Beaumont Rehabilitation And Healthcare Center

parameters for 1 of 2 residents reviewed for physician orders. (Resident D) Finding includes: Resident

blood pressure), atrial fibrillation (irregular heartbeat), and end stage renal (kidney) disease.Current orders included midodrine (increases blood pressure) 10 milligrams, by mouth, two times a day every Monday, Wednesday, and Friday for blood pressure.

Hold if systolic (top number) blood pressure is greater than 130 (2/20/26).The clinical record indicated the following:On 2/27/26 the resident's blood pressure was 139/73 millimeters (mm) Hg (mercury).

Midodrine was administered.On 3/4/26 the resident's blood pressure was 138/82 mm Hg.

Midodrine was administered.On 3/11/26 the resident's blood pressure was 169/93 mm Hg.

Midodrine was administered.On 3/25/26 the resident's blood pressure was 132/65 mm Hg.

Midodrine was administered.On 4/8/26 the resident's blood pressure was 141/73 mm Hg.

Midodrine was administered.On 4/10/26 the resident's blood pressure was 205/100 mm Hg.

Midodrine was administered.A current care plan, revised on 3/6/26, indicated Resident D was at risk for medication side effects related to hyperparathyroidism, hypotension (low blood pressure), inflammation, renal failure, chronic obstructive pulmonary disease and anticoagulant use.

Interventions included: administer medications as indicated by physician orders (11/20/25).

During an interview, on 4/24/26 at 12:57 p.m., the DON reviewed Resident D's midodrine order and administration record.

She indicated the order included blood pressure parameters and the electronic administration record indicated midodrine was administered on the identified dates.A current policy, dated 12/1/24, titled Physician Services and Orders, provided by the DON on 4/24/26 at 1:19 p.m., indicated the following: Policy: It is the policy of the facility to ensure that the medical care of each resident is supervised by a physician.

The facility will provide care and services related to physician services in accordance with State and Federal regulations.

Procedure: 11.

All physician orders will be followed as prescribed and if not followed, the reason shall be recorded in the resident's medical record during that shift.410 Indiana Administrative Code (IAC) 16.2-3.1-37(a)

155005 04/24/2026

Beaumont Rehabilitation and Healthcare Center 1345 N Madison Ave Anderson, IN 46011

herself.

The IDT team determined what interventions were to be implemented and the intervention

CNA 38 indicated Resident E was a fall risk. CNA 38 confirmed there was not a call for assistance

or in his bathroom.

Resident E did not fall out of bed, and a low bed was not utilized. CNA 38 had never observed a reacher-type assistive device in the resident's room and had not seen the resident have one.

Resident E used to be on another unit, and it was possible he had omitted fall interventions in his old room, but not since he transferred to this unit.

She was unsure when he transferred rooms, but it had been quite a while ago.

During an interview, on 4/23/26 at 2:36 p.m., LPN 41 confirmed Resident E did not have anti-tippers on his wheelchair, and the wheelchair brake handles did not contain brightly colored tape.

She was uncertain if the wheelchair seat was considered lowered or not.

During an interview, on 4/24/26 at 11:40 a.m., the DON indicated care plan interventions were to be followed.

Resident E last changed rooms in 2024, and previous fall interventions may have been for his previous room and were not transferred with his room change.

She observed Resident E's wheelchair on 4/23/26 and his brakes did not have brightly colored tape on them.

She was unsure if his wheelchair seat was lowered when she observed the wheelchair but noted the wheelchair did not contain anti-tippers.

During an interview, on 4/24/26 at 2:28 p.m., LPN 22 indicated care plan interventions were to be followed.

Unit managers followed up with implemented interventions to ensure they were in place.

When a resident switched rooms, the interventions would follow the resident to the new room, such as non-skid strips and posted signs.A current facility policy, dated 10/20/25, titled Falls Management and Fall Risk, and provided by the Regional Director of Operations on 4/23/26 at 2:25 p.m., indicated the following: Policy/Procedure: 3.

Each resident will have a resident centered fall care plan developed and implemented with updates as needed. 4 The care plan will be reviewed at a minimum of quarterly, post fall, annually, and with significant change in condition.8.

The falls related care plan will address both prevention of falls as well as when applicable specific interventions in response to an occurrence of a fall.11. If falling occurs despite initial interventions, staff will implement additional or different interventions or indicate why the current approach remains relevant.14.staff will re-evaluate the situation and whether it is appropriate to continue or change current interventions.A current facility policy, dated 2/22/25, titled Comprehensive Care Plans, provided by the DON, on 4/24/26 at 1:19 p.m., indicated the following: Policy: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident.

Procedure: 4 .including the right to: e.

Receive the services, interventions, and items included in the plan of care .12.

The interdiciplinary team reviews and updates the care plan and ensures interventions in place are implemented per plan of care: .This citation relates to Intake 2984573. 410 Indiana Administrative Code (IAC) 16.2-3.1-35(g)(1)410 IAC 16.2-3.1-45(a)

155005 04/24/2026

Beaumont Rehabilitation and Healthcare Center 1345 N Madison Ave Anderson, IN 46011

of 2 residents reviewed for dialysis. (Residents D & E) Findings include:1.Resident E's clinical record

on renal dialysis, acquired absence of a kidney, and type 2 diabetes mellitus with diabetic chronic kidney disease.Current physician orders included monitor left chest dialysis access site for infection daily, obtain vital signs, blood pressure and pulse, and monitor pre and post dialysis for: altered mental status, lethargy, edema, chest pain, shortness of breath, abdominal pain, nausea, vomiting, unusual itching, bleeding at site, bruises, abnormal muscle cramps, redness, swelling, tenderness, or signs of infection at dialysis site every shift on Mondays, Wednesdays, and Fridays, apixaban 5 milligram tablet (blood thinner) to be administered orally twice a day, and check site of dialysis catheter every shift for drainage and condition of dressing.

Review of the clinical record indicated a pre-dialysis assessment was not completed for Resident E on March 6, 24, and 30, 2026.Review of the clinical record indicated a post-dialysis assessment was not completed for Resident E on March 4, 6, 9, 13, 20, 23, 24, 30, and April 3, 8, 10, 22, 2026.Resident E's dialysis binder indicated dialysis had been completed on these dates.2.Resident D's clinical record was reviewed 4/22/26 at 11:00 a.m.

Diagnosis included end stage renal disease with dependence on renal dialysis and chronic kidney disease stage 5 (end stage kidney failure that needs dialysis or a kidney transplant).Current physician orders included monitor right chest port for infection daily, apixaban 5 milligram tablet (blood thinner) to be administered orally twice a day, check arteriovenous (AV) access site to right chest port every shift for active thrill and bruit, do not perform blood pressures or venipuncture on access arm, and leave dressing in place (If present) for 12 hours post-treatment, check AV fistula site for bruit and thrill every shift, check site of dialysis catheter every shift for drainage and condition of dressing.

Review of the clinical record indicated a post-dialysis assessment was not completed for Resident D on March 4, 6, 13, 20, 23, 25 and April 3, 8, 13, 15, 2026.Resident D's dialysis binder indicated dialysis had been completed on these dates.

During an interview, on 4/23/26 at 1:55 p.m., LPN 18 indicated nurses were to perform pre and post dialysis assessments each day a resident had a dialysis treatment.

The assessments were to be completed in the resident's electronic health record and there was a communication form in the resident's dialysis binder.

During an interview, on 4/23/26 at 2:25 p.m., the DON indicated nurses were to complete a pre-dialysis assessment before the resident left the facility for dialysis and complete a post-dialysis assessment upon the resident's return to the facility.

The assessments were to be documented in the resident's electronic health record.

During an interview, on 4/24/26 at 2:28 p.m., LPN 22 indicated nurses were to complete pre and post dialysis assessments.

The post assessment was important as the nurse was to assess access points for infusion and any dressings that were in place.

During an interview, on 4/24/26 at 2:00 p.m., the DON indicated nursing did not complete pre and post Dialysis assessments for Residents D & E.A current facility policy, dated 2/22/21, titled Dialysis provided by the Regional Director of Operations, on 4/23/24 at 2:25 p.m., indicated the following: Policy: To ensure residents receiving hemodialysis are monitored for complications.A current facility policy, undated, titled Hemodialysis Access Care, provided by the Administrator, on 4/24/26 at 12:04 p.m., indicated the following: .

Documentation: The general medical nurse should document in the resident's medical record every shift as follows: 1.

Location of catheter. 2.

Condition of dressing (interventions if needed). 3. If dialysis was done during shift. 4.

Any part of report from dialysis nurse post-dialysis being given. 5.

Observations post-dialysis.This citation relates to Intake 2970449.410 Indiana Administrative Code (IAC) 16.2-3.1-37(a)

155005 04/24/2026

Beaumont Rehabilitation and Healthcare Center 1345 N Madison Ave Anderson, IN 46011

serve food in accordance with professional standards.

of food for resident use in refrigerators on the nursing units for 2 of 3 nursing unit refrigerators

refrigerators, accompanied by the Dietary Manager, on 4/22/26 at 12:53 p.m., the following was observed: 1.On the Intermediate unit, a small refrigerator was located in the nurses' station.

The refrigerator contained a packaged deli sandwich, dated 4/14/26, a frozen entree, an unopened bottle of strawberry soda, an unopened strawberry/banana Greek yogurt, four open partial bottles of waters, an open partial bottle of mandarin orange water, and an undated foam container with cabbage, sausage, corn bread, and an unidentiˆable yellow substance.

The freezer section of the refrigerator contained a sticky, soft, ice cream sandwich, two frozen nutritional supplements, and an uncovered Dairy Queen cup that was stuck to the shelf of the freezer. LPN 33 indicated that the refrigerator was for the residents and the staff had a break room for storing their items.

They normally stored fortiˆed pudding and applesauce for the residents in the refrigerator.2. On the Arcadia unit, a refrigerator was located in the dining/kitchen area.

The refrigerator contained a staff member's lunch tote.

The freezer contained an unopened candy bar, a clear storage bag of ˆour, and a plastic grocery bag with two ice packs.

The Memory Care Director indicated the ice packs were used on a resident's breast who had a new diagnosis of breast cancer.

During an interview, on 4/23/26 at 4:10 p.m. the Regional Director of Operation indicated that staff should not have stored there personal food in the refrigerators and that there was a breakroom available for staff to store their food. A current facility policy, titled Food Storage, provided by the Administrator on 4/24/26 at 9:48 a.m. indicated the following: .Procedure.12.

Leftover food should be stored in covered containers or wrapped carefully and securely and clearly labeled and dated before refrigerated.

Leftover food must be used within 7 days or discarded as per the 2022 Federal Food Code. 13.

All refrigerator units should be always kept clean and in good working condition. all foods should be covered, labeled and dated and routinely monitored to assure that foods (including leftovers) will be consumed by their use by dates, or frozen (where applicable) or discarded.410 IAC 16.2-3.1-21(i)(3)

155005 04/24/2026

Beaumont Rehabilitation and Healthcare Center 1345 N Madison Ave Anderson, IN 46011

During an interview, on 4/24/26 at 2:28 p.m., LPN 22 indicated an AV fistula site in an extremity was to be assessed for a bruit and thrill, but not in a chest port. A chest port for dialysis would not have a bruit and thrill. An assessment of a chest port consisted of ensuring the dressing was intact and if there was bleeding.

Resident E did not have an AV fistula. LPN 22 confirmed Resident D's dialysis and access site orders on his EMAR and ETAR were written incorrectly and contained errors.

Resident D's right chest port should not be assessed for a bruit and thrill, and he did not have an AV fistula.

During an interview, on 4/24/26 at 3:00 p.m., the DON indicated when physician orders were entered, they were audited the next business day by the management team.

Resident D's dialysis orders had a lot of things wrong within the orders, and she discontinued the orders during the interview.

She confirmed nurses had documented AV fistula assessments and neither Resident D nor E had an AV fistula. A current facility policy, undated, titled Documentation in Medical Record provided by the Administrator, on 4/24/26 at 2:42 p.m., indicated the following: Policy: Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation.

Policy Explanation and Compliance Guidelines: 3.

Principles of documentation include, but are not limited to: a.

Documentation shall be factual, objective, and resident centered. i.

False information should not be documented. ii.

Record descriptive and objective information based on first-hand knowledge of the assessment, observation, or service provided.b.

Documentation shall be accurate, relevant, and complete, containing sufficient details about the resident's care and/or responses to care.This citation relates to Intake 2970449.410 Indiana Administrative Code (IAC) 16.2-3.1-50(a)(2)