Every finding on record at Miller's Merry Manor

Based on observation, interview and record review, the facility failed to follow appropriate sanitation guidelines while serving food in 1 of 2 dining rooms affecting 15 of 19 residents who consumed food in the Memory Care dining room. Finding includes:During a continuous observation in the Memory Care unit, on 6/4/2026 from 11:14 A.M. until 11:39 A.M., the following was observed during meal service.-CNA 4 was observed with her hand over the top of the glassware and with her thumb over the rim of the dinnerware plates three times during the meal service.-CNA 4 took a dinner roll from a plastic bag with her bare hands and placed the dinner roll on a resident's plate. During a continuous observation in the Memory Care unit, on 6/5/2026 from 11:03 A.M. to 11:27 A.M., the following was observed during meal service. -CNA 4 was observed with her hand over the top of the drinkware once and with her thumb over the rim of the dinnerware plate twice.-CNA 2 was observed with her hand over the top of the drinkware twice, with her thumb over the rim of the dinnerware plate twice and placing her thumb inside a salad bowl once. During an interview, on 6/10/2026 at 9:29 A.M., CNA 2 indicated she had received training on proper serving of meals. She indicated the thumb should not have been over the rim of the plates or salad bowl and the drinkware should not have been served with her hands over the top of the cup. A policy was requested for meal services. The Executive Director, on 6/10/2026 at 11:13 A.M., indicated the facility did not have a policy regarding serving meal services, but rather a competency. A Competency was provided by the Executive Director, on 6/10/2026 at 11:40 A.M. The competency, titled, Staff Competency for Hand Hygiene During Dining, indicated, .While serving residents, staff is careful not to touch surface of plate, inside bowls, surface of utensils, rims of cups and glasses and serving trays are handled appropriately. 410 IAC (Indiana Administrative Code) 3.1-21(i)(3)

Based on observation, interview and record review, the facility failed to ensure infection control practices were being followed for residents in Enhanced Barrier Precautions for 2 of 17 residents observed. (Resident 18 & 50) The facility also failed to ensure eye drops were administered in a sanitary manner according to professional and policy standards for 1 of 1 residents observed receiving eye drops. (Resident 40) Findings include: 1. During an observation of Resident 18's room door on 6/5/2026 at 11:38 A.M., a sign had been hanging on the outside of the door indicating the resident was in Enhanced Barrier Precautions (EBP) and Personal Protective Equipment (PPE) was needed for any close contact care for the resident. The signage indicated staff members were required to wear gloves and a gown for close contact care. During the observation, CNA 6 had been assisting Resident 18 with a transfer using a mechanical lift wearing gloves, but had not been wearing a gown. During an interview with Resident 18 on 6/5/2026 at 11:44 A.M., Resident 18 indicated CNA 6 had not been wearing a gown while transferring him. Resident 18 indicated that no staff had ever worn a gown when they had been assisted him with his transfers and did not know the staff should have been wearing gowns. Resident 18's record review was completed on 6/5/2026 at 2:00 P.M. Diagnoses included, but were not limit to: cerebral infarction due to occlusion or stenosis of unspecified carotid artery, prostatic hyperplasia, major depressive disorder, morbid obesity and muscle wasting and atrophy. A current Physician's order, dated 4/22/2026 indicated resident was in Enhanced Barrier Precautions during high contactresident care related to having a indwelling catheter. A current Care Plan, initiated on 6/17/2024, indicated Resident 18 had required enhanced barrier precautions during high contact care. Two current interventions, initiated on 6/17/2024, indicated PPE equipment would be available, and staff would place a sign on the door to communicate EBP to all staff and visitors. A review of the Report Sheet that CNA 6 used to identify which residents were in EBP was completed on 6/10/2026 at 10:00 A.M. The Report Sheet indicated Resident 18 had been been marked for Enhanced Barrier Precautions. 2. During an observation on 6/5/2026 at 11:59 A.M., a sign had been hanging on the outside of the door indicating the resident was in Enhanced Barrier Precautions (EBP) and Personal Protective Equipment (PPE) was needed for any close contact care for the resident. The signage indicated staff members were required to wear gloves and a gown for close contact care. CNA 6 had been assisting Resident 50 with a transfer while wearing gloves, but had not been wearing a gown. During an interview on 6/5/2026 at 12:07 P.M., Resident 50 indicated he had been assisted by only CNA 6 just now during his transfer and CNA 6 had worn gloves, but had not worn a gown. Resident 50 indicated he had been in the facility for two years and staff had never wore a gown when transferring him and had been unsure why staff would wear a gown while providing care. Resident 50's record review was completed on 6/9/2026 at 10:30 A.M. Diagnoses included, but were not limited to: diabetes mellitus, atrial fibrillation, chronic obstructive pulmonary disease, chronic respiratory failure and morbid obesity. A Quarterly Minimum Data Set (MDS) completed on 5/14/2026 indicated Resident 50 had adequate hearing, clear speech, had been able to make himself understood and had been able to understand others. Resident 50 had intact cognition and had been dependent on staff for all transfers. A current Physician's order, dated 6/8/2026, indicated Resident 50 required Enhanced Barrier Precautions related to having a wound. A current Care Plan, initiated on 11/15/2023, indicated Resident 18 had required enhanced barrier precautions during high contact care related to a wound. Two current interventions, initiated on 11/15/2023, indicated PPE equipment would be available, and staff would place a sign on the door to communicate EBP to all staff and visitors. During an interview with CNA 6 on 6/9/2026 at 1:45 P.M., CNA 6 indicated he had been unable to recall if he had worn PPE on 6/5/2026 while assisting Residents 18 and 50 before lunch. CNA 6 indicated if a resident's door had a sign indicating the resident was in EBP, then any listed PPE on the sign should be used when transferring a resident with a mechanical lift. A review of the Report Sheet that CNA 6 used to identify EBP was completed on 6/10/2026 at 10:00 A.M. The Report Sheet indicated Resident 50 had not been marked for Enhanced Barrier Precautions. 3. During an observation of eye drop administration with RN 3, on 6/8/2026 at 9:54 A.M., staff failed to perform hand hygiene and apply gloves prior to administering eye drops to resident 46. During an interview at 6/8/2026 at 9:55 A.M., RN 3 acknowledged she should have washed her hands and put on gloves prior to administering the eye drops to Resident 46. On 6/9/2026 at 2:00 P.M., the Executive Director provided a policy dated 5/3/2026, and titled, Enhanced Precautions for novel and targeted MDROS. The ED identified the policy as the policy currently used by the facility. The policy indicated, .Procedure: Residents with wounds or indwelling devices and residents infected or colonized with a multidrug resistant organism will be cared for by staff using a gown and gloves during high contact resident care . Examples of high contact resident care included, but are not limited to: . 3. Transferring An undated policy titled Eye Drops and Eye Ointment Procedure was provided by the DON on 6/10/2026 at 11:40 A.M. The policy indicated.16. Perform hand hygiene and put on gloves. 410 Indiana Administrative Code 16.2-3.1-18(a)

Based on observation, interview and record review, the facility failed to transfer residents with the appropriate amount of staff while using a mechanical lift for 2 of 3 residents reviewed. (Residents 50 and 6) Findings include:During an observation on 6/5/2026 at 11:59 A.M., Resident 50 was elevated in the air above his wheelchair while seated in a mechanical lift sling that was being operated by CNA 6. There was no other staff member present during the transfer. During an interview on 6/5/2026 at 12:05 P.M., CNA 6 indicated he had transferred Resident 50 without any assistance. During an interview on 6/5/2026 at 12:07 P.M., Resident 50 indicated he had been assisted, by only CNA 6, during his transfer. Resident 50 indicated he believed two staff members were required to use the mechanical lift when transferring him, but he was not sure because sometimes two staff members transferred him with the mechanical lift and sometimes only one staff member used the mechanical lift to transfer him.During an observation and interview, on 6/8/2026 at 10:45 A.M., QMA 7 arrived to assist Resident 50 to the bathroom and informed the resident he would come back in a few minutes. At 10:49 A.M., QMA 7 was observed entering Resident 50's room with the mechanical lift and no other staff. At 11:03 A.M. QMA 7 left Resident 50's room with the mechanical lift alone by himself.During an interview on 6/8/2026 at 10:50 A.M., Resident 50 indicated QMA 7 had just transferred him using the mechanical lift without the assistance of a second staff member. During an interview on 6/8/2026 at 2:36 P.M., QMA 7 indicated he had used the mechanical lift to transfer Resident 50 alone around 11:00 A.M. that morning. QMA 7 indicated Resident 50 required the assistance of one staff member for mechanical lift transfers. QMA 7 indicated he used a Report Sheet to identify how residents were to be transferred. QMA 7 referred to his Report Sheet and indicated Resident 50 was supposed to receive the assistance of one per his Report Sheet.On 6/8/2026 at 2:37 P.M, a copy of QMA 7's report sheet was requested. During an interview with the Director of Nursing (DON,) on 6/8/2026 at 2:50 P.M., she indicated the reason QMA 7 had believed Resident 50 was an assistance of one during a mechanical lift transfer was because the Report Sheet had not contained the number of staff required for transfer assistance and QMA 7 had not seen the note indicating the resident should be transferred with the mechanical lift and the assistance of two staff members. A review of QMA 7's report sheet was completed on 6/9/2026 at 8:45 A.M. The Report Sheet indicated Resident 50 had been marked for transfer with a mechanical lift but did not have the number of people required to assist the resident listed on the space to indicated if 1 or 2 (staff) box. However, in the notes section of the Report Sheet, Resident 50 had been noted to have required assistance of two staff members during mechanical lift transfers for maneuvering and positioning of lower extremities to reduce the risk of incidental contact with lift equipment. Resident 50's record review was completed on 6/9/2026 at 10:30 A.M. Diagnoses included, but were not limited to: diabetes mellitus, atrial fibrillation, chronic obstructive pulmonary disease, chronic respiratory failure and morbid obesity.A Quarterly Minimum Data Set (MDS) dated [DATE] indicated Resident 50 had adequate hearing, clear speech, had been able to make himself understood and was able to understand others. Resident 50 had intact cognition and was dependent on staff for all transfers.A current Care Plan, initiated on 9/21/2023, indicated Resident 50 needed assistance with activities of daily living due to requiring substantial assistance with bed mobility and dependence of staff for assistance for transfers. An intervention, initiated on 2/27/2026, indicated Resident 50 required the assistance of two staff members when transferring with the mechanical lift.A Nursing-Occurrence Initial Assessment note, completed on 3/4/2026, indicated Resident 50 had been found to have a three centimeter (cm) by four cm bruise on his left inner ankle. Resident 50 had been unable to state how he obtained the bruise. A Facility-Post Occurrence Interdisciplinary Team (IDT) & Fall Risk assessment note, dated 3/4/2026 and signed on 3/5/2026, indicated the root cause of the bruise had been found to be consistent with possible contact with the mechanical lift during transfers. The IDT had recommended staff utilize two staff during mechanical lift transfers to assist with with maneuvering and positioning lower extremities and to reduce the risk of incidental contact with lift equipment. The note indicated Utilize two staff during mechanical lift transfers to assist with maneuvering and positioning lower extremities and to reduce the risk of incidental contact with lift equipment.During an interview with QMA 7 on 6/10/2026 at 9:40 A.M., QMA 7 indicated he should not have moved Resident 50 without a second staff member present and had not seen the note on the Report Sheet indicating Resident 50 required the assistance of two staff members for transfers with the mechanical lift. 2. During an observation on 6/5/2026 at 12:42 P.M., CNA 7 was noted exiting Resident 6's room pushing a mechanical lift.During an interview on 6/5/2026 at 12:43 P.M., CNA 7 indicated she had used the mechanical lift to transfer Resident 6 by herself. A review of the Report Sheet was completed on 6/9/2026 at 8:45 A.M. The Report Sheet indicated Resident 6 required a mechanical lift for transfers and two staff members were required during transfers.Resident 6's record review was completed on 6/9/2026 at 10:00 A.M. Diagnoses included, but were not limited to: dementia with behavioral disturbances, type 2 diabetes mellitus, dysphagia, hemiplegia affecting left nondominant side, anxiety, cognitive communication deficit and major depressive disorder. A Quarterly MDS assessment, completed on 5/7/2026, indicated Resident 6 had unclear speech, was able to make herself understood, understood others and had severe cognitive impairment. Resident 6 hallucinated, had not rejected care and was dependent on the staff for all transfers. A current Physician's order, dated 9/30/2025, indicated Resident 6 required a mechanical lift for all transfers.A current Care Plan, initiated on 9/21/2023 and revised on 3/13/2026, indicated Resident 6 had been dependent on staff for assistance with all transfers. An intervention initiated, on 2/27/2026, indicated Resident 6 required to be transferred by two staff members with the mechanical lift. During an interview with the Executive Director (ED) on 6/10/2026 at 8:25 A.M. he indicated the facility did not have a policy related to following the plan of care. On 6/9/2026 at 9:00 A.M. the DON provided a policy dated 11/10/2016 and titled, Joerns Hoyer Stature Lift Policy, and identified the policy as the one currently used by the facility. The policy indicated, To safely transfer a resident from one surface to another via use of a mechanical lift. The Hoyer Stature lift may safely be used by one staff member if the the resident can follow instructions or is cooperative with the transfer. If in doubt, a second staff member should be present during the transfer. 410 Indiana Administrative Code 16.2-3.1-(a)(2)

Based on interview, record review and interview, the facility failed to provide a bowel movement protocol to prevent symptoms of constipation for 1 of 2 residents reviewed for constipation. (Resident 61) Finding includes:During an interview, on 6/4/2026 at 2:16 P.M., Resident 61 complained she struggled with constipation issues due to her multiple sclerosis diagnoses. She indicated she had not received treatment for her constipation.A record review was completed for Resident 61, on 6/10/2026 at 1:25 P.M. Diagnoses included, but were not limited to: multiple sclerosis, spastic paraplegia, chronic idiopathic constipation and irritable bowel syndrome.A Quarterly Minimum Data Set (MDS) assessment, dated 3/19/2026, indicated Resident 61 was cognitively intact, was always incontinent of her bowels and was dependent on staff for toileting hygiene.Physician Order's for Resident 61 included the following medications:- initiated 12/16/2025, Fleet Rectal Enema, insert 1 applicatorful rectally every 24 hours as needed for constipation.- initiated 12/10/2025, Milk of Magnesia Suspension 400 milligrams per 5 milliliters, give 30 milliliters by mouth every 24 hours as needed for constipation.-initiated 1/29/2026, sennosides tablet 8.6 milligrams, give two tablets by mouth two times a day for constipation.-initiated 6/4/2026, Polyethylene Glycol 3350 Powder, give 17 grams by mouth daily and every 24 hours as needed for constipation in 4 ounces of fluid of choice.-initiated 6/8/2026, Dulcolax Rectal Suppository 10 milligrams, insert one suppository rectally every three days in the evening and every 24 hours as needed for constipation.A Bowel Movement Record for Resident 61, from May 22, 2026 through May 30, 2026, indicated the following bowel movements.-5/22/2026 a large bowel movement.-5/28/2026 a small bowel movement.-5/30/2026 a large bowel movement.A Medication Administration Record, dated May 2026, indicated the routine bowel medications had been administered and the following as needed medication had been administered.-5/28/2026 at 1:23 P.M., Polyethylene Glycol 3350 Powder 17 grams and was effective.-5/28/2026 at 4:18 A.M., Milk of Magnesia Suspension 400 milligrams per 5 milliliters, 30 milliliters and was effective.-5/30/2026 at 9:02 A.M., Dulcolax Rectal Suppository 10 milligrams and was effective.A Care Plan, initiated on 12/10/2025, indicated Resident 61 had the potential for constipation related to decreased mobility. The goal was for Resident 61 to have a comfortable and regular bowel movement every one to three days. Interventions included, but were not limited to the following: administer laxatives and/or stool softeners as ordered, encourage fluid intake and record bowel movement size.During an interview, on 6/10/2026 at 9:52 A.M., RN 3 indicated a resident should have a bowel intervention daily after three days without a bowel movement until a bowel movement had occurred and a small bowel movement would not have been considered successful bowel movement.There was no documentation regarding why the ordered bowel interventions, including medications, had not been administered until 5 days after Resident 61 had had a countable bowel movement. Thus, Resident 61 went eight days from 5/22/2026 until 5/30/2026 without a countable bowel movement and five days without a successful and timely interventions.A current policy was provided by the Executive Director, on 6/10/2026 at 11:26 P.M. The policy titled, Bowel Elimination, indicated, .A. Purpose: To ensure that each resident maintains a safe and healthy bowel elimination pattern.B. Procedure.2. If resident complains of constipation, or at least on the 3rd day with no bowel movement, an ordered bowel aide or stool softener will be administered. 3. If within 8 hours of administering the bowel aide or softener, the resident has not had a bowel movement, another bowel aide will be administered. 4. If within another 8 hours the resident has not had a bowel movement, the nurse will do an abdominal assessment, and notify the Physician. Any orders given will be carried out. 410 IAC (Indiana Administrative Code) 3.1-37(a)

Based on observation, interview, and record review, the facility failed to develop a comprehensive care plan related to edema and vision for 3 of 18 residents whose care plans were reviewed. (Residents 42, 7, and 78) Findings include: 1. During an observation on 6/5/2026 at 9:53 A.M., ace wraps (elastic bandages) were noted on both of Resident 42's legs. She was unable to indicate the reason for the wraps. A record review for Resident 42 was completed on 6/5/2026. Diagnoses included, but were not limited to, unspecified heart failure and peripheral vascular disease. A Quarterly Minimum Data Set (MDS) assessment, completed on 3/27/2026, indicated Resident 42 received a diuretic. medication. Physician Orders included, but were not limited to, ace wraps were to be applied to both lower legs in the morning and removed at night, initiated on 6/4/2026 and furosemide (a diuretic medication) 20 milligrams (mg), 2 tablets were to be given by mouth one time a day for edema. Resident 42's current Care Plan did not address edema. During an interview, on 6/8/2026 at 2:15 P.M., the Minimum Data Set Coordinator indicated there was not a care plan initiated to address Resident 42s edema and the use of the ace wraps to her legs. 2. During an interview, on 6/5/2026 at 9:47 A.M., Resident 7 indicated, My vision sucks. He indicated he was unsure if his power of attorney had consented for him to be seen by optometry services. A record review for Resident 7 was completed on 6/8/2026 at 8:47 A.M. Diagnoses included, but were not limited to: nontraumatic intracranial hemorrhage, vascular dementia, diabetes mellitus type 2 and seizures. A Quarterly Minimum Data Set (MDS) assessment, dated 3/12/2026, indicated Resident 7 was cognitively intact and had impaired vision and did not wear corrective lenses. A Social Service Assessment, dated 12/11/2025, indicated Resident 7's power of attorney had declined optometry services and Resident 7 had been able to read his menu in the dining room and would often write notes on the offered menu. A Social Service Assessment, dated 3/12/2026, indicated Resident 7's power of attorney had again declined optometry services even though Resident 7 had been struggling to read his menu in the dining room, but would still sometimes write notes on the offered menu. A Care Plan for Resident 7's visual decline and impairment could not be located in Resident 7's medical record. During an interview, on 6/10/2026 at 10:39 A.M., the Social Service Director (SSD) indicated Resident 7 could have used a magnifying glass to enhance his vision while attempting to read the menu. The SSD indicated his visual difficulties should have been care planned and interventions put in place to assist the resident with his vision issues. 3. During observations, on 6/4/2026 at 11:28 A.M., 6/5/2026 at 9:58 A.M., and 6/5/2026 at 1:43 P.M., Resident 78 was observed without corrective lenses (glasses). A record review for Resident 78 was completed, on 6/8/2026 at 11:56 A.M. Diagnoses included, but were not limited to: dementia, Parkinson's disease and encephalopathy. An admission MDS, dated [DATE], indicated Resident 78 had severe cognitive impairment and had adequate vision with corrective lenses. A Social Service Assessment, dated 5/18/2026, indicated Resident 78 was able to read normal size print with her glasses. A Care Plan for Resident 78's visual impairment could not be located in Resident 78's medical record. During an interview, on 6/10/2026 at 9:27 A.M., CNA 2 indicated Resident 78 should have been wearing her glasses daily. During an interview, on 6/10/2026 at 10:39 A.M., the Social Service Director (SSD) indicated the visual aids should have been care planned. A current policy was provided by the Executive Director, on 6/10/2026 at 9:11 A.M. The policy titled, Care Plan Development & Review, indicated, .To assure that a comprehensive care plan for each resident includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment process. To assure that the care plan is communicated effectively to the staff and responsible party.C. The comprehensive care plan is designed to: I. Address needs, strengths and preferences that are identified in the comprehensive assessment. II. Identify and incorporate risk factors associated with identified focuses.iv Reflect treatment goals and objectives in measurable outcomes.VII. Show evidence of efforts to find alternative means to address problems when resident is refusing treatment. 410 IAC (Indiana Administrative Code) 3.1-35(b)(1)

Based on observation, interview and record review, the facility failed to ensure a resident was free from involuntary seclusion by placing a resident in unnecessary Contact/Droplet Isolation for 1 of 17 residents observed. (Resident 17)Finding includes: During an observation of Resident 80's room door on 6/5/2026 at 9:58 A.M., a sign had been hanging on the outside of the door indicating the resident was in Contact/Droplet Isolation. The signage indicated staff members were required to wear a mask, a face shield, gloves and a gown when entering the room. During an interview on 6/5/2026 at 10:00 A.M., CNA 9 indicated he was not sure why Resident 80 was in isolation. On 6/5/2026 at 10:02 A.M., CNA 9 indicated the nurse responsible for Resident 80 indicated the resident had ben placed in isolation on June 1, 2026 for aspiration pneumonia. CNA 9 indicated anyone entering the room was supposed to put on a mask, face shield, gown and gloves. During an interview on 6/5/2026 at 10:01 A.M., Resident 80 indicated he was in isolation because he had aspiration pneumonia. Resident 80 indicated he needed to stay in his room except for when he went for a walk with therapy. Resident 80 indicated he had not been asked to wear a mask when he went outside of his room for therapy. Resident 80's record review was completed on 6/9/2026 at 1:00 P.M. Diagnoses included but were not limited to: pneumonia, stage three chronic kidney disease and spinal stenosis. A Physician's order, initiated on 6/1/2026 and discontinued on 6/10/2026, indicated Resident 80 required Droplet Isolation and was to be in a single room and not allowed to leave room. A stop sign was to have been placed on the door and all services should have been provided in the resident's room. During an interview with the Infection Prevention Nurse (IP) on 6/9/2026 at 1:30 P.M., the IP nurse indicated it was the practice of the facility to place residents with any type of pneumonia in Contact/Droplet Isolation. During an interview on 6/10/2026 at 9:00 A.M., the DON indicated the Regional IP had been supplied incorrect information regarding pneumonia and isolation and had shared the incorrect information with the facility's IP nurse. The DON indicated the facility followed the recommendations of the Center for Disease Control and Prevention (CDC) for isolation requirements and the facility confirmed through the CDC's website that no isolation was required for pneumonia. The DON indicated the order for Contact/Droplet Isolation had been cancelled that morning and Resident 80 should not have been placed in isolation on 6/1/2026. 410 Indiana Administrative Code 16.2-3.1-27(1)(4)

Based on record review and interviews, the facility failed to notify the physician of the unavailability of a medication for 1 of 5 residents reviewed for unnecessary medications. (Resident 3)Findings include: A record review for Resident 3 was completed on 6/8/2026 at 9:27 A.M. Diagnoses included, but were not limited to, enterocolitis due to Clostridium difficile (C. diff. a bacterium that causes severe inflammation of the colon and watery diarrhea). A Significant Change Minimum Data Set (MDS) assessment, dated 3/14/2026, indicated Resident 2's cognition was intact, he was frequently incontinent of his bowels and was receiving an antibiotic medication. Physician Orders included, but were not limited to, Vancomycin 125 milligrams (mg) one capsule by mouth one time a day every 3 days for Clostridium difficile until 07/15/2026. Resident 3 was also taking a probiotic, Saccharomyces boutardii 250 mg by mouth twice a day to improve gut bacteria.A Care Plan Problem, initiated on 4/17/2026, indicated Resident 3 had a diagnosis of Clostridium difficile with an intervention to administer medications as ordered.Review of the Medication Administration Record for May and June 2026 indicated the Saccharomyces boulardii was unavailable from 5/9/2025 to 6/7/2026, when it was discontinued. Nursing Progress Notes during this time indicated the resident's daughter was going to provide the medication until it had arrived from the Veterans Administration. The physician was not notified that the medication had not been available until 5/28/2026 at 7:58 A.M.During an interview on 6/8/2026 at 2:00 P.M., LPN 5 indicated if a medication was unavailable, she checked the emergency supply then called the pharmacy for a stat (immediate) delivery and then notified the physician.During an interview on 6/9/2026 at 10:14 A.M., the DON indicated the physician should have been notified as soon as staff noted the medication was unavailable on 5/9/2026.A current policy, date 4/24/2026 and titled, Unavailable Medications was provided on 6/5/2026 at 3:12 P.M. by the ED. The policy indicated, .Notify the physician of the situation and explain the circumstances, expected availability, and optional therapies that are available.410 IAC (Indiana Administrative Code) 3.1-5(a)(3)

Based on record review and interview, the facility failed to follow physician orders for daily weights and failed to transcribe physician orders accurately for 2 of 22 residents whose physician orders were reviewed. (Residents 55 & 267) Findings include: 1. The record for Resident 55 was reviewed on 2/6/2025 at 1:58 P.M. Diagnoses included, but were not limited to: diabetes, dementia, depression and anxiety. A Physician's Order, dated 2/19/2025, indicated an order for daily weight-after voiding and before breakfast/medications with the same clothes every day shift. A current Care Plan for nutrition, dated 1/10/2025, indicated the resident was at nutritional risk related to: Potential for weight fluctuations related to fluid shifts and receives diuretic therapy. Interventions included but were not limited to: Diet is served as ordered. Select my own menus. Monitor weights and intakes. The November weight documentation and Nursing Progress Notes, from 11/1/2024 through 11/30/2024, lacked daily weights and/or documentation of why the daily weight was not obtained for the following dates: 11/9, 11/10, 11/18, 11/23 and 11/28/2024. The December weight documentation and Nursing Progress Notes, from 12/1 through 12/31/2024, lacked daily weights and/or documentation of why the daily weight was not obtained for the following dates: 12/7, 12/12, 12/16, 12/21, 12/22, 12/30 and 12/31/2024. The January weight documentation and Nursing Progress Notes, from 1/1 through 1/31/2025, lacked daily weights and/or documentation of why the daily weight was not obtained for the following dates: 1/1, 1/2, 1/4, 1/5, 1/6, 1/9, 1/13, 1/19 and 1/27/2025. During an interview, on 2/7/2025 at 9:15 A.M., the Director of Nursing indicated the resident should have been weighed daily and on the missed days, the facility should have documented in the Nursing Progress Notes as to why the weights had not been obtained. On 2/7/2025 at 1:08 P.M., the Director of Nursing indicated the facility did not have a policy regarding weights. 51598 2. A record review for Resident 267 was completed on 2/6/2025 at 9:38 A.M. Diagnoses included, but were not limited to: depression, end stage renal disease, dysphagia and diabetes mellitus type two. A Care Plan, initiated on 2/5/2025, indicated Resident 267 had depression and required the use of an antidepressant. A discharge medication order list from [Name of Hospital], dated 1/31/2025, included: sertraline (an antidepressant) 50 milligram (mg) tablet take 0.5 tablet (25 mg) by mouth at bedtime. However, the sertraline order was incurrately transcribed as 50mg 1 tablet by mouth at bedtime on the facility's admission orders. A Medication Administration Record (MAR), dated February 2025, indicated Resident 267 received sertraline 50mg on six of six days, instead of the 25mg by mouth at bedtime as per the medication order list. A Nursing Progress Note, dated 1/31/2025, indicated the Nurse Practioner had clarified a heparin order from the Resident's discharge medication orders, but there was no evidence in Resident 267's medical record the order for the sertraline was reviewed and increased from 25mg to 50mg. During an interview, on 2/7/2025 at 9:11 A.M., RN 9 indicated the facility used the discharge medication list from the hospital. She indicated Resident 267 should have been on sertraline 25mg daily. During an interview, on 2/7/2025 at 10:40 A.M., the ADON indicated she had had a conversation with the NP regarding Resident 267 sertraline. She stated the NP did not feel that sertraline 25 mg would be effective, so she ordered sertraline 50mg. The ADON indicated she did not document this conversation in the medical record. A current facility policy provided by the DON on 2/7/2025 at 11:30 A.M., titled New Order Transcription, indicated: to ensure that physician orders are transcribed and maintained in a manner that ensures safety upon administration. 3.1-37 (a)

Based on interviews and observation, the facility failed to ensure resident funds were immediately available during non-business hours. This deificent practice had the potential to affect 24 of 24 residents with trust funds. Finding includes: During an interview, on 2/5/2025 at 9:25 A.M., Resident 12 indicated the facility had informed him he could only get his resident trust account funds when the business office was open. During an observation, on 2/7/2025 at 10:43 A.M., a sign at the front receptionist's desk was observed with the following: Resident Trust Funds Availability For those residents who have a Resident Trust Fund account with [facility name]: These funds are available to you seven [7] days a week, during the following times: Business Office Monday-Friday 8:30am-4:30pm ICF 1's Nurse's Station Saturday & Sunday 10:00am-2:00pm During an interview, on 2/7/2025 at 10:45 A.M., the Business Office Manger indicated residents could obtain their money during business hours, Monday through Friday and there was a time perimeter on Saturday and Sunday for residents to obtain resident trust money. She indicated the facility placed a time frame for the access and availability of funds. During an interview, on 2/7/2025 at 1:42 P.M., the Executive Director indicated monies, from Resident Trust funds, were available at the nurse's station after business office hours. He indicated the facility preferred to complete financial transactions during business hours. During an interview, on 2/7/2025 at 1:44 P.M., CNA 10 indicated resident funds were not available outside of the facility's business hours. During an interview, on 2/7/2025 at 1:52 P.M., RN 5, who worked on the ICF (intermediate care facility) hallway, indicated she did not have Resident Trust money available after business hours in her medication cart for the residents to access. A current policy was provided by the Director of Nursing, on 2/7/2025 at 1:25 P.M. The policy titled, Resident Fund Procedures, indicated, .3. Funds should be readily available for residents. It is suggested that the family members and/or the resident be advised of the business office hours at the time of admission. Money is not available when the business office is not open; therefore, money is not available on weekends or evenings

Based on observation, interview and record review, the facility failed to ensure over the counter medications were labeled properly and failed to ensure opened medications were dated when opened for 1 of 4 medication storage areas observed. (ICF 3 medication cart) Finding includes: On 2/6/2025 at 2:22 P.M., a medication storage observation of the ICF 3 medication cart was completed with RN 5 and the following was observed: - a bottle of ibuprofen 200 mg (milligrams) with no resident label. - an opened and unlabeled bottle of CoQ10. - an opened and unlabeled bottle of Vitamin D 3. - an opened and unlabeled bottle of aspirin 81 mg. - an opened and unlabeled bottle of Ferrosol 325 mg. - an opened and unlabeled bottle of Milk of Magnesia (MOM). - a bottle of Men's multi vitamin with no resident label. - a box of daily probiotic pills with no label. - an opened and undated bottle of Guaifenesin liquid. - 2 opened and undated bottles of MOM. During an interview, on 2/6/2025 at 2:36 P.M., RN 5 indicated the medications should have been labeled and should have had opened dates on them. On 2/7/2025 at 1:08 P.M., the Director of Nursing provided the policy titled, Medication Labels, dated 4/24/2019, and indicated the policy is the one currently used by the facility. The policy indicated . Medications are labeled in accordance with facility requirements and state and federal laws 3.1-25(k)

Based on record review and interview, the facility failed to ensure a PRN (as needed) antianxiety medication was not ordered/used for more than 14 days and lacked documentation for the use of an antipsychotic for 2 of 6 residents reviewed for unnecessary medications. (Resident 19 & 39) Findings include: A record review for Resident 19 was completed on 2/6/2025 at 11:36 A.M. Diagnoses included but were not limited to Alzheimer's, psychotic disorder with delusions, and anxiety. A Quarterly Minimum Data Set (MDS) assessment, dated 11/26/2024, indicated Resident 19 had exhibited signs of delusions but had not exhibited any other behaviors. The assessment also indicated Resident 19 had not received any psychotropic medications. A Physician's Order, dated 1/8/2025, and discontinued on 2/4/2025, indicated lorazepam (an anti-anxiety medication) 0.5 milligrams (mg) by mouth every 4 hours as needed (PRN) for anxiety. A Physician's Order, dated 2/4/2025, and with a stop dated of 5/1/2025, indicated lorazepam 0.5mg by mouth every 4 hours PRN for anxiety. A Care Plan, initiated on 1/16/2025, indicated Resident 19 had a PRN anxiolytic (an anti-anxiety medication). A consultant pharmacist communication to the physician, dated 1/30/2025, and signed by the Nurse Practitioner (NP) on 2/5/2025, indicated the mega rule only allows 14 days of PRN anxiolytics: however, physician can document in the medical record why it is needed longer . The NP indicated on the form terminal agitation, with no supportive documentation of the terminal agitation in the medical record for Resident 19. Nursing progress notes, from 12/23/2024 to 2/6/2025, did not indicate Resident 19 had exhibited any behaviors, anxiety or agitation to support the terminal agitation documented by the NP. A Physician's assessment, dated 1/9/2025, did not indicate why the PRN lorazepam was initiated and ordered longer than 14 days. During an interview, with the Director of Nursing ( DON) on 2/7/2025 at 9:43 A.M., she indicated she was unsure why the lorazepam was initiated or why it had been ordered for more than 14 days. 49994 2. On 2/6/2025 at 9:53 A.M., a record review was completed for Resident 39. Diagnoses included, but were not limited to: anxiety and dementia. A Quarterly MDS (Minimum Data Set), dated 1/3/2025 indicated Resident 39's cognition was significantly impaired and the resident used an antipsychotic medication on a daily basis. Current Physician's Orders, dated 11/28/2024 indicated Resident 39 received Seroquel (antipsychotic) oral tablet 50 mg (milligrams) by mouth at bedtime and quetiapine fumurate 100 mg tablet by mouth one time a day for a diagnosis of anxiety and combative behaviors. Resident 39's record lacked documentation of a medical indication to support the use of Seroquel. During an interview on 2/06/2025 at 1:46 P.M., the DON indicated Resident 39 did not have an appropriate diagnosis for the use of Seroquel. On 2/6/2025 at 2:49 P.M., the DON provided a policy titled, Psychotropic Medication Use, dated 2/18/2019 and indicated it was the policy currently being used by the facility. The policy indicated, Purpose: To ensure that medication regimen helps promote or maintain the residents highest practicable mental, physical, and psychosocial well-being as identified by the resident and/or representative(s) in collaboration with the attending physician/psychiatrist and facility staff; each resident receives only those medications, in doses and for the duration clinically indicated to treat the residents assessed condition(s); 1. The facility will assure that medication therapy is based upon an adequate indication for use by documenting the supporting diagnosis/indication of use at the time the order for psychotropic medication is obtained/received . A current facility policy provided by the DON, on 2/7/2025 at 11:30 A.M., titled Psychotropic Medication Use indicated, .PRN orders will be limited to 14 days, unless the attending physician or prescribing practitioner believes that it is appropriate for the PRN to be extended beyond the 14 days. He/she should document their rationale in the resident's medical record 3.1-48(a)(4)

Based on observations, record review and interview, the facility failed to provide activities for a dependent resident for 1 of 3 residents reviewed for activities. (Resident 40) Finding includes: During an observation, on 2/4/2025 at 9:46 A.M.,10:56 A.M. and 2:49 P.M., Resident 40 was observed in her room without visual or auditory stimulation. During an observation, on 2/5/2025 at 10:49 A.M., Resident 40 was seated in a reclined position in her Broda chair in her room without visual or auditory stimulation. During an observation, on 2/5/2025 at 3:04 P.M., Resident 40 was observed in her bed sleeping. During an observation, on 2/6/2025 at 11:02 A.M., Resident 40 was observed in her room without visual or auditory stimulation. A record review for Resident 40 was completed on 2/6/2025 at 1:12 P.M. Diagnoses included, but were not limited to: cerebral infarction, hemiplegia, dementia and delirium. A Quarterly Minimum Data Set (MDS) assessment, dated 1/31/2025, indicated Resident 40 was severely cognitively impaired and received hospice care. A current Care Plan, initiated 11/25/2022, indicated Resident 40 enjoyed increased socialization/stimulation received through involvement in group activities. Interventions included, but were not limited to: -Would attend sensory activities. -Make sure Resident 40 received invitations to readings. -Encourage family to bring in radio/tape player for Resident 40 to keep in her room. -Activities would invite to all current events, educational activities and group activities. -Resident 40 enjoyed activities including: small groups, current events, outside, games and possibly arts/crafts. -Resident 40 stated she currently enjoyed watching television shows such as Hallmark types of shows. -Need assist to/from activities. A current Care Plan, dated 5/3/2024, indicated Resident 40 was at risk for feelings of loneliness or feeling self-isolated. Interventions included, but were not limited to: assist Resident 40 in finding services, equipment or activities they enjoy (i.e. books on tape, music lessons, games and stationery) and invite and encourage out-of-room activities. Despite the care planned interventions to address activity preferences and combat lonliness and isolation, Resident 40 was not observed in an activity, nor with visual or auditory stimulation in her room. During an interview, on 2/7/2025 at 9:52 A.M., the Activity Director indicated Resident 40 was involved in sensory activities, passive watching and 1:1 visits. She indicated Resident 40 should have had a visual or auditory activity in her room. A current policy was provided, on 2/7/2025 at 1:25 P.M., by the Director of Nursing. The policy titled, Life Enrichment Program Guidelines, indicated, .To enhance the lives of our residents through activity involvement. Benefits include: decreased behaviors, and increased overall satisfaction, and quality of life 3.1-33(b)(8)

Based on observation, record review and interview, the facility failed to provide enhanced barrier precautions (EBP) for a resident with a pressure ulcer for 1 of 3 residents reviewed for pressure ulcers. (Resident 46) Finding includes: During an interview, on 2/4/2025 at 10:28 A.M., Resident 46 indicated he had had a sore on his buttock for the past three weeks. A record review for Resident 46 was completed on 2/6/2024 at 9:45 A.M. Diagnoses included, but were not limited to: heart failure, diabetes mellitus type 2, obesity, polyneuropathy and edema. A Quarterly Minimum Data Set (M.DS) assessment, dated 1/31/2025, indicated Resident 46 was cognitively intact and had a Stage 2 pressure ulcer. A Pressure Injury Note, dated 1/2/2025 at 12:03 P.M., indicated a new in-house stage 2 pressure ulcer was observed to the left mid-buttock. A Physician's Order, dated 1/28/2025, indicated to cover the wound with Duoderm (moisture-resistant wound dressing) every Tuesday and as needed if displaced or soiled. A Care Plan, dated 1/2/2025, indicated Resident 46 had a pressure ulcer. The goal was the wound would not show any signs or symptoms of infection. During an observation, on 2/7/2025 at 10:23 A.M., RN 5 held Resident 46's lower garments and removed his incontinence brief to expose the pressure ulcer. RN 5 had gloves placed on her hands, but was not wearing a gown when this assistance was provided. During an interview, on 2/7/2025 at 10:27 A.M., CNA 4 indicated she was aware of residents in enhanced barrier precautions by the signage on the resident's door. She indicated if a resident had a pressure wound beyond stage 1, enhanced barrier precautions should be in place. During an interview, on 2/7/2025 at 10:36 A.M., RN 5 indicated enhanced barrier precautions should be in place for residents with an indwelling catheter, colostomy bags, wounds and residents with multi drug-resistant organisms. She indicated she would know a resident had enhanced barrier precautions by the sign on the door and by the orders in electronic medical record. However, during an observation, on 2/7/2025 at 10:42 A.M., there was no sign on Resident 46's door to indicate enhanced barrier precautions were needed or a physician's order to indicate enhanced barrier precautions were needed. A current policy was provided by the Director of Nursing, on 2/7/2025 at 1:25 P.M. The policy titled, Enhanced Precautions for the novel and targeted MDRO's [Multi Drug-Resistant Organisms] indicated, .To prevent the spread of multi drug resistant organisms [MDRO] from one resident to another resident via health care workers hands and clothing and to protect vulnerable residents. The use of EBP is intended to interrupt the spread of novel or targeted MDROs. EBP is targeted use of gown and glove use during high contact resident care activities for: Residents with wounds and indwelling devices 3.1-18(a)

Based on record review and interview, the facility failed to ensure the physician was notified of abnormal blood sugar results for 1 of 1 residents reviewed for physician notification. (Resident 54) Findings include: 1. The record for Resident 54 was reviewed on 2/6/2025 at 3:57 P.M. Diagnoses included, but were not limited to: hemiplegai, neurogenic bladder, diabetes and cancer. A Quarterly Minimum Data Set (MDS) assessment, dated 1/22/2025, indicated the resident received antidepressant and hypoglycemic medications. Current Physician Orders for Resident 54 included the following: - Humalog Inject 15 units subcutaneously three times a day for diabetes. Give 15 minutes AC (before) meal/snack. Notify MD if BS (blood sugar) less than 100 or greater than 400. If s/s (signs/symptoms) present, follow blood sugar flowchart and document in progress note. Hold if blood sugar is less than 150. - Glargine insulin -Inject 32 units subcutaneously one time a day for diabetes. Hold if BS is less than 100 or greater than 400 and notify the MD. Monitor for s/s of hypo/hyperglycemia and notify MD if present. A current Care Plan, initiated on 6/17/2024, included the following interventions: Give medications as ordered. Monitor blood sugar as ordered. Notify MD of blood sugar readings outside the ordered parameters. The November Medication Administration Record (MAR) indicated the following blood glucose result: - 11/3 the blood sugar result was 71 mg/DL. - 11/4 the blood sugar result was 83 mg/DL. - 11/7 the blood sugar result was 96 x 2 mg/DL. - 11/8 the blood sugar result was 98 x 2 mg/DL. - 11/9 the blood sugar result was 87 mg/DL. - 11/11 the blood sugar result was 91 mg/DL. - 11/17 the blood sugar results were 84 & 96 mg/DL. - 11/21 the blood sugar result was 96 mg/DL. - 11/22 the blood sugar results were 77 x 2 mg/DL. - 11/24 the blood sugar result was 98 mg/DL. - 11/25 the blood sugar result was 82 mg/DL. - 11/29 the blood sugar result was 80 mg/DL. The Nursing Progress Notes for November lacked documentation indicating the physician had been notified of the abnormal blood sugar results. The December MAR indicated the following blood glucose results: - 12/1 the blood sugar result was 84 x 2 mg/DL. - 12/3 the blood sugar result was 88 mg/DL. - 12/6 the blood sugar result was 85 mg/DL. - 12/7 the blood sugar result was 98 mg/DL. - 12/9 the blood sugar results were 97 x 2 mg/DL. - 12/11 the blood sugar result was 96 mg/DL. - 12/13 the blood sugar result was 94 mg/DL. - 12/16 the blood sugar result was 87 mg/DL. - 12/23 the blood sugar result was 93. mg/DL - 12/25 the blood sugar result was 85. mg/DL - 12/27 the blood sugar result was 94 mg/DL. - 12/29 the blood sugar result was 88 mg/DL. - 12/30 the blood sugar result was 80 mg/DL. - 12/31 the blood sugar result was 96 mg/DL. The Nursing Progress Notes for December lacked documentation indicating the physician had been notified of the abnormal blood sugar results. The January 2025 MAR indicated the following blood glucose results: - 1/1 the blood sugar result was 88 mg/DL. - 1/3 the blood sugar results were 98 and 92 x 2 mg/DL. - 1/4 the blood sugar result 74 and 70 mg/DL. - 1/7 the blood sugar result was 75 mg/DL. - 1/8 the blood sugar result was 82 mg/DL. - 1/9 the blood sugar results were 68 and 72 mg/DL. - 1/10 the blood sugar results were 99 and 83 mg/DL. - 1/12 the blood sugar result was 69 mg/DL. - 1/13 the blood sugar result was 92 mg/DL. - 1/15 the blood sugar result was 82 mg/DL. - 1/16 the blood sugar results were 90 x 2 mg/DL. - 1/17 the blood sugar result was 99 mg/DL. - 1/19 the blood sugar result was 80 mg/DL. - 1/24 the blood sugar result was 72 mg/DL. - 1/29 the blood sugar result was 95 mg/DL. - 1/31 the blood sugar result was 88 mg/DL. The Nursing Progress Notes for December lacked documentation indicating the physician had been notified of the abnormal blood sugar results. During an interview, on 2/7/2025 at 1:08 P.M., the Director of Nursing indicated the physician should have been notified. On 2/7/2025 at 1:08 P.M., the Director of Nursing provided the policy titled, Physician & Family Notification of Condition Changes, dated 5/14/2024, and indicated the policy was the one currently used by the facility. The policy indicated . II. Notify the physician of any change in the condition that may or may not warrant a change in the treatment plan. III. Notify the physician when values monitored are outside of ordered parameters 3.1-5(a)(3)

Base on observation, interview and record review, the facility failed to ensure staff-directed activities were provided in the evening and on the weekends for 1 of 1 resident reviewed for activities. (Resident 3). This had the potential to affect 52 out of 70 residents residing in the facility. Finding includes: During an interview on 4/17/2024 at 10:02 A.M., Resident 3 indicated the facility had no activities in the evenings or on the weekend. She would like to attend activities in the evening and on the weekends. They only had holiday type activities on the weekend for days like Easter and Christmas. A record review was completed on 4/19/2024 at 2:34 P.M. Diagnoses included, but were not limited to: end stage renal disease, type 2 diabetes, and heart failure. An Activity Care Plan, dated 11/11/2022, indicated that she enjoyed increased socialization, stimulation received through her involvement in group activities. She was a social person and attended most activities. The Activity Calendar, dated April of 2024, indicated the last activity during the week was scheduled at either 1:30 P.M. or 2 P.M. On every other Saturday, April 13 and 27, a church service was scheduled for 10:00 A.M. There were no activities on the schedule for April 6, 7, 14, 20, 21, and 28th for the long-term care and rehab units. There were 2 activities provided in the dementia unit on Sundays. The Activity Calendar, dated March 2024, indicated the last activity during the week was scheduled either 1:30 P.M. or 2 P.M. On every other Saturday, there was a 10:00 A.M. church service on March 2,16, and 30th, and an Easter egg hunt on Saturday the 23rd. There were no activities scheduled on March 3, 9,10,17, 24, or 31. During an interview on 4/22/2024 at 1:27 P.M., the Activity Director (AD) indicated she only had one full time assistant who worked Monday thru Friday and a part time assistant who worked Tuesday, Wednesday, and Thursday. The AD came in on Saturday for the church service and then socialized with the residents, but had no other scheduled activities unless it was a holiday. As far as evening activities, her entire staff were gone by 4:30 P.M. during the week. She had no one to do evening or weekend activities. On 4/22/2024 at 2:30 P.M., the Administrator provided a policy titled, Activities, dated 10/13/2010, and indicated the policy was the one currently used by the facility. The policy indicated .A. Evaluate the level of functioning for current population. Using the levels of Dementia guide sheet. B. Offer at least 2 activities daily for each of the 3 groups. Some activities may be offered for a specific group, others may appeal to all levels. I. Level 5/-6 (Alert/oriented, typically rehab residents). II. 3/4 (will avoid activities requiring new learning) Provide no fail activities - activities they are comfortable doing - no new learning. III. Level 1/2 (these are your lowest functioning - typically the ones who sleep during activities - they need sensory stem) . 3.1-33(c)

Based on observation, interview, and record review, the facility failed to ensure an allegation of a resident's missing property was reported immediately or within 2 hours after an allegation was made to the State Survey Agency for 1 of 1 resident reviewed for abuse. (Resident 42) Finding includes: During an interview on 4/17/2024 at 10:51 A.M., Resident 42 indicated she just found out $25.00 was missing from her purse today. The last time she saw it was last Friday, and she had it for about 2 weeks. She has always kept her money in her wallet inside her purse, which was placed in a small area between two dressers. She did not put her money anywhere else. Once a month, activities would order food out from a restaurant and today was gyros. When she went to get her money, it was not there. She planned on telling the Social Services Director and indicated it had happened before. She planned on asking for a lock box from the social worker. During an interview on 4/19/2024 at 9:43 A.M., the resident indicated she had told the social worker, and he was doing an investigation. He did give her a lock box to keep her money it i, which she now kept in the compartment of her walker and carried the key in her pocket. She had not heard any results of the investigation yet. During an interview on 4/22/2024 at 9:52 A.M., the resident indicated she had not heard how the investigation was going. During an interview on 4/23/2024 at 10:56 A.M., the resident indicated the Administrator came in to talk to her yesterday about the missing money and looked through her purse and drawers. He did not find any money. A police officer had not come to talk to her. A record review was completed for Resident 42 on 4/18/2024 at 2:38 P.M. Diagnoses included, but were not limited to: chronic obstructive pulmonary disease, type 2 diabetes, hypertension and major depressive disorder. A Quarterly Minimum Data Set (MDS) assessment, dated 4/10/2024, indicated the resident was cognitively intact. A Progress Notes, dated 4/17/2024, 4/18/2024, 4/19/2024 and 4/22/2024, indicated there was no documentation of the missing money. During an interview on 4/22/2024 at 10:20 A.M., the Social Worker indicated he had a couple of grievances he had been working on. During an interview on 4/22/2024 at 10:22 A.M., the Administrator indicated he had no reportable incidents completed since the survey started During an interview on 4/22/2024 at 10:28 A.M., the Social Worker presented two grievances: 1) dated 4/17/2024 for missing money for Resident 42 and 2) for two missing sweatshirts for another ressident. He indicated the missing money could possibly be misappropriation, but he had not finished looking for the money, he looked in her purse, drawers and with laundry. It potentially would be reported to state if it was not found, but it probably should have been reported and then a follow-up completed. That is what they normally would do. During an interview on 4/22/2024 at 2:15 P.M., the Administrator indicated he reported the missing money today to IDOH and initiated an investigation since the survey team was asking about it. He was not sure what the policy stated, but it should have reported it within 24-48 hours. On 4/22/2024 at 2:30 P.M., the Administrator provided a policy titled, Incident Reporting to the ISDH, dated 11/29/2017, and indicated the policy was the one currently used by the facility. The policy indicated .It is the policy of Miller's Merry Manor to report all incidents (formally known as unusual occurrences) to the Long - Term Care Division of the Indiana State Department of Health. Time frames for reporting: Immediately, but no later than 2 hours - suspicion of a crime with serious bodily injury OR allegation of abuse, Within 24 hours - does not involve abuse and does not result in serious bodily injury. 12. Misappropriation of resident property/exploitation - Examples and not limited to: a. Theft of personal property, such as jewelry . 3.1-28(c)

Based on observation, interview and record review, the facility failed to ensure housekeeping maintained a sanitary room environment related to dust and floors not swept or mopped for 1 of 1 resident reviewed for environment. (Resident 42) Finding includes: During an interview and observation on [DATE] at 11:06 A.M., Resident 42 indicated she did not feel her room was clean. They had one housekeeper that was fantastic but was no longer here. The other housekeepers cleaned the toilet, bathroom sink and took out the trash. They seldom mopped and swept the floors in the bedroom, and they did not dust. The blinds needed to be dusted, it's been at least 2 months. The blinds, picture frames, and shelves in the bathroom with angel figurines were observed to be dusty. During an interview and observation on [DATE] at 1:19 P.M., Resident 42 indicated that staff had cleaned the bathroom and dry mopped the floors, but did not wash the floor. The blinds, picture frames and shelves in the bathroom with angel figurines were observed to be dusty. During an interview and observation on [DATE] at 1:44 P.M., Resident 42 indicated staff had cleaned the bathroom, swept, and mopped the floors, but no one had dusted. The blinds, picture frames and shelves in the bathroom were observed to be dusty. During an interview on [DATE] at 9:54 A.M., Resident 42 indicated no one cleaned her room this weekend, the girls only removed her trash. Today the housekeeper was not in the bathroom long enough to do anything, and the floors had not been swept or mopped. The blinds, picture frames and shelves in the bathroom were observed to be dusty. During an interview on [DATE] at 11:06 A.M., Resident 42 indicated the bathroom was cleaned and dust mopped but was not wet mopped, trash containers were emptied. The blinds, picture frames and bathroom shelves were observed to be dusty. A record review was completed for Resident 42 on [DATE] at 2:38 P.M. Diagnoses included, but were not limited to: chronic obstructive pulmonary disease, type 2 diabetes, hypertension and major depressive disorder. During an interview on [DATE] at 9:30 A.M., Housekeeper 4 indicated when she cleaned a resident's room, she put cleaner in the toilet bowl, sprayed the sink with TB quat solution and waited 3 minutes, so she collected the trash and put it in her bin. Then she would go back to clean the sink and toilet bowl. Then she sprayed a microfiber with quat and wiped down tables, doorknobs, light switches, the sanitizer dispenser, swept the room with a dust mop, restocked toilet paper and paper towel, then used a wet mop and put a wet floor sign out. She dusted twice a week on Mondays and Fridays, including the blinds, light fixtures, windowsills and bathroom corners. She worked on ICF-2 unit. During an interview on [DATE] at 8:50 A.M., Housekeeper 5 indicated that when she cleaned a resident room, she removed the trash, then cleaned the bathroom, door handles, paper towels, soap, hand sanitizer, swept and mopped the floors. She only dusted a room when a resident discharged , died or switched rooms. She worked on ICF-3 unit. During an interview on [DATE] at 11:08 A.M., the Environmental Supervisor indicated she would expect her staff to clean the resident's room daily. The order was up to them, but included spray the toilet & sink with quat solution and let it set for 3 minutes, check the paper towel and toilet paper, then clean the inside and outside of the toilet, sink, & bedside tables, then sweep and mop and put out a wet floor sign. Once a week they should do a more through clean, check refrigerators and clean all high touch areas. On [DATE] at 11:13 A.M., the Administrator provided a policy titled, Resident Room Cleaning, undated, and indicated it is the policy currently used by the facility. The policy indicated . DAILY Procedure: 5) sweep and mop floor. 7) Dust with a clean rag and QUAT spray TV's. 8) Dust with a clean rag and QUAT spray bedside tables. 9) Dust with a clean rag and QUAT spray windowsills. MONTHLY: High dust with a clean rag and QUAT spray the following: Over bed lights, Picture frames on walls, Door's and frame's, Closet's, Curtain rod's, Sprinkler pipes, Switch plates, Closets: Floor's and shelves. Wipe with QUAT spray. Sweep and mop floor . 3XXX,d+[DATE]

Based on interview, record review, and interview, the facility failed to update a care plan regarding the use of splints for 1 of 18 residents reviewed for care plans. (Resident 19) Finding includes: A record review for Resident 19 was completed on 4/18/2024 at 1:13 P.M. Diagnoses included, but were not limited to: functional quadriplegia, lobster-claw hand, contracture of muscle right hand, and muscle weakness. A Quarterly Minimum Data Set (MDS) assessment, dated 2/5/2024, indicated upper extremity impairment on both upper extremities. During an observation on 4/18/2024 at 9:27 A.M., Resident 19 was observed to have contracture on both hands, and Resident 19 indicated he wears splints during the nighttime hours. A Physician's Order, dated 2/6/2020, indicated Resident 19 to wear a left palm protector with finger separators during sleeping hours, and indicated Resident 19 to wear a right-handed splint during the night/sleeping hours, dated 4/25/2023. A Care Plan dated 6/2/2020, indicated a splint/brace program with assistance needed for application of the brace to bilateral hands due to lobster-claws. An intervention dated 1/6/2021, indicated the left-hand brace on at 8:30 A.M. and off at 11:30 A.M., and on at 6:30 P.M., and off at 9:30 P.M. Other interventions, dated 9/3/2021, indicated a restorative nursing program for the left-hand brace to be applied at 8:30 A.M. and off at 11:30 A.M., and applied at 6:30 P.M. and removed at 9:30 P.M., and on the right hand to place splint/brace at bedtime and remove in the morning. During an interview on 4/23/2024 at 2:34 P.M., the MDS (Minimum Data Set) Coordinator indicated care plans were updated at least quarterly and with any new medication or new change to the resident's status. She indicated any new orders should be reflected in the care plan. A policy was provided on 4/23/2024 at 3:54 P.M. by the Director of Nursing. The policy titled, Care Plan Development and Review, dated 1/24/2020, indicated, .Purpose A. To assure that a comprehensive care plan for each resident includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment process. To assure that the care plan is communicated effectively to the staff and responsible party .3. Care Plan Revisions A: Care plans will be revised daily and PRN [as needed] as changes in the resident's condition dictate. Changes include but are not limited to changes int eh Physician orders, diet changes, therapy changes, behavior changes, ADL [activities of daily living] changes, skin changes, etc. [et cetera] 3.1-35(d)(2)(B)

Based on interview and record review, the facility failed to notify the physician of blood sugars outside the ordered parameters for 1 of 1 resident reviewed for insulin, and weight changes due to heart failure for 1 of 3 residents reviewed for hospitalization . (Resident 19) Finding includes: During an interview on 4/17/2024 at 10:47 A.M., Resident 19 indicated he had high blood sugar and had been recently hospitalized for muscle problems. A record review for Resident 19 was completed on 4/18/2024 at 2:17 P.M. Diagnoses included, but were not limited to: heart failure, diabetes mellitus type 2, chronic kidney disease, atrial fibrillation, and anemia. An Admission Minimum Data Set (MDS) assessment, dated 3/12/2024, indicated Resident 19 received insulin for 7 days during the assessment period, and had heart failure and diabetes mellitus as diagnoses. A Physician's Order dated 3/5/2024, indicated to check the blood sugar as needed for signs and symptoms of hypo/hyperglycemia, and to notify the physician for blood sugars less than 70 and greater than 400. A review of the blood sugar record from 3/7/2024 through 4/17/2024 indicated, Resident 19 had the following blood sugars: - 3/11/2024 7:45 A.M. 62 mg/dL (milligrams per deciliter) - 3/13/2024 6:15 A.M. 51 mg/dL - 3/20/2024 6:31 A.M. 68 mg/dL - 4/13/2024 9:14 P.M. 417 mg/dL A Nurse's Note, dated 3/13/2024 at 6:32 A.M., indicated Resident 19's blood sugar at 5:44 A.M. was 72. Resident 19 was given a snack, and the blood sugar was rechecked at 6:15 A.M. with a reading of 51. Resident 19 was given a Nepro protein drink. A Nurse's Note, dated 3/13/2024 at 6:57 A.M., indicated Resident 19 was able to drink approximately 120 milliliters of Nepro, and asked for 2 small pretzel squares from his personal snacks. Resident 19's blood sugar was now 71. After consuming the pretzel squares, Resident 19 indicated he was feeling less fuzzy. A Nurse's Note dated 3/20/2024 at 6:50 A.M., indicated Resident 19 was provided four ounces of orange juice for a blood sugar of 68. A Care Plan, dated 3/5/2024, indicated Resident 19 had diabetes and had the potential for having hyper/hypoglycemia (high and low blood sugars). The goal was to have signs or symptoms of hypo/hyperglycemia. Interventions dated 3/5/2024, indicated to notify the physician of blood sugar readings outside the ordered parameters. On 4/23/2024 at 12:25 P.M., RN 2 reviewed the electronic medical record for notification to the physician for blood sugars outside the ordered range. RN 2 indicated there were no notes for notification to the physician for blood sugars out of range for 3/11/2024, 3/13/2024, 3/20/2024, and 4/13/2024. On 4/8/2024, Resident 19 was readmitted to the facility after being admitted to the hospital on 4/5/2024. An Admission History and Physical, dated 4/5/2024, indicated resident 19 presented to the emergency room after being found more lethargic and shorter of breath. The Internal Medicine Hospitalist Discharge Summary, dated 4/8/2024, indicated acute on chronic combined systolic and diastolic congestive heart failure with a discharge recommendation of hospice services. The report indicated Resident 19 had been previously hospitalized for treatment of congestive heart failure. A Physician's Order, dated 4/3/2024, indicated obtain a daily weight after voiding and before breakfast and medication, with the same clothes done each day. The physician was to be notified for a 2-pound weight gain in one day and a four-pound weight gain in five days. Resident 19's weight indicated the following: - 4/14/2024 8:42 A.M. 143.5 pounds - 4/15/2024 no weight was obtained - 4/16/2024 1:24 P.M. 146.0 - 4/18/2024 10:41 A.M. 148.5 pounds (5-pound weight gain in 5 days) - 4/20/2024 10:58 P.M. 145.5 pounds - 4/21/2024 9:50 A.M. 147.5 pounds (2-pound weight gain in 1 day) A Care Plan, dated 4/1/2024, indicated Resident 19 had heart failure. An intervention included following the heart failure protocol as listed on the medication administration record and treatment administration record. During an interview on 4/23/2024 at 11:14 A.M., RN 2 indicated the physician should have been notified if Resident 19 had a weight gain of two pounds in one day or a four-pound weight gain in 5 days. She indicated Resident 19 did not have notification on 4/16/2024, 4/18/2024, and 4/21/2024. The physician was at the facility on 4/18/2024, but the weight gain was not addressed. During an interview on 4/23/2024 at 11:19 A.M., RN 2 indicated the physician should be notified for a blood sugar less than 70 or greater than 400 for Resident 19. She indicated the documentation should be in the progress notes or in the electronic medication administration record notes. A policy was provided on 4/23/2024 at 3:54 P.M. by the Director of Nursing. The policy was titled, Weight Management Program. The Director of Nursing indicated a specific policy was not available for heart failure. A policy was provided on 4/23/2024 at 3:54 P.M. by the Director of Nursing. The policy titled, Blood Glucose Monitoring, indicated, .1. Policy It is the policy of [facility name] to monitor blood glucose per physician's orders and to assess for signs of hypoglycemia or hyperglycemia .4. Procedure C. Each resident shall have specific physician orders for the following: I. Parameters for physician notification both for high and low readings 3.1-37(a)

Based on observation, interview and record review, the facility failed to ensure a thorough investigation was initiated for an allegation of a resident's missing property for 1 of 1 resident reviewed for abuse. (Resident 42) Finding includes: During an interview on 4/17/2024 at 10:51 A.M., Resident 42 indicated she just found out $25.00 was missing from her purse today. The last time she saw it was last Friday, and she had it for about 2 weeks. She has always kept her money in her wallet inside her purse, which was placed in a small area between two dressers. She did not put her money anywhere else. Once a month, activities would order food out from a restaurant and today was gyros. When she went to get her money, it was not there. She planned on telling the Social Services Director and indicated it had happened before. She planned on asking for a lock box from the social worker. During an interview on 4/19/2024 at 9:43 A.M., the resident indicated she had told the social worker, and he was doing an investigation. He did give her a lock box to keep her money it i, which she now kept in the compartment of her walker and carried the key in her pocket. She had not heard any results of the investigation yet. During an interview on 4/22/2024 at 9:52 A.M., the resident indicated she had not heard how the investigation was going. During an interview on 4/23/2024 at 10:56 A.M., the resident indicated the Administrator came in to talk to her yesterday about the missing money and looked through her purse and drawers. He did not find any money. A police officer had not come to talk to her. A record review was completed for Resident 42 on 4/18/2024 at 2:38 P.M. Diagnoses included, but were not limited to: chronic obstructive pulmonary disease, type 2 diabetes, hypertension and major depressive disorder. A Quarterly Minimum Data Set (MDS) assessment, dated 4/10/2024, indicated the resident was cognitively intact. Progress Notes, dated 4/17/2024, 4/18/2024, 4/19/2024 and 4/22/2024, indicated there was no documentation of the missing money. During an interview on 4/22/2024 at 10:20 A.M., the Social Worker indicated he had a couple of grievances he had been working on. During an interview on 4/22/2024 at 10:22 A.M., the Administrator indicated that he has had no reportable incidents since the survey team entered the building. During an interview on 4/22/2024 at 10:28 A.M., the Social Worker presented two grievances: 1) dated 4/17/2024 for missing money for Resident 42 and 2) for two missing sweatshirts for another resident. He indicated the missing money could possibly be misappropriation, but he had not finished looking for the money, he looked in her purse, drawers and with laundry. It potentially would be reported to state if it was not found, but it probably should have been reported and then a follow-up completed. That is what they normally would do. He spent about a week doing an investigation and did not ask the resident if a crime was committed. He had not interviewed any other residents to see if they had any missing money. He had not done any investigations except for the grievance paper presented. The Administrator may have done an investigation because he was aware of the missing money. During an interview on 4/22/2024 at 2:15 P.M., the Administrator indicated he reported the missing money today to IDOH, and initiated an investigation since the survey team was asking about it. He just started interviewing alert and oriented residents and talking to staff. He left a message with a detective with the local Police Department to report a suspicion of a crime of missing money. On 4/17/2024 at 11:30 A.M., the Administrator provided a policy titled, Abuse Prohibition, Reporting, and Investigation, dated 4/18/2023, and indicated the policy was the one currently used by the facility. The policy indicated . 4. Miller's Health Systems has policies and procedures in place that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the investigation is in progress. 5. Miller's Health Systems has a policy and procedure in place that all reasonable suspicions of crime according to the Elder Justice act are reported to the Indiana Department of Health and the local law enforcement agency. The Reporting Reasonable Suspicions of a Crime against a Resident form located on the ISDH website will be used . 3.1-28(d)

Based on observation, record review and interview, the facility failed to implement specific interventions to prevent heel pressure ulcers for 1 resident in a sample of 4 residents reviewed for pressure ulcer development . (Resident #C) Finding includes: The clinical record for Resident #C was reviewed on 08/26/13 at 1:00 P.M. Resident #C was admitted to facility on 05/16/13, with diagnoses, including but limited to: paralysis agitans, diabetes, malaise and fatigue, anorexia, abdominal aneurysm non-ruptured, hypertension, [MEDICAL CONDITIONS] and acute [MEDICAL CONDITION]. The nursing admission assessment, completed on 05/16/13, indicated there were no pressure ulcers noted on Resident #C. The initial MDS (Minimum Data Set) assessment, completed on 05/24/13, indicated the resident had no pressure ulcer but was at risk for pressure ulcer development. The health care plan for Skin Risk, initiated on 05/17/13, included the following interventions: "Assess food likes and dislikes, Encourage meal/fluid intake and record, Monitor labs as available, Monitor skin daily during care, Provide pericare as needed, Provide pressure reducing device to bed, Provide pressure reducing device to chair and Skin assessment at least weekly by nurse." Interview with Resident #C, on 08/26/13 at 1:30 P.M., indicated when he was first admitted to the facility he spent most of his time siting up in his wheelchair. He indicated it had a thin cushion with "liquid" of some kind in the cushion. He indicated he wore socks when he was up in the wheelchair. Review of the electronic weekly nursing assessments, indicated for 06/19/13 and 06/26/13, the box to mark if the skin was assessed was not checked. An assessment, titled, "Nursing- New Skin Alteration Assessment," completed on 07/25/13, indicated the resident had new wounds. The description of the wounds indicated the following: "Area noted to outer left heel measuring 4.0 cm by 5.2 cm. Area is nonblanchable. Edges appear black. Appears fluid filled. Center is purple. Area noted to right heel. Area with hard and peeling skin. No redness or drainage noted." On 08/26/13 at 1:30 P.M., the heels and buttocks of Resident #C were observed with Wound nurse, LPN #10. The right heel had a pencil eraser sized brownish/purplish hard area on the middle of the bottom of the heel. The outer edge of the left heel had a quarter sized shiny black area with an rectangular shaped purple area to the side and connected to the black area. Neither area was open. LPN #10 indicated both heel areas were hard to touch and were being treated with foam padding and kerlix. She also indicated the resident was wearing blue padded boots and was in bed now except for meal and when walking with restorative. Interview with Resident #C and LPN #10, on 08/26/13 at 1:30 P.M., indicated he had worn the boots for the about the past month since he had been spending more time in his bed. There was no indication specific interventions to protect he resident's heels were in place prior to the development of his heel pressure areas. This Federal tag relates to Complaint #IN 5315 3.1-40(a)(1)

Based on observation, record review, and interview, the facility failed to implement specific interventions to prevent heel pressure ulcers for 1 resident in a sample of 4 residents reviewed for pressure ulcer development . (Resident #C) Finding includes: The clinical record for Resident #C was reviewed on 08/26/13 at 1:00 P.M. Resident #C was admitted to facility on 05/16/13, with diagnosis, including but limited to, paralysis agitans, diabetes, malaise and fatigue, anorexia, abdominal aneurysm non-ruptured, hypertension, [MEDICAL CONDITIONS], and acute [MEDICAL CONDITION]. The nursing admission assessment, completed on 05/16/13, indicated there were no pressure ulcers noted on Resident #C The initial MDS (Minimum Data Set) assessment, completed on 05/24/13, indicated the resident had no pressure ulcer but was at risk for pressure ulcer development. The health care plan for Skin Risk, initiated on 05/17/13, included the following interventions: "Assess food likes and dislikes, Encourage meal/fluid intake and record, Monitor labs as available, Monitor skin daily during care, Provide pericare as needed, Provide pressure reducing device to bed, Provide pressure reducing device to chair, and Skin assessment at least weekly by nurse." Interview with Resident #C, on 08/26/13 at 1:30 P.M., indicated when he was first admitted to the facility he spent most of his time siting up in his wheelchair. He indicated it had a thin cushion with "liquid" of some kind in the cushion. He indicated he wore socks when he was up in the wheelchair. Review of the electronic weekly nursing assessments, indicated for 06/19/13 and 06/26/13, the box to mark if the skin was assessed was not checked. An assessment, titled, "Nursing- New Skin Alteration Assessment," completed on 07/25/13, indicated the resident had new wounds. The description of the wounds indicated the following: "Area noted to outer left heel measuring 4.0 cm by 5.2 cm. (centimeters) Area is nonblanchable. Edges appear black. Appears fluid filled. Center is purple. Area noted to right heel. Area with hard and peeling skin. No redness or drainage noted." On 08/26/13 at 1:30 P.M., the heels and buttocks of Resident #C were observed with Wound nurse, LPN #10. The right heel had a pencil eraser sized brownish/purplish hard area on the middle of the bottom of the heel. The left heel had a quarter sized shiny black area with an rectangular shaped purple area to the side and connected to the black area. The area on the left heel was noted on the outer edge of his left heel. Neither area was open. LPN #10 indicated both heel areas were hard to touch and were being treated with foam padding and kerlix. She also indicated the resident was wearing blue padded boots and was in bed now except for meal and when walking with restorative. Interview with Resident #C and LPN #10 indicated he had worn the boots for the about the past month since he had been spending more time in his bed. There was no indication specific interventions to protect he resident's heels were in place prior to the development of his heel pressure areas. This Federal tag relates to Complaint #IN 5315. 3.1-40(a)(1)