Evergreen Crossing And The Lofts
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
caused serious eye irritation, keep container tightly closed, and if the liquid got on skin shower immediately), an opened spray bottle of Krud [NAME] cleaner (a cleaner/degreaser - a hazardous statement indicated caused eye irritation, potential harm if swallowed or inhaled, and avoid getting on skin or breathing), a bucket of paint, and a bucket of dirty water sitting among blankets, trash bags, trash, dirty rags, and painting supplies. There was also an opened blue 5-gallon bucket of paint with a roller inside, there was no lid on the bucket. On 12/30/25 at 11:45 a.m., Resident N was observed propelling himself from near the nurse's station in the center of the unit, to the end of the hallway and he stopped near the utility cart. Licensed Practical Nurse (LPN) 4 indicated Resident N was confused and wandered up and down the hallways all the time. On 12/30/25 at 12:30 p.m., a third observation of the utility cart with painting supplies parked near Resident N's room. Resident N's clinical record was reviewed on 12/31/25 at 2:10 p.m. Diagnoses on Resident N's profile included autistic disorder, unspecified dementia, and intellectual disabilities. A quarterly MDS, completed on 11/28/25, indicated Resident N had severe cognitive impairment. The resident required moderate to significant assistance from staff for most ADL's (activities of daily living) and could propel himself in a wheelchair after setting him up. On 12/30/25 at 3:50 p.m., the Executive Director (ED) indicated the utility cart was being used by a painter working on the vacant room next to Resident N. The cart should have been secured in the room being refurbished, not left in the hallway unsupervised. On 12/31/25 at 2:15 p.m., the Regional [NAME] President of Risk Management provided a Hazardous Material and Waste Management policy, revised 10/7/19, and indicated the policy was the one being used by the facility. The policy indicated, .8. The facility shall establish and implement processes for selecting, handling, storing, transporting, and disposing of hazardous materials .10. The facility shall ensure that all chemicals and wastes are maintained appropriately to ensure a safe environment. This citation relates to Intake 2691777. 3.1-45(a)(1)3.1-45(a)(2)
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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
12/31/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Evergreen Crossing and the Lofts
5404 Georgetown Road Indianapolis, IN 46254
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
During an interview on 12/31/25 at 9:42 a.m., LPN 5 indicated on the Health hallways the 2 residents on her assignment that required morning insulin both wore a FreeStyle [NAME] electronic glucose monitoring system. The electronic reader was used to determine if the resident's blood sugar was normal or if additional insulin coverage was needed. LPN 5 would look at the reader, and if she did not think it was correct according to that resident's normal reading, or how they were acting, she would retake their blood sugar by poking their finger. LPN 5 indicated she administered her 2 residents' insulin according to when
the resident requested, usually around 8:00 a.m. If the resident received long-acting insulin the timing of the insulin administration was not as important, but if the resident received short acting insulin she preferred to wait until the breakfast or lunch trays were served to prevent the blood sugar from dropping too low. On 12/31/25 at 3:40 p.m., the [NAME] President of Risk Management indicated medication administration times on the MAR included, Early am = 4:00 a.m. - 7:00 a.m.AM = 6:00 a.m. - 11:00 a.m.Afternoon = 12:00 p.m. - 3:00 p.m.PM = 4:00 p.m. - 7:00 p.m. HS = 8:00 p.m. - 11:00 p.m. Humalog Insulin prescribing information, at www.humalog.com (5/20/25), was provided by the Regional [NAME] President of Risk Management on 12/31/25 at 3:15 p.m. The manufacturers instruction indicated administer Humalog insulin, (a rapid acting insulin designed for quick action to match mealtime glucose), by subcutaneous injection into
the abdominal wall, thigh, upper arm, or buttocks within 15 minutes before a meal or immediately after a meal. Lantus Insulin prescribing information (6/2022), the Food and Drug Administration, at https://www.fda.gov/drugsatfdawww.humalog.com for the latest approved by the FDA, was provided by the Regional [NAME] President of Risk Management on 12/31/25 at 3:15 p.m. The manufacturers instruction indicated, administer Lantus insulin, (a long-acting insulin was designed to provide a slow, steady release of insulin to manage blood sugar levels between meals and overnight), by subcutaneous injection into the abdominal area, thigh, or deltoid once daily at any time of day, but at the same time every day. On 12/31/25 at 2:15 p.m., the Regional [NAME] President of Risk Management provided a Medication Administration policy, undated, and indicated the policy was the one being used by the facility. The policy indicated, 1. a.
The purpose of this policy guidance for general medication administration Administer medications only as prescribed by the provider.f. Observe the [five rights] in giving each medication: i. the right resident ii. the right time . This citation relates to Intake 2691777. 3.1-48(c)(2)
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EVERGREEN CROSSING AND THE LOFTS in INDIANAPOLIS, 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 INDIANAPOLIS, 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 EVERGREEN CROSSING AND THE LOFTS or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.