Inspection Reports for Whitlock Place
1719 S ELM ST, CRAWFORDSVILLE, IN, 47933
Back to Facility ProfileInspection Report Summary
The most recent inspection on July 9, 2025, found no deficiencies related to the complaint investigated. Earlier inspections showed a pattern of deficiencies involving medication administration documentation, infection control, food storage and safety, resident rights, and staff certification, with some substantiated complaints related to resident care and safety. Notable issues included a nurse working under the influence of alcohol with access to medications, failure to follow safe transfer procedures resulting in resident injury, and problems with food service complaint responses. Enforcement actions included termination of staff involved in the alcohol incident, but fines or license suspensions were not listed in the available reports. The facility’s recent clean inspection suggests some improvement following prior citations.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
19% worse than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
58 residents
Based on a July 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 0
Date: Jul 9, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00460377.
Complaint Details
Complaint IN00460377 was investigated and found to have no deficiencies related to the allegations.
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.
Inspection Report
Complaint Investigation
Census: 62
Deficiencies: 0
Date: Mar 27, 2025
Visit Reason
This visit was conducted for the investigation of three complaints: IN00452302, IN00454894, and IN00455680.
Complaint Details
Complaints IN00452302, IN00454894, and IN00455680 were investigated and no deficiencies related to the allegations were cited for any of them.
Findings
No deficiencies related to the allegations in any of the three complaints were cited. The facility was found to be in compliance with relevant regulations regarding the complaint investigations.
Report Facts
Residential Census: 62
Inspection Report
Complaint Investigation
Census: 67
Deficiencies: 0
Date: Dec 26, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00449329.
Complaint Details
Complaint IN00449329 was investigated and found to have no deficiencies related to the allegations.
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.
Inspection Report
Annual Inspection
Census: 65
Deficiencies: 4
Date: Oct 29, 2024
Visit Reason
This visit was for a State Residential Licensure Survey conducted on October 25, 28, and 29, 2024, as an annual survey by the Indiana State Department of Health.
Findings
The facility was found noncompliant in several areas including failure to publicly display resident rights, improper food storage with boxes on the floor, unsafe food temperature monitoring practices, and lack of an infection control tracking system. Plans of correction were submitted for each deficiency with corrective actions and monitoring procedures.
Deficiencies (4)
Facility failed to ensure a copy of resident rights was publicly accessible.
Facility failed to ensure boxes of food were stored off the floor in the dry food storage room.
Facility failed to obtain food temperatures in a safe and sanitary manner during kitchen observations.
Facility failed to maintain an infection control program with a tracking system for infections and antibiotic treatment.
Report Facts
Residential Census: 65
Number of boxes of canned goods on floor: 2
Number of boxes in stacks touching floor: 2
Food temperature obtained: 148
Number of residents affected by infection control deficiency: 46
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lasha Batemane | Executive Director | Signed report and referenced in Plan of Correction correspondence. |
| Cook 3 | Named in findings related to food storage and food temperature monitoring deficiencies. | |
| Dietary Manager | Interviewed regarding food storage and temperature monitoring practices. | |
| Administrator | Interviewed regarding resident rights display and food storage policies. | |
| Director of Health and Wellness | DHW | Interviewed regarding infection control program and tracking system. |
| Assistant Business Office Manager | Interviewed regarding awareness of resident rights display. |
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 1
Date: Aug 9, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00438959 and IN00439594 regarding medication administration issues at the facility.
Complaint Details
This visit was complaint-related for complaints IN00438959 and IN00439594. The deficiencies cited relate to allegations in these complaints.
Findings
The facility failed to ensure medications were documented as administered to 2 of 4 residents reviewed for medication administration. Several medications were not administered on specific dates without documented reasons on the Medication Administration Record (MAR).
Deficiencies (1)
Failed to ensure medications were documented as administered to 2 of 4 residents reviewed for medication administration (Residents C and D).
Report Facts
Residential Census: 60
Missed medication administration instances: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lasha Batemane | Executive Director | Signed the Plan of Correction letter |
| Director of Health and Wellness (DHW) | Interviewed regarding medication administration policies and practices | |
| Qualified Medication Aide (QMA) 3 | Interviewed regarding medication administration and documentation practices |
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 0
Date: Jun 10, 2024
Visit Reason
This visit was for the Investigation of Complaints IN00434716 and IN00436073.
Complaint Details
Complaint IN00434716 and Complaint IN00436073 were investigated with no deficiencies cited related to the allegations.
Findings
No deficiencies related to the allegations were cited for either complaint. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the investigation of these complaints.
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 2
Date: Jan 12, 2024
Visit Reason
The visit was conducted as an investigation of Complaint IN00422656 regarding state deficiencies related to staffing and resident care.
Complaint Details
Complaint IN00422656 was substantiated with state deficiencies cited at R240 and R117 related to staffing and resident transfer safety.
Findings
The facility failed to ensure certified CPR staff were present on overnight shifts for 12 of 30 shifts reviewed, and failed to follow safe transfer procedures for a resident resulting in rib fractures. The facility lacked policies on CPR certification and resident transfers, and some staff were not CPR certified.
Deficiencies (2)
Facility failed to ensure certified CPR staff on overnight shifts for 12 of 30 shifts reviewed.
Facility failed to follow safe transfer procedures using assistance device and two staff members, resulting in resident rib fractures.
Report Facts
Shifts without CPR certified staff: 12
Staff members not CPR certified: 4
Resident census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lasha Batemane | Executive Director | Interviewed regarding staffing and CPR certification; signed plan of correction. |
| CNA 3 | Involved in improper transfer of Resident B resulting in rib fractures. | |
| Director of Nursing | Director of Nursing | Interviewed about notification of resident injury and staff training. |
| CNA 4 | Interviewed about transfer procedures and use of gait belts. | |
| CNA 5 | Observed assisting Resident B transfer using gait belt. |
Inspection Report
Annual Inspection
Census: 51
Deficiencies: 8
Date: Sep 27, 2023
Visit Reason
This visit was for a State Residential Licensure Survey, including the Investigation of Complaint IN00417654.
Complaint Details
Complaint IN00417654 was investigated and no deficiencies related to the allegations were cited.
Findings
The facility was found deficient in multiple areas including confidentiality of medical records during medication administration, lack of documentation of quarterly fire drills, insufficient CPR and first aid certified staff on duty, unsanitary carpet conditions, unclean stove hood vent and lack of sanitary handwashing equipment in the kitchen, improper medication handling by staff, incomplete tuberculosis testing documentation for residents, and inadequate hand hygiene supplies in community restrooms.
Deficiencies (8)
Failed to ensure staff-maintained confidentiality of medical records during medication pass administration for 1 of 5 residents reviewed (Resident 33).
Lacked documentation that fire drills had been conducted at least quarterly on all shifts during review of 12 of 12 months.
Failed to ensure a minimum of one staff person was CPR and first aid certified onsite at all times for 7 of 7 scheduled days reviewed.
Failed to ensure a clean and sanitary environment; carpet throughout the facility had multiple dark stains of various sizes in all hallways.
Failed to ensure the stove hood filter vent was cleaned for 3 of 3 kitchen observations and failed to provide sanitary handwashing equipment for staff to dry their hands in 2 of 2 kitchen observations.
Failed to maintain sanitary conditions during medication administration for 3 of 5 residents reviewed (Residents 10, 1, and 33) due to staff touching pills with bare hands.
Failed to ensure residents were assessed for Tuberculosis through Mantoux skin test upon admission for 3 of 3 residents reviewed (Residents 27, 57, and 58).
Failed to ensure staff washed their hands after each direct resident contact; community restrooms lacked individual paper towels in dispensers.
Report Facts
Residential Census: 51
Deficiency completion date: Oct 25, 2023
Fire drills documentation: 0
CPR and first aid certification missing shifts: 7
Kitchen hood cleaning missing weeks: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lasha Batemane | Executive Director | Signed report and referenced in correspondence |
| QMA 3 | Named in findings related to confidentiality breach and improper medication handling | |
| Director of Nursing | Director of Nursing | Interviewed regarding confidentiality, CPR certification, medication administration, and tuberculosis testing |
| Administrator | Administrator | Interviewed regarding fire drills, carpet condition, and kitchen cleaning |
| Dietary Manager | Interviewed regarding kitchen hood cleaning and handwashing supplies | |
| Cook 3 | Observed and interviewed regarding kitchen cleaning and handwashing | |
| Certified Nurse Aide 4 | Observed regarding handwashing practices |
Inspection Report
Complaint Investigation
Census: 45
Deficiencies: 1
Date: Apr 19, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00406267 regarding residents' food service complaints.
Complaint Details
Complaint IN00406267 was substantiated with a state deficiency cited at R0041 related to residents' rights and food service complaints.
Findings
The facility failed to ensure implementation of their policy and procedure for responding to residents' food service complaints for 3 of 4 residents interviewed and for responding to resident council food service grievances for all 21 residents in attendance. Residents reported issues such as poor food quality, inadequate serving sizes, and lack of response to complaints.
Deficiencies (1)
Failure to ensure implementation of policy and procedure for responding to residents' food services complaints.
Report Facts
Facility Census: 45
Residents in attendance at Resident Council: 21
Residents interviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Lay-Wolf | RN, RDCS | Laboratory Director's or Provider/Supplier Representative's signature on the report. |
| Regional Executive Director | Interviewed regarding awareness of residents' food service complaints and grievance log. | |
| Executive Director | Responsible for corrective actions and monitoring compliance related to food service complaints. | |
| Regional Director of Operations | Provided re-education and re-training to Executive Director and dining staff on policy implementation. |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 4
Date: Sep 15, 2022
Visit Reason
This visit was for the investigation of complaint IN00390133 regarding a nurse under the influence of alcohol who entered a resident's apartment uninvited and was left in the facility overnight with access to medication keys.
Complaint Details
Complaint IN00390133 was substantiated. The complaint involved a nurse under the influence of alcohol who entered a resident's apartment uninvited and was left in the facility overnight with access to medication keys. The DON and the nurse were placed on administrative leave and subsequently terminated.
Findings
The facility failed to ensure residents' privacy and safety when a nurse under the influence of alcohol was left in the facility overnight with access to medication carts, medication room, and resident apartments. The nurse entered a resident's apartment uninvited during the night, causing distress. The Director of Nursing (DON) was found to have improperly handled the situation and was terminated. The facility also failed to timely report the incident to the Indiana Department of Health.
Deficiencies (4)
Failed to ensure residents' right to privacy when a nurse under the influence of alcohol entered a locked residential apartment uninvited during the night.
Failed to report an unusual occurrence of a nurse working under the influence of alcohol to the Indiana Department of Health in a timely manner.
Failed to follow the Drug & Alcohol-Free Workplace policy when a Licensed Practical Nurse was found drunk in the facility and allowed to remain on the premises with keys to medication carts, medication room, and resident apartments.
Failed to ensure a nurse under the influence of alcohol did not have access to the medication room or medications stored in medication carts including scheduled narcotic medications.
Report Facts
Residents present: 56
Deficiencies cited: 4
Completion date for plan of correction: Oct 15, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN 9 | Licensed Practical Nurse | Nurse found intoxicated on duty, entered resident apartment uninvited, left in facility overnight with medication keys, subsequently terminated |
| Resident H | Resident whose apartment was entered uninvited by intoxicated nurse | |
| Director of Nursing | DON | Failed to properly handle intoxicated nurse incident, left nurse in facility overnight, delayed reporting, subsequently terminated |
| Regional Director of Care Services | RDCS | Interviewed regarding incident and reporting |
| Executive Director | ED | Involved in investigation, retraining, and monitoring compliance |
| Interim Care Service Manager | CSM | Involved in retraining and monitoring compliance |
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