St Augustine Home for the Aged

In the surveyor’s words

From the most serious findings on record at St Augustine Home for the Aged, in the surveyor’s own words.

• Actual harm, isolatedF689Jan 12, 2022

  Based on interview and record review, the facility failed to prevent a fall by not using the correct amount of staff as indicated in the resident's Minimum Data Set (MDS) assessment (medical data information used for understanding individual resident's needs and abilities) and allowing Certified Nursing Assistants to assess residents abilities related to physical transfers for 1 of 3 resident's reviewed for falls with injuries. (Resident B) This resulted in harm when Resident B had a fall and sustained a fracture to the residents right wrist. Finding includes: The record for Resident B was reviewed on 1/11/22 at 12:10 p.m. […]

• No harm, potential for more than minimal, widespreadF837Jul 1, 2022

  Based on interview and record review, the facility failed to employ a licensed facility Administrator for the period of February 2022 through the exit date of the survey, July 1, 2022. This deficient practice had the potential to affect 25 of 25 residents residing in the facility. Finding includes: During an interview, on 07/01/2022 at 3:43 p.m., the Mother of the facility indicated the previous Administrator had been terminated the end of February 2022 and the facility had been without an Administrator since. Mother indicated she was licensed in two other states, but not Indiana. She had applied to the Indiana Professional Licensing (IPL) board to transfer her license to the state of Indiana at the end of April but had not heard back. […]

• No harm, potential for more than minimal, isolatedF644Jul 2, 2025

  Based on interview and record review, the facility failed to ensure a new Preadmission Screening and Resident Review (PASARR) was completed after an increase of an antipsychotic medication secondary to continued and increased behaviors for 1 of 1 resident reviewed for PASARR. (Resident 2) Findings include: The clinical record for Resident 2 was reviewed on 6/27/25 at 1:32 p.m. The diagnoses included, but were not limited to, anxiety disorder, major depressive disorder, and dementia with moderate psychotic disturbances. A Level I PASARR, dated 4/28/25, indicated Resident 2 did not currently have a known or suspected developmental condition or diagnosis that affects intellectual and/or adaptive functioning. […]

• No harm, potential for more than minimal, isolatedF684Jul 2, 2025

  Based on interview and record review, the facility failed to ensure a medication was held according to the physician's order for 1 of 1 resident reviewed for quality of care. (Resident 8) Findings include: The clinical record for Resident 8 was reviewed on 6/27/25 at 10:48 a.m. The diagnoses included, but were not limited to, congestive heart failure, atrial fibrillation, and type 2 diabetes. A physician's order, dated 12/20/23, indicated to give metoprolol (a medication to reduce blood pressure) 12.5 milligrams (mg) by mouth 2 times per day with instruction to hold the medication for a systolic blood pressure less than 110 or a heart rate less than 55. […]

• No harm, potential for more than minimal, isolatedF761Jul 2, 2025

  Based on observation, interview and record review, the facility failed to ensure medications were dated after the medication was opened, expired blood glucose control solution was disposed of, and chemicals were properly stored for 1 of 1 medication cart and 1 of 1 medication storage room reviewed for medication storage. Findings include: 1. The medication cart was reviewed, on 6/27/25 at 9:00 a.m., and the following were observed: a. In the large top drawer of the medication cart, brimonidine tartrate ophthalmic solution (eye drops) had been opened and the bottle did not include an open date. Dorzolamide/Timolol ophthalmic solution (eye drops) had been opened, and the bottle did not include an open date. b. […]