Based on observation, interview, and record review, the facility failed to monitor a male resident for verbal and physically aggressive behaviors, towards female residents, and alcohol consumption for 1 of 1 residents reviewed for behaviors. This resulted in resulted in 2 female residents being verbally abused and 1 female resident being physically (death) and sexually abused. (Resident B, Resident C, Resident D, Resident E) This deficient practice resulted in an Immediate Jeopardy. The Immediate Jeopardy began on, 1/28/22 at approximately 12:00 p.m., when the facility failed to implement behavior monitoring and appropriate interventions to manage the behaviors for a male resident that became aggressive toward female residents and consuming alcohol. …
F742 citations in Indiana
Quality of Life and Care Deficiencies
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Indiana cites F742 less often than its own record predicts
0.70 times the national share — cited less often here than elsewhere.
Of every deficiency written in Indiana in 2025, this is the portion that was F742.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Indiana surveyors wrote
F742 findings written in Indiana, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview, and record review, the facility failed to ensure a resident with a major mental illness was treated appropriately and failed to implement individualized interventions resulting in a physical/mental altercation between a staff member and the residents for 1 of 6 residents reviewed for mental/psychosocial services. (Resident B). Using the reasonable person concept, the resident would likely have psychological harm of chronic or recurrent fear and anxiety from how RN 5 handled the interactions with Resident B. …
Based on observation, interview and record review, the facility failed to ensure behavioral triggers were identified and assessed for 1 of 2 residents reviewed (Resident 14).Findings include: On 5/26/26 at 10:25 AM, Resident 14 was observed lying in bed. Numerous framed photographs were observed on display in Resident 14's room.In an interview, on 5/26/26 at 10:25 AM, Resident 14 indicated they felt alone due to the loss of their mother and brother. Resident 14 became tearful when showing numerous photos of their mother and brother. Resident 14 indicated their mom passed away in 2020. Resident 14 indicated they found out their brother had passed away on Thanksgiving 2023; the resident had been waiting for the brother to arrive for Thanksgiving dinner. …
The short window
Recent years
| Year | Share of Indiana citations | vs expected |
|---|---|---|
| 2023 | 0.11% | 1.01× |
| 2024 | 0.31% | 2.49× |
| 2025 | 0.08% | 0.70× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Indiana surveyors cite →
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