Aperion Care University Park

F-F812 for additional information about current kitchen findings.

See

F-F814 for additional information about current maintenance of facility waste findings.

A review of the current Quality Assurance and Improvement Program (QAPI) did not include performance improvement plans pertaining to labeling and dating items in the kitchen or maintenance of the facility dumpster.

During an interview, on 4/11/25 at 2:30 PM, the Administrator indicated he had reviewed the kitchen and waste container concerns cited last annual survey for six months as committed to in the plan of correction.

He indicated at the end of six months the concerns were closed and the Quality Assurance team moved on to different areas of concern, including the physical environment, infection control, weights and falls.

A current policy titled Quality Assurance and Improvement Program Policy, dated 10/1/23 provided by the Administrator on 4/11/24 at 2:51 PM, indicated the facility's QAPI plan should develop corrective actions to ensure the monitoring of effectiveness of performance improvement activities. The policy indicated the program should ensure the improvements are sustained.

3.1-52

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 18 155567 Department of Health & Human Services Printed: 08/29/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 155567 B. Wing 04/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

University Park Rehabilitation and Healthcare 1400 Medical Park Dr Fort Wayne, IN 46825

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 51881 potential for actual harm Based on observation, interview, and record review, the facility failed to maintain procedures to help prevent Residents Affected - Few the development and transmission of communicable diseases and infections during 3 of 3 observations.

Findings include:

1. During an observation on 04/09/25 at 09:53 AM, Licensed practical nurse (LPN) 2 placed her laptop on the mattress of Resident 23. The resident's covered foot contacted the laptop during a blood glucose measurement. LPN 2 placed the laptop and the glucometer on top of the medication cart without disinfecting

the devices. LPN 2 placed the glucometer into the drawer of the medication cart.

In an interview, on 04/09/25 at 10:05 AM, LPN 2 indicated Resident 23 was the only resident that used the glucometer.

2. During an observation, on 04/09/25 at 10:42 AM, LPN 2 had gloves on, gave an intramuscular injection, removed the gloves, but did not perform hand hygiene before touching the medication cart.

In an interview, on 04/09/25 at 10:59 AM, the Assistant Director of Nursing (ADON), indicated staff should perform hand hygiene before and after giving medications to each resident.

3. During an observation on 04/09/25 at 11:02 AM LPN 2 returned from the medication room and placed medication on the cart. LPN 2 took the pitcher of water from the cart to the ice chest and scooped new ice into the pitcher without performing hand hygiene before touching the ice scoop.

In an interview, on 04/09/25 at 11:15 AM, the Director of Nursing (DON) indicated staff should wipe down the glucometer with Super Sani-Cloth Wipes before putting the meter into a drawer. She also indicated the laptop should not have been on the bed with a resident.

A current policy, dated 6/11/24, titled Capillary Blood Sampling Devices, provided by the DON on 4/9/25 at 1:32 PM, indicated blood glucose meters are cleaned and disinfected between resident use. Use an approved disinfectant, wipe the meter clean and allow the meter to stay wet during the duration of the manufacturer's contact time. Remove gloves and wash hands.

A current policy, dated 9/11/23, titled Handwashing/ Hand Hygiene/ Gloving, provided by the DON on 4/9/25 at 1:32 PM, indicated staff should use an alcohol-based hand rub before and after direct contact with residents, before preparing or handling medications, after contact with resident's intact skin, after contact with blood and body fluid, after removing gloves, and before handling food.

A current policy, undated, titled Intramuscular Injections, provided by the DON on 4/9/25 at 1:32 PM, indicated staff should perform hand hygiene before putting on gloves. After removing gloves, staff should wash and dry hands.

3.1-18(a)(l)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 18 155567 Department of Health & Human Services Printed: 08/29/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 155567 B. Wing 04/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

University Park Rehabilitation and Healthcare 1400 Medical Park Dr Fort Wayne, IN 46825

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 45794

Residents Affected - Many Based on observation, interview and record review, the facility failed to ensure a clean and sanitary environment was maintained on 3 of 3 units observed. 65 residents resided in the facility.

Findings include:

During a facility tour, on 4/11/25 from 9:50 AM until 10:07 AM, an air vent above the 200 hall nurses' station was observed to be covered with grey clumps too numerous to count. Near the 300-hall entrance, an air vent was observed to be covered with grey clumps. An air vent near room [ROOM NUMBER], was observed to have grey clumps around the edges.

During an observation, on 4/11/25 at 11:14 AM, pencil eraser sized grey clumps too many to count were observed on the vented cover of the return air duct above the hallway near the east nurses' station. The Maintenance Director opened the cover causing clumps to fall to the counter of the nurses' station and nearby floor. The Maintenance Director pulled out the filter covering the circle shaped return air duct and revealed a covering of dust on the outside of the filter (part of the filter facing the cover). The filter was dated 3/26/25.

During an interview, on 4/11/25 at 11:17 AM, the Maintenance Director indicated the filters were changed monthly. The Maintenance Director indicated the vent covers were cleaned monthly. The Administrator indicated due to the filter's proximity to the residents' smoking area door and high traffic of the unit, the filter typically accumulated a lot of dust and debris.

A current facility policy, dated 9/11/23, indicated the facility would maintain the cleanliness of exhaust fans monthly. The policy indicated all the dust from the vents would be removed with a vacuum and an air compressor when needed.

This citation is related to Complaint IN00456775.

3.1-19(e)

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