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Complaint Investigation

Betz Nursing Home

Inspection Date: September 15, 2025
Total Violations 1
Facility ID 155694
Location AUBURN, IN
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Inspection Findings

F-Tag F0761

Pharmacy Service Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Based on observation, interview and record review the facility failed to ensure staff were present for medication administration for 2 of 3 residents reviewed (Resident B, Resident C).Findings include:1.During

an interview, on 9/15/25 at 10:10 AM, Resident B's family indicated the facility often left medications at bedside. Resident B's family indicated Resident B could not self administer their own medications safely.Resident B's record was reviewed on 9/15/25 at 10:35 AM, diagnoses included end stage renal disease. There were no self administration of medications evaluations documented for Resident B. There were no physician orders for self administration of medications for Resident B. 2. During an observation, on 9/15/25 at 11:23 AM, Resident C's medications were observed at bedside.During an interview, on 9/15/25 at 11:23 AM, Resident C indicated Licensed Practical Nurse (LPN) 3 placed his medications at bedside for his lunch. Resident C indicated he didn't receive lunch until around 1 PM.During an interview, on 9/15/25 at 11:28 PM, LPN 3 indicated no residents in the facility were able to self-administer their medications. LPN 3 indicated she placed Resident C's medications at bedside to take during his lunch. LPN 3 indicated no medications were allowed at bedside. During an interview, on 9/15/25 at 12:09 PM, the Director of Nursing (DON) indicated no residents were able to self-administer their medications. The DON indicated Resident C's medications should not be left at bedside.Resident C's record was reviewed on 9/15/25 at 11:46 AM.

Diagnoses included end stage renal disease and type 2 diabetes mellitus. There were no physician orders for self administration of medication for Resident C. An admission care plan, dated 8/7/25, indicated the nurse was to administered Resident C's medications as ordered.An admission Minimum Data Set (MDS) assessment, indicated Resident C had a Brief Interview of Mental Status (BIMS) of 15/15 (cognitively intact). There were no self-administration of medication evaluations documented for Resident C.During an interview, on 9/15/25 at 11:17 AM, Registered Nurse (RN) 4 indicated medications were never left at bedside. RN 4 indicated the nurse waited for the resident to take the medication prior to the nurse leaving

the room. A policy, last revised 1/2015, titled Self Administration of Medications, was provided by the Regional Nurse on 9/15/25 at 12:11 PM. The policy indicated a self-administration assessment and order were completed for residents who self- administered medications. This finding relates to Intake 2595411. 3.1-25(b)(3)

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

BETZ NURSING HOME in AUBURN, IN inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

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

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 AUBURN, 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 BETZ NURSING HOME or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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