Greencroft Healthcare

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 interview and record review, the facility failed to provide showers timely for a dependent resident for 1 of 4 residents who were reviewed for showers. (Resident D)During an interview on 12/16/2025 at 2:40 P.M., Resident D could not recall the last time he had had a shower. Resident D's record review was completed on 12/18/2025 at 2:45 P.M. Diagnoses included, but were not limited to: displaced fracture of cervical vertebra, Lewy Bodies dementia, Parkinson's disease and right foot drop. An admission Minimum Data Set (MDS) assessment, dated 9/19/2025, indicated Resident D had intact cognition and was dependent on staff for showering. Resident D's record lacked the documentation that he had been given a shower on 11/17, 11/20, 11/27, 12/1 and 12/15/2025 as scheduled. There was no documentation to indicate the resident had been showered on different dates or he had refused a shower on his scheduled dates. A current Care Plan, initiated on 9/16/2025, indicated Resident B had self-care deficit related to bathing. An intervention, initiated 9/16/2025, indicated staff was to help the resident with activities of daily living. During an interview on 12/18/2025 at 3:30 P.M., the Director of Nursing (DON) indicated there was not any more shower sheets or documentation indicating Resident D had received two showers a week.

The DON indicated all residents should have been offered two showers or bed baths per week and if the resident refused, the refusal should have been documented in the resident's record. On 12/18/2025 at 3:330 P.M., the DON provided a policy, dated 11/15/2025 and titled, Activities of Daily Living. The DON identified the policy as the one currently used by the facility. The policy indicated, .Care and services will be provided for the following activities of daily living: 1. Bathing, dressing, grooming and oral care This citation relates to Intake 2643464.3.1-38(a)(3)

Residents Affected - Few

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

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greencroft Healthcare

1225 Greencroft Dr Goshen, IN 46527

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 0689 Level of Harm - Actual harm Residents Affected - Few

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

tripping hazard for other residents and moved the walker across the room, against the wall, out of Resident B's reach. The ADON indicated she believed the intervention to keep the walker within reach had not applied to the dining room and had only applied to the resident's room. No information had been provided to establish if the intervention should not have been utilized in the dining room or other common areas of

the facility before the end of the survey on 12/18/2025 at 4:10 P.M. During an interview on 12/18/2025 at 1:40 P.M., the ADON indicated she had not been aware Resident B's Care Plan regarding fall risk had not been updated with any new intervention or why the IDT had not reviewed the fall from 10/10/2025. The ADON indicated if a resident refused an intervention, the refusal should have been documented in the Electronic Medical Record. During an interview on 12/18/2025 at 1:45 P.M., the Director of Nursing (DON) indicated the facility did not have a policy for following the Care Plan interventions.On 12/18/2025 at 3:00 P.M. the ADON provided a policy, dated 11/15/2025 and titled, Post Fall Assessment Policy and identified it as the policy currently used by the facility. The policy indicated, .9. Update the resident's care plan based on findings from the post-fall assessment and probable root cause of the fall The past noncompliance began

on 10/10/2025 when staff failed to implement fall interventions for Resident B. The harm level citation was corrected on 12/4/2025 when the facility implemented a systemic plan that included a review of all residents at risk for falls, review of the care plan interventions for all residents at risk for falls, education of all front line staff regarding fall interventions and care plan implementation and weekly auditing of all falls to ensure the plan had been implemented correctly. This citation relates to Intakes 2643464 and 2677313. 3.1-45 (a)(2)

Event ID:

Facility ID:

If continuation sheet