Waters Of Indianapolis, The

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

and her brief was unfastened on the left side and bent approximately halfway down in the front. CNA 1 thought this was suspicious because she had just changed Resident C's brief and repositioned her in bed.

CNA 1 left Resident C as she found her and immediately went to get RN 1 so she could observe exactly what CNA 1 observed. When CNA 1 returned to Resident C's room with RN 1, Resident C was observed with the sheet pulled approximately halfway down the bed, her brief unfastened on the left side and bent approximately halfway down in the front. There had been no changes in the way Resident C had been observed by CNA 1 initially. When RN 1 asked Resident C if she had been touched, Resident C was unable to verbalize what had happened but was able to point at her breast.On 12/30/25 at 9:09 a.m., the DON provided a copy of a facility policy, titled Abuse Prevention Program, dated 10/22/22, and indicated this was

the current policy used by the facility. A review of the policy indicated it was the policy of the facility to prevent abuse.This citation relates to Intake 2686747.3.1-27(a)(1)

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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

Waters of Indianapolis, The

3895 S Keystone Ave Indianapolis, IN 46227

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on interview and record review, the facility failed to ensure a full description of an allegation of sexual abuse was reported to the state health department for 1 of 3 residents reviewed for abuse. A male resident was observed leaving a female resident's room. The female resident was found lying in her bed with the sheet pulled down, her brief unlatched on one side and bent down in the front, and her gown pulled up. (Resident B, Resident C) Findings include:On 12/30/25 at 9:09 a.m., the Director of Nursing (DON) provided a copy of a facility reportable incident, dated 12/5/25 at 12:30 p.m. A review of the reportable incident brief description indicated Resident C made an allegation that Resident B touched her breast.During an interview on 12/31/25 at 8:15 a.m., Resident C was unable to describe the details of a sexual abuse allegation that had been made against Resident B. Resident C repeated the word fine after each question of the interview. On 12/31/25 at 8:30 a.m., the DON provided a copy of a written statement from CNA 1, dated 12/5/25 at 11:50 a.m. (approximately 1 hour prior to the facility reportable incident being submitted), and indicated this was a written statement regarding the allegation of sexual abuse made by Resident C against Resident B. A review of the written statement indicated CNA 1 was at the nurse's station when she heard Resident C yelling. As CNA 1 was walking toward Resident C's room, she observed Resident B wheeling out of Resident C's room. CNA 1 asked Resident B why he was in Resident C's room and educated him that he should not be in a female resident's room. When CNA 1 walked in Resident C's room, Resident C's gown was pulled up, sheet off of her, and brief was open. CNA 1 immediately got RN 1.

During an interview on 12/31/25 at 10:32 a.m., RN 1 indicated she was the nurse caring for Resident C, on 12/5/25, when Resident C made an allegation of sexual abuse against Resident B. CNA 1 reported to RN 1 that she heard Resident C yelling no, so CNA 1 entered Resident C's room. Resident B was in her room and was escorted out and back to his room which was just across the hallway from Resident C's room.

When RN 1 entered Resident C's room, she observed Resident C lying in bed with the left side of her brief unfasted. Resident C indicated to RN 1 that a man entered her room and touched her then pointed at her breast. Since Resident C's brief was unfastened, RN 1 asked if Resident B touched her anywhere else other than her breast and Resident C indicated no. During an interview on 12/31/25 at 10:42 a.m., CNA 1 indicated, on 12/5/25 at approximately 11:00 a.m., she was at the nurse's station and heard Resident C yelling out. As CNA 1 was walking toward Resident C's room, she observed Resident B wheeling out of Resident C's room and he indicated he had gotten lost. CNA 1 instructed Resident B that he was not supposed to be in a female resident's room. When CNA 1 entered Resident C's room, she observed Resident C lying in bed with the sheet pulled approximately halfway down the bed, her gown was pulled up, and her brief was unfastened on the left side and bent approximately halfway down in the front. CNA 1 thought this was suspicious because she had just changed Resident C's brief and repositioned her in bed.

CNA 1 left Resident C as she found her and immediately went to get RN 1 so she could observe exactly what CNA 1 observed. When CNA 1 returned to Resident C's room with RN 1, Resident C was observed with the sheet pulled approximately halfway down the bed, her brief unfastened on the left side and bent approximately halfway down in the front. There had been no changes in the way Resident C had been observed by CNA 1 initially. When RN 1 asked Resident C if she had been touched, Resident C was unable to verbalize what had happened but was able to point at her breast. On 12/30/25 at 9:09 a.m., the DON provided a copy of a facility policy, titled Abuse Prevention Program, dated 10/22/22, and indicated this was

the current policy used by the facility. A review of the policy indicated allegations of abuse must be reported.This citation relates to Intake 2686747.3.1-28(c)

Event ID:

Facility ID:

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