Inspection Reports for The Waters of Peru Skilled Nursing Facility
317 BLAIR PIKE, IN, 46970
Back to Facility ProfileInspection Report Summary
The most recent inspection on April 9, 2025, was a complaint investigation and found no deficiencies related to the allegations. Earlier inspections showed a pattern of deficiencies primarily involving Life Safety Code issues such as smoke alarm replacement, sprinkler maintenance, and door hardware, as well as resident care concerns including care planning, infection control, and proper use of equipment. Complaint investigations were consistently unsubstantiated, and no fines, immediate jeopardy findings, or license actions were listed in the available reports. Prior Life Safety Code deficiencies were addressed with corrective actions and plans of correction, and the facility demonstrated compliance in subsequent revisits. The overall trend suggests improvement in Life Safety Code compliance, although some resident care and environmental issues were noted in the mid-2024 annual survey.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
5.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
26% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
100% occupied
Based on a April 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 42
Capacity: 42
Deficiencies: 0
Apr 9, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00456923.
Findings
No deficiencies related to the allegations in Complaint IN00456923 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the complaint investigation.
Complaint Details
Complaint IN00456923 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census: 42
Total Capacity: 42
Medicare Census: 6
Medicaid Census: 20
Other Payor Census: 16
Inspection Report
Complaint Investigation
Census: 32
Capacity: 32
Deficiencies: 0
Sep 30, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00442687.
Findings
No deficiencies related to the allegations in Complaint IN00442687 were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00442687 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare residents: 2
Medicaid residents: 15
Other payor residents: 15
Inspection Report
Re-Inspection
Census: 38
Capacity: 130
Deficiencies: 0
Sep 26, 2024
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 08/19/24 was performed by the Indiana Department of Health in accordance with 42 CFR 483.90(a).
Findings
The Waters of Peru Skilled Nursing Facility was found to be in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2. The facility was fully sprinklered with appropriate fire alarm and smoke detection systems.
Report Facts
Facility capacity: 130
Census: 38
Inspection Report
Life Safety
Census: 30
Capacity: 130
Deficiencies: 3
Aug 19, 2024
Visit Reason
A Life Safety Code Recertification and State Licensure Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a) and NFPA 101 standards.
Findings
The facility was found not in compliance with Life Safety Code requirements, including failure to replace battery-operated smoke alarms in resident sleeping rooms, corrosion on sprinkler heads outside the main entrance, and lack of ground fault circuit interrupter (GFCI) protection in a wet location. Corrective actions and plans of correction were submitted with compliance dates in September 2024.
Severity Breakdown
SS=F: 1
SS=E: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to replace 68 battery-operated smoke alarms in resident sleeping rooms that were over 10 years old, not in accordance with NFPA 72. | SS=F |
| Failed to ensure 4 sprinkler heads outside the main entrance were free of corrosion and dirt, requiring replacement per NFPA 25. | SS=E |
| Failed to provide ground fault circuit interrupter (GFCI) protection for a wet location receptacle powering the kitchen/main dining room ice machine, violating NFPA 70 requirements. | SS=E |
Report Facts
Battery-operated smoke alarms: 68
Sprinkler heads: 4
Residents affected: 30
Facility capacity: 130
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debra L Coppernoll | Administrator | Named in relation to findings and plan of correction. |
| Debbie Coppernoll | Administrator | Named in plan of correction correspondence and corrective actions. |
| Maintenance Director | Interviewed regarding deficiencies and corrective actions for smoke alarms and sprinkler heads. | |
| Maintenance Supervisor/designee | Responsible for corrective actions and monitoring preventive maintenance. |
Inspection Report
Annual Inspection
Deficiencies: 0
Jul 24, 2024
Visit Reason
The inspection was conducted as a Paper Compliance Review to the Annual Recertification and State Licensure Survey.
Findings
Waters of Peru Skilled Nursing Facility 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
Annual Inspection
Census: 34
Capacity: 34
Deficiencies: 10
Jul 24, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted on July 21-24, 2024 at Waters of Peru Skilled Nursing Facility.
Findings
The survey identified multiple deficiencies including failure to provide written bed hold policy upon hospital transfer, untimely comprehensive care area assessments and care plans, lack of person-centered care plans for behaviors and hospice care, failure to revise care plans timely, inadequate activities programming, improper use of mechanical lifts causing injury, failure to prevent weight loss and maintain hydration, improper oxygen therapy management, unsanitary food handling, and failure to follow infection control protocols during peri care.
Severity Breakdown
SS=D: 9
SS=E: 1
Deficiencies (10)
| Description | Severity |
|---|---|
| Failed to provide written bed hold information to resident or representative upon hospital transfer. | SS=D |
| Failed to complete resident Care Area Assessment in a timely manner. | SS=D |
| Failed to ensure comprehensive person-centered care plans for residents with behaviors and hospice care. | SS=D |
| Failed to revise and update care plans timely for activities, infections, and pressure ulcers. | SS=D |
| Failed to implement activities program incorporating resident interests and hobbies. | SS=D |
| Failed to properly use mechanical lift resulting in resident injury. | SS=D |
| Failed to provide interventions to prevent significant weight loss and maintain adequate hydration. | SS=D |
| Failed to follow physician's orders for oxygen use and store oxygen tubing appropriately. | SS=D |
| Failed to ensure physician ordered snacks were provided and staff did not thumb eating surfaces of dinnerware. | SS=E |
| Failed to ensure staff changed gloves and performed hand hygiene when providing peri care. | SS=D |
Report Facts
Census: 34
Total Capacity: 34
Deficiencies cited: 10
Resident 9 laceration size: 3
Resident 24 weight loss: 12.2
Resident 24 oxygen flow rate: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debra L Coppernoll | Administrator | Signed plan of correction and correspondence |
| CNA 10 | Involved in mechanical lift incident with Resident 9 | |
| CNA 12 | Involved in mechanical lift incident with Resident 9 | |
| LPN 13 | Nurse who discovered oxygen concentrator off for Resident 24 | |
| CNA 3 | Observed failing to change gloves and perform hand hygiene during peri care |
Inspection Report
Complaint Investigation
Census: 33
Capacity: 33
Deficiencies: 0
Feb 21, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00427225.
Findings
No deficiencies related to the complaint allegation were cited. The facility was found to be in compliance with applicable regulations.
Complaint Details
Complaint IN00427225 was investigated and found to have no deficiencies related to the allegation.
Report Facts
Census Payor Type - Medicare: 1
Census Payor Type - Medicaid: 20
Census Payor Type - Other: 12
Inspection Report
Life Safety
Census: 36
Capacity: 130
Deficiencies: 0
Nov 21, 2023
Visit Reason
A Post Survey Revisit (PSR) to the PSR on 10/26/23 to the Life Safety Code Recertification and State Licensure Survey conducted on 09/14/23 was conducted by the Indiana Department of Health in accordance with 42 CFR Subpart 483.90(a).
Findings
At this Life Safety Code Survey, The Waters of Peru Skilled Nursing Facility was found in compliance with the Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 483.90(a).
Report Facts
Certified beds: 130
Census: 36
Inspection Report
Life Safety
Census: 35
Capacity: 130
Deficiencies: 1
Oct 26, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 09/14/23 was conducted by the Indiana Department of Health in accordance with 42 CFR Subpart 483.90(a).
Findings
The facility failed to maintain latching hardware on 1 of 7 smoke barrier doors, which did not properly close and latch when tested. This deficiency could affect staff and up to 30 residents and was previously cited on 09/14/23 without effective correction.
Deficiencies (1)
| Description |
|---|
| Failed to maintain latching hardware on 1 of 7 smoke barrier doors; doors did not properly close and latch when tested. |
Report Facts
Certified beds: 130
Census: 35
Smoke barrier doors inspected: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debra Coppernoll | Administrator | Named in plan of correction and correspondence regarding the inspection |
| Brenda Buroker | Director of Long Term Care | Recipient of plan of correction correspondence |
| Maintenance Director | Maintenance Director | Interviewed regarding smoke barrier door latching hardware deficiency |
| Maintenance Supervisor | Maintenance Supervisor/designee | Performed repairs and inspections of smoke barrier doors as part of corrective actions |
Inspection Report
Life Safety
Census: 38
Capacity: 130
Deficiencies: 4
Sep 14, 2023
Visit Reason
The visit was conducted as a Life Safety Code Recertification and State Licensure Survey by the Indiana Department of Health in accordance with 42 CFR 483.90(a) and NFPA 101 standards.
Findings
The facility was found not in compliance with Life Safety Code requirements, including issues with smoke barrier door latching hardware, hazardous area protection, sprinkler system maintenance, and corridor door closures. Corrective actions were planned and implemented to address these deficiencies.
Severity Breakdown
SS=E: 3
SS=C: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to maintain latching hardware on 1 of 7 smoke barrier doors which did not close and latch properly. | SS=E |
| Failed to ensure 1 storage room with large amounts of combustible storage and greater than 50 square feet was protected as a hazardous area; corridor door did not self-close and latch. | SS=E |
| Failed to ensure sprinkler system was provided with spare sprinklers properly stored in protective slots; 4 spare sprinklers were not in protected slots. | SS=C |
| Failed to ensure 1 corridor door was provided with a means suitable for keeping the door closed, had no impediment to closing, latching and would resist passage of smoke; door to resident room 36 was impeded by privacy curtain. | SS=E |
Report Facts
Facility capacity: 130
Census: 38
Deficiencies cited: 4
Date of compliance: Sep 27, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debbie Coppernoll | Administrator | Named in relation to findings and plan of correction |
| Maintenance Director | Interviewed regarding deficiencies and corrective actions | |
| Maintenance Supervisor/designee | Performed repairs and inspections related to deficiencies |
Inspection Report
Annual Inspection
Census: 35
Capacity: 35
Deficiencies: 3
Aug 25, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from August 21 to August 25, 2023.
Findings
The facility was found deficient in following physician orders for medication administration and use of adaptive devices for 2 residents, maintaining clean oxygen concentrators for 2 residents, and providing a safe, functional, sanitary, and comfortable environment in 5 resident rooms and 1 lounge area.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to follow physician orders for administration of pain medication and use of palm protectors and offloading boots for 2 residents. | SS=D |
| Failed to ensure oxygen concentrators were clean and free from dust for 2 residents. | SS=D |
| Failed to provide a safe, functional, sanitary, and comfortable environment related to wainscoting falling off walls, peeling paint, unpainted spackle, and unattached electrical outlet in resident rooms and lounge area. | SS=D |
Report Facts
Census: 35
Total Capacity: 35
Deficiencies cited: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Debra Coppernoll | Administrator | Signed plan of correction and correspondence with state department |
| Georgia McQuinn | Staff Development Director | Provided staff education on following physician orders and cleaning oxygen concentrators |
| RN 4 | Observed administering medication incorrectly and admitted not following physician orders | |
| LPN 10 | Provided information about documentation of use of palm shields and heel lift device | |
| Director of Nursing | Interviewed regarding proper use of devices and cleaning of oxygen concentrators | |
| Director of Maintenance | Provided information about environmental deficiencies and maintenance procedures |
Inspection Report
Renewal
Deficiencies: 0
Aug 25, 2023
Visit Reason
The inspection was conducted as a Paper Compliance Review to the Recertification and State Licensure Survey.
Findings
Waters of Peru Skilled Nursing Facility 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
Re-Inspection
Census: 47
Capacity: 130
Deficiencies: 0
Aug 5, 2022
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey conducted on 06/06/22 by the Indiana Department of Health.
Findings
The facility was found in compliance with Requirements for Participation in Medicare/Medicaid, Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
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