Inspection Report Summary
The most recent inspection on June 26, 2024, identified multiple deficiencies related to transfer notices, hot water temperatures, kitchen sanitation, medication administration, documentation, infection control, and admission testing. Earlier inspections showed a pattern of issues including resident protection, abuse policies, medication management, food safety, and infection control. Complaint investigations were substantiated in both recent surveys, with deficiencies cited in areas such as abuse prevention and food service. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility’s inspection history indicates ongoing challenges with regulatory compliance, with some issues recurring over time.
Deficiencies (last 2 years)
Deficiencies (over 2 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
16
12
8
4
0
Census
Latest occupancy rate
54 residents
Based on a June 2024 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 54
Deficiencies: 8
Date: Jun 26, 2024
Visit Reason
This visit was for a State Residential Licensure Survey which included the Investigation of Complaint IN00421227.
Complaint Details
Complaint IN00421227 was investigated during this survey. State deficiencies related to the allegations are cited at R0045.
Findings
The facility was found deficient in multiple areas including failure to provide written transfer/discharge notices, maintain hot water temperatures within required range, maintain kitchen sanitation and food safety, timely administration of prescribed antibiotics, documentation of medication disposition, completeness of resident transfer forms, infection control practices related to insulin needle recapping, and administration of tuberculin skin tests prior to admission.
Deficiencies (8)
Failure to provide written notice of transfer or discharge and place a copy in the resident's clinical record for 2 of 2 records reviewed.
Failed to maintain hot water temperatures between 100 and 120 degrees Fahrenheit at point of use for 3 of 3 rooms observed.
Facility kitchen food preparation and serving areas were not free of personal staff items, hair nets were not utilized, food was not properly dated, expired food was not disposed of, dish machine temperatures were inadequate, and kitchen was not maintained clean and sanitary.
Failed to ensure a resident requiring an antibiotic received the prescribed medication in a timely manner.
Failed to document disposition of released, returned, or destroyed medications in the resident's clinical record for 1 of 2 residents reviewed.
Failed to ensure transfer forms included all required information for 2 of 2 residents reviewed.
Failed to ensure used insulin needles were not recapped for 2 of 2 injections randomly observed.
Failed to ensure tuberculin skin tests were administered prior to or at the time of admission for 1 of 5 records reviewed.
Report Facts
Residents present: 54
Hot water temperature: 131
Hot water temperature: 124
Hot water temperature: 128
Dishwasher wash temperature: 116
Dishwasher rinse temperature: 119
Missed antibiotic doses: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kim Lingle | Executive Director | Signed the report |
| Director of Nursing | Director of Nursing | Interviewed regarding transfer forms, medication administration, and infection control practices |
| QMA 4 | Qualified Medication Aide | Observed administering insulin and recapping needles |
| Dietary Manager | Dietary Manager | Interviewed during kitchen inspection regarding sanitation and food safety |
| Director of Plant Operations | Director of Plant Operations | Interviewed regarding hot water temperatures and kitchen observations |
Inspection Report
Follow-Up
Census: 53
Deficiencies: 0
Date: Jun 9, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the State Residential Licensure Survey and a PSR to Investigations of Complaints IN00406175 and IN00406078 completed on April 20, 2023.
Complaint Details
Complaints IN00406175 and IN00406078 were investigated and found to be corrected.
Findings
Bloom at German Church was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to the State Residential Licensure Survey and PSR to Investigation of Complaints IN00406175 and IN00406078.
Report Facts
Residential Census: 53
Inspection Report
Complaint Investigation
Census: 57
Deficiencies: 15
Date: Apr 20, 2023
Visit Reason
This visit was for a State Residential Licensure Survey including the Investigation of Complaints IN00406175 and IN00406078.
Complaint Details
Complaint IN00406175 - State deficiencies related to the allegations are cited at R268, R406. Complaint IN00406078 - State deficiencies related to the allegations are cited at R268, R269, R273, and R272.
Findings
The facility was found deficient in multiple areas including failure to protect residents from sexual and mental abuse, failure to develop a clear abuse policy, incomplete health screenings for employees, incomplete resident evaluations and care plans, improper medication administration, inadequate food service and infection control practices.
Deficiencies (15)
Failed to protect residents from sexual and mental abuse by not determining capacity to consent to sexual activity and not developing a plan to address sexual activity and psychological harassment for 2 residents.
Failed to develop an abuse policy that clearly states assurance that all residents are free of abuse.
Did not assure a 2-step tuberculin skin test was completed for 2 of 5 employee records reviewed.
Failed to ensure resident's semiannual weights were included in evaluation of needs for 1 of 5 residents reviewed.
Failed to revise a resident's service plan as needs changed related to frequent falls for 1 of 5 residents.
Failed to assess a resident for ability to self-administer medications for 1 of 5 residents reviewed.
Failed to ensure as needed (PRN) medications administered by Qualified Medication Assistants were authorized by licensed nursing personnel for 2 of 5 residents reviewed.
Failed to provide meals that provided a balanced distribution of daily nutritional requirements for all residents.
Failed to ensure meals and/or substitutions were approved by a registered dietician for all residents.
Failed to ensure food was served at safe and appropriate temperatures for 9 residents receiving room trays and 1 resident with puree diet.
Failed to maintain kitchen equipment in good working order; reach-in freezer condenser leaking onto foods, expired food items, unlabeled and undated opened food items, and kitchen staff not wearing beard/mustache restraints.
Failed to maintain complete medical record including emergency contact information for 1 of 5 residents reviewed.
Failed to ensure resident death record included notification of physician for 1 of 2 closed records reviewed.
Failed to develop a comprehensive care plan in cooperation with mental health service provider for 1 of 5 residents reviewed.
Failed to properly prevent and/or contain COVID-19 and ensure infection control by staff not donning/doffing appropriate PPE for a resident in droplet transmission and not performing hand hygiene between lunch tray deliveries.
Report Facts
Residents affected: 57
Employees missing 2-step TB test: 2
Residents reviewed for evaluation: 5
Residents receiving room trays with temperature issues: 9
Residents reviewed for medication administration: 5
Residents reviewed for infection control: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kim Lingle | Executive Director | Signed report and provided interviews regarding abuse policy and infection control. |
| Cheryl Ditltzer | NP | Provided follow-up orders and care plan updates for Resident N. |
| Tiffini Smith | NP | Provided follow-up orders and care plan updates for Resident N. |
| LPN 1 | Licensed Practical Nurse | Interviewed regarding sexual activity and education of residents. |
| LPN 2 | Licensed Practical Nurse | Interviewed regarding sexual activity and resident interactions. |
| LPN 3 | Licensed Practical Nurse | Reported resident statements about sexual activity and abuse. |
| LPN 4 | Licensed Practical Nurse | Interviewed regarding PPE use and resident care. |
| QMA 10 | Qualified Medication Assistant | Administered PRN medications without nurse authorization. |
| QMA 11 | Qualified Medication Assistant | Missing 2-step tuberculin skin test documentation. |
| QMA 12 | Qualified Medication Assistant | Missing 2-step tuberculin skin test documentation. |
| WD | Wellness Director | Interviewed regarding employee health screenings and PRN medication authorization. |
| DON | Director of Nursing | Provided multiple interviews regarding care plans, infection control, medication administration, and record completeness. |
| DM | Dietary Manager | Interviewed regarding menu planning, food preparation, and kitchen sanitation. |
| CNA 2 | Certified Nursing Assistant | Observed and interviewed regarding PPE use and resident care. |
| HHA 17 | Home Health Aide | Observed delivering lunch trays and PPE use. |
| KS 2 | Kitchen Staff | Observed preparing pureed meals and kitchen sanitation issues. |
| KS 22 | Kitchen Staff | Observed not wearing beard restraint during food preparation. |
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