Harcourt Terrace Nursing And Rehabilitation

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

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Based on interview and record review, the facility failed to ensure a resident was treated with respect and dignity for 1 of 3 residents reviewed for resident rights. (Resident B)Findings include:A facility reported incident, dated 9/22/25, indicated a staff member had a concern regarding a female resident who was treated roughly by a QMA (Qualified Medication Aide) during care on 9/15/25 at 8:01 p.m. The clinical

record for Resident B was reviewed on 9/23/25 at 1:45 p.m. The diagnoses included, but were not limited to, dementia with other behavioral disturbances, Alzheimer's disease, generalized anxiety disorder, pain, difficulty in walking, and cognitive communication deficit.A care plan, dated 10/19/23, indicated Resident B refused medications and ancillary services. The interventions included, but were not limited to, offer other staff as needed, provide Resident B with safety and redirect the resident as needed.A care plan, dated 10/19/23, indicated Resident B had a hearing loss. The interventions included, but were not limited to, facing the resident when speaking, obtain the resident's attention before speaking, speak clearly, and adjust tone as needed. A facility document, titled Employee Communication Form, dated 9/19/25, indicated QMA 1 was terminated from the facility for a violation of resident rights related to disregarding resident safety.During an interview, on 9/22/25 at 4:03 p.m., LPN 6 indicated QMA 1 had taken Resident B to the shower room and gave her a shower on 9/15/25. QMA 1 brought the resident back to her room with the resident sitting on the seat of her rollator walker and pushing the resident from the shower room to her bed.

LPN 6 heard QMA 1 talk loudly at Resident B to get up, get up, get up. When LPN 6 arrived at the doorway of Resident B's room, she observed QMA 1 attempting to put the resident to bed. LPN 6 felt QMA 1 was being rough with Resident B. LPN 6 told QMA 1 there was a better way to assist the resident to bed, to step out of the room, and she would finish placing Resident B in the bed.During an interview, on 9/22/25 at 7:29 p.m., QMA 1 indicated she had taken Resident B to the shower room and pushed her back to her room with

the resident sitting on the seat part of her rollator walker. QMA 1 asked Resident B to stand up, so she could place her in bed, but the resident refused. QMA 1 lifted her up with both her arms under the resident's armpits and placed her on the bed. LPN 6 was standing in the doorway watching her place the resident to bed and told QMA 1 she had been rough with the resident, to step out of the room, and LPN 6 finished placing Resident B in the bed.During an interview, on 9/23/25 at 11:30 a.m., the Clinical Support nurse indicated QMA 1 was terminated because she did not understand Resident B should not have been placed in bed when she did not get up off her walker. The facility did not find QMA 1 abusive to the resident, but she did violate her resident rights. A current facility policy, titled Resident [NAME] of Rights, dated 12/17 and provided by the Director of Nursing on 9/22/25 at 1:50 p.m., indicated .The resident has the right to be treated with consideration, respect and recognition of their dignity and individuality .The resident will have

the right to the following.Refuse any treatment or service, including medication This citation relates to Intake 2621869.3.1-3(t)

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harcourt Terrace Nursing and Rehabilitation

8181 Harcourt Rd Indianapolis, IN 46260

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

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

stopped QMA 7 and immediately told the nurse. During an interview, on 9/22/25 at 4:30 p.m., QMA 7 indicated she was trying to change Resident C's brief. Resident C yelled out while QMA 7 was changing her. She stopped providing care and was going to go tell the nurse Resident C was in pain when CNA 4 walked into the room and told her to stop the care. CNA 4 went and reported her to the nurse, and she was suspended. She was able to come back to work. A current facility policy, titled Ambulation with walker, dated 2/2010 and provided by the Director of Nursing on 9/23/25 at 2:29 p.m., indicated Place the gait belt around the resident's waist. 8. Place walker in front of resident as close to the bed as possible. 9. Have the resident grasp both arms of the walker. 10. Brace the leg of the walker with your foot and place your hand

on top of the walker. 11. Assist the resident to stand on count of three.Walk slightly behind and to the affected side of the resident holding onto the gait belt.Remove the gait belt A current facility policy, titled Resident [NAME] of Rights, dated 12/17 and provided by the Director of Nursing on 9/22/25 at 1:50 p.m., indicated .The resident has the right to be treated with consideration, respect and recognition of their dignity and individuality .The resident will have the right to the following.Refuse any treatment or service, including medication This citation relates to Intake 2621869.3.1-38(a)(2)(B)

Event ID:

Facility ID:

If continuation sheet