Rosewalk Village
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
sound.QMA 6 did not indicate the time she had discovered Resident B was missing or the time she notified
the nurse during her interview.During an interview, on 11/10/25 at 4:38 p.m., Resident B's family member indicated she was concerned he was found outside the facility as anything could have happened to him.During an observation and interview, beginning on 11/12/25 at 2:24 p.m., the doors were found to have keypad entrances. Pressure was applied to the doors to see if they would open and they did not.
Maintenance 2 opened the G-hall doors and a high pitch loud alarm sounded. Maintenance 2 also demonstrated how if the door was not closed properly, the alarm would still sound.During an interview, on 11/12/25 at 3:26 p.m., the Regional Director of Clinical Service indicated the facility staff were interviewed related to the elopement and no one heard an alarm sounding. The facility did not have any more information to provide related to the elopement.During an interview, on 11/13/25 at 9:25 a.m., the Executive Director indicated he was unsure if the door company which came and inspected the doors after Resident B's elopement was the company which originally installed the system on the door due to the age of the system. He further indicated the door company only came out if there was an issue and the facility called them out.A current facility policy, titled Elopement Prevention and Response Program, dated 10/2020 and received from the Director of Nursing on 11/10/25 at 11:24 a.m., indicated .It is the policy of the facility that staff who have residents under their care are responsible for knowing the location of those residents, and
the case of a missing resident, ensuring appropriate action is taken.A current facility policy, titled Abuse Prohibition, Reporting, and Investigating, dated 6/2023 and received from the Director of Nursing on 11/12/25 at 11:24 a.m., indicated .Failure to provide goods and services to a resident(s) necessary to avoid physical harm.Facility's indifference or disregard for resident care, comfort or safety resulting physical harm, pain, mental anguish, or emotional services.The past noncompliance immediate jeopardy began on 12/21/24. The immediate jeopardy was removed and corrected by 10/31/25 after the facility implemented a systemic plan that included the following actions: the facility completed elopement risks on all residents, elopement drills with staff, all staff were educated on the elopement procedure and high-risk behaviors, a second antenna on the G-hall double door exit was installed due to only having one antenna, proper operation the system was working properly was ensured, the range was increased, and the door codes were changed to prevent unauthorized exitsThis citation relates to Intake 2657596.3.1-45(a)(1)3.1-45(a)(2)
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ROSEWALK VILLAGE 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 ROSEWALK VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.