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Complaint Investigation

George Ade Memorial Health Care Center

Inspection Date: November 12, 2025
Total Violations 2
Facility ID 155719
Location BROOK, IN
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Inspection Findings

F-Tag F0684

Quality of Life and Care Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

10/26/25 when the pain continued.On 10/26/25 at 9:47 p.m., indicated at 9:40 p.m. the resident had severe pain in the right knee and neck. There was decreased strength and range of motion of the right leg and edema of the right knee and right foot. Acetaminophen was administered as ordered by the physician and

the resident was assisted to bed and positioned with his right leg elevated. The physician was notified.On 10/27/25 at 11:54 A.M., the resident was assisted to the bathroom and would not stand. He required two staff to transfer on and off the toilet. He indicated his legs were hurting. The physician was made aware of

the pain.There was no nursing assessment of the legs documented.On 10/27/25 at 6:35 p.m. an order was received from the physician for a right knee x-ray.A Physician's Progress Note, dated 10/29/25 at 7:39 p.m., indicated it was very difficult to evaluate the resident related to dementia. He complained of back, right leg, and right knee pain and still had trouble walking. The right leg had full passive range of motion. The right knee x-ray was negative for injuries.A Medicare Meeting Report, dated 10/30/25, indicated the resident ambulated with moderate to maximum assistance of one - two staff members with a front-wheeled walker.

The gait training indicated he used a front-wheeled walker with moderate to maximum assistance of two staff.A Nurse's Progress Note, dated 11/1/25 at 6:40 a.m., indicated the CNA reported the right leg appeared shorter than the left. There was a discoloration of the right hip of light yellow in color with a purple color in the center and measured six cm by five cm. The resident complained of pain to the right leg when touched. The right leg was shorter than the left and rotated laterally. An order for a right hip x-ray was obtained from the Physician and the resident remained non-weight bearing.A right hip x-ray report, dated 11/1/25, indicated a right femoral neck fracture.A Nurse's Progress Note, dated 11/1/25 at 12:38 p.m., indicated a physician's order to transfer the resident to the hospital.A Hospital Discharge summary, dated [DATE REDACTED], indicated a right hemiarthroplasty (artificial implant) was completed to the right hip.A Nurse's Progress Note, dated 11/4/25 at 4:30 p.m., indicated the resident was transferred back to the facility from

the hospital.During an interview on 11/12/25 at 2:29 p.m., Physical Therapist (PT) 1 indicated the resident had pain with flexion of the right hip. There was an x-ray of the right knee that showed no fracture. He would complain of pain in the right leg from the mid-thigh down past the knee. He was able to bear weight and could walk 10 feet with maximum assistance of two. His gait had a limp, which was not normal for him.

Before the fall he was independent with ambulation. There was a big discrepancy in his status after the fall.

His complaints of pain would vary, one day he didn't have pain, the next day he would. There was range of motion to the right knee though it was limited due to the pain. He required two staff to transfer him and some days he would not bear any weight.During an interview on 11/12/25 at 2:47 p.m., the Director of Nursing (DON), indicated she had only asked for the right knee to be x-rayed because this is what he had hurt when he fell. She acknowledged no further assessments had been completed by the nurses when the right leg pain increased and the functional status of the right leg had changed until 11/1/25.This citation relates to Intake 2658600.3.1-37

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

George Ade Memorial Health Care Center

3623 East State Rd 16 Brook, IN 47922

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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F-Tag F0689

Quality of Life and Care Deficiencies
Harm Level: Actual Harm

Federal health inspectors cited GEORGE ADE MEMORIAL HEALTH CARE CENTER in BROOK, IN for a deficiency under regulatory tag F-F0689 during a complaint investigation conducted on 2025-11-12.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Scope/Severity Level G: isolated, actual harm that is not immediate jeopardy.

Actual harm to residents was documented as a result of this deficiency.

This was one of 2 deficiencies cited during this inspection of GEORGE ADE MEMORIAL HEALTH CARE CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-30.

📋 Inspection Summary

GEORGE ADE MEMORIAL HEALTH CARE CENTER in BROOK, 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 BROOK, 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 GEORGE ADE MEMORIAL HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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