Majestic Care Of Connersville

F 0600 Level of Harm - Actual harm Residents Affected - Few

An eCare Triage note, dated 10/16/25, indicated LPN reported that Resident B alerted staff that another resident groped her breast on the way inside from the 8:00 p.m. smoke break. Another resident witnessed

the event. The DON was notified.

The Medication Administration Record (MAR) indicated Resident B received buspirone HCL 5 mg (milligram) scheduled tablet at bedtime, on 10/15/25, for anxiety. 1d. The clinical record for Resident G was reviewed on 10/28/25 at 9:40 a.m. The diagnoses included, but were not limited to, type 2 diabetes mellitus, generalized anxiety disorder, and depression.

The Quarterly MDS assessment, dated 9/19/25, indicated Resident G was moderately cognitively impaired.

During an interview with Resident G on 10/27/25 at 1:55 p.m., Resident G indicated a couple weeks prior that she was wheeling herself in her wheelchair down the hallway when Resident C came up behind her and started pushing the wheelchair for her. Resident G indicated Resident C took his hand and started sliding it down the front of her chest. Resident G indicated she swiped his hand away and told him to cut it out. Resident G indicated she had told a couple of staff members. Resident G indicated these sexual behaviors keep happening outside when residents were coming back in from the smoking area with Resident C, but no one ever sees it. Resident G indicated the DON had not come in to speak with her about

this event.

An Abuse, Mistreatment, Neglect, Exploitation and Misappropriation policy was provided by the DON on 10/27/25 at 11:00 a.m. It indicated .Sexual abuse is a non-consensual sexual contact of any type with a resident .C. Prevention & Identification (b.) identifying, correcting, and intervening in situations in which abuse is more likely to occur .D. Protect the Resident (b.)3) The facility will ensure other residents are protected

This citation is related to Intake 2644466. 3.1-27(a)(1)

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Majestic Care of Connersville

1029 E 5th Street Connersville, IN 47331

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on interview and record review, the facility failed to report an allegation of sexual abuse to the Indiana Department of Health (IDOH) for 2 of 6 residents reviewed for sexual abuse (Resident C and Resident G). Findings include:1. The clinical record for Resident C was reviewed on 10/27/25 at 10:45 a.m.

The diagnoses included, but were not limited to, vascular dementia, depression, anxiety, hypertension, heart failure and epilepsy. The Quarterly Minimum Data Set (MDS) assessment for Resident C, dated 8/22/25, indicated the resident was severely cognitively impaired for daily decision making. The resident was independent with ambulation. The safety checks for Resident C, dated 10/5/25 through 10/9/25, indicated the resident was being monitored every 15 minutes for sexually acting out. There was no further documentation in the resident's clinical record pertaining to any behaviors that led to the 15-minute checks being initiated. During an interview with Registered Nurse (RN) 1 on 10/27/25 at 11:40 a.m., she indicated

she was the nurse, on 10/6/25, and Resident C was on 15-minute checks. RN 1 was unsure why the resident was on 15-minute checks and was unable to find any further documentation besides the 15-minute check sheet for Resident C. During an interview with the Director of Nursing (DON) on 10/27/25 at 1:40 p.m., she indicated, on 10/5/25, it was reported to her that Resident C may have been doing something he should not have been doing. The DON indicated another resident reported that Resident C was being inappropriate with female residents. Resident G might have been one of them. The DON indicated the incident was not reported to IDOH. During an interview with the Regional [NAME] President of Operations

on 10/28/25 at 9:43 a.m., he indicated he was the Administrator of the facility, on 10/5/25, and the DON had texted him and said Resident C was touching a female resident and he was unsure who the female resident was. The allegation was not reported to IDOH. During an interview with RN 1 on 10/28/25 at 10:47 a.m.,

she indicated she remembered, on 10/5/25, that Resident C was on 15-minute checks because he was sexually acting out towards female residents. RN 1 was unsure who the female residents were. During an

interview with the DON on 10/28/25 at 12:45 p.m., she indicated she was unsure why there was no documentation in Resident C's clinical record about the incident on 10/5/25. 2. The clinical record for Resident G was reviewed on 10/28/25 at 9:40 a.m. The diagnoses included, but were not limited to, type 2 diabetes mellitus, generalized anxiety disorder, and depression.The Quarterly MDS assessment, dated 9/19/25, indicated Resident G was moderately cognitively impaired. During an interview with Resident G on 10/27/25 at 1:55 p.m., Resident G indicated a couple weeks ago that she was wheeling herself in her wheelchair down the hallway when Resident C came up behind her and started pushing the wheelchair.

Resident G indicated Resident C took his hand and started sliding it down the front of her chest. Resident G indicated she swiped his hand away and told him to cut it out. Resident G indicated she had told a couple of staff members but were unsure of their names. Resident G indicated these sexual behaviors keep happening outside when residents were coming back in from the smoking area with Resident C, but no one ever sees it. Resident G indicated the DON had not spoken with her about this event.The abuse policy was provided by the DON on 10/27/25 at 11:00 a.m. The policy indicated if there was an allegation of abuse the Administrator would notify the IDOH. This citation relates to Intake 2644466. 3.1-28(c)

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Majestic Care of Connersville

1029 E 5th Street Connersville, IN 47331

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 0610 Level of Harm - Actual harm

who: witnessed or heard the incident; came in close contact with resident/patient the day of the incident (residents, family members), employees who worked closely with the accused person and/or alleged victim

the day of the incident. Review all relevant medical reports and records. This citation is related to Intake 2644466.3.1-28(d)

Residents Affected - Few

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Majestic Care of Connersville

1029 E 5th Street Connersville, IN 47331

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)

Federal health inspectors cited MAJESTIC CARE OF CONNERSVILLE in CONNERSVILLE, IN for a deficiency under regulatory tag F-F0744 during a complaint investigation conducted on 2025-10-29.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 4 deficiencies cited during this inspection of MAJESTIC CARE OF CONNERSVILLE.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-11-14.