Deficiencies per Year
8
6
4
2
0
Unclassified
Census Over Time
Inspection Report
Complaint Investigation
Census: 101
Deficiencies: 0
Apr 9, 2025
Visit Reason
This visit was conducted to investigate complaints IN00456997 and IN00457232 at Silver Birch of Kokomo.
Findings
No deficiencies related to the allegations in complaints IN00456997 and IN00457232 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00456997 and IN00457232 were investigated and found to have no deficiencies related to the allegations.
Inspection Report
Complaint Investigation
Census: 101
Deficiencies: 5
Nov 12, 2024
Visit Reason
This visit was for a State Residential Licensure Survey including the investigation of multiple complaints (IN00446341, IN00444901, IN00444774, IN00435166, IN00434264, IN00430789, IN00428631, IN00427639, IN00427436).
Findings
The facility was found noncompliant in several areas including misappropriation of narcotic medications by a staff member affecting four residents, failure to ensure CPR and first aid training for staff on multiple shifts, missed medication doses due to unavailability, and incomplete annual health statements and tuberculosis testing for residents.
Complaint Details
The visit included investigation of complaints IN00446341, IN00444901, IN00444774, IN00435166, IN00434264, IN00430789, IN00428631, IN00427639, IN00427436. Deficiencies related to allegations were cited for complaints IN00446341, IN00444774, and IN00428631. Other complaints had no deficiencies related to the allegations.
Deficiencies (5)
| Description |
|---|
| Failed to ensure residents were free from misappropriation of narcotic and controlled substance medications by a staff member for 4 residents. |
| Failed to ensure staff met requirements for CPR and first aid training for 7 of 21 shifts reviewed. |
| Failed to ensure medications were available as prescribed for 1 resident, resulting in missed doses of diabetic medication. |
| Failed to ensure residents had annual health statements for 3 of 9 residents reviewed. |
| Failed to ensure a 2-step Mantoux tuberculosis test was completed prior to admission for 2 of 4 residents reviewed. |
Report Facts
Shifts without CPR and first aid coverage: 7
Missed medication doses: 2
Residents reviewed for annual health statements: 9
Residents reviewed for tuberculosis testing: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Stewart | Executive Director | Named as contact for plan of correction and compliance confirmation. |
| QMA 2 | Staff member implicated in narcotic medication misappropriation. | |
| Director of Nursing | Director of Nursing (DON) | Involved in review and reporting of narcotic discrepancies and staff training. |
| LPN 5 | Licensed Practical Nurse | Mentioned in relation to medication availability and narcotic administration. |
| Business Office Manager | Reported missing CPR and first aid coverage on shifts. |
Inspection Report
Follow-Up
Census: 118
Deficiencies: 0
Apr 4, 2024
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00425471 completed on January 19, 2024.
Findings
Silver Birch of Kokomo was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to Investigation of Complaint IN00425471.
Complaint Details
Complaint IN00425471-Corrected
Inspection Report
Complaint Investigation
Census: 115
Deficiencies: 5
Jan 19, 2024
Visit Reason
This visit was for the investigation of complaints IN00422063 and IN00425471. Complaint IN00422063 had no state deficiencies cited, while complaint IN00425471 had state deficiencies cited related to the allegations.
Findings
The facility was found deficient in multiple areas including failure to treat a resident with respect and dignity during incontinence care, failure to ensure residents were free from physical and verbal abuse, failure to protect residents' property from misappropriation related to narcotic medications, and failure to ensure insulin was administered only by licensed or certified personnel.
Complaint Details
Complaint IN00422063 had no state deficiencies cited. Complaint IN00425471 had state deficiencies cited related to allegations of abuse, misappropriation of narcotics, and improper insulin administration.
Deficiencies (5)
| Description |
|---|
| Failure to ensure a resident was treated with respect and dignity during incontinence care. |
| Failure to ensure a resident was free from physical abuse related to another resident physically abusing him. |
| Failure to ensure a resident was free from verbal abuse by a staff member. |
| Failure to ensure residents were free from misappropriation of property related to narcotic medications and failure to follow narcotic count policy. |
| Failure to ensure insulin was administered by licensed or certified personnel for 11 of 12 residents reviewed. |
Report Facts
Residential census: 115
Missing Oxycodone tablets: 15
Missing Norco tablets: 3
Residents reviewed for injectable medication: 12
Residents with insulin administered by uncertified personnel: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Stewart | Executive Director | Named in plan of correction and complaint investigation |
| QMA 3 | Qualified Medication Aide | Administered insulin without certification; involved in narcotic misappropriation |
| CNA 4 | Terminated for verbal abuse of Resident E | |
| CNA 6 | Involved in inappropriate incontinence care of Resident G | |
| LPN 5 | Licensed Practical Nurse | Involved in narcotic count and medication administration |
| QMA 7 | Qualified Medication Aide | Witnessed verbal abuse incident and assisted Resident E |
Inspection Report
Complaint Investigation
Census: 120
Deficiencies: 0
Nov 6, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00416082 and IN00419977 at Silver Birch of Kokomo.
Findings
No deficiencies related to the allegations in complaints IN00416082 and IN00419977 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00416082 - No deficiencies related to the allegations were cited. Complaint IN00419977 - No deficiencies related to the allegations were cited.
Inspection Report
Follow-Up
Census: 119
Deficiencies: 0
Sep 5, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to a State Residential Licensure Survey completed on July 14, 2023, including a PSR to the Investigation of Complaints IN00410800 and IN00411735.
Findings
Silver Birch of Kokomo was found to be in compliance with 410 IAC 16.2-5 regarding the PSR to the State Residential Licensure Survey and the Investigation of Complaints IN00410800 and IN00411735. Both complaints were corrected.
Complaint Details
Complaint IN00410800 and Complaint IN00411735 were investigated and found to be corrected.
Report Facts
Residential Census: 119
Inspection Report
Complaint Investigation
Census: 120
Deficiencies: 0
Aug 18, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00414635, IN00414671, and IN00414920.
Findings
No deficiencies related to the allegations in complaints IN00414635, IN00414671, and IN00414920 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaints IN00414635, IN00414671, and IN00414920 were investigated and found to have no deficiencies related to the allegations.
Report Facts
Residential census: 120
Inspection Report
Complaint Investigation
Census: 120
Deficiencies: 0
Aug 1, 2023
Visit Reason
This visit was for the investigation of complaints IN00413486 and IN00413967.
Findings
No deficiencies related to the allegations in complaints IN00413486 and IN00413967 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00413486 and Complaint IN00413967 were investigated with no deficiencies cited related to the allegations.
Report Facts
Residential census: 120
Inspection Report
Complaint Investigation
Census: 118
Deficiencies: 4
Jul 11, 2023
Visit Reason
This survey was a State Residential Licensure Survey including the investigation of complaints IN00410800 and IN00411735.
Findings
The facility failed to ensure residents were free from sexual abuse related to staff and resident incidents, failed to conduct fire drills in conjunction with the local fire department and on all shifts quarterly, failed to administer medication as ordered for one resident, and failed to maintain proper sanitation in the kitchen including air drying pans, changing deep fryer oil, and maintaining safe freezer temperatures.
Complaint Details
Complaint IN00410800 involved medication administration errors and sexual abuse allegations related to a staff member sending nude pictures to a resident. Complaint IN00411735 involved sexual abuse allegations related to a male resident sexually assaulting female residents.
Deficiencies (4)
| Description |
|---|
| Failed to ensure residents were free from sexual abuse related to a staff member sending nude pictures to a resident and a male resident sexually assaulting two female residents. |
| Failed to hold fire and disaster drills in conjunction with the local fire department every six months, failed to hold fire drills once a month, and failed to hold fire drills on every shift at least once every quarter. |
| Failed to follow physician's orders and administer a resident her pain medication as ordered. |
| Failed to follow proper sanitation procedures for air drying metal pans, changing the oil in the deep fryer, and maintaining walk-in freezer temperature to keep food frozen. |
Report Facts
Residents present: 118
Fire drills completed: 10
Walk-in freezer temperature: 15
Medication doses missed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Stewart | Executive Director | Named in plan of correction and investigation of sexual abuse complaint |
| Director of Nursing | Interviewed regarding sexual abuse incidents and medication administration | |
| Culinary Manager | Interviewed regarding kitchen sanitation and freezer temperature issues | |
| Qualified Medication Aide 9 | Observed and interviewed regarding medication administration error |
Inspection Report
Complaint Investigation
Census: 114
Deficiencies: 0
May 31, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00409646.
Findings
No deficiencies related to the allegations were cited. The facility was found to be in compliance with 42 CFR 483, Subpart B and 410 IAC 16.2-5 regarding the complaint investigation.
Complaint Details
Complaint IN00409646 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Residential census: 114
Inspection Report
Complaint Investigation
Census: 104
Deficiencies: 1
Mar 15, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00399826 at Silver Birch of Kokomo.
Findings
No deficiencies related to the complaint allegations were cited. However, an unrelated deficiency was cited involving physical abuse where a staff member aggressively touched a resident's forehead during a physical altercation.
Complaint Details
Complaint IN00399826 was investigated and found to be substantiated regarding the staff member's abuse. The staff member (Server 3) was terminated. Resident B confirmed the incident and indicated feeling safe at the facility. The allegation was thoroughly investigated with interviews and witness statements.
Deficiencies (1)
| Description |
|---|
| Facility failed to ensure a resident was free from physical abuse related to a staff member aggressively touching the resident's forehead during a physical altercation. |
Report Facts
Residential census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Piper Bakrevski | Senior Clinical Advisor | Signed the report |
| Server 3 | Culinary Server | Named in physical abuse finding; terminated for abuse |
| Executive Director | Interviewed and witnessed the abuse incident | |
| Director of Health and Wellness | Interviewed during investigation |
Inspection Report
Re-Inspection
Census: 104
Deficiencies: 0
Feb 2, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00396076 completed on December 21, 2022.
Findings
Silver Birch of Kokomo was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to Investigation of Complaint IN00396076.
Complaint Details
Complaint IN00396076 was corrected.
Inspection Report
Complaint Investigation
Census: 106
Deficiencies: 2
Dec 21, 2022
Visit Reason
This visit was conducted for the investigation of Complaint IN00396076, which was substantiated with state deficiencies cited related to the allegations.
Findings
The facility failed to ensure a resident was free from neglect during transport, resulting in Resident B falling from his wheelchair on the facility bus. Additionally, the facility failed to ensure staff were appropriately trained for their job responsibilities, specifically the Life Enrichment Coordinator 3 who was responsible for transporting residents safely.
Complaint Details
Complaint IN00396076 was substantiated with state deficiencies cited at R0052 and R0119 related to neglect and personnel noncompliance.
Deficiencies (2)
| Description |
|---|
| Failed to ensure a resident was free from neglect during transport, resulting in a fall from wheelchair. |
| Failed to ensure staff member was appropriately trained to ensure resident safety prior to driving the facility bus. |
Report Facts
Residential Census: 106
Distance of transport: 80
Deficiency completion date: Jan 27, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Life Enrichment Coordinator 3 | Life Enrichment Coordinator | Named in findings for failure to properly secure resident during transport and lack of appropriate training; employment terminated. |
| Executive Director | Interviewed regarding the incident and facility policies; involved in corrective action planning. | |
| Director of Nursing | Director of Nursing | Provided documentation including termination notice and training records. |
Inspection Report
Complaint Investigation
Census: 107
Deficiencies: 5
Sep 15, 2022
Visit Reason
This visit was for a State Residential Licensure Survey including the Investigation of Complaints IN00378962, IN00384360, IN00385474, IN00386619, and IN00388939.
Findings
The facility was found noncompliant in several areas including failure to ensure assistance animals had required veterinary examinations and immunizations, failure to obtain semiannual resident weights and timely medication self-administration assessments, failure to have resident service plans signed and dated, failure to secure medications properly, and failure to complete annual TB screening for one resident.
Complaint Details
Complaints IN00378962 and IN00386619 were substantiated with no deficiencies related to the allegations cited. Complaints IN00384360, IN00385474, and IN00388939 were unsubstantiated due to lack of evidence.
Deficiencies (5)
| Description |
|---|
| Failed to have assistance animals examined and immunized as required for 5 of 8 animals reviewed. |
| Failed to ensure residents' weights were obtained semiannually for 6 of 7 residents reviewed and medication self-administration assessments were completed timely for 2 of 2 residents. |
| Failed to ensure resident service plans were signed and dated by the resident for 2 of 7 residents reviewed. |
| Medications were left unsecured on a medication cart for 10 residents observed. |
| Failed to administer an annual Tuberculin (TB) screening for 1 of 7 residents reviewed. |
Report Facts
Residents with assistance animals reviewed: 8
Residents with assistance animals not up to date: 5
Residents reviewed for weights: 7
Residents with missing semiannual weights: 6
Residents reviewed for medication self-administration: 2
Residents with untimely medication self-administration assessments: 2
Residents reviewed for service plan signatures: 7
Residents without signed service plans: 2
Residents with unsecured medications observed: 10
Residents reviewed for annual TB screening: 7
Residents missing annual TB screening: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Health Services | Interviewed regarding medication self-administration assessments, weights, service plans, medication storage, and TB screening. | |
| Qualified Medication Aide 2 | QMA | Interviewed regarding unsecured medications on medication cart. |
| Executive Director | ED | Provided assistance animal vaccination records and pet policy information. |
| Director of Nursing and Wellness | DONW | Conducted audits, provided education, and responsible for ongoing monitoring and quality assurance. |
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