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Complaint Investigation

Charlestown Place At New Albany

August 12, 2025 · New Albany, IN · 4915 Charlestown Rd
Citations 2
CMS Rating 1/5
Beds 158
Provider ID 155668
Healthcare Facility
Charlestown Place At New Albany
New Albany, IN  ·  View full profile →
Inspection Summary

CHARLESTOWN PLACE AT NEW ALBANY in NEW ALBANY, IN — inspection on August 12, 2025.

Found 2 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.

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Inspection Findings

FF0550
Resident Rights Deficiencies
Potential for More Than Minimal Harm

and she told him that anything with FSSA (Family and Social Services Administration) on it, the facility was allowed to open. He asked her to show him where, in the Federal Regulations, that it said they could open someone's mail without their permission.

Again, he was told that they were allowed to open any mail with FSSA on it. He was also told on 7/28/25 that he had signed for the representative to receive his information.

The only thing he had signed was a form giving permission for the representative from (name of the outside company) that helps individuals navigate the Medicaid application process to assist him with the paperwork for Medicaid. At 9:55 a.m., the resident provided the letter for the surveyor to review.

The mailing date was 7/18/25 and the letter was observed to be addressed to the resident only.The progress note, dated 7/23/25 at 3:15 p.m., indicated the Director of Social Services, Business Office Manager and Assistant Business Office Manager visited the resident in his room to present a discharge letter and transfer/discharge notice of and discharge date d of 8/23/25

Review of the admission Packet Agreement, signed by Resident H on 11/13/24, included, but was not limited to, the following Section 1: Parties to the Agreement .This admission and Consent to Treat Agreement .is made between the Resident identified above (Resident) and/or by the Resident Representative identified above on behalf of the Resident .and the Facility listed above .Resident Mail .The Resident will receive all mail unopened unless requested otherwise as indicated below .Forward all mail unopened to the Resident Representative The admission Packet Agreement lacked documentation of a resident representative listed for Resident H.On 8/11/25 at 9:55 a.m., the State Form 55386, Authorized Representative for Health Coverage was reviewed. It included, but was not limited to, If you want someone to act on your behalf in applying for benefits and/or act for you on an ongoing basis, this form must be completed. Be sure to select the function(s) that the representative is authorized to do.

You can select [NAME] than one representative and choose the same or different functions.

The representative may be an individual or an organization.

Complete ONE form per authorized representative.

Both you and your representative must sign and date this form The form was singed on 4/4/25 by Resident H and the representative from Medicaid Done Right.

The clinical record lacked documentation of any other authorized representative forms.On 8/11/25 at 10:53 a.m., the Executive Director indicated that the authorized representative form provided to surveyor was signed by the person from the (name of company) that helps individuals navigate the Medicaid process.

The facility had always opened the mail for FSSA for residents so they could scan the information and ensure timeliness of provided information to the outside company. It allowed the (name of company) the ability to follow up with any issues quickly.

They are now going to take Resident H the mail and open with him.On 8/12/25 at 1:45 p.m., the Social Services Director indicated the discharge notice was provided to the resident on 7/23/25 really for no reason.

The previous notice was overturned by the court, so we were trying to figure out how to move forward.This Citation relates to Complaint 25754913.1-3(a)3.1-3(s)(1)

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/12/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Charlestown Place at New Albany

4915 Charlestown Rd New Albany, IN 47150

SUMMARY STATEMENT OF DEFICIENCIES

Based on interview and record review, the facility failed to ensure a blood pressure medication was held for a resident (Resident K) with out of parameter blood pressures for 1 of 3 residents reviewed for quality of care.Findings Include: The clinical record for Resident K was reviewed on 8/11/25 at 2:16 p.m.

The resident's diagnosis included, but was not limited to, hypertension.The care plan, dated 6/9/25, indicated the resident had altered cardiovascular status due to hypertension and medications were to be administered as ordered by the physician.The physician's order, dated 4/5/25, indicated the resident was to receive Lisinopril (medication for high blood pressure) 10 mg (milligrams) daily in the morning.

The medication was to be held if the resident's systolic blood pressure (SBP) was less than 110.

Review of the July 2025 and August 2025 medication administration record indicated the resident received the medication on the following dates:-On 7/08/25, the Lisinopril was administered to the resident with a SBP of 100-On 7/11/25, the Lisinopril was administered to the resident with a SBP of 100-On 7/23/25, the Lisinopril was administered to the resident with a SBP of 106-On 7/28/25, the Lisinopril was administered to the resident with a SBP of 100-On 7/29/25, the Lisinopril was administered to the resident with a SBP of 104-On 8/04/25, the Lisinopril was administered to the resident with a SBP of 106-On 8/05/25, the Lisinopril was administered to the resident with a SBP of 103-On 8/06/25, the Lisinopril was administered to the resident with a SBP of 109

During an interview, on 8/12/25 at 10:30 a.m., Registered Nurse (RN) 5 indicated if a resident's blood pressure was out of parameters, the medication should not be given. On 8/12/25 at 12:44 p.m., the Executive Director provided a current, undated copy of the document titled Medication Administration. It included, but was not limited to, Medications will be administered .in accordance to applicable State, Local and Federal laws, consistent with accepted standards of practice .Obtain and record any vital signs as necessary prior to medication administration This Citation relates to Complaint 25809923.1-37

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in NEW ALBANY, IN, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CHARLESTOWN PLACE AT NEW ALBANY or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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