North Park Nursing: Fall Prevention Failures - IN
Resident D had already fallen multiple times before November 25, when staff heard her yelling from the activity area at 8:45 p.m. They found her lying on her right side in front of her wheelchair, unable to explain how she fell.
The facility's interdisciplinary team determined the root cause the next day: the resident had initially refused to be placed in bed after dinner, then tried to transfer herself without help. They implemented a new intervention requiring staff to provide "a sensory activity or a busy box within staff's eyesight" when she declined to go to bed.
The intervention lasted two days.
On November 28 at 7:24 p.m., a nursing assistant reported finding the same resident seated on the floor in another resident's room. This fall was also unwitnessed.
Federal inspectors found the facility's own fall risk assessment had identified Resident D as high risk. Her care plan specifically noted she was "impulsive" with "altered awareness of immediate physical environment" and "lack of understanding of one's physical and cognitive limitations." She used a wheelchair, required assistance for all transfers, and had already fallen twice since her previous assessment, with one fall causing injury.
The resident's care plan had been in place since May 2023, with the most recent revision occurring December 22 — one day before the federal inspection and nearly a month after her second documented fall.
The facility's own fall management policy requires care plans to be "reviewed and updated as necessary" after each fall incident and mandates that "all falls will be discussed by the interdisciplinary team at the next clinical meeting."
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for North Park Nursing Center from 2025-12-23 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 4, 2026 · Our methodology
NORTH PARK NURSING CENTER in EVANSVILLE, IN was cited for violations during a health inspection on December 23, 2025.
Resident D had already fallen multiple times before November 25, when staff heard her yelling from the activity area at 8:45 p.m.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.