Envive of River City

In the surveyor’s words

From the most serious findings on record at Envive of River City, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF577May 15, 2026

  Based on observation, record review, and interview, the facility failed to ensure the most recent standard survey results and plan of correction were available to view. Finding includes:On 5/14/26 at 12:15 p.m., a binder containing previous survey results was observed in the front lobby of the facility. The binder did not contain any results for recent surveys conducted by the Indiana Department of Health in 2026 other than a survey conducted by Life Safety Code.On 5/15/26 at 8:40 a.m., the DON (Director of Nursing) indicated the facility did not have a specific policy for survey results being available, they followed the state board of health regulations.410 IAC (Indiana Administrative Code) 3.1-3(b)(1)

• No harm, potential for more than minimal, widespreadF921May 15, 2026

  Based on observation and record review, the facility failed to ensure a safe, sanitary, and homelike environment for residents who resided in the facility for 3 of 3 units observed and 2 of 2 dining rooms. Baseboards, walls, door trim on resident rooms were marred or had chipped paint, floors had debris built up. (100 unit, 200 unit, 300 unit, 100 unit dining room, 200 unit dining room). Findings include: On 5/14/26 at 8:45 am the following was observed throughout the facility on all units: Walls on the unit hallways were marred and/or soiled.Baseboards on units were marred and/or soiled.Door trim around resident rooms were marred or had chipped paint.Floors on the hallways and nurses stations had debris build up in corners, around and under all heating/cooling units. […]

• No harm, potential for more than minimal, widespreadF867Jul 13, 2023

  Based on interview and record review, the facility failed to complete a Quality Assurance and Performance Improvement Program based on identification, investigation, analysis, and prevention of adverse events in the facility within the past year. The data collection form lacked sufficient detail to identify potential high-risk, high-volume, or problem-prone areas for improvement that were counted under the other category of the data collection form. Findings include: During an interview on 7/13/23 at 9:29 A.M. with the Director of Nursing (DON) and Assistant Director of Nursing (ADON), they indicated they were not aware of any Performance Improvement Projects occurring at the present time or during the past year. […]

• No harm, potential for more than minimal, widespreadF727Oct 14, 2021

  Based on record review and interview, the facility failed to provide a Director of Nursing (DON) working 3 of 3 days reviewed and failed to provided RN coverage for 8 hours or more a day. The facility lacked a RN as the Director of Nursing (DON) and the nursing schedule lacked RN coverage for at least 8 hours a day. (October 3, October 4, October 5, October 6, October 8, October 9, October 10, October 11, October 12, October 13, and October 14, 2021) Findings include: 1. On 10/12/21 at 8:30 a.m., the Acting Director of Nursing indicated she had been the Acting DON since May, 2021, when the previous DON left employment. On 10/13/21 at 4:22 p.m., the Acting DON indicated she was an LPN and was the current Acting DON. […]

• No harm, potential for more than minimal, patternF552Jan 7, 2026

  Based on interview and record review, the facility failed to obtain an informed consent (a process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment) prior to the administration of medication and a lab test. The facility administered psychotropic medications without informed consent (Resident 21, Resident 3, Resident 5, and Resident 1) and completed a serum drug screen without informed consent (Resident 21 and Resident 3).Findings include: 1. During an interview on 1/4/26 at 2:03 P.M., Resident 21 indicated that the facility gave him a drug test without his consent. They told him the blood draw was to check on the status of his diabetes. On 1/5/26 at 2:42 P.M., Resident 21's clinical record was reviewed. […]