South Shore Health & Rehabilitation Center
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
indicated the Paxlovid had not yet arrived, and the nurse manager was made aware. The record lacked documentation that the physician was notified that the resident did not receive the Paxlovid as ordered.During an interview on 9/19/25 at 2:30 p.m., the DON and Corporate Nurse 1 indicated the nurse should have notified the physician that the resident did not receive the medication as prescribed and documented the notification in the resident's record.A policy titled, Notification of Changes, received as current from the DON on 8/19/25 at 2:58 p.m. indicated, . The facility must . consult the resident's physician . when there is a change requiring such notification . Circumstances requiring notification include: . a need to alter a treatment.3.1-5(a)(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
09/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
South Shore Health & Rehabilitation Center
353 Tyler St Gary, IN 46402
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 F0684
F 0684
time when her blood pressure was less than 100/60:
Level of Harm - Minimal harm or potential for actual harm
9/10/25 at 9:00 a.m. blood pressure 103/58 9/12/25 at 9:00 a.m. blood pressure 107/54
Residents Affected - Few
A Physician's Order, dated 8/5/24 and listed as current on the September 2025 POS, indicated the resident was to receive Midodrine HCl (a medication for low blood pressure) 10 milligrams (mg) every 8 hours as needed (PRN) for hypotension. Give when systolic blood pressure (top number) was less than 90.
The July, August, and September 2025 Medication Administration Records (MARs) indicated the resident's blood pressure was monitored once a day rather than every 8 hours.
The July 2025 MAR indicated on 7/30/25 at 9:00 a.m., the resident's blood pressure was 79/55. The resident did not receive the PRN Midodrine.
The August 2025 MAR indicated on 8/20/25 at 9:00 a.m., the resident's blood pressure was 83/60. The resident did not receive the PRN Midodrine.
During an interview on 9/19/25 at 2:40 p.m., the Director of Nursing indicated the resident should have received the Midodrine as ordered and a clarification order for the Lisinopril should have been obtained.
- 3. Resident D's record was reviewed on 9/18/25 at 3:07 p.m. Diagnoses included, but were not limited to,
hemiplegia and hemiparesis following a cerebral infarction, diabetes mellitus, and atrial fibrillation.
The Quarterly MDS, dated [DATE REDACTED], indicated the resident had moderate cognitive impairment and was dependent for toileting and transfers.
A complete blood count (CBC) and comprehensive metabolic panel (CMP) lab tests were completed on 4/28/25. There were handwritten orders at the bottom of the lab results that indicated to repeat the labs in one week and to give potassium 40 milliequivalents x 1.
There were no orders for the repeat lab or the potassium entered into the electronic record. There was no indication the repeat lab had been completed in one week or the potassium had been given as ordered.
During an interview on 9/22/25 at 1:59 p.m., the Director of Nursing indicated the repeat lab had not been done and the potassium had not been given.
This citation relates to Intake 2597285. 3.1-37(a)
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
09/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
South Shore Health & Rehabilitation Center
353 Tyler St Gary, IN 46402
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 F0760
F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
p.m., indicated the resident had wheezing and shortness of breath on exertion. New orders were received including Paxlovid (an oral antiviral medication for treating Covid-19 in patients who are at high risk of the disease progressing to a more severe illness) twice a day for 5 days.A Nurse's Note, dated [DATE REDACTED] at 6:43 p.m., indicated the Paxlovid had not yet arrived and the nurse manager was made aware. The [DATE REDACTED] Medication Administration Record (MAR) indicated the resident only received 3 of the 10 scheduled doses of Paxlovid. The record lacked documentation as to why the resident did not receive the medication as ordered. During an interview on [DATE REDACTED] at 2:30 p.m., the DON and Corporate Nurse 1 indicated the medication came as one unit from the pharmacy, and should have been available for the resident to receive as ordered. They did not know why the resident did not receive the medication as it was prescribed. The manufacturer prescriber administration instructions for Paxlovid indicated to alert the patient of the importance of completing the full 5-day treatment course and to continuing isolation in accordance with public health recommendations to maximize viral clearance and minimize transmission of SARS-CoV-2. If
the patient misses a dose of Paxlovid within 8 hours of the time it is usually taken, the patient should take it as soon as possible and resume the normal dosing schedule. This citation relates to Intake 2597285.3.1-48(c)(2)
Event ID:
Facility ID:
If continuation sheet
SOUTH SHORE HEALTH & REHABILITATION CENTER in GARY, 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 GARY, 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 SOUTH SHORE HEALTH & REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.