Inspection Reports for Silver Birch at Cook Road
3731 W Cook Rd, Fort Wayne, IN 46818, United States, IN, 46818
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Inspection Report
Complaint Investigation
Census: 81
Deficiencies: 0
Jun 10, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00458688.
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.
Complaint Details
Complaint IN00458688 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Renewal
Census: 108
Deficiencies: 0
Jan 30, 2025
Visit Reason
This visit was for a State Residential Licensure Survey conducted on January 29 and 30, 2025.
Findings
Silver Birch at Cook Road was found to be in compliance with 410 IAC 16.2-5 in regard to the State Residential Licensure Survey.
Inspection Report
Complaint Investigation
Census: 107
Deficiencies: 2
Jan 15, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00451033 regarding bed bug infestations in resident rooms.
Findings
The facility failed to notify residents and their representatives timely about bed bug infestations found during a canine inspection on 12/17/24 and delayed treatment until 1/8/25. Multiple residents' rooms were affected, and ongoing treatment and monitoring plans were implemented.
Complaint Details
Complaint IN00451033 alleged the facility had a pest control company conduct a canine inspection for bed bugs on 12/17/24. Resident F's room was observed to have bed bugs on 12/17/24, but neither the resident nor the Power of Attorney were notified until 1/3/25 and treatment was delayed until 1/8/25. Several residents had visitors or left the facility during this period, potentially spreading infestation. The complaint was substantiated with state deficiencies cited.
Deficiencies (2)
| Description |
|---|
| Failed to notify a resident of an identified bed bug infestation in the resident's room in a timely manner. |
| Failed to ensure adequate pest control was provided timely, affecting 12 residents. |
Report Facts
Residential Census: 107
Number of affected residents: 12
Number of rooms with bed bug signs: 20
Days delayed for treatment: 22
Inspection Report
Complaint Investigation
Census: 111
Deficiencies: 0
Oct 22, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00444587.
Findings
No deficiencies related to the allegations in Complaint IN00444587 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00444587 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 108
Deficiencies: 0
Sep 16, 2024
Visit Reason
This visit was conducted for the investigation of multiple complaints numbered IN00441178, IN00441424, IN00441521, IN00442049, IN00442368, and IN00443057.
Findings
No deficiencies related to the allegations in any of the complaints were cited. The facility was found to be in compliance with the relevant regulations regarding the investigation of these complaints.
Complaint Details
Complaints IN00441178, IN00441424, IN00441521, IN00442049, IN00442368, and IN00443057 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Complaint investigations: 6
Inspection Report
Complaint Investigation
Census: 108
Deficiencies: 0
Aug 6, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00439365, IN00439495, and IN00440253.
Findings
No deficiencies related to the allegations were cited for any of the complaints investigated. The facility was found to be in compliance with applicable regulations regarding the complaints.
Complaint Details
Complaints IN00439365, IN00439495, and IN00440253 were investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 111
Deficiencies: 0
Jul 22, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00437560.
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.
Complaint Details
Complaint IN00437560 was investigated and found to have no related deficiencies.
Inspection Report
Complaint Investigation
Census: 112
Deficiencies: 0
Jun 19, 2024
Visit Reason
The visit was conducted to investigate four complaints: IN00435949, IN00436033, IN00436322, and IN00436383.
Findings
No deficiencies related to the allegations in any of the four complaints were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the investigations.
Complaint Details
Complaints IN00435949, IN00436033, IN00436322, and IN00436383 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Residential Census: 112
Inspection Report
Complaint Investigation
Census: 111
Deficiencies: 0
May 23, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00432662 and IN00432947.
Findings
No deficiencies related to the allegations in complaints IN00432662 and IN00432947 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Investigation of Complaints IN00432662 and IN00432947 found no deficiencies related to the allegations; facility in compliance.
Inspection Report
Complaint Investigation
Census: 112
Deficiencies: 0
Apr 1, 2024
Visit Reason
This visit was for the Investigation of Complaint IN00429724.
Findings
No deficiencies related to the allegations are cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00429724 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 111
Deficiencies: 7
Mar 13, 2024
Visit Reason
This visit was for a State Residential Licensure Survey including the investigation of complaints IN00429392, IN00429688, and IN00429770.
Findings
The facility was found deficient in timely reporting of unusual occurrences, monitoring and notification of blood pressure and blood sugar levels, labeling and dating of opened food items, diet order documentation, clinical documentation for hospital transfers, and documentation related to resident death and release of remains. Some complaints were substantiated with cited deficiencies.
Complaint Details
Complaint IN00429392 had no deficiencies related to the allegations. Complaint IN00429688 had state deficiencies cited related to blood pressure and blood sugar monitoring. Complaint IN00429770 had state deficiencies cited related to administration and management including failure to report unusual occurrences timely.
Deficiencies (7)
| Description |
|---|
| Failed to ensure unusual occurrences were reported within 24 hours for 1 of 2 residents reviewed (Resident 4). |
| Failed to ensure blood pressure was monitored and physician was notified as ordered for 2 of 4 residents reviewed (Resident 9). |
| Failed to ensure physician notification for elevated blood sugar levels for Resident 13. |
| Failed to ensure opened food items were labeled and dated and drip pan was emptied and cleaned in the kitchen. |
| Failed to ensure diet orders were obtained and reviewed for 4 of 16 residents reviewed (Residents 13, 14, 15, and 16). |
| Failed to ensure clinical documentation related to continuity of care for hospital transfers for 2 of 2 residents reviewed (Residents 7 and 8). |
| Failed to ensure relevant documentation pertaining to the release of the resident's remains, personal items and medications for 1 of 2 residents reviewed (Resident 7). |
Report Facts
residential_census: 111
dates_of_survey: 2024-03-13 to 2024-03-14
deficiency_completion_dates: Apr 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cathy Vasil | Executive Director | Named in relation to findings and plan of correction. |
| Nurse Practitioner 10 | Nurse Practitioner | Mentioned in relation to diabetic care and progress notes. |
| Assistant Director of Nursing | Interviewed regarding blood pressure monitoring, hospital transfer documentation, and death documentation. | |
| Culinary Manager | Interviewed regarding food labeling and kitchen cleanliness. |
Inspection Report
Complaint Investigation
Census: 113
Deficiencies: 0
Feb 9, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00426480 and IN00426586.
Findings
No deficiencies related to the allegations in complaints IN00426480 and IN00426586 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00426480 - No deficiencies related to the allegations are cited. Complaint IN00426586 - No deficiencies related to the allegations are cited.
Inspection Report
Complaint Investigation
Census: 103
Deficiencies: 0
Dec 12, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00422143, IN00422228, and IN00422247 at Silver Birch At Cook Road.
Findings
No deficiencies related to the allegations in complaints IN00422143, IN00422228, and IN00422247 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding these complaints.
Complaint Details
Complaints IN00422143, IN00422228, and IN00422247 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Residential Census: 103
Inspection Report
Complaint Investigation
Census: 106
Deficiencies: 1
Oct 30, 2023
Visit Reason
This visit was conducted for the investigation of three complaints (IN00418769, IN00419223, and IN00419864) regarding the facility.
Findings
No deficiencies were cited for complaints IN00418769 and IN00419223. For complaint IN00419864, the facility failed to provide care based on individual needs and service plans for one resident (Resident F), specifically related to medication administration documentation and supervision.
Complaint Details
Complaint IN00418769 and IN00419223 had no deficiencies related to the allegations. Complaint IN00419864 was substantiated with state deficiencies cited at R0240 related to medication administration and care based on individual needs for Resident F.
Deficiencies (1)
| Description |
|---|
| Failure to provide care based on individual needs and service plans for Resident F, including incomplete and missing medication administration signatures and documentation. |
Report Facts
Residential Census: 106
Missing medication signature dates: 9
Complaints investigated: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Meghann Giarraputo | Vice President for Clinical Services | Signed the report |
| Hemmington Mwanza | Interim Executive Director | Contact person for plan of correction compliance |
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 0
Aug 30, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00415438.
Findings
No deficiencies related to the allegations in Complaint IN00415438 were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00415438 was investigated and found to have no related deficiencies; the complaint was not substantiated.
Report Facts
Residential Census: 115
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 0
Aug 8, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00413255 and IN00413828.
Findings
No deficiencies related to the allegations in complaints IN00413255 and IN00413828 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00413255 and Complaint IN00413828 were investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 119
Deficiencies: 0
Jul 6, 2023
Visit Reason
This visit was for the investigation of complaints IN00411699 and IN00412102.
Findings
No deficiencies related to the allegations were cited for either complaint. The facility was found to be in compliance with relevant regulations regarding the complaints.
Complaint Details
Complaint IN00411699 and IN00412102 were investigated with no deficiencies found related to the allegations.
Inspection Report
Complaint Investigation
Census: 117
Deficiencies: 0
Jun 19, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00409459.
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.
Complaint Details
Complaint IN00409459 was investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 119
Deficiencies: 0
Apr 17, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00405839 and IN00406341.
Findings
No deficiencies related to the allegations in complaints IN00405839 and IN00406341 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00405839 and IN00406341 were investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 118
Deficiencies: 0
Mar 30, 2023
Visit Reason
This visit was for a State Residential Licensure Survey and included the Investigation of Complaint IN00404409.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with the State Residential Licensure Survey requirements.
Complaint Details
Complaint IN00404409 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Residential Census: 118
Inspection Report
Complaint Investigation
Census: 116
Deficiencies: 2
Feb 6, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00397938, which was substantiated with state deficiencies cited related to the allegations.
Findings
The facility failed to ensure a self-medication administration assessment was completed for one resident who self-administered medication, and failed to ensure accurate documentation of medication administration for the same resident.
Complaint Details
Complaint IN00397938 was substantiated with state deficiencies cited at R0216 and R0243 related to self-medication assessment and medication documentation.
Deficiencies (2)
| Description |
|---|
| Failed to ensure a self-medication administration assessment was completed for 1 of 4 residents reviewed (Resident B). |
| Failed to ensure documentation was accurate for medication administration for 1 of 4 residents reviewed (Resident B). |
Report Facts
Residents reviewed: 4
Medication administration dates documented: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Piper Bakrevski | Senior Clinical Advisor | Signed as Laboratory Director's or Provider/Supplier Representative |
| Director of Nursing | Interviewed regarding self-medication assessment and medication documentation deficiencies | |
| Qualified Nursing Assistant 2 | Interviewed and indicated Resident B self-administered nasal spray and documented medication administration |
Inspection Report
Complaint Investigation
Census: 118
Deficiencies: 0
Dec 25, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00397687.
Findings
The complaint IN00397687 was substantiated; however, no deficiencies related to the allegations were cited. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00397687 was substantiated but no deficiencies related to the allegations were cited.
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 0
Oct 24, 2022
Visit Reason
This visit was for the investigation of complaints IN00391693 and IN00392239.
Findings
Both complaints IN00391693 and IN00392239 were found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with relevant regulations regarding these complaints.
Complaint Details
Complaint IN00391693 - Unsubstantiated due to lack of evidence. Complaint IN00392239 - Unsubstantiated due to lack of evidence.
Inspection Report
Complaint Investigation
Census: 113
Deficiencies: 2
Aug 24, 2022
Visit Reason
This visit was conducted for the investigation of four complaints (IN00384287, IN00384710, IN00384853, and IN00386791). Three complaints were unsubstantiated, and one complaint (IN00386791) was substantiated with related State Residential Findings cited.
Findings
The facility failed to ensure controlled substances were free from misappropriation and maintained in a secured environment for 7 residents. Numerous narcotic medications lacked proper destruction documentation, and medications were found unsecured in LPN 1's office. The facility's policies on medication disposal and narcotic storage were not properly followed.
Complaint Details
Complaint IN00384287, IN00384710, and IN00384853 were unsubstantiated with no findings. Complaint IN00386791 was substantiated with related findings at R0064 and R0304.
Deficiencies (2)
| Description |
|---|
| Failed to ensure controlled substances were free from misappropriation for 7 residents (Resident B, S, T, W, X, Y, Z). |
| Failed to maintain controlled substances in a secured environment under double lock for 7 residents. |
Report Facts
Residents affected: 7
Residential Census: 113
Medication audit frequency: 5
Completion date for corrective actions: Sep 19, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN 1 | Allegedly removed Resident S's narcotics from the community; no longer employed at the facility. | |
| Regional Nurse Director | Interviewed regarding investigation and medication discrepancies. | |
| QMA 2 | Qualified Medication Aide | Provided information about narcotic storage and counting procedures. |
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