Hickory Creek At Winamac

Based on observation, record review, and interview , the facility failed to serve food under sanitary conditions related to dishes stored upright near the stove top, not allowing the blender pieces to air dry after washing and sanitizing between each use, the cook allowing blender pieces to touch his clothes, holding food temperatures not up to temperature before serving, storing a scoop in a food container, and the cook touching the inside of the blender blade with ungloved hands. This had the potential to affect all 24 residents who received food from the kitchen. (Main Kitchen)Findings include:1. The Initial Kitchen Tour was completed on 11/17/25 at 10:30 a.m. with the Dietary Manager (DM).Plates were observed stored upright and not covered next to the stove top. During an interview at the time of the observation, the DM indicated the plates were not stored inverted because the heating element would not work correctly if the plates were stored inverted. Plates were stored upright so that the heating element worked. The staff should keep the plates covered when they were stored.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, and interview, the facility failed to ensure an ADL (activities of daily living) Care Plan was updated to include the use of a hand splint for 1 of 2 residents reviewed for range of motion. (Resident 2)Finding includes:On 11/17/2025 at 10:50 a.m., Resident 2 was observed lying in his bed. He had an edema glove on his left hand and there was a hand splint on the bed. He indicated he wore the hand splint at night only. The resident's record was reviewed on 11/18/25 at 10:20 a.m. Diagnoses included, but were not limited to, hemiplegia (one sided paralysis) and hemiparesis (one-sided weakness) following a cerebral infarction (stroke) affecting the left side, diabetes mellitus, and hypertension. The admission Minimum Data Set assessment, dated 9/28/25, indicated the resident was cognitively intact and had hemiparesis and hemiplegia affecting the left side. A Physician's Order, dated 10/2/25, indicated to wear a resting hand splint to the left hand at bedtime. An ADL Care Plan, dated 9/22/25, indicated the resident requires assistance with ADLs…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to ensure twice weekly one-to-one activities were implemented for a cognitively impaired and dependent resident for 1 of 2 residents reviewed for activities. (Resident 11) Finding includes: On 11/17/25 at 10:03 a.m., Resident 11 was observed lying in her bed awake. On 11/17/25 at 11:29 a.m., Resident 11 was observed lying in her bed. On 11/18/25 at 12:34 p.m., Resident 11 was observed making noises while eating in the dining room, she was receiving assistance from staff at the time. After she had finished lunch, the staff assisted her to return to bed. On 11/19/25 at 11:37 a.m., Resident 11 was lying in her bed. There was a group activity going on in the dining room at the time. Resident 11's record was reviewed on 11/19/25 at 3:47 p.m. Diagnoses included, but were not limited to, cerebral palsy, moderate intellectual disabilities, legal blindness, and hearing loss. The Quarterly Minimum Data Set (MDS) assessment, dated 10/15/25, indicated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, and interview, the facility failed to ensure a resident received timely treatment for itching skin for 1 of 1 resident reviewed for non-pressure skin conditions. (Resident 8)Finding includes:On 11/17/25 at 11:51 a.m., Resident 8 was observed in bed. She was rubbing her left arm against her body and indicated she had a rash and her arm was itching. She indicated this had been ongoing for a few weeks and there was no treatment being applied. On 11/19/25 at 3:25 p.m., the resident was observed in bed again rubbing her arm against her body and indicated it was itching. The Director of Nursing (DON) was present and observed her left arm. There was a pink, slightly raised rash on her forearm. The resident indicated it had been there for several weeks and she had told the nurse about it, but was unable to identify the nurse she reported it to. The DON indicated she had not been made aware of the concern, and the rash had not been identified during a shower on the previous day. The resident's record was reviewed on 11/19/25 at 2:45 p.m. Diagnoses…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure food was prepared in form to meet the individual needs related to not making pureed food using the Pureed Food Preparation Guidelines to ensure nutritional value of food. This had the potential to affect the 2 residents who received a pureed diet.Finding includes:On 11/20/25 at 11:29 a.m., [NAME] 1 was observed making pureed foods. He started with two servings of pureed meatballs. He added six meatballs to the blender and a 3/4 cup of beef broth and blended the mixture. He then added three scoops of thickener and blended again. He tested it and indicated it was correct consistency. The cook indicated he had been doing this for a while and was aware of how much beef broth and thickener was needed. The cook then pureed two servings of broccoli. He put the broccoli in the blender and added an unmeasured amount of water from a pitcher, then added two scoops of thickener and blended again, then indicated it was the correct consistency. The cook indicated he normally put water in with vegetables when he…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure there were 8 hours of consecutive RN (Registered Nurse) coverage for 9 out of 20 days reviewed. This had the potential to affect all 27 residents in the facility. Finding includes: On 9/6/24 at 11:21 a.m., the Nursing Staff Schedules dated 8/18/24 through 9/6/24 were reviewed. There was no RN scheduled for 8/18/24, 8/20/24, 8/21/24, 8/22/24, 8/23/24, 8/27/24, 8/31/24, 9/1/24, and 9/6/24. During an interview on 9/6/24 at 11:49 a.m., the Administrator indicated there was not 8 hours of RN coverage on the above dates. 3.1-17(b)(3)

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure a sanitary kitchen related to expired foods, undated and/or unlabeled food, and foods open to air in the refrigerator and freezer. The facility also failed to ensure a cook cleaned a food thermometer probe correctly before checking temperatures of food. This had the potential to affect 27 residents who received meals prepared in the kitchen. Findings include: 1. On 9/3/24 at 10:46 a.m., during the initial kitchen tour with [NAME] 1, the following was observed: a. First refrigerator - There were 3 bags of lettuce. The best by used date was 8/27/24. - There was a sealable bag of chicken [NAME] dated 8/29/24. The use by date was 9/1/24. - There was a sealable bag that was open to air. The bag contained scrambled eggs and was dated 9/1/24. b. First freezer - There was a sealable bag with an unknown meat in the bag. There was no label on the bag that included the contents or when it was frozen. During an interview at the time of the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure food was prepared in form to meet individual needs related to not making pureed food the correct consistency. This had the potential to affect the 2 residents who received a pureed diet. Finding includes: On 9/5/24 at 11:27 a.m., [NAME] 2 was observed preparing pureed food. She indicated she was going to puree 3 servings of [NAME] Dogs (hot dog with a meat sauce). She placed 3 hot dogs with an unmeasured amount of meat sauce into the blender and blended. She poured the mixture out into a container and indicated it was finished. The cook was asked how she was sure if there were no hot dog chunks in the puree. She then proceeded to take a fork and stir up the puree. There were visible chunks of hot dog still observed. The cook then poured the mixture back into the blender and added an unmeasured amount of water to the blender and blended. She poured the mixture back into another container. She stirred the container with a fork and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure infection control practices and standards were maintained, related to staff touching pills during medication administration for 1 of 12 residents observed during medication administration. (QMA 1, QMA 2, and Resident 9) Findings include: 1. On 9/4/24 at 11:33 a.m., QMA 1 was observed preparing Resident 9's medications. She popped one tamulosin (medication to improve urination) capsule from the medication card into her hand. She then opened up the capsule with her hands and poured the medication into a cup and administered the medication. During an interview at the time, QMA 1 indicated she normally just opened up the capsules with her hands and did not wear gloves. 2. On 9/5/24 at 12:37 p.m., QMA 2 was observed preparing Resident 9's medications. She popped one tamulosin capsule from the medication card into her hand. She then opened up the capsule with her hands and poured the medication into a cup and administered the medication. During an interview at the time, QMA 2 indicated she normally wore…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.