Inspection Reports for
Waters of Columbia City Skilled Nursing Facility
640 W ELLSWORTH ST, COLUMBIA CITY, IN, 46725
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
11.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
174% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
28
21
14
7
0
Occupancy
Latest occupancy rate
17% occupied
Based on a December 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Annual Inspection
Census: 14
Deficiencies: 5
Date: Dec 12, 2025
Visit Reason
Annual inspection survey conducted to assess compliance with regulatory requirements for Waters of Columbia City Skilled Nursing Facility.
Findings
The facility was found deficient in multiple areas including failure to ensure dignity during meal service, failure to follow physician orders for medication administration, lack of oxygen orders for a resident, unsecured medications in the medication cart, and unsafe food distribution practices related to dishwasher temperature and sanitation.
Deficiencies (5)
F 0550: The facility failed to ensure dignity during meal service for 6 of 14 residents seated together in the main dining room, resulting in long waits and residents being served out of order.
F 0684: The facility failed to follow physician orders for 1 of 12 residents reviewed, including failure to administer as-needed Bumex for documented weight gain and edema.
F 0695: The facility failed to ensure oxygen orders were in place for 1 of 2 residents reviewed who was receiving oxygen therapy.
F 0761: The facility failed to ensure medications were secured in the medication cart for 3 of 22 residents reviewed, leaving medications unattended and accessible.
F 0812: The facility failed to maintain safe food distribution and sanitation of tableware for all 45 residents, including dishwasher temperatures below required levels and improper handling of clean dishes.
Report Facts
Residents present in dining room: 14
Residents reviewed for medication security: 22
Residents affected by dignity deficiency: 6
Residents affected by medication order deficiency: 1
Residents affected by oxygen order deficiency: 1
Residents affected by medication security deficiency: 3
Residents affected by food sanitation deficiency: 45
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Interviewed regarding meal service delays, medication administration, oxygen orders, and medication cart security |
| Certified Nurse Aide 14 | Certified Nurse Aide | Observed serving meals in dining room and interviewed about meal tray distribution |
| Certified Nurse Aide 6 | Certified Nurse Aide | Observed serving meals and interviewed about meal tray distribution |
| Qualified Medicine Aide 3 | Qualified Medicine Aide | Interviewed about resident complaints regarding meal wait times |
| Registered Nurse 4 | Registered Nurse | Interviewed regarding oxygen orders for Resident 47 |
| Registered Nurse 5 | Registered Nurse | Interviewed regarding medication cart security and medication preparation |
| Dietary Manager | Dietary Manager | Interviewed regarding dishwasher temperature issues and food sanitation |
| Administrator | Administrator | Interviewed regarding food service and dishwasher issues |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 0
Date: Jun 3, 2025
Visit Reason
This visit was for the investigation of complaints IN00458537 and IN00458734.
Complaint Details
Complaint IN00458537 - No deficiencies related to the allegations are cited. Complaint IN00458734 - No deficiencies related to the allegations are cited.
Findings
No deficiencies related to the allegations in complaints IN00458537 and IN00458734 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census: 33
Medicare census: 5
Medicaid census: 17
Other payor census: 11
Inspection Report
Re-Inspection
Census: 31
Capacity: 84
Deficiencies: 0
Date: Jan 16, 2025
Visit Reason
A Post Survey Revisit (PSR) was conducted to the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey originally conducted on 11/20/2024.
Findings
At this PSR survey, Waters of Columbia City Skilled Nursing Facility was found in compliance with Emergency Preparedness Requirements and Life Safety Code Requirements. The facility was fully sprinklered except for a shed providing facility services which was not sprinklered.
Inspection Report
Routine
Census: 26
Capacity: 84
Deficiencies: 13
Date: Nov 20, 2024
Visit Reason
Routine Emergency Preparedness and Life Safety Code inspection 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 not in compliance with Emergency Preparedness requirements including failure to annually review and update the Emergency Preparedness Plan, maintain a documented all-hazards risk assessment, update policies and procedures, provide subsistence needs agreements, maintain communication plans, conduct training and testing, and maintain Life Safety Code compliance including hazardous area door closures, sprinkler maintenance, fire extinguisher operability, electrical outlet safety, and proper use of extension cords and power strips.
Deficiencies (13)
Failed to review and update the Emergency Preparedness Plan at least annually.
Failed to maintain an Emergency Preparedness Plan based on a documented facility and community-based risk assessment utilizing an all-hazards approach.
Failed to review and update Emergency Preparedness Plan Policies and Procedures at least annually.
Failed to ensure emergency preparedness policies include subsistence needs for staff and residents including emergency fuel agreements.
Failed to ensure emergency preparedness policies include development and annual review of arrangements with other LTC facilities and providers.
Failed to review and update the Emergency Preparedness Plan Communication plan at least annually.
Failed to review and update the Emergency Preparedness Plan Training program at least annually.
Failed to conduct annual training demonstrating staff knowledge of the Emergency Preparedness Program.
Failed to ensure storerooms greater than 50 square feet used for storage of large amounts of combustibles were protected as hazardous areas with self-closing doors.
Failed to ensure sprinklers in the kitchen cooking room were free of corrosion.
Failed to ensure electrical outlet in satellite kitchen contained a cover plate and was protected from damage.
Failed to ensure K-class portable fire extinguisher was repaired or replaced when pressure gauge was not in operable range.
Failed to ensure extension cords and power strips were not used as a substitute for fixed wiring in patient care areas.
Report Facts
Facility capacity: 84
Census: 26
Number of storerooms greater than 50 sq ft: 6
Number of sprinklers with corrosion: 2
Number of electrical outlets missing cover plates: 1
Number of K-class fire extinguishers with pressure gauge issues: 1
Number of extension cords and power strips improperly used: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Barnes | Administrator | Named as facility administrator signing the report and involved in corrective actions. |
Inspection Report
Complaint Investigation
Census: 27
Capacity: 27
Deficiencies: 0
Date: Oct 30, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00445853.
Complaint Details
Complaint IN00445853 was investigated and found to have no substantiated Federal or State deficiencies related to the allegations.
Findings
No Federal or State deficiencies related to the allegations were cited. The facility was found to be in compliance with applicable regulations regarding the complaint.
Report Facts
Medicare census: 2
Medicaid census: 15
Other payor census: 10
Inspection Report
Annual Inspection
Census: 27
Capacity: 27
Deficiencies: 5
Date: Oct 21, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted on October 16, 17, 18, and 21, 2024.
Findings
The facility was found deficient in maintaining safe and comfortable temperatures in resident areas, ensuring personal hygiene of fingernails, safe storage of treatment supplies, safe and sanitary food storage, and proper infection prevention and control practices including hand hygiene and cleaning of blood glucose monitors.
Deficiencies (5)
Failed to ensure safe and comfortable temperatures between 71 and 81 degrees in resident areas for 4 of 27 residents.
Failed to ensure personal hygiene of fingernails for 1 of 6 residents reviewed (Resident 22).
Failed to ensure safe storage of treatment supplies for 1 of 27 residents reviewed (Resident 11).
Failed to ensure safe and sanitary food storage practices for facility prepared leftovers.
Failed to ensure hand hygiene was correctly performed and blood glucose monitors were properly cleaned during care for 4 of 8 residents reviewed (Residents 11, 13, 14, and 128).
Report Facts
Residents affected by temperature deficiency: 4
Residents reviewed for fingernail hygiene: 6
Residents reviewed for treatment supply storage: 27
Residents reviewed for infection control: 8
Temperature readings below 71 degrees: Multiple temperature logs showed readings as low as 61 degrees in resident rooms.
Leftover food storage dates: Leftovers dated from 10/9/24 to 10/13/24 were found, some without dates.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Barnes | Administrator | Interviewed regarding temperature issues and corrective actions. |
| Maintenance 3 | Provided information about HVAC system and temperature monitoring. | |
| DON (Director of Nursing) | Director of Nursing | Provided information on personal hygiene, infection control policies, and corrective actions. |
| LPN 6 | Licensed Practical Nurse | Observed during medication pass and infection control deficiencies. |
| QMA 2 | Qualified Medicine Aide | Reported improper storage of treatment supplies. |
| Cook 7 | Provided information about leftover food storage. | |
| CDM 8 | Certified Dietary Manager in training | Provided information about leftover food storage and dating. |
| NP 5 | Nurse Practitioner | Observed during wound care with improper hand hygiene. |
| CNA 4 | Certified Nurse Aide | Observed during wound care. |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Oct 21, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey was conducted.
Findings
The Waters of Columbia City Skilled Nursing Facility 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
Routine
Deficiencies: 5
Date: Oct 16, 2024
Visit Reason
The inspection was conducted as a routine survey to assess compliance with regulatory standards related to resident care, safety, hygiene, medication storage, food safety, and infection control at the skilled nursing facility.
Findings
The facility was found to have multiple deficiencies including failure to maintain safe and comfortable ambient temperatures in resident rooms, inadequate personal hygiene care for residents, improper storage of treatment supplies, unsafe food storage practices, and lapses in infection prevention and control practices such as improper hand hygiene and blood glucose meter cleaning.
Deficiencies (5)
F 0584: The facility failed to maintain ambient temperatures between 71 and 81 degrees in resident areas, with observed temperatures as low as 61 degrees in resident rooms.
F 0677: The facility failed to ensure personal hygiene of fingernails was met for a resident requiring assistance, with long, uneven fingernails and unclean conditions observed.
F 0761: The facility failed to ensure safe storage of treatment supplies, with medications and treatment items found unsecured in resident rooms and bathrooms.
F 0812: The facility failed to ensure safe and sanitary food storage practices, with leftover food containers improperly dated and stored beyond policy limits.
F 0880: The facility failed to ensure proper infection prevention practices, including inadequate hand hygiene and improper cleaning of blood glucose meters during resident care.
Report Facts
Residents reviewed: 27
Residents reviewed: 6
Residents reviewed: 8
Temperature readings: 61
Leftover food container dates: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 6 | Licensed Practical Nurse | Named in infection prevention and control deficiencies related to hand hygiene and blood glucose meter cleaning |
| Director of Nursing | Director of Nursing | Provided information on policies and observations related to personal hygiene, infection control, and blood glucose meter cleaning |
| Administrator | Facility Administrator | Interviewed regarding building temperature issues and treatment supply storage |
| Maintenance 3 | Maintenance Staff | Interviewed regarding HVAC system and temperature monitoring |
| Qualified Medicine Aide 2 | Qualified Medicine Aide | Interviewed regarding treatment supply storage |
| Certified Dietary Manager in training (CDM 8) | Certified Dietary Manager in training | Interviewed regarding food storage practices |
| Nurse Practitioner 5 | Nurse Practitioner | Observed and interviewed related to infection control during wound care |
| Certified Nurse Aide 4 | Certified Nurse Aide | Observed during wound care |
Inspection Report
Complaint Investigation
Census: 26
Deficiencies: 0
Date: Oct 1, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00443476 and IN00443957.
Complaint Details
Investigation of Complaints IN00443476 and IN00443957 found no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in complaints IN00443476 and IN00443957 were cited. The facility was found to be in compliance with relevant regulations.
Report Facts
Census: 26
Medicare residents: 2
Medicaid residents: 15
Other residents: 9
Inspection Report
Complaint Investigation
Census: 28
Capacity: 28
Deficiencies: 0
Date: Aug 27, 2024
Visit Reason
This visit was for the investigation of Complaint IN00440779.
Complaint Details
Complaint IN00440779 - 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: 28
Total Capacity: 28
Medicare Census: 2
Medicaid Census: 15
Other Payor Census: 11
Inspection Report
Complaint Investigation
Census: 32
Capacity: 32
Deficiencies: 0
Date: Jul 31, 2024
Visit Reason
This visit was conducted for the investigation of four complaints: IN00437996, IN00438039, IN00438052, and IN00438721.
Complaint Details
Complaints IN00437996, IN00438039, IN00438052, and IN00438721 were investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in any of the four complaints were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type: 32
Census Payor Type: 17
Census Payor Type: 15
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 0
Date: Jun 25, 2024
Visit Reason
This visit was conducted to investigate two complaints, IN00435853 and IN00436571, regarding the Waters of Columbia City Skilled Nursing Facility.
Complaint Details
Complaint IN00435853 and Complaint IN00436571 were investigated with no deficiencies cited related to the allegations.
Findings
No deficiencies related to the allegations in either complaint were cited. The facility was found to be in compliance with applicable federal and state regulations.
Report Facts
Census: 33
Census Bed Type - SNF: 2
Census Bed Type - SNF/NF: 31
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 20
Census Payor Type - Other: 11
Inspection Report
Re-Inspection
Census: 29
Capacity: 29
Deficiencies: 0
Date: Mar 22, 2024
Visit Reason
This visit was a Post Survey Revisit (PSR) to the Investigation of Complaint IN00428695 completed on February 22, 2024.
Complaint Details
Complaint IN00428695 - Corrected.
Findings
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 PSR to the Investigation of Complaint IN00428695. The complaint was corrected.
Report Facts
Census: 29
Total Capacity: 29
Medicaid Census: 15
Other Payor Census: 14
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Feb 22, 2024
Visit Reason
The inspection was conducted in response to a complaint regarding a medication error involving Resident Q, who was given an opioid medication not prescribed for her, resulting in a change of condition and death.
Complaint Details
The complaint reported that on 2/16/24, Resident Q was mistakenly given another resident's MS Contin 30 mg tablet. The family was notified at 10:00 a.m. that day and told the resident would be monitored. However, the resident was not adequately monitored, and at 5:30 p.m. was found not breathing and later pronounced dead. The complaint investigation found failures in monitoring and communication.
Findings
The facility failed to ensure Resident Q was effectively monitored for adverse reactions after receiving another resident's MS Contin 30 mg tablet. The lack of adequate respiratory assessment and monitoring following the medication error led to Resident Q becoming unresponsive and subsequently dying.
Deficiencies (2)
F 0684: The facility failed to provide appropriate treatment and care according to orders and resident preferences by not effectively assessing respiratory status after a medication error involving MS Contin, resulting in resident death.
F 0760: The facility failed to ensure Resident Q did not receive an opioid medication prescribed for another resident and failed to monitor for signs and symptoms of adverse reaction, resulting in resident becoming unresponsive and death.
Report Facts
Medication dose: 30
Oxygen flow rate: 2
Time of medication error: 8
Time family notified: 10
Time resident found unresponsive: 17.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 7 | Licensed Practical Nurse | Administered the incorrect MS Contin 30 mg tablet and monitored Resident Q |
| RN 8 | Registered Nurse | Took over care at 2:00 p.m., observed Resident Q coughing and gurgling but did not assess breath sounds or oxygen saturation until late |
| Nurse Practitioner | Nurse Practitioner | Notified of medication error and gave monitoring orders but was not updated on resident condition changes |
| CNA 2 | Certified Nurse Aide | Reported Resident Q's coughing and gurgling but was unsure if nurse assessed the resident |
| CNA 3 | Certified Nurse Aide | Observed Resident Q sleepy with rattly breathing but did not notify nurse |
| CNA 4 | Certified Nurse Aide | Observed Resident Q coughing and gagging, elevated head of bed but did not report to charge nurse |
Inspection Report
Complaint Investigation
Census: 31
Deficiencies: 2
Date: Feb 20, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00427464 and IN00428695, resulting in a Partially Extended Survey due to Substandard Quality of Care with Immediate Jeopardy.
Complaint Details
Complaint IN00427464 had no deficiencies related to the allegations. Complaint IN00428695 resulted in federal/state deficiencies cited at F684 and F760 related to medication error and inadequate monitoring leading to Resident Q's death.
Findings
The facility failed to ensure proper assessment and monitoring of Resident Q after a medication error where she was given MS Contin 30 mg not prescribed for her. This failure led to a change in condition and subsequent death. The Immediate Jeopardy was identified on 2/16/24 and removed on 2/22/24 after corrective actions including staff education and monitoring were implemented.
Deficiencies (2)
Failure to adequately assess respiratory status after a medication error for Resident Q, resulting in change of condition and death.
Failure to ensure Resident Q did not receive an opioid medication prescribed for another resident and failure to monitor for adverse reactions, resulting in death.
Report Facts
Census: 31
Medication error date: Feb 16, 2024
Immediate Jeopardy removal date: Feb 22, 2024
Narcotic dose: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nurse #1 | Nurse | Immediately interviewed and suspended pending investigation after medication error discovery on 02/16/24 |
| LPN 7 | Licensed Practical Nurse | Administered incorrect medication to Resident Q and monitored vital signs; notified Nurse Practitioner |
| RN 8 | Registered Nurse | Took over care after LPN 7, failed to monitor oxygen saturation and respiratory status adequately |
| Nurse Practitioner | Nurse Practitioner | Notified of medication error, gave monitoring instructions, but was not informed of Resident Q's condition changes |
Inspection Report
Complaint Investigation
Census: 37
Deficiencies: 0
Date: Jan 8, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00424438.
Complaint Details
Complaint IN00424438 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 applicable regulations.
Report Facts
Census Bed Type: 37
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 15
Census Payor Type - Other: 20
Inspection Report
Re-Inspection
Census: 38
Capacity: 84
Deficiencies: 0
Date: Nov 30, 2023
Visit Reason
A Post Survey Revisit (PSR) was conducted to the Emergency Preparedness Survey and the Life Safety Code Recertification and State Licensure Survey originally conducted on 10/24/23.
Findings
At this Post Survey Revisit, The Waters of Columbia City Skilled Nursing Facility was found in compliance with Emergency Preparedness Requirements and Life Safety Code Requirements for Medicare and Medicaid Participating Providers and Suppliers.
Inspection Report
Census: 36
Capacity: 84
Deficiencies: 4
Date: Oct 24, 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 and life safety requirements.
Findings
The facility was found not in compliance with emergency preparedness requirements, failing to conduct required emergency plan exercises twice per year including unannounced staff drills. Life Safety Code deficiencies included failure to protect a storage room with combustible materials as a hazardous area, malfunctioning self-closing door on the elevator machine room, and missing fire drills on each shift for 2 of 4 quarters.
Deficiencies (4)
Failed to conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using emergency procedures.
Failed to ensure storage room with large amounts of combustible storage and greater than 50 square feet was protected as a hazardous area; door held open by a box.
Elevator machine room door self-closing device did not fully close and latch the door.
Failed to conduct fire drills on each shift for 2 of 4 quarters.
Report Facts
Facility capacity: 84
Census: 36
Deficiency count: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Barnes | Executive Director | Signed the report |
| Maintenance Director | Interviewed regarding emergency preparedness exercises and elevator door deficiency | |
| Administrator | Interviewed and involved in exit conference and corrective action plans |
Inspection Report
Annual Inspection
Census: 37
Deficiencies: 5
Date: Sep 29, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from September 26 to 29, 2023.
Findings
The facility was found deficient in multiple areas including resident dignity related to catheter privacy, privacy during resident council meetings, confidentiality of medical records, sufficient nursing staff to meet resident needs, and infection prevention and control practices.
Deficiencies (5)
Failure to ensure dignity for residents with indwelling catheters by not covering catheter bags, visible from hallway.
Failure to provide a private setting for resident council meetings, resulting in interruptions by staff.
Failure to ensure privacy and confidentiality of medical records; medication carts left unattended with resident information visible.
Failure to maintain sufficient nursing staff to implement fall prevention and provide personal assistance as preferred by residents.
Failure to consistently implement infection prevention strategies including hand hygiene and proper handling of linens and utensils.
Report Facts
Census: 37
Residents with recent falls: 20
Residents requiring 2 staff for mechanical lift: 6
Staffing ratios: 17
Staffing ratios: 10
Staffing ratios: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Barnes | Executive Director | Signed the inspection report |
| Director of Nursing | Director of Nursing | Provided policies and interviews regarding dignity, privacy, staffing, and infection control |
| LPN 2 | Licensed Practical Nurse | Observed leaving medication cart unattended with resident information visible and failing to perform hand hygiene between tasks |
| CNA 4 | Certified Nurse Aide | Observed unable to assist resident due to staffing shortages |
| Cook 8 | Cook | Observed removing dirty dishes without gloves and wiping hands on pants |
| Qualified Medicine Aide 6 | Qualified Medicine Aide | Observed touching resident equipment and cups without hand hygiene |
| Activity Director | Activity Director | Interviewed regarding resident council meeting privacy |
| Administrator | Administrator | Interviewed regarding resident council meeting privacy and hand hygiene expectations |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Sep 29, 2023
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure survey.
Findings
The Waters of Columbia City 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
Routine
Deficiencies: 5
Date: Sep 29, 2023
Visit Reason
The inspection was conducted as a routine survey to assess compliance with regulatory requirements related to resident rights, privacy, staffing, infection control, and other care standards at Waters of Columbia City Skilled Nursing Facility.
Findings
The facility was found deficient in multiple areas including failure to ensure resident dignity regarding catheter bag visibility, lack of privacy during resident council meetings, breaches in confidentiality of medical records, inadequate staffing levels impacting resident care, and inconsistent implementation of infection prevention and control practices.
Deficiencies (5)
F 0550: The facility failed to ensure dignity for 2 of 8 residents by leaving catheter bags uncovered and visible from the hallway.
F 0565: The facility failed to provide a private setting for resident council meetings for 4 of 16 residents, resulting in interruptions by staff.
F 0583: The facility failed to keep residents' personal and medical records confidential when medication carts were left unattended with screens displaying resident information.
F 0725: The facility failed to provide adequate nursing staff to meet resident needs, resulting in delayed assistance and unmet personal care for 4 of 6 residents.
F 0880: The facility failed to consistently implement infection prevention strategies, including improper hand hygiene and unsafe handling of dining utensils and resident care items.
Report Facts
Residents affected: 2
Residents affected: 4
Residents affected: 2
Residents affected: 4
Residents affected: 25
Total residents: 37
Licensed nurses per shift: 2
Licensed nurses per shift: 1
Nurse aides ratio: 1
Nurse aides ratio: 1
Falls reported: 20
Residents requiring 2 staff for transfer: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 2 | Licensed Practical Nurse | Named in findings related to confidentiality breach and infection control lapses |
| Director of Nursing | Director of Nursing | Provided policies and interviewed regarding staffing and infection control |
| Administrator | Facility Administrator | Interviewed regarding resident council meeting privacy and infection control |
| Activity Director | Activity Director | Present during resident council meeting and interviewed about meeting privacy |
| Certified Nurse Aide 4 | Certified Nurse Aide | Mentioned in staffing and resident call light response findings |
| Qualified Medicine Aide 6 | Qualified Medicine Aide | Observed in infection control lapses and resident council meeting interruptions |
| Licensed Practical Nurse 3 | Licensed Practical Nurse | Interviewed regarding infection control practices |
Inspection Report
Complaint Investigation
Census: 37
Deficiencies: 0
Date: Jun 19, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00409156.
Complaint Details
Complaint IN00409156 was investigated and found to have no deficiencies related to the allegations.
Findings
No deficiencies related to the allegations in Complaint IN00409156 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Census Bed Type - SNF/NF: 30
Census Bed Type - SNF: 7
Census Total: 37
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 24
Census Payor Type - Other: 10
Census Payor Type - Total: 37
Inspection Report
Life Safety
Census: 38
Capacity: 84
Deficiencies: 0
Date: Jan 4, 2023
Visit Reason
An Emergency Preparedness Survey and a Life Safety Code (LSC) 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.
Findings
The facility was found in compliance with Emergency Preparedness Requirements and Life Safety Code requirements. The facility is fully sprinklered except for a shed providing facility services which was not sprinklered.
Report Facts
Facility capacity: 84
Census: 38
Inspection Report
Renewal
Census: 39
Capacity: 39
Deficiencies: 0
Date: Dec 1, 2022
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from November 28 to December 1, 2022.
Findings
Waters of Columbia City Skilled Nursing 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.
Report Facts
Census Bed Type: 39
Census Payor Type: 39
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