Robin Run Health Center

F 0569

Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.

Level of Harm - Minimal harm or potential for actual harm

Based on interview, and record review, the facility failed to maintain a system for management of resident funds, and return personal funds within 30 days of discharge, for 8 of 11 residents reviewed for misappropriation of property (Residents F, G, H, J, K, L, M, and N). Findings include:Anonymous concerns

during the survey process indicated that residents' personal money was being mismanaged by management. Residents had not been reimbursed 30 days after discharge, and some non-return of funds dated back to residents who discharged in December 2023. Eleven (11) resident accounts were reviewed for reimbursement. a. On 4/16/25, Resident F's account was closed, and a refund of $2940.97 was still due. b. On 6/22/23, Resident G's account was closed, and a refund of $839.00 was still due. c. On 4/16/24, Resident H's account was closed, and a refund of $73.40 was still due. d. On 9/24/24, Resident J was discharged from the facility, and a refund of $100.00 was still due. e. On 11/12/24, Resident K's account was closed, and a refund of $16.18 was still due. f. On 5/28/24, Resident L's account was closed, and a refund of $160.00 was still due. g. On 11/12/24, Resident M's account was closed, and a refund of $7480.00 was still due. h. On 5/14/24, Resident N's account was closed, and a refund of $2121.48 was still due. During an interview on 8/14/25 at 12:02 p.m., the Business Office Manager (BOM) indicated resident money was managed by a third-party money management system from the corporate office.

Resident/resident representatives were provided with a monthly statement that explained money received and spent on behalf of the resident, and the monthly balance. The BOM input resident census status daily into an electronic report, which could be reviewed by the corporate office daily. After a resident discharged from the facility for any reason, the resident bill was settled at the facility, and in approximately 30 days the BOM submitted a request to the accounts payable program, with the expectation that a check/refund would issue from the corporate office. On 8/18/25 at 3:45 p.m., the BOM provided a Conveyance of Resident Funds policy, dated March 2021, and indicated the policy was the one currently being used by the facility.

The policy indicated, The resident's personal funds and a final accounting of funds are returned to the resident, the resident's representative or to the resident's estate [individual or probate jurisdiction per state law], as applicable, withing thirty [30] days from the date of the resident's discharge or eviction from the facility, or death.This citation relates to Intake 2583293, and 2590546. 3.1-6(h)

Residents Affected - Some

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Robin Run Health Center

6370 Robin Run W Indianapolis, IN 46268

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

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 observation, interview, and record review, the facility failed to ensure residents who were dependent on staff for bathing and showering assistance received those services for 4 of 15 residents reviewed for Activities of Daily Living (ADL) assistance (Residents C, P, Q, and R). Findings include:A confidential concern during the survey indicated there were residents that had not received a showerer for over a month.1. On 8/15/25 at 12:45 p.m., Resident C was observed sitting in a manual wheelchair (WC) at bedside with his feet propped on a bed, his hair was combed but looked greasy. The resident indicated that

he had only received 1 shower since his admission to the facility a few weeks prior. An aide had been assisting him to bed one evening and offered to help him with a shower, and at the time he was pleased as his hair was gummy and slimy, and he had a doctor's appointment the next day and wanted to look presentable. Point of Care (POC - an electronic documentation system) documentation indicated, Resident C was scheduled to have a shower weekly on Tuesday and Friday. Documentation of bathing in the past 30 days included a shower on 8/12/25. There was no documentation of the resident having refused to have a shower. Resident C's clinical record had no care plan related to refusals of care, or resident preference for bathing/showering. 2. On 8/15/25 at 1:25 p.m., Resident P was observed lying in bed with her eyes closed.

There was a strong urine odor in the room that permeated out into the hallway. POC documentation indicated, Resident P was scheduled to have a shower weekly on Monday and Thursday. Documentation of bathing in the past 30 days included a shower on 7/17/25. There was no documentation of the resident having refused to have a shower.Resident P's clinical record had no care plan related to refusals of care, or resident preference for bathing/showering.3. On 8/15/25 at 1:25 p.m., Resident Q was observed lying awake on his bed watching TV. There was a strong urine odor in the resident's room that permeated out into the hallway. POC documentation indicated, Resident Q was scheduled to have a shower weekly on Tuesday and Friday. Documentation of bathing in the past 30 days indicated the resident had not received a shower. There was no documentation of the resident having refused to have a shower. Resident Q's clinical

record had no care plan related to refusals of care, or resident preference for bathing/showering.4. On 8/15/25 at 1:25 p.m., Resident R was observed lying on her bed among a large number of personal items,

she had a disheveled appearance. POC documentation indicated, Resident R was scheduled to have a shower weekly on Wednesday and Saturday. Documentation of bathing in the past 30 days indicated the resident had received showers on 7/1925, and 8/9/25. There was no documentation of the resident having refused to have a shower. Resident R's clinical record had no care plan related to refusals of care, or resident preference for bathing/showering.On 8/18/25 at 11:07 a.m., review of handwritten shower/skin sheet documentation with the Medical Records Supervisor, dated July and August 2025. There was no further documentation of showers having been given for Residents C, P, Q, and R. On 8/18/25 at 3:45 p.m.,

the DON provided a Bath, Shower/Tub policy, dated February 2018, and indicated the policy was the one currently being used by the facility. The policy indicated, The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin.Documentation: 1. The date and time the shower/tub bath was performed. 2. The name and title of the individual[s] who assisted the resident with the shower/tub bath. 3. The assessment date [e.g., any reddened areas, sores, etc., on the resident's skin] obtained during the shower/tub bath. 4. How the resident tolerated the shower/tub bath. 5. If the resident refused the shower/tub bath, the reason[s] why and

the intervention taken. 6. The signature and title of the person recording the data.Reporting: 1. Notify the supervisor if the resident refuses the shower/tub bath.This citation relates to Intake 2583293. 3.1-38(a)(2)(A)3.1(b)(2)

Residents Affected - Some

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Robin Run Health Center

6370 Robin Run W Indianapolis, IN 46268

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

transferred with the assistance of 2 staff members to stand and pivot. The resident did not ambulate. LPN 13 indicated, on 8/12/25 she had received report from the night shift nursing staff that Resident E had bruising on her face. The night staff did not know when the bruise had occurred. LPN 13 indicated, if she found a new skin area, she would notify LPN 12 who was the wound nurse, document a nursing progress note, and complete a skin assessment. The nurse would then notify the MD, DON, and resident representative. To her knowledge, the QMA working the evening of 8/11/25 had reported the information to LPN 8 who was the nurse in charge on the healthcare hallways, but she had no idea what the nurse did with the information. During an interview on 8/18/25 at 12:00 p.m., the DON indicated before being questioned by a visitor on 8/15/25, she had been unaware of Resident E's facial redness and bruising. The DON had initiated her own investigation at that time. The DON knew the resident had experienced a fall when she rolled out of the bed on 7/31/25 and now thought the resident might have experienced an undocumented fall by rolling out of bed a second time on 8/5/25 that resulted in the resident's facial bruising. The DON indicated there was no documentation to indicate the DON, physician or resident representative had been notified of a second fall or facial bruising at the time of an incident. During an

interview on 8/18/25 at 12:15 p.m., the DON indicated, Resident E had no trunk control and would lean forward in a prior manual wheelchair she had. While her investigation continued, conversations with staff indicated the resident had experienced a 2nd fall, this time from her wheelchair, which had resulted in the resident having facial bruising. Hospice had since provided the resident with a Broda chair that allowed her to be reclined, and a new mattress with a bolster overlay on the bed. On 8/18/25 at 1:05 p.m., the DON provided a Prevention of Pressure Injuries policy, dated April 2020, and indicated the policy was the one currently being used by the facility. The policy indicated, Assess the resident on admission [within eight hours] for existing pressure injury risk factors. Repeat the risk assessment weekly and upon changes of condition. 1. Conduct a comprehensive skin assessment upon [or soon after] admission, with each risk assessment, as indicated according to the resident's risk factors, and prior to discharge.3. Inspect the skin

on a daily basis when performing or assisting with personal care of ADLs. a. Identify any signs of developing pressure injuries [i.e. non-blanching erythema] .Monitoring: 1. Evaluate, report, and document potential changes in the skin.On 8/18/25 at 1:05 p.m., the DON provided an Acute Condition Changes Clinical Protocol policy, dated March 2018, and indicated the policy was the one currently being used by the facility. The policy indicated, 1. The physician will help identify individuals with a significant risk for having acute changes of condition during their stay.The nursing staff will contact the physician based on the urgency of the situation.Monitoring and Follow-Up: 1. The staff will monitor and document the resident/patient's progress and responses to treatment, and the physician will adjust treatment accordingly.

1. 2. The physician will help the staff monitor a resident/patient with a recent acute change of condition until

the problem or condition has resolved or stabilized.This citation relates to Intakes 2583293, and 2590611.3.1-37(a)

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Robin Run Health Center

6370 Robin Run W Indianapolis, IN 46268

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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

personal care of ADLs. a. Identify any signs of developing pressure injuries [i.e. non-blanching erythema] .Monitoring: 1. Evaluate, report, and document potential changes in the skin.On 8/18/25 at 1:05 p.m., the DON provided an Acute Condition Changes - Clinical Protocol policy, dated March 2018, and indicated the policy was the one currently being used by the facility. The policy indicated, .1. The physician will help identify individuals with a significant risk for having acute changes of condition during their stay.The nursing staff will contact the physician based on the urgency of the situation.Monitoring and Follow-Up: 1. The staff will monitor and document the resident/patient's progress and responses to treatment, and the physician will adjust treatment accordingly. 2. The physician will help the staff monitor a resident/patient with a recent acute change of condition until the problem or condition has resolved or stabilized.This citation relates to Intakes 2583293 and 2583772.3.1-40(a)(1)3.1-40(a)(2)3.1-40(a)(3)

Event ID:

Facility ID:

If continuation sheet