Waters Of Covington, The

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

shall be implemented when an employee or agent become aware of abuse or neglect of a resident or of an allegation of suspected abuse or neglect of a resident by a 3rd party. employees are required to report any incident, allegation, or suspicion of potential abuse, neglect or mistreatment they observe, hear about or suspect to the Administrator or an immediate supervisor who will immediately report the allegation to the Administrator. The Administrator is the Abuse Coordinator. All incidents will be documented, whether or not abuse occurred, was alleged or suspected. Any incident or allegation involving abuse or mistreatment will result in an abuse investigation. For any incident involving suspicion of abuse, neglect, or mistreatment, the Administrator or person appointed by the Administrator will gather further facts prior to making a determination to conduct an abuse investigation. The immediate jeopardy that began on 9/24/25 was removed on 10/17/25, when the facility ensured a systemic plan to include education and monitoring of staff to ensure staff provided supervision and required care to all residents residing at the facility. The noncompliance remained at the lower scope and severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy because of the facility's need for continued monitoring.

This citation relates to Intake 2633270. 3.1-27(a)

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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

10/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Waters of Covington, The

1600 E Liberty St Covington, IN 47932

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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

BM on 10/6/25 at 5:59 a.m. 72 hours later, on 10/9/25 at 5:59 a.m., resident G had not had another recorded BM. Resident G's MAR indicated, he received a PRN suppository on 10/9/25 at 1:31 p.m., (6 hours after the triggered 72-hour mark) which was recorded as effective, but the record lacked documentation of a recorded BM. Resident G had a recorded BM on 10/12/25 at 5:59 a.m. 72 hours later,

on 10/15/25 at 5:59 a.m. Resident G did not have another recorded BM. A nursing progress note, dated 10/16/25 at 10:18 a.m., indicated Resident G had not had a bowel movement and was assessed and found to have hypoactive bowel sounds and a firm abdomen. He did not complain of pain at that time, was administered M.O.M. at 10:10 a.m. and the physician was notified. According to the facilities proactive audit reviews, Resident G triggered for no BMs on 10/9/25 and 10/10/25 with Hospice being notified on 10/10/25. d. On 10/16/25 at 1:28 p.m., a record review was completed for Resident H. He had the following diagnoses which included but were not limited to major depressive disorder, heart transplant, hypertension, muscle weakness, and unsteadiness on feet. His brief interview mental status (BIMS) score on 9/28/25 was 15, indicating his mental status was intact. His MDS, dated [DATE REDACTED], indicated he was continent of bowel and not receiving a bowel management program. Resident H was prescribed Miralax 17 grams (gm) daily in a large glass of water for bowel health dated 8/30/25. He was prescribed Milk of Magnesia (MOM) 30 milliliters (ml) daily as needed for constipation dated 9/30/25. He had no bowel movement from 9/30/25 through 10/3/25.

On 10/4/25 at 21:59 he had a medium sized bowel movement. Resident's care plan lacked any mention of

the potential for constipation. During an interview on 10/16/25 at 11:50 a.m., the DON indicated some of the time discrepancies may be due to a technological date/time recording error for some new tables that had been used by the aides to chart. Some of the tablets were several hours behind the actual time zone, and had not been fixed yet. During an interview on 10/17/25 at 11:45 a.m., the Administrator indicated it was his expectation for nursing staff to immediately respond to Resident B's complaints of pain and take appropriate measures to assist him or send him to the emergency room. Further, it was his expectation that nursing staff should be charting accurately, and following the new facility protocol as implemented by the DON and MD. On 10/16/25 at 10:25 a.m., the Administrator provided a copy of facility policy titled, Bowel Protocol, dated 10/1/25. At this time the ADM indicated, there had been a bowel regimen in place at the time Resident B experienced his obstruction and hospitalization, but it was evidently not being implemented or monitored effectively, so the DON and MD with the clinical team got together to create a revised protocol, which he provided at that time. The new protocol indicated, .use stepwise approach: A. no BM for 3 days [give] M.O.M. 30 ml by mouth once daily. B. If no BM for 4 days, notify the physician or NP. 5.

Documentation: record all bowel movements (date, time, consistency, amount), note interventions used and resident response, notify provider if: no BM 4+ days, signs of bowel obstructions or impaction, persistent diarrhea or bleeding. 6. Special considerations: Opioid-induced constipation; initiate stimulant laxative at some time as opioid. May require methylnaltrexone if refractory. Palliative/Hospice Residents: prioritize comfort, liberal use of laxatives and suppositories as needed. The immediate jeopardy that began on 9/24/25 was removed on 10/17/25, when the facility ensured a systemic plan to include education and monitoring of staff to ensure staff assessed and monitored residents for pain and change in condition, and that staff followed the facility bowel protocol. The noncompliance remained at the lower scope and severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy because of the facility's need for continued monitoring. This citation relates to Intake 2633270. 3.1-37(a)

Event ID:

Facility ID:

If continuation sheet