Inspection Report Summary
The most recent inspection on April 30, 2025, found no deficiencies related to the complaint investigated. Earlier inspections showed a mixed record, with some citations primarily involving dietary staff not wearing hair coverings, service plan documentation, medication administration, and safety issues such as unsecured hazardous materials and water temperature control. Complaint investigations during this period were mostly unsubstantiated, with one substantiated complaint in December 2022 that cited medication administration errors and personnel certification lapses. No fines, immediate jeopardy findings, or license actions were listed in the available reports. The facility appears to have addressed prior deficiencies, as recent complaint investigations have not identified new issues.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
52% better than Indiana average
Indiana average: 4.2 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
75 residents
Based on a April 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Census: 75
Deficiencies: 0
Date: Apr 30, 2025
Visit Reason
This visit was for the Investigation of Complaint IN00456316.
Complaint Details
Complaint IN00456316 - No deficiencies related to the allegation are cited.
Findings
No deficiencies related to the allegation were cited. Country Charm was found to be in compliance with 410 IAC 16.2-5 in regard to the Investigation of Complaint IN00456316.
Inspection Report
Complaint Investigation
Census: 84
Deficiencies: 0
Date: Mar 13, 2025
Visit Reason
This visit was conducted for the investigation of Complaint IN00454962.
Complaint Details
Complaint IN00454962 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: 87
Deficiencies: 0
Date: Jan 10, 2025
Visit Reason
This visit was conducted for the investigation of complaints IN00450588 and IN00450662.
Complaint Details
Investigation of Complaints IN00450588 and IN00450662 found no deficiencies related to the allegations; facility was in compliance.
Findings
No deficiencies related to the allegations in complaints IN00450588 and IN00450662 were cited. The facility was found to be in compliance with applicable regulations.
Report Facts
Residential Census: 87
Inspection Report
Complaint Investigation
Census: 87
Deficiencies: 0
Date: Dec 13, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00446458.
Complaint Details
Complaint IN00446458 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: 84
Deficiencies: 2
Date: Aug 29, 2024
Visit Reason
This visit was for a State Residential Licensure Survey including the investigation of four complaints (IN00439225, IN00440221, IN00440415, and IN00441587).
Complaint Details
Investigation of Complaints IN00439225, IN00440221, IN00440415, and IN00441587 found no deficiencies related to the allegations.
Findings
No deficiencies were cited related to the complaints investigated. However, two deficiencies were identified: one related to a missing resident or representative signature on a service plan for one resident, and another related to staff failing to wear hair restraints properly in the kitchen during food preparation.
Deficiencies (2)
Facility failed to ensure a service plan was signed and dated by the resident or representative for 1 of 7 residents reviewed (Resident 135).
Facility failed to ensure foods were served in a sanitary and safe manner; staff hair was not covered while in the kitchen food preparation area (Dietary Manager, Cook 2, Dietary Aide 3, Dietary Aide 4, Dietary Server 5).
Report Facts
Residents reviewed for service plans: 7
Residents census: 84
Kitchen observations: 4
Staff members observed without proper hair covering: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tricia Abdon | Regional Clinical Manager | Signed the report |
| Unnamed Director of Nursing | Director of Nursing | Provided Resident 135's assessment and service plan, and interviewed regarding missing signature |
| Unnamed Administrator | Administrator | Interviewed regarding service plan signature requirements and facility policies |
| Dietary Manager | Observed with uncovered hair in kitchen and provided policies | |
| Cook 2 | Observed with uncovered facial hair in kitchen | |
| Dietary Aide 3 | Observed with uncovered hair in kitchen | |
| Dietary Aide 4 | Observed with uncovered hair in kitchen | |
| Dietary Server 5 | Observed with uncovered hair in kitchen |
Inspection Report
Complaint Investigation
Census: 81
Deficiencies: 0
Date: Oct 23, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00419364.
Complaint Details
Complaint IN00419364 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
Renewal
Census: 83
Deficiencies: 3
Date: Sep 13, 2023
Visit Reason
This visit was for a State Residential Licensure Survey conducted on September 11, 12, and 13, 2023, to assess compliance with state residential licensure requirements.
Findings
The facility was found deficient in maintaining secure storage of hazardous materials, controlling hot water temperatures within safe limits, and ensuring dietary staff wore hair coverings in the kitchen. Corrective actions and monitoring plans were established for each deficiency.
Deficiencies (3)
Facility failed to ensure potentially hazardous materials were kept secure behind locked doors to prevent resident access in the Maintenance Shop and Storage Room.
Facility failed to ensure water temperatures were maintained between 100 and 120 degrees Fahrenheit for 2 of 9 resident rooms on the 400 unit.
Facility failed to ensure dietary staff's hair was covered to prevent exposure to food while in the kitchen for 4 of 4 observations.
Report Facts
Residential Census: 83
Water temperature readings: 125
Water temperature readings: 127
Water temperature readings: 129
Water temperature readings: 128
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Julie Madison | Executive Director | Signed the report and provided policy information |
| Dining Service Chef 2 | Observed not wearing hair covering in the kitchen during food preparation | |
| Wellness Director | Provided information about Maintenance Shop and Storage Room door security | |
| Maintenance Director | Provided information about water temperature monitoring and door security |
Inspection Report
Complaint Investigation
Census: 86
Deficiencies: 0
Date: Mar 27, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00401748 and IN00404022.
Complaint Details
Investigation of Complaints IN00401748 and IN00404022 found no deficiencies related to the allegations; facility was in compliance.
Findings
No deficiencies related to the allegations in complaints IN00401748 and IN00404022 were cited. The facility was found to be in compliance with applicable regulations.
Inspection Report
Follow-Up
Census: 86
Deficiencies: 0
Date: Jan 17, 2023
Visit Reason
This visit was a Post Survey Revisit (PSR) to the State Residential Licensure Survey completed on December 7, 2022, including the PSR to the Investigation of Complaint IN00395326 completed on December 7, 2022.
Complaint Details
Complaint IN00395326 was investigated and found to be corrected.
Findings
Country Charm was found to be in compliance with 410 IAC 16.2-5 in regard to the PSR to the State Residential Licensure Survey and the PSR to Investigation of Complaint IN00395326.
Report Facts
Residential Census: 86
Inspection Report
Complaint Investigation
Census: 88
Deficiencies: 0
Date: Dec 20, 2022
Visit Reason
This visit was for the Investigation of Complaint IN00396909.
Complaint Details
Complaint IN00396909 - Unsubstantiated due to lack of evidence.
Findings
Complaint IN00396909 was found to be unsubstantiated due to lack of evidence. The facility was found to be in compliance with 410 IAC 16.2-5 regarding the complaint investigation.
Inspection Report
Complaint Investigation
Census: 87
Deficiencies: 3
Date: Dec 6, 2022
Visit Reason
This visit was for a State Residential Licensure Survey which included the Investigation of Complaint IN00395326.
Complaint Details
Complaint IN00395326 was substantiated with state deficiencies cited at R0241 related to medication administration errors and other personnel issues.
Findings
The facility was found to have substantiated deficiencies related to the complaint, including failure to document times for tuberculin skin tests for employees, failure to maintain valid certifications for a Qualified Medication Assistant (QMA), and failure to administer medications as ordered by the physician for two residents.
Deficiencies (3)
Failed to document the time a tuberculin skin test was administered and read for 3 of 5 employees reviewed (QMA 1, QMA 2, QMA 3).
Failed to ensure certifications were valid for 1 of 19 CNA/QMAs reviewed (QMA 4 worked with expired certifications).
Failed to administer medications as ordered by the physician for 2 of 5 residents reviewed (Resident B and Resident C), resulting in inaccurate dosing.
Report Facts
Residential Census: 87
Number of employees reviewed for tuberculin skin test documentation: 5
Number of CNA/QMA certifications reviewed: 19
Number of residents reviewed for medication administration: 5
Number of missed doses for Resident C: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Julie Madison | Executive Director | Signed the report. |
| QMA 1 | Qualified Medication Assistant | Employee with undocumented times for tuberculin skin test. |
| QMA 2 | Qualified Medication Assistant | Employee with undocumented times for tuberculin skin test. |
| QMA 3 | Qualified Medication Assistant | Employee with undocumented times for tuberculin skin test. |
| QMA 4 | Qualified Medication Assistant | Employee who worked with expired QMA and CNA certifications. |
| Director of Nursing Services | Interviewed regarding certification and medication administration deficiencies. | |
| Administrator | Interviewed regarding expired certifications and medication errors. | |
| Wellness Director | Responsible for audits and corrective actions related to TB testing and certifications. |
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