Countryside Meadows
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
unwitnessed fall in her room and sustained a skin tear on her lower extremity. The root cause of the fall was that the resident was trying to get up by herself, and the intervention was for her to have an Occupational Therapy evaluation. The record lacked follow-up or indication on how or where she sustained the skin tear.
Upon Resident B's move to the secured memory care unit, a comprehensive care plan was initiated on 10/10/25 which indicated, Resident resides on a secured memory careunit related to diagnosis of unspecified dementia. an intervention for the plan of care was, Keep environment free from hazards. A Nurse Practitioner (NP) progress notes, dated 10/17/25 at 10:28 a.m., indicated Resident B had .dressings
on her bilateral lower legs from some injuries that the nurse and staff are not aware of what could have caused it, the wound is just some scrapes that they have been changing daily right now. The record lacked follow-up or indication for how she sustained the skin tears. On 10/31/25 a new comprehensive care plan was initiated which indicated, Resident has skin tears to right knee and back of left knee. Interventions for
this plan of care included, but were not limited to, Observe resident environment for potential to cause skin trauma. A nursing progress note, dated 11/5/25 at 10:27 a.m., indicated Resident B accidentally hit her left leg against the bed frame during a transfer and sustained a laceration on her left lower extremity with moderate bleeding. The nurse applied first aide and called 911 for her to be sent out to the emergency room (ER) for further evaluation and treatment. Corresponding ER documentation, dated 11/6/25 at 2:19 a.m., indicated patient from [facility] with large deep leg laceration to left lower leg. Staff reported they were transferring patient from wheelchair to bed when laceration occurred. Bleeding controlled. The wound was reapproximated in one layer with 6 simple interrupted sutures. Approximately 4 running sutures to approximate the areas in-between the simple interrupted sutures. On 11/10/25 at 3:00 p.m., The ADM and DON indicated there was no policy to address environmental hazards but they could provide a routine maintenance policy. On 11/10/25 at 3:19 p.m., the ADM provided a copy of current, but undated facility policy titled, Maintenance Procedure. The policy indicated, Beds: Frequency: semi-annual. Check bed casters to make certain brakes are locking, if so equipped. Check side rails to determine if they are working smoothly. Tighten nuts and bolts. Lubricate bed-adjusting mechanisms. This citation relates to Intake
- 2662177. 3.1-45(a)
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COUNTRYSIDE MEADOWS in AVON, IN inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 AVON, 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 COUNTRYSIDE MEADOWS or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.