Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 26 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
0G
0H
0I
Potential for more than minimal harm
22D
2E
2F
Potential for minimal harm
0A
0B
0C
March 17, 2026Complaint inspection · 2 citations
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident's wound prevention interventions were implemented and the care plan was updated for 1 of 3 residents reviewed for wounds. (Resident C)
- D
Provide care by qualified persons according to each resident's written plan of care.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure Qualified Medication Aides (QMA) were completing wound treatments within their scope of practice for 1 of 3 residents reviewed for wounds. (QMA 5, 7, 9 and Resident D)
February 16, 2026Complaint inspection · 1 citation
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Inspectors wroteBased on interview and record review, the facility failed to protect a resident's right to be free from staff abuse during care for 1 of 3 residents reviewed for abuse. (Resident C)
December 10, 2025Complaint inspection · 2 citations
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Inspectors wroteBased on record review and interview, the facility failed to ensure an allegation of staff to resident physical and verbal abuse was reported to the State Agency (Indiana Department of Health) for 1 of 3 residents reviewed for abuse. (Resident E)
- D
Respond appropriately to all alleged violations.
Inspectors wroteBased on interview and record review, the facility failed to investigate an allegation of staff to resident abuse and failed to implement the facility policy to protect residents following an allegation of abuse for 1 of 3 residents reviewed for abuse. (Resident E)
May 22, 2025Standard inspection · 11 citations
- F
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Inspectors wroteBased on interview and record review, the facility failed to ensure the Dietary Manager completed the required education to meet the qualifications for a Dietary Manager. This deficiency had the potential to impact 56 of 56 residents who received meals from the facility kitchen.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation, interview, and record review, the facility failed to store and prepare food under safe and sanitary conditions related to kitchen equipment, utensil storage, food storage, and chemical storage. This deficient practice had the potential to affect 56 of 56 residents who received food from the facility kitchen.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure meals were palatable for 17 of 31 residents reviewed for palatable meals. (Residents 3, 4, 5, 9, 17, 19, 23, 25, 33, 34, 36, 40, 49, 50, 51, 108, and 109)
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Inspectors wroteBased on observation, record review, and interview, the facility failed to provide a dignified dining experience for 2 of 20 residents observed during meal service in the main dining room. (Residents 22, 45)
- D
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Inspectors wroteBased on interview and record review, the facility failed to provide notification of Medicare non-coverage for 2 of 3 residents reviewed for Beneficiary Protection Notifications. (Residents 49, 14)
- D
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Inspectors wroteBased on observation and interview, the facility failed to provide clean equipment for 2 of 19 residents reviewed for wheelchair cleanliness. (Residents 22 and 34)
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on observation, record review, and interview, the facility failed to implement fall precautions and update care plan interventions following falls for 1 of 2 residents reviewed for accidents. (Resident 41)
- D
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Inspectors wroteBased on observation, record review, and interview, the facility failed to implement interventions to prevent and promote the healing of a pressure injury for 1 of 3 residents reviewed for pressure injuries. (Resident 109)
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, record review, and interview, the facility failed to implement seizure precautions for 1 of 2 residents reviewed for accidents. (Resident 41)
- D
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Inspectors wroteBased on record review and interview, the facility failed to implement approaches to maintain a Quality Assurance and Performance Improvement (QAPI) program activities to prevent repeat deficiencies identified during a revisit to the annual survey.
- D
Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently implement facility policy for enhanced barrier precautions for staff to identify those residents requiring enhanced barrier precautions for 1 of 3 residents reviewed for enhanced barrier precautions. (Resident 21)
March 12, 2025Complaint inspection · 1 citation
- D
Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation and interview, the facility failed to maintain appropriate infection control practices during urinary catheter care for 1 of 1 residents reviewed for Enhanced Barrier Precautions. (Resident D)
August 5, 2024Standard inspection · 0 citations
March 21, 2024Complaint inspection · 2 citations
- D
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide palatable food to 23 residents in the main dining room during meal service.
- D
Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation and interview, the facility failed to maintain infection control practices while serving food to 23 residents in the main dining room, in accordance with facility policy for meal service.
January 25, 2024Complaint inspection · 4 citations
- D
Allow residents to self-administer drugs if determined clinically appropriate.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents were assessed to determine ability to self-administer medications prior to self-administering for 2 of 3 residents observed during random observations. (Resident E and Resident D)
- D
Provide safe and appropriate respiratory care for a resident when needed.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident was supervised per facility policy during a nebulizer treatment for 1 of 1 resident randomly observed for respiratory treatment during a medication administration observation. (Resident H)
- D
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Inspectors wroteBased on record review and interview, the facility failed to administer medications per physician's order for 2 of 2 residents reviewed for following physicians' orders for narcotics. (Resident F and Resident J)
- D
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Inspectors wroteBased on observation and interview, the facility failed to ensure resident's topical medication was stored securely for 2 of 2 random observations.
June 30, 2023Standard inspection · 3 citations
- E
Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide physician-ordered enhanced barrier precautions (EBP) for 3 of 6 residents reviewed for transmissions-based precautions (Resident 3, Resident 37, and Resident 95).
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure adequate supervision was provided and individualized interventions were implemented to prevent falls for 1 of 2 residents reviewed for falls (Resident 16).
- D
Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.
Inspectors wroteBased on interview and record review, the facility failed to ensure the physician was notified of a significant weight loss for 2 of 3 residents reviewed for nutrition (Resident 30 and Resident 31).
Fire safety inspections
42 fire safety citations on file: 16 on May 22, 2025, 19 on August 5, 2024, 7 on June 30, 2023.
Every fire safety citation42 citations
- F
Implement emergency and standby power systems.
E 41 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Have approved installation, maintenance and testing program for fire alarm systems.
K 345 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Have simulated fire drills held at unexpected times.
K 712 · May 22, 2025 · Corrected (the home has a date of correction)
- F
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
K 761 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Have a battery powered remote alarm panel in a location accessible by operating personnel.
K 916 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Ensure that testing and maintenance of electrical equipment is performed.
K 921 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Keep aisles, corridors, and exits free of obstruction in case of emergency.
K 211 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Have exits that are accessible at all times.
K 271 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
K 321 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Provide properly protected cooking facilities.
K 324 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Install corridor and hallway doors that block smoke.
K 363 · May 22, 2025 · Corrected (the home has a date of correction)
- E
Have properly installed electrical wiring and gas equipment.
K 511 · May 22, 2025 · Corrected (the home has a date of correction)
- C
Establish procedures for tracking staff and patients during an emergency.
E 18 · May 22, 2025 · Corrected (the home has a date of correction)
- C
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
K 346 · May 22, 2025 · Corrected (the home has a date of correction)
- C
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
K 354 · May 22, 2025 · Corrected (the home has a date of correction)
- F
Develop and maintain an Emergency Preparedness Program (EP).
E 4 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Develop Emergency Preparedness policies and procedures.
E 13 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Create arrangements with other facilities to receive patients.
E 25 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Develop a communication plan.
E 29 · August 5, 2024 · Corrected (the home has a date of correction)
- F
List the names and contact information of those in the facility.
E 30 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Establish staff and initial training requirements.
E 37 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Provide properly protected cooking facilities.
K 324 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
K 372 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
K 914 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Have a battery powered remote alarm panel in a location accessible by operating personnel.
K 916 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Have proper fire barriers, ventilation and signs for the transfilling of oxygen.
K 927 · August 5, 2024 · Corrected (the home has a date of correction)
- E
Use approved construction type or materials.
K 161 · August 5, 2024 · Corrected (the home has a date of correction)
- E
Inspect, test, and maintain automatic sprinkler systems.
K 353 · August 5, 2024 · Corrected (the home has a date of correction)
- E
Provide properly sized and located linen or trash receptacles.
K 754 · August 5, 2024 · Corrected (the home has a date of correction)
- D
Install corridor and hallway doors that block smoke.
K 363 · August 5, 2024 · Corrected (the home has a date of correction)
- C
Conduct testing and exercise requirements.
E 39 · August 5, 2024 · Corrected (the home has a date of correction)
- C
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
K 346 · August 5, 2024 · Corrected (the home has a date of correction)
- C
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
K 354 · August 5, 2024 · Corrected (the home has a date of correction)
- C
Provide a written emergency evacuation plan.
K 711 · August 5, 2024 · Corrected (the home has a date of correction)
- F
Conduct testing and exercise requirements.
E 39 · June 30, 2023 · Corrected (the home has a date of correction)
- F
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · June 30, 2023 · Corrected (the home has a date of correction)
- E
Meet other general requirements.
K 100 · June 30, 2023 · Corrected (the home has a date of correction)
- E
Install emergency lighting that can last at least 1 1/2 hours.
K 291 · June 30, 2023 · Corrected (the home has a date of correction)
- E
Meet other general requirements that are deficient.
K 300 · June 30, 2023 · Corrected (the home has a date of correction)
- E
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
K 372 · June 30, 2023 · Corrected (the home has a date of correction)
- E
Meet other general requirements that are deficient.
K 500 · June 30, 2023 · Corrected (the home has a date of correction)