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Complaint Investigation

Northern Lakes Nursing And Rehabilitation Center

September 17, 2025 · Angola, IN · 516 N Williams St
Citations 2
CMS Rating 2/5
Beds 99
Provider ID 155449
Healthcare Facility
Northern Lakes Nursing And Rehabilitation Center
Angola, IN  ·  View full profile →
Inspection Summary

NORTHERN LAKES NURSING AND REHABILITATION CENTER in ANGOLA, IN — inspection on September 17, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0580
Resident Rights Deficiencies
Immediate Jeopardy

jeopardy to resident health or safety

inhaler earlier in the day.

The nurse indicated CNA 4 did not tell him the pain was radiating to the resident's chest.

Resident K was sitting on the side of the bed, complaining his shoulder hurt. He does not remember a change in skin color. He did not assess the shoulder pain, his breath sounds, or his heart sounds. He indicated he asked the resident if he wanted to go to the hospital because he always asked residents if they wanted to go to the hospital. He did not call the physician because Resident K wanted to see if he felt better, but he did not go back and check on the resident. He did not report any issues to the nurse coming on shift.In an interview, on [DATE] at 10:41 AM, Qualified Medication Assistant (QMA) 5 indicated she had administered no prn medications to Resident K on the day shift of [DATE]. QMA 5 indicated Resident K looked to be his normal self, had no complaints of pain and was up and around the facility as usual. QMA 5 indicated when she saw a change in resident condition, she would report it to the nurse who would report it to the doctor.In an interview, on [DATE] at 11:19 AM, CNA 6 indicated she was taking Resident K's breakfast tray to him, and noticed him sitting up in bed, and slumped over.

She indicated his color was gray, and when she touched his hand to wake him, his skin was cold and hard.A current undated policy, titled Change of Condition, indicated All staff members shall communicate any information about resident status change to appropriate licensed personnel immediately upon observation.

The policy indicated when the nurse was notified of the change of condition, the nurse must immediately assess the resident, including vital signs, lung sounds, and other assessments as indicated by the change, including complaints of new or worsened pain.

The Immediate Jeopardy that began on [DATE] was removed and the deficient practice corrected on [DATE] when the facility conducted audits of current resident's condition to ensure no changes and re-educated nursing staff regarding assessments, documentation, and physician notification but will remain at the lower scope and severity of no actual harm with potential for more than minimal harm that is not immediate jeopardy.

This Citation relates to Intake 2616068.3.1-5(a)(2)

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/17/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Northern Lakes Nursing and Rehabilitation Center

516 N Williams St Angola, IN 46703

SUMMARY STATEMENT OF DEFICIENCIES

According to an article titled acute pain, retrieved on [DATE] from simple nursing. com, when a resident complains of pain, the nurse should assess the cause, assess the symptoms, ask the resident their stated level of pain, take vital signs, then monitor the resident's pain level every 2 hours and contact the physician when pain is unrelieved, worsens or radiates into the chest.

Pain radiating into the chest could be a sign of heart attack. In an interview, on [DATE] at 10:41 AM, QMA 5 indicated she had administered no prn medications to Resident K on the day shift of [DATE]. QMA 5 indicated Resident K looked to be his normal self, had no complaints of pain and was up and around the facility as usual. In an interview, on [DATE] at 11:19 AM, CNA 6 indicated she was taking Resident K's breakfast tray to him, and noticed him sitting up in bed, and slumped over.

She indicated his color was gray, and when she touched his hand to wake him, his skin was cold and hard.A current undated policy, titled Change of Condition, indicated all staff members should communicate any information about resident status change to appropriately licensed personnel immediately upon observation.

The policy indicated when the nurse was notified of the change of condition, the nurse must immediately assess the resident, including vital signs, lung sounds, and other assessments as indicated by the change, including complaints of new or worsened pain.

The Immediate Jeopardy that began on [DATE] was removed and the deficient practice corrected on [DATE] when the facility conducted audits of current resident's condition to ensure no changes and re-educated nursing staff regarding assessments and documentation but will remain at the lower scope and severity of no actual harm with potential for more than minimal harm that is not immediate jeopardy.

This Citation relates to Intake 2616068.3.1-37

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ANGOLA, IN, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from NORTHERN LAKES NURSING AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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