Aperion Care Lincoln

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

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

Based on observation and interview, the facility failed to report an alleged violation of sexual abuse to the State Survey Agency for 1 of 1 allegation of abuse reviewed. (Resident T)Finding includes:In an anonymous interview, it was indicated that Resident B asked Resident T for sex and to see her breasts, and that Resident T was not capable of giving consent.During an interview on 9/24/25 at 9:24 A.M., the Director of Nursing (DON) indicated that a few weeks prior, a Certified Nurse Aide (CNA) had reported to her that Resident B went into Resident T's room and asked her to be his girlfriend and if she had ever had sex.

Resident T responded no and Resident B left. The DON was unable to remember when that incident occurred.During an interview on 9/24/25 at 11:00 A.M., the DON indicated that the CNA also reported to her that Resident T showed Resident B her breasts. She indicated that the incident occurred on or around 8/23/25.During an interview on 9/24/25 at 1:04 P.M., the Administrator indicated he was aware of the incident that occurred between Resident B and Resident T. He was unaware it needed to be reported to the State Survey Agency.During an interview on 9/24/25 at 1:10 P.M., the Regional [NAME] President of Operations indicated that she was aware of the incident that occurred between Resident B and Resident T, but was unaware that it needed to be reported to the State Survey Agency.During an interview on 9/24/25 at 2:27 P.M., the Administrator indicated that the facility did not have a policy related to reporting alleged violations and followed State regulations.This citation relates to Intake 2608809.3.1-28(c)

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Lincoln

1236 Lincoln Ave Evansville, IN 47714

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

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to conduct a thorough investigation of an allegation of abuse for 1 of 1 residents reviewed for abuse. (Resident T)Finding includes:In an anonymous interview, it was indicated that Resident B asked Resident T for sex and to see her breasts, and that Resident T was not capable of giving consent.During an interview on 9/24/25 at 9:24 A.M., the Director of Nursing (DON) indicated that a few weeks prior, a Certified Nurse Aide (CNA) had reported to her that Resident B went into Resident T's room and asked her to be his girlfriend and if she had ever had sex. Resident T responded no and Resident B left. She completed a capacity for sexual consent assessment for both residents at that time and told Resident B he could not ask those questions to other residents. She indicated that there was no other documentation surrounding the incident between Resident B and Resident T.During an interview

on 9/24/25 at 11:00 A.M., the DON indicated that the CNA also reported to her that Resident T showed Resident B her breasts.During an interview on 9/24/25 at 1:04 P.M., the Administrator indicated he was aware of the incident that occurred between Resident B and Resident T. He indicated both residents were interviewed and the event was discussed in morning meeting following the event, but there was no documentation about the incident or the investigation.During an interview on 9/24/25 at 1:10 P.M., Regional [NAME] President of Operations indicated that the residents were determined to have capacity to consent but was unsure how the facility determined if someone was cognitively able to give consent. She indicated that she talked with Resident T but she was not able to provide any documentation related to an investigation of the incident.On 9/24/25 at 2:27 P.M., the Administrator provided a current Sexuality-Capacity to Consent Determination policy, revised 7/15/24, that indicated The facility will conduct

an investigation and protect the resident from non-consensual sexual relations anytime the facility has reason to suspect that the resident does not wish to engage in sexual activity or may not have the capacity to consent . During the course of the investigation of an allegation of resident sexual abuse or other situation as warranted, the Interdisciplinary Team shall assess and make a determination of whether the sexual activity was consensual on the part of the resident(s) and document the findings of the assessment

in a progress note and/or in the plan of care.This citation relates to Intake 2608809.3.1-28(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

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Lincoln

1236 Lincoln Ave Evansville, IN 47714

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 0658

Ensure services provided by the nursing facility meet professional standards of quality.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to ensure a resident's wound treatments were completed as ordered for 1 of 3 resident's reviewed for wounds. (Resident C) Finding includes:On 9/23/25 at 1:39 P.M., Resident C's clinical record was reviewed. Resident C's diagnoses included, but were not limited to, type 2 diabetes mellitus without complications. The most recent Minimum Data Set (MDS) Assessment, dated 7/21/25, indicated Resident C was cognitively intact, and had a surgical wound.

Physician orders included, but were not limited to: Wound vac to be changed every three days; Start Date 8/8/25 The electronic treatment administration record indicated Resident C's wound vac was scheduled to be changed on the following days in September 2025, but was not changed:9/7/259/10/25 During an

interview on 9/24/25 at 12:32 P.M., the Director of Nursing indicated Resident C's wound vac was not changed on 9/7/25 or 9/10/25. On 9/24/25 at 3:02 P.M., the Administrator provided a policy titled Skin Condition Assessment and Monitoring, revised 6/2018, that indicated Physician ordered treatments shall be initialed by the staff on the electronic Treatment Administration Record after each administration. Other nursing measures not involving medications shall be documented in the weekly wound assessment or nurses note.' This citation relates to Intake 2615547. 3.1-35(g)(1)

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

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Lincoln

1236 Lincoln Ave Evansville, IN 47714

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 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to ensure a bath or shower was provided for 1 of 3 residents reviewed for bathing. (Resident C) Finding includes:On 9/23/25 at 1:39 P.M., Resident C's clinical record was reviewed. Resident C's diagnoses included, but were not limited to, type 2 diabetes mellitus without complications. The most recent Minimum Data Set (MDS) Assessment, dated 7/21/25, indicated Resident C was cognitively intact and required moderate assistance (staff do part of the work) for bathing. During an observation on 9/23/25 at 1:00 P.M., Resident C indicated that bathing had not been completed or bed linen hadn't been changed in weeks. Resident C had a very pungent sour smell, greasy hair, and long, soiled fingernails. The point of care (POC, a certified nurses aide charting system) indicated Resident C preferred bathing twice weekly in the evenings. Paper and electronic shower records were reviewed for the last 30 days, and indicated Resident C had not received or refused a bath or shower

on the following dates: 8/26/259/12/259/19/25 The bathing records indicated Resident C had not had their hair shampooed from 8/26/25 through 9/23/25. On 9/24/25 at 2:27 P.M., the Administrator provided a policy titled Bathing Shower and Tub Bath, revised 1/2018, that indicated A shower, tub bath, or bed/sponge bath will be offered according to the resident's preference, two times per week or according to the resident's preferred frequency and as needed or requested. This citation relates to Intake 2588834. 3.1-38(a)(3)

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

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Lincoln

1236 Lincoln Ave Evansville, IN 47714

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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

of care shall be reviewed and/or updated at least quarterly and with a change in condition such as a new or worsening behavior or a behavior event requiring increased monitoring.On 9/24/25 at 2:27 P.M., the Administrator provided a current Sexuality-Capacity to Consent Determination policy, revised 7/15/24, that indicated The facility will conduct an investigation and protect the resident from non-consensual sexual relations anytime the facility has reason to suspect that the resident does not wish to engage in sexual activity or may not have the capacity to consent . During the course of the investigation of an allegation of resident sexual abuse or other situation as warranted, the Interdisciplinary Team shall assess and make a determination of whether the sexual activity was consensual on the part of the resident(s) and document

the findings of the assessment in a progress note and/or in the plan of care.This citation relates to Intake 2608809.3.1-37(a)3.1-43(a)(1)

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

09/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Lincoln

1236 Lincoln Ave Evansville, IN 47714

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Based on observation, interview, and record review, the facility failed to ensure proper storage of medications for 1 of 1 medication rooms reviewed. The medication room, treatment cart, and medication refrigerator were not locked. (First Floor Medication Room)Finding includes: On 9/23/25 at 1:04 P.M., the first floor medication room that contained the Emergency Drug Kit (EDK) was observed unlocked. Inside the room, the treatment cart and the refrigerator that contained insulin, suppositories, and other cold medication was observed unlocked. At that time, Qualified Medication Aide (QMA) 16 indicated that the medication room, treatment cart, and medication refrigerator were all supposed to be locked.On 9/24/25 at 2:27 P.M., the Administrator provided a current Medication Storage policy, revised 7/2/19, that indicated Facility should ensure that all medications and biologicals, including treatment items, are securely stored in

a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors.This citation relates to Intake 2615731.3.1-25(m)

Event ID:

Facility ID:

If continuation sheet