Castleton Health Care Center

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

A Resident Rights Quality of Life policy was provided by the ED on 9/22/25 at 2:46 p.m. It indicated, “Purpose. To ensure that all residents are treated with the level of dignity they are entitled to while residing at the Facility. Policy. Each resident shall be cared for in a manner that promotes and enhances the quality of life, dignity, respect and individuality…VII. Facility Staff speaks respectfully to residents at all times, including addressing the resident by his or her name of choice…XII. Demeaning practices and standards of care that compromise dignity are prohibited…”

A resident rights policy was provided by the ED on 9/22/25 at 2:46 p.m. It indicated, “…Employees are to treat all residents with kindness, respect, and dignity and honor the exercise of resident's rights…”

This citation relates to Intakes 2605799 and 2613777. 3.1-3(t)

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Castleton Health Care Center

7630 E 86th St Indianapolis, IN 46256

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 0558

Reasonably accommodate the needs and preferences of each resident.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to ensure a resident's call light was within reach for 1 of 2 residents reviewed for call devices in reach. (Resident N)Findings include:The clinical

record for Resident N was reviewed on 9/17/25 at 12:30 p.m. Her diagnoses included, but were not limited to, chronic obstructive pulmonary disease, chronic kidney disease, heart failure, and arthritis. The ADL (activities of daily living) care plan, revised 8/18/25, indicated he had an ADL self-care performance deficit related to impaired balance, limited mobility, pain, and shortness of breath, and she would refuse to get out of bed. An intervention was to encourage her to use bell to call for assistance. The 8/29/25 Quarterly MDS (Minimum Data Set) assessment indicated she was moderately cognitively impaired. An observation and

interview were conducted with Resident N in her room on 9/17/25 at 12:18 p.m. She was lying in bed. Her call light cord was tied around the right side rail, hanging down the right side of her bed, eight inches from

the floor. Resident N had a wooden stick, one inch wide, one and half feet long on her bedside table in front of her. She used it to attempt to reach her call light, but she was unsuccessful. She indicated staff were in

the room about an hour and a half earlier, but they didn't adjust her call light to be within reach. She stated, Most of the time I can't reach my call light. I don't suffer too much [sic] not being able to reach it. I take my stick and start beating on the table, and they can hear me, and then they come. She indicated she couldn't get her hand around to reach the call light cord, and she couldn't turn over to reach the light. Resident N again tried to reach her call light cord, but she couldn't. She stated, I can't get it in my hand and do anything. When she soiled her brief, she hit the bedside table or side rail with her wooden stick to get staff's attention. Resident N demonstrated this at this time. An observation and interview with Resident N were conducted on 9/17/25 at 1:55 p.m. She was lying in bed, eating her lunch. No one else was in the room at

this time. Her call light remained in the same position, wrapped around the right side rail of her bed, hanging down, eight inches from the floor. Resident N indicated she wasn't sure who brought her lunch tray to her, but they did not ensure her call light was in reach. An observation of Resident N and interview with UM (Unit Manager) 6 was conducted on 9/17/25 at 1:57 p.m. UM 6 untangled her call light from the side rail and placed it within reach of Resident N. UM 6 indicated her call light should always be within her reach, and they may need to get a clip for the call light or a different type of call light. The Use of Call Light policy was provided by NC (Nurse Consultant) 1 on 9/19/25 at 10:54 a.m. It indicated, It is the policy of this home to ensure residents have a call light within reach that they are physically able to access and that they have been instructed on its use .All nursing personnel must always be aware of call lights. Ensure call light is within reach of resident prior to leaving the residents room .Be sure call lights are placed near the resident, never on the floor or bedside stand.This citation relates to Intakes 2605799 and 2613777. 3.1-3(v)(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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Castleton Health Care Center

7630 E 86th St Indianapolis, IN 46256

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

hair.

Level of Harm - Minimal harm or potential for actual harm

An interview was conducted with Resident Q on 9/18/25 at 10:34 a.m. He indicated he'd been asking to be shaved for the past three weeks.

Residents Affected - Few

An observation of Resident Q was conducted on 9/22/25 at 12:58 p.m. His facial hair was freshly shaven.

The September 2025 shower sheets indicated he was last shaved on 9/15/25.

An interview was conducted with Resident Q on 9/22/25 at 3:18 p.m. He indicated staff just shaved his facial hair yesterday, but he'd been asking for last two or three weeks.

A Quality-of-life resident rights policy was provided by the Executive Director on 9/22/25 at 2:46 p.m. It indicated, “To ensure that all residents are treated with the level of dignity they are entitled to while residing at the facility…Each resident shall be cared for in a manner that promotes and enhances the quality of life, dignity, respect and individuality…”

The Shaving policy was provided by the ED (Executive Director) on 9/23/25 at 9:52 a.m. It indicated, I. The Facility provides for the removal of facial hair as a component of the resident's hygienic program. II. Male residents may be shaved daily, and female resident may be shaved as needed.

This citation relates to Intakes 2605799 and 2613777. 3.1-38(a)(3)(D) 3.1-38(a)(3)(E)

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Castleton Health Care Center

7630 E 86th St Indianapolis, IN 46256

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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

following dates: twice on 9/3/25, once on 9/5/25, three times on 9/7/25, twice on 9/8/25, twice on 9/9/25, twice on 9/10/25, once on 9/13/25, twice on 9/14/25, three times on 9/15/25, twice on 9/16/25, twice on 9/17/25, three times on 9/18/25, once on 9/19/25, twice on 9/20/25, and three times on 9/21/25. One of the administrations, on 9/17/25, was documented as given at 1:41 a.m., which coincided with Resident BB's

interview of when he received the medication. The September 2025 TAR was blank for the above PRN oxycodone-acetaminophen administrations regarding the pain assessment order. The corresponding progress notes in the electronic health record did not include vital signs or non- pharmacological interventions. An interview was conducted with the DON on 9/22/25 at 10:56 a.m. She indicated they obtained vital signs when a resident complained of pain, because their temperature or blood pressure could change. They documented in the MAR/TAR, but not necessarily anywhere else. The DON reviewed Resident BB's electronic clinical record and indicated she was unable to locate any verification of vital signs or non-pharmacological interventions attempted for his PRN pain medication administrations. The Pain Management policy was provided by the ED (Executive Director) on 9/22/25 at 11:30 a.m. It indicated, The Licensed Nurse will administer pain medication as ordered and document medication administered on the Medication Administration Record (MAR) .Nursing Staff will implement timely interventions to reduce the increase in severity of pain .Nursing Staff will also utilize non-pharmacological interventions by adjusting

the resident's environment to reduce pain. This citation relates to Intake 2613777. 3.1-37(a)

Event ID:

Facility ID:

If continuation sheet