88
Capacity: 88
Deficiencies: 0
Apr 20, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00406518 and IN00404417 at Rolling Meadows Health Care Center.
Findings
No deficiencies related to the allegations in complaints IN00406518 and IN00404417 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00406518 and Complaint IN00404417 were investigated; no deficiencies related to the allegations were cited.
Report Facts
Census Bed Type: 88
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 61
Census Payor Type - Other: 25
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 12, 2023
Visit Reason
Paper compliance to the Emergency Preparedness Survey conducted on 03/27/23 was completed on 04/12/23.
Findings
Rolling Meadows Health Care Center was found in compliance with Requirements for Participation in Medicare/Medicaid, 42 CFR Subpart 483.73, Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.
Inspection Report
Routine
Census: 92
Capacity: 115
Deficiencies: 1
Mar 27, 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 to assess compliance with emergency preparedness requirements and life safety code standards.
Findings
The facility was found not in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers due to failure to conduct required emergency plan exercises at least twice per year, including unannounced staff drills. The facility was found in compliance with Life Safety Code requirements.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. | SS=F |
Report Facts
Facility capacity: 115
Census: 92
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peyton Byrd | Administrator | Named as facility representative and involved in exit conference |
Inspection Report
Renewal
Census: 97
Capacity: 97
Deficiencies: 0
Mar 17, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey, including the Investigation of Complaints IN00403719 and IN00403928.
Findings
No deficiencies related to the allegations in 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 in regard to the Recertification and State Licensure Survey and the complaint investigations.
Complaint Details
Complaint IN00403719 and Complaint IN00403928 were investigated with no deficiencies related to the allegations cited.
Report Facts
Census: 97
Total Capacity: 97
Medicare Census: 12
Medicaid Census: 63
Other Payor Census: 22
Inspection Report
Complaint Investigation
Census: 97
Capacity: 97
Deficiencies: 0
Mar 17, 2023
Visit Reason
This visit was for the investigation of Complaint IN00403928 and Complaint IN00403719, conducted in conjunction with the Recertification and State Licensure Survey.
Findings
No deficiencies related to the allegations in Complaints IN00403928 and IN00403719 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00403928 and Complaint IN00403719 were investigated with no deficiencies related to the allegations cited.
Report Facts
Census: 97
Total Capacity: 97
Medicare Census: 12
Medicaid Census: 63
Other Payor Census: 22
Inspection Report
Complaint Investigation
Census: 85
Capacity: 85
Deficiencies: 0
Dec 21, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00394356.
Findings
The complaint IN00394356 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00394356 was investigated and found unsubstantiated due to lack of evidence.
Report Facts
Medicare census: 6
Medicaid census: 59
Other payor census: 20
Inspection Report
Complaint Investigation
Census: 84
Capacity: 84
Deficiencies: 0
Aug 1, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00386609.
Findings
The complaint was substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00386609 was substantiated, but no deficiencies related to the allegations were cited.
Report Facts
Census Bed Type: 84
Census Payor Type - Medicare: 10
Census Payor Type - Medicaid: 56
Census Payor Type - Other: 18
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