Kingston Health Center Of Fort Wayne
Inspection Findings
F-Tag F0684
F 0684
contacted to verify the orders. After verification of orders the medication list should be sent to the pharmacy.This finding relates to Intake 2653113.3.1-37
Level of Harm - Minimal harm or potential for actual harm 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
11/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kingston Health Center of Fort Wayne
1010 W Washington Center Rd Fort Wayne, IN 46825
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 F0812
F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Based on interview, observation and record review the facility failed to follow sanitation methods to maintain
a clean environment in the kitchen area. 107 of 107 residents who resided in the facility ate food prepared
in the kitchen.Findings include:During an observation, on 11/19/25 at 10:20 AM, 22 plus live gnats were observed in the dining room corner, on the opposite wall from the dishwasher. There were 3 carts covered
in dried yellow and white liquid. There were also 3 carts of leftover food from breakfast waiting to be washed.During an interview, on 11/19/25 at 10:21 AM, the Dietary Manager (DM) indicated pest control had treated the gnats and it had resolved. The DM indicated there had been increased cleaning of the area and the carts were cleaned nightly. The DM indicated there was no documentation for nightly cart cleaning.
The DM indicated the carts observed in the dining room had not been cleaned nightly based on appearance.During an interview, on 11/19/25 at 10:37 AM, the Maintenance Director indicated the pest control company had treated the area for gnats last week.A pest control log was provided by the Maintenance Director on 11/19/2025 at 10:37 AM. The log indicated on 10/31/25 pest control observed fruit flies in the kitchen area. On 11/13/25, the log indicated drain flies were found in the kitchen sinks, there was food over the dishwasher area and the kitchen/dining room area needed improved sanitation.During an interview, on 11/20/25 at 10 AM, the Administrator indicated the carts were not cleaned nightly as required.
The Administrator indicated the area should have been cleaned to maintain sanitation and prevent pests.The was no documentation of regular cleaning to the area or carts.A current policy, dated 10/2024, titled Cleaning and Disinfection of Environment, was provided by the Administrator on 11/20/25 at 10 AM.
The policy indicated surfaces and floors were cleaned on regular basis and when visibly soiled.A current policy, dated 9/2019, titled Cleaning Food Carts, was provided by the Administrator on 11/20/25 at 10 AM.
The policy indicated the food carts were cleaned and sanitized after each use and meal.This finding relates to Intake 2651582.3.1-21(i)(3)
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
11/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kingston Health Center of Fort Wayne
1010 W Washington Center Rd Fort Wayne, IN 46825
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 F0925
F 0925
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Level of Harm - Minimal harm or potential for actual harm
Based on interview, observation and record review the facility failed to follow sanitation methods to prevent pests. 107 of 107 residents who resided in the facility ate food prepared in the facility kitchen.Findings include:During an observation on 11/19/25 at 10:20 AM, 22 plus live gnats were observed in the dining room corner, on the opposite wall of the dishwasher. There were 3 carts covered in dried yellow and white liquid. There were also 3 carts of leftover food from breakfast waiting to be washed.During an interview on 11/19/25 at 10:21 AM, the Dietary Manager (DM) indicated pest control had treated the gnats and it had resolved. The DM indicated there had been increased cleaning of the area and the carts were cleaned nightly. The DM indicated there was no documentation for nightly cart cleaning. The DM indicated the carts observed in the dining room had not been cleaned nightly based on appearance.During an interview, on 11/19/25 at 10:37 AM, the Maintenance Director indicated the pest control company had treated the area for gnats last week.A pest control log was provided by the Maintenance Director on 11/19/2025 at 10:37 AM. The log indicated on 10/31/25 pest control observed fruit flies in the kitchen area. On 11/13/25, the log indicated drain flies were found in the kitchen sinks, there was food all over the dishwasher area and the kitchen/dining room area needed improved sanitation. There was no documentation the area had been treated again for the gnats.During an interview on 11/20/25 at 10 AM, the Administrator indicated the carts were not cleaned nightly as required. The Administrator indicated the area should have been cleaned to maintain sanitation and prevent pest.The was no documentation of regular cleaning to the area or carts.A current policy, dated 10/2024, titled Cleaning and Disinfection of Environment, was provided by the Administrator on 11/20/25 at 10 AM. The policy indicated surfaces and floors were cleaned on regular basis and when visibly soiled.A current policy, dated 9/2019, titled Cleaning Food Carts, was provided by the Administrator on 11/20/25 at 10 AM. The policy indicated the food carts were cleaned and sanitized after each use and meal.This finding relates to Intake 26515823.1-19(f)(4)
Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Kingston Health Center of Fort Wayne in FORT WAYNE, 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 FORT WAYNE, 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 Kingston Health Center of Fort Wayne or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.