Inspection Reports for
Whitlock Place

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.

This visit was complaint-related for complaints IN00438959 and IN00439594. The deficiencies cited relate to allegations in these complaints.

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).

Complaint IN00422656 was substantiated with state deficiencies cited at R240 and R117 related to staffing and resident transfer safety.

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.

Complaint IN00417654 was investigated and no deficiencies related to the allegations were cited.

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.

Complaint IN00406267 was substantiated with a state deficiency cited at R0041 related to residents' rights and food service complaints.

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.

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.

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.