| General |
| City |
| Kokomo |
Peru |
| State attribute explanation |
| In |
In |
| Street |
| 3518 S Lafountain St |
390 W Boulevard |
| Zip Code |
| 46,902 |
46,970 |
| Phone |
| 7,654,534,666 |
7,654,734,900 |
|
Overall Star Rating |
| 1 |
4 |
|
Health Inspections Star Rating |
| 1 |
4 |
|
Nurse Staffing Star Rating |
| 3 |
2 |
|
Quality Measures Star Rating |
| 2 |
3 |
|
RN Only Star Rating |
| 3 |
3 |
|
Number of Certified Beds |
| 105 |
36 |
|
Total Number of Residents |
| 50 |
34 |
|
Percent of Occupied Beds |
| 48 % |
94 % |
| Health Survey Date |
| 9/22/2011 |
2/23/2012 |
| Fire Survey Date |
| 9/29/2011 |
3/9/2012 |
| Sprinkler Status |
| Fully Sprinklered |
Fully Sprinklered |
| Program Participation |
| Medicare And Medicaid |
Medicare And Medicaid |
| Type of Ownership |
| For Profit - Corporation |
Non Profit - Corporation |
| Located Within a Hospital? |
| No |
No |
| Multi Nursing Home Ownership? |
| No |
Yes |
| Resident and Family Councils |
| Resident |
Resident |
| Continuing Care Retirement Community? |
| No |
No |
| Quality Indicator Survey? |
| No |
No |
| Special Focus Facility? |
| No |
No |
| Civil Money Penalty Count |
| 2 |
2 |
| Total Enforcement Actions Count |
| 2 |
2 |
| # of deficiencies |
| 27 |
3 |
|
| Staff Information |
| Number of Residents |
| 50 |
34 |
| Number of RN Hours Per Resident Per Day |
| 0.7 |
0.63 |
| Number of LPN/LVN Hours Per Resident Per Day |
| 0.95 |
0.63 |
| Total Number of Licensed Staff Hours Per Resident Per Day |
| 1.65 |
1.26 |
| Number of CNA Hours Per Resident Per Day |
| 0.13 |
0.03 |
| Number Therapy Hours Per Resident Per Day |
| 0.13 |
0.03 |
| Mistreatment Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 08/25/2011date Of Correction: 10/05/2011 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 08/25/2011date Of Correction: 10/05/2011 |
|
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 3deficiency: Protect Each Resident From All Abuse, Physical Punishment, And Being Separated From Others.survey Date: 08/25/2011date Of Correction: 10/05/2011 |
|
| Deficiency #4 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 04/28/2011date Of Correction: 05/06/2011 |
|
| Deficiency #5 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 04/28/2011date Of Correction: 05/06/2011 |
|
| Deficiency #6 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Deficiency #7 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Deficiency #8 |
| Scope: Fewlevel Of Harm: 2deficiency: Protect Each Resident From All Abuse, Physical Punishment, And Being Separated From Others.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Resident Rights Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 04/19/2011date Of Correction: 05/17/2011 |
Scope: Fewlevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 05/11/2010date Of Correction: 06/02/2010 |
| Deficiency #2 |
| Scope: Somelevel Of Harm: 2deficiency: Reasonably Accommodate The Needs And Preferences Of Each Resident.survey Date: 03/07/2011date Of Correction: 04/06/2011 |
|
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 03/07/2011date Of Correction: 05/17/2011 |
|
| Deficiency #4 |
| Scope: Fewlevel Of Harm: 2deficiency: Help And Prepare Each Resident For A Safe And Easy Discharge And Transfer From The Nursing Home.survey Date: 11/29/2010date Of Correction: 01/21/2011 |
|
| Deficiency #5 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Written Records When A Resident Is Transferred Or Discharged.survey Date: 11/29/2010date Of Correction: 01/21/2011 |
|
| Quality Care Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Make Sure That Each Resident Gets A Nutritional And Well Balanced Diet, Unless It Is Not Possible To Do So.survey Date: 04/19/2011date Of Correction: 05/17/2011 |
Scope: Fewlevel Of Harm: 3deficiency: Properly Care For Residents Needing Special Services, Including: Injections, Colostomy, Ureostomy, Ileostomy, Tracheostomy Care, Tracheal Suctioning, Respiratory Care, Foot Care, And Prostheses.survey Date: 05/11/2010date Of Correction: 06/02/2010 |
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 04/19/2011date Of Correction: 05/17/2011 |
Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 05/11/2010date Of Correction: 06/02/2010 |
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 3deficiency: Give Each Resident Enough Fluids To Keep Them Healthy And Prevent Dehydration.survey Date: 03/07/2011date Of Correction: 04/06/2011 |
|
| Deficiency #4 |
| Scope: Fewlevel Of Harm: 3deficiency: Make Sure That Each Resident Gets A Nutritional And Well Balanced Diet, Unless It Is Not Possible To Do So.survey Date: 03/07/2011date Of Correction: 05/17/2011 |
|
| Deficiency #5 |
| Scope: Fewlevel Of Harm: 2deficiency: Make Sure Services Provided By The Nursing Facility Meet Professional Standards Of Quality.survey Date: 03/07/2011date Of Correction: 04/06/2011 |
|
| Deficiency #6 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 11/29/2010date Of Correction: 01/21/2011 |
|
| Deficiency #7 |
| Scope: Fewlevel Of Harm: 3deficiency: Make Sure That Each Resident Who Enters The Nursing Home Without A Catheter Is Not Given A Catheter, And Receive Proper Services To Prevent Urinary Tract Infections And Restore Normal Bladder Function.survey Date: 09/22/2010date Of Correction: 10/07/2010 |
|
| Deficiency #8 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 09/22/2010date Of Correction: 10/07/2010 |
|
| Deficiency #9 |
| Scope: Fewlevel Of Harm: 3deficiency: Give Residents Proper Treatment To Prevent New Bed (pressure) Sores Or Heal Existing Bed Sores.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Deficiency #10 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Medically-related Social Services To Help Each Resident Achieve The Highest Possible Quality Of Life.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Resident Assessment Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Conduct Initial And Periodic Assessments Of Each Resident's Functional Capacity.survey Date: 03/07/2011date Of Correction: 04/06/2011 |
|
| Administration Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 07/29/2010date Of Correction: 10/07/2010 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 04/09/2010date Of Correction: 04/26/2010 |
|
| Nutrition and Dietary Deficiencies |
| Deficiency #1 |
| Scope: Manylevel Of Harm: 2deficiency: Store, Cook, And Serve Food In A Safe And Clean Way.survey Date: 01/03/2011date Of Correction: 01/17/2011 |
|
| Quality Measures Q1 |
| Percent of long-stay residents who received an antipsychotic medication |
| 22 % |
|
| Percent of long-stay residents whose need for help with daily activities has increased |
| 1.50 % |
|
| Percent of long-stay residents who lose too much weight |
| 7.8 % |
|
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 5.4 % |
75.2 % |
| Percent of long-stay residents with a urinary tract infection |
| 11.8:1 |
16.7 % |
| Percent of long-stay residents who have depressive symptoms |
| 75.2 % |
19.4:1 |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
75.2 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 33.3 % |
|
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 74.6 % |
|
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 78.3 % |
|
| Percent of short-stay residents who newly received an antipsychotic medication |
| 75.2 % |
75.2 |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 3.8 % |
9.7 % |
| Quality Measures Q3 |
| Percent of long-stay residents who received an antipsychotic medication |
| 20.3 % |
27.7 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 1.1 % |
|
| Percent of long-stay residents who self-report moderate to severe pain |
| 15.3 % |
14.2 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 10.3:1 |
12.5 % |
| Percent of long-stay residents who lose too much weight |
| 9.4 / 10.4 |
7.5 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 39.2 % |
65.6 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 4 % |
1.1 % |
| Percent of long-stay residents with a urinary tract infection |
| 15.3 % |
14.6 % |
| Percent of long-stay residents who have depressive symptoms |
| 2.1 % |
14.3 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
75.2 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 2.8 % |
14.6 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 33.9 % |
|
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 77.7 % |
|
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 84 % |
|
| Percent of short-stay residents who newly received an antipsychotic medication |
| 24.6 % |
|