Robin Run Health Center

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record reviews and interviews, the facility failed to ensure a newly admitted resident had a code status ordered and displayed in their chart for 1 of 1 residents reviewed for code status concerns (Resident G).

Findings include:On [DATE REDACTED] at 11:35 a.m. Resident G's record was reviewed. They were a long-term care resident whose diagnoses included, but were not limited to, hypertension (high blood pressure) and type 2 diabetes. At the time of the review Resident G was their own responsible party. The medical record lacked

an order for Resident G's code status. Hospital records, dated [DATE REDACTED] at 3:15 p.m., indicated Resident G's code status for that hospital stay was a full code status. During an interview on [DATE REDACTED] at 9:25 a.m.

Resident G indicated they wanted to be a full code status and wished to have all interventions in place.

During an interview on [DATE REDACTED] at 10:57 a.m. Licensed Practical Nurse (LPN) 7 indicated she knew Resident G was a full code from the hospital records and they had the Physician Orders for Scope of Treatment (POST) (a medical document that turns a seriously ill patient's treatment wishes into portable physician's orders, covering decisions like CPR, life support, and antibiotics to ensure preferences for end-of-life care are followed) form ready for the resident's family to fill out. Resident G's family visited the Resident on [DATE REDACTED]. LPN 7 indicated they knew she had visited but did not have time to have her fill the paperwork out while she was at the facility. At the time of exit a copy of a current facility policy titled, Advanced Directives, was provided. That policy indicated . The resident has the right to formulate an advanced directive, including

the right to accept or refuse medical or surgical treatment. Advanced directives are honored in accordance with state law and facility policy. Determining Existence of Advanced Directive 1. Prior to or upon admission of a resident, the social services director or designee inquires of the resident, his/her family members and/or legal representative, about the existence of any written advanced directives. Decision-Making Capacity 1. Upon admission the interdisciplinary team assesses the residents decision-making capacity and identifies the primary decision-maker if the resident is determined not to have decision making capacity

This citation relates to Intake 2696487. 3.1-4(d)3.1-4(e)3.1-38(f)3.1-4(l)(4)

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

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Based on observation, record review, and interview, the facility failed to update a resident's care plan after

an allegation and incidents occurred for 3 of 5 residents reviewed for care plans (Residents B, C, and F).Findings include: 1. On 12/22/25 at 11:28 a.m., Resident B was observed sitting up in a wheelchair. She denied any pain when asked. She was noted to have bruising over the bridge of her nose, along with both eyes. She denied knowing how she received the bruising.On 12/22/25 at 1:30 p.m., observed Resident B up ambulating with her chin to her chest, making it hard to see where she was going. A record review was completed on 12/22/25 at 1:45 p.m. She had the following diagnoses to include, but not limited to, gastric reflux, anxiety disorder, hypertension, hallucinations, and Alzheimer's disease. A progress note, dated 10/11/25 at 5:12 p.m., indicated she had a history of wandering aimlessly about the unit.She had a care plan, dated 7/11/25, indicating she was at risk for wandering/elopement, she had a history of wandering into other residents' rooms and space related to diagnosis and unable to identify boundaries or safety.She had a care plan, dated 7/28/25, indicating she was at risk for falls related to confusion, dementia and refuses to wear shoes and likes to walk around bare footed. She had a care plan, dated 12/22/25, indicating she was on anticoagulant therapy.She had an order, dated 7/12/25, for aspirin 81milligrams (mg) by mouth daily for abnormal EKG (electrocardiogram).Her bruising was not updated on the care plan.2. On 12/22/25 at 1:41 p.m., Resident C was observed sitting in a wheelchair. She indicated she was at a children's party and denied any pain. She denied any allegations of sexual abuse.A record review was completed for Resident C. She had the following diagnoses which included, but were not limited to, hypertension, vitamin D deficiency, delusional disorder, osteoporosis, dementia, and schizoaffective disorder.A progress note made on 12/18/25 at 6:51 p.m., indicated Resident C made an allegation that a teacher sexually assaulted her. An investigation was initiated.On 12/22/25 at 1:51 p.m., spoke with the daughter and she indicated her mother had a urinary tract infection at the time of the allegation and she believed it was the infection that made her mother make the allegation.On 12/18/25 at 7:42 p.m., physician orders were noted by the physician for labs and to obtain urine for testing.On 12/22/25 a progress note was made indicating the urine results were reviewed by the physician and she started on an antibiotic for 5 days for a urinary tract infection.Resident C had a care plan, dated 12/2/22, indicating she had impaired cognitive functioning and impaired thought processes/encephalopathy, experiencing consistent delusions related to others trying to harm her and will ruminate on the same delusion for sometimes several days.Her care plan was not updated after the allegation of sexual abuse.3. On 12/22/25 at 1:41 p.m., observed Resident F sitting up in a chair with bruising noted to her right jawline. She denied any pain. On 12/23/25 at 10:13 a.m., a record review was completed for Resident F. She had the following diagnoses which included but were not limited to Alzheimer's disease, vascular dementia, bradycardia (slow heartbeat), and cardiomyopathy (disease of the heart muscle). On 12/15/25 a progress note indicated resident had discoloration to her jaw area after being suctioned last Friday.On 12/16/25 a progress note indicated resident had discoloration to right jaw related to being suctioned. Her record lacked a care plan for the bruising to her jawline. During an interview on 12/23/25 at 1:31 p.m., the Administrator indicated the care plans were updated after being informed the records were lacking care plans.A policy titled, Care Plans, Comprehensive Person-Centered, dated March 2023, was provided by the Administrator on 12/23/25 at 3:45 p.m. It indicated, .Assessments of residents are ongoing and care plans are revised as information about the residents and the resident's condition change.This citation relates to Intakes 2697032 and 2685850.3.1-35(c)(2)

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

12/23/2025

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

On 12/15/25 his weight was omitted.

Level of Harm - Minimal harm or potential for actual harm

A policy titled, Weight Assessment and Intervention, was provided by the Administrator on 12/23/25 at 3:45 p.m. It indicated, Residents are weighed upon admission and at intervals established by the interdisciplinary team.

Residents Affected - Few

This citation relates to Intake 2681660. 3.1-37

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

12/23/2025

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, interviews, and record review, the facility failed to ensure proper infection control practices were used when caring for a resident who was in Enhanced Barrier Precautions (EBP) for 1 of 3 residents reviewed for infection control concerns (Resident G). Findings include:On 12/22/25 at 10:30 a.m. Resident G was observed in her room from the hallway. The resident was lying in bed calling out for help, the resident's call light was on at the time of the observation. Resident G had a catheter bag hanging on the side of their bed that was draining urine. There was no EBP sign on or around her door. The inside of Resident G's room was observed and there was no EBP sign in the room at the time of the observation. On 12/22/25 at 10:45 a.m. an unknown Certified Nursing Assistant (CNA) and an unknown physical therapy assistant were observed as they assisted Resident G with moving up in bed. Both staff members only wore gloves during the care they provided. On 12/22/25 at 11:00 a.m. the same unknown CNA and an unknown Qualified Medication Aide (QMA) were observed as they assisted Resident G with getting comfortable in bed. Both staff members only wore gloves during the care they provided. On 12/22/25 at 11:15 a.m. the unknown QMA left the room and RN 8 came in to assist the unknown CNA with adjusting Resident G. Both staff members only wore gloves during the care they provided. On 12/22/25 at 11:35 a.m. Resident G's medical record was reviewed. They were a long-term care resident who was admitted to the facility from the hospital on [DATE REDACTED] at approximately 4:00 p.m. A clinical admission note, dated 12/19/25, indicated Resident G had a pressure ulcer on her coccyx (tailbone) and had an indwelling urinary catheter. On 12/23/25 at 9:25 a.m. Resident G was observed as she lay in bed. There was an EBP sign observed inside the resident's room. There was a Personal Protective Equipment (PPE) cart next to the room next door to Resident G's room, but not one next to the resident's room. RN 8 was observed helping Resident G with getting comfortable. RN 8 only wore gloves during the care she provided. During an interview on 12/23/25 at 10:57 a.m. LPN 7 indicated Resident G was only on EBP because they had a wound. The Infection Prevention (IP) nurse indicated they were also on EBP because they had an indwelling catheter. The IP nurse indicated gloves, and a gown should be worn any time someone would be in high contact with the resident. On 12/23/25 at 1:20 p.m. Resident G's catheter bag was observed laying on the ground next to the bed. At the time of exit a copy of a current facility policy titled, Policies and Practices- Infection Control was provided. That policy indicated .This facility's infection control policies and practices are intended to facilitate maintaining a safe, comfortable environment and to help prevent and manage transmission of diseases and infections. 2. The objective of our infection control policies and practices are to: a. prevent.infections in the facility. EBP was not discussed in this policy, and no other policy was provided. This citation relates to Intake 2696487. 3.1-18(b)

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet