Belmont Health & Rehabilitation, The
Inspection Findings
F-Tag F0686
F 0686 Level of Harm - Minimal harm or potential for actual harm
A Facility Wound Management Report, indicated the resident had a Stage 3 pressure ulcer to the right lateral ankle that was identified on 02/11/2025. The Wound Management Report was created on 02/14/2025. The wound measured 1.5 cm X 2 cm X 0.1 cm.
The resident had the following orders in place at the time the wound was identified:
Residents Affected - Few -A physician's order, dated 06/05/2024 through 03/06/2025, to perform a weekly skin inspection on Fridays.
If any new areas were identified, a new skin impairment event was to be opened, and -A physician's order, dated 02/12/2025 through 04/09/2025, to cleanse the right lateral ankle with normal saline, pat dry, apply skin prep to the peri-wound, apply moistened Prisma to base of the wound, cover with
a 4 x 4 gauze, wrap with conforming rolled gauze, and secure with tape.
The Event Reports lacked an assessment for the resident's right lateral ankle.
The resident's shower sheets lacked any indication the resident had any wounds on 02/03/2025, 02/06/2025, or 02/10/2025.
The resident's clinical record lacked documentation of the resident's wound until 02/14/2025, when it was a Stage 3 pressure ulcer.
The February 2025 EMAR/ETAR lacked documentation that the right ankle treatment was completed prior to 02/14/2025.
During an interview, on 09/29/2025 at 10:25 A.M., Licensed Practical Nurse (LPN) 9 indicated the nurses assessed the residents' skin weekly and it was documented in the EMAR/ETAR. The Certified Nurse Aides (CNAs) would check the residents' skin daily and would let the nurse know of any new skin impairments.
The CNAs also completed shower sheets and would document the new skin impairments and let the nurse know. Once a new skin impairment was identified the nurse would measure the wound, document it in wound management and in a nurse's note, let the wound nurse know, and get a new treatment order.
During an interview, on 09/29/2025 at 2:25 P.M., the Facility Wound Nurse indicated the resident's right ankle wound developed in February 2025. The wound was a Stage 3 when it was first identified. The nurses assessed residents' skin weekly in the EMAR/ETAR. If a new wound was identified, then it should be documented in a skin event and a progress note. The CNAs would document skin impairments on the shower sheets and would notify the nurse. The resident's ankle wound should have been identified before it was a Stage 3.
The current facility policy, titled SKIN MANAGEMENT PROGRAM, most recently revised in 2025, was provided by the Regional Director of Operations on 09/30/2025 at 3:48 P.M. The policy indicated, .The facility will assess/identify the presence of risk factors that may contribute to the development of pressure ulcers.in an effort to prevent skin breakdown and/or further deterioration.Residents who receive assistance with bathing and/or pericare will be observed daily by nursing staff and any observance of red areas, open areas .will be reported to the licensed nurse for further assessment .
This citation relates to intake 2617395. 3.1-49(a)(2)
FORM CMS-2567 (02/99) Previous Versions Obsolete
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
09/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Belmont Health & Rehabilitation, The
540 Belmont Drive Columbus, IN 47201
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)
F-Tag F0692
F 0692
-09/02/2025 at dinner, -09/07/2025 at dinner, and-09/21/2025 at dinner.
Level of Harm - Minimal harm or potential for actual harm
During an interview, on 09/29/2025 at 10:19 A.M, QMA (Qualified Medication Aide) 5 indicated all resident meals, that included breakfast, lunch, and dinner were documented in the resident's clinical record on the computer. If the residents refused a meal or were out of the facility during the meal they were able to document, it also.
Residents Affected - Some
The current facility policy titled, Meal Consumption Record was provided by the Assistant Director of Nursing on 09/29/25 4:35 P.M. The policy indicated, .To provide means to monitor the resident's daily intakes.Percentage of meals consumed daily will be recorded on the document designated by the facility.
This citation relates to Intake 2617395. 3.1-46(a)(1)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
BELMONT HEALTH & REHABILITATION, THE in COLUMBUS, 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 COLUMBUS, 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 BELMONT HEALTH & REHABILITATION, THE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.