Countryside Meadows
COUNTRYSIDE MEADOWS in AVON, IN — inspection on August 1, 2024.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
During an interview on [DATE] at 2:00 p.m., the Director of Nursing (DON) indicated the facility did not have a policy or procedure related to lab services/STAT lab services.
On [DATE] at 1:33 p.m., the Senior [NAME] President (SVP) of Customer Service for the contracted Lab Service company provided a copy of the Lab's timeline of events for the Resident F's STAT lab order as follows:
a.
Order for STAT labs was received on [DATE] at 2:54 p.m.
b. On [DATE] at 7:03 p.m., a Lab Associate called the facility to notify them, a Lab Technician would not be available until the next morning and made a note, nurse didn't answer page.
155792
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 155792 B.
Wing 08/01/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Countryside Meadows 762 N Dan Jones Rd Avon, IN 46123
F-F684.
This citation relates to Complaint IN00438111.
3.1-4(l)(4)
155792
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 155792 B.
Wing 08/01/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Countryside Meadows 762 N Dan Jones Rd Avon, IN 46123
During the care plan meeting, the guardian was informed, her brother had been asked and signed a DNR form and Resident E's overall treatment plan and goals had been changed to palliative care without her knowledge or consent.
The guardian indicated no one was authorized to sign off, and/or make treatment changes or decisions about Resident E's care.
During an interview on 8/1/24 at 12:58 p.m., Resident E's son indicated his sister was Resident E's guardian, but she lived out of state. So he was often asked to visit Resident E on her behalf to check on his condition. He indicated there was some confusion on the part of the facility and Resident E's DNR was presented to him under the assumption that his dementia had gotten worse and that he was at the end of his life, basically, he was getting ready to pass.
Resident E's son indicated the NP brought him a DNR form and said it was OK for him to sign it.
Resident E's son indicated the form was presented to him as already approved by the guardian.
On 7/31/24 at 10:00 a.m., Resident E's medical record was reviewed. He was a long-term care resident who resided on the secured memory care unit with diagnoses which included, but were not limited to, Parkinson's disease (a chronic, progressive brain disorder that affects the body's motor and non-motor systems), Alzheimer's disease (a degenerative brain disease which affects memory and cognition), peripheral vascular disease (a progressive disorder that occurs when blood vessels outside of the heart or brain narrow, block, or spasm), and atherosclerosis (the thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery).
155792
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 155792 B.
Wing 08/01/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Countryside Meadows 762 N Dan Jones Rd Avon, IN 46123