Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

PAOLI HEALTH AND LIVING COMMUNITY

PAOLI, IN · 109 certified beds · Last Life Safety survey April 11, 2025

CMS Certification Number 155333 · first certified June 1989

Ownership

Operated by CARDON & ASSOCIATES · Government - County

No change of ownership on CMS record since January 1, 2016, when the records begin.

20
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
4
Tags cited more than once
Across separate surveys
10
Inspection & testing records
Of the citations on file

Position within IN

20 citations — more than 66% of the 507 certified nursing homes in IN. Compared within IN rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 4 citations; the earlier surveys in the window averaged 8. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (March 2026 to June 2026), and past the point by which nine in ten IN facilities have been surveyed. This facility’s last Life Safety survey was April 2025. Facilities in IN are typically surveyed 11–14 months after the last one (median 13), measured over 883 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

3 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Physical environment (health survey)

5 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 20 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IN, and nationally. Surveyors differ markedly between states, so the IN figure is the meaningful one.

This facility20IN median15National median11
Citations on file over three years, compared
MeasureCitations
This facility20
Median facility in IN15
Median facility nationally11

Survey history

Citations at each Life Safety survey
72022-0392024-0242025-04
Citations at each Life Safety survey
Survey dateCitations
March 30, 20227
February 13, 20249
April 11, 20254

Most-cited tags

Most-cited tags at this facility
K-03533K-03452K-03512K-05112K-09231K-05311K-07121K-02001
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0353Inspect, test, and maintain automatic sprinkler systems.32025-04-11
K-0345Have approved installation, maintenance and testing program for fire alarm systems.22025-04-11
K-0351Install an approved automatic sprinkler system.22024-02-13
K-0511Have properly installed electrical wiring and gas equipment.22024-02-13
K-0923Have proper medical gas storage and administration areas.12022-03-30
K-0531Have elevators that firefighters can control in the event of a fire.12024-02-13
K-0712Have simulated fire drills held at unexpected times.12024-02-13
K-0200Meet other general requirements.12024-02-13

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 9
  • Egress Deficiencies 4
  • Services Deficiencies 3
  • Miscellaneous Deficiencies 2
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies9
Egress Deficiencies4
Services Deficiencies3
Miscellaneous Deficiencies2
Gas, Vacuum, and Electrical Systems Deficiencies2

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

April 11, 2025 — 4 citations

Citations issued on April 11, 2025
TagWhat the surveyor checksStatus
K-0331Construct fire resistant interior walls.Deficient, Provider has date of correction (May 20, 2025)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (May 20, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (May 20, 2025)
K-0711Provide a written emergency evacuation plan.Deficient, Provider has date of correction (May 20, 2025)

February 13, 2024 — 9 citations

Citations issued on February 13, 2024
TagWhat the surveyor checksStatus
K-0200Meet other general requirements.Deficient, Provider has date of correction (March 21, 2024)
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.Deficient, Provider has date of correction (March 21, 2024)
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (March 21, 2024)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (March 21, 2024)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (May 9, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (March 21, 2024)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (March 21, 2024)
K-0531Have elevators that firefighters can control in the event of a fire.Deficient, Provider has date of correction (March 21, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (March 21, 2024)

March 30, 2022 — 7 citations

Citations issued on March 30, 2022
TagWhat the surveyor checksStatus
K-0271Have exits that are accessible at all times.Deficient, Provider has date of correction (June 1, 2022)
K-0341Install a fire alarm system that can be heard throughout the facility.Deficient, Provider has date of correction (June 1, 2022)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (June 1, 2022)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (June 1, 2022)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (June 1, 2022)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (June 1, 2022)
K-0927Have proper fire barriers, ventilation and signs for the transfilling of oxygen.Deficient, Provider has date of correction (June 1, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.