Envive Of Lawrenceburg

F 0689 Level of Harm - Actual harm Residents Affected - Few

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

findings from the computed tomography (CT) scan indicating the resident had a new right medial orbital blowout fracture with opacification of the adjacent ethmoid sinuses. Additionally, a subtle new acute fracture within the posterior right orbital wall. A hematoma in the right cheek with extensive surrounding inflammation. Also, a laceration with a total repaired wound length of 5 centimeters (cm). The current facility policy, titled Falls and Fall Risk, managing, with a revision date of August 2024, was provided by the Administrator on 9/22/2025 at 4:20 P.M. The policy indicated, .the staff will identify interventions related to

the residents' specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling .The current facility policy, titled Safe lifting and Movement of Residents, with a revision date of August 2024, was provided by the Administrator on 9/22/2025 at 4:20 P.M. The policy indicated, .In order to protect the safety and well-being of staff and residents, and to promote quality of care, this facility uses appropriate techniques and devices to lift and move residents .This citation relates to Intake 2616965.3.1-45(a)(1)

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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

09/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Envive of Lawrenceburg

403 Bielby Rd Lawrenceburg, IN 47025

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 0919

Make sure that a working call system is available in each resident's bathroom and bathing area.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review the facility failed to provide adequate equipment to allow residents to call for assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area from the residents bedside for 1 of 3 residents reviewed. (Resident C) Findings include:During an interview, on 9/22/2025 at 9:08 A.M., Resident C indicated he had no call light available. When Resident C moved into his room Maintenance came in, and he told the resident there was no spot to hook a call light up. He had been in the room for a few months, and had never received a call light. The facility provided a bell to ring, but he was unable to find it anymore. When he did have access to the bell staff were never able to hear it no matter how much he rang because he was located at the last room at the end of the hallway. Usually if he needed someone he would go into the bathroom and use the call light in there. There was one night he was unable to get out of bed, and needed to vomit and he had to yell out for help because he had no call light available. During an interview and

observation, on 9/22/25 at 10:14 A.M., Registered Nurse (RN) 2 indicated Resident C used a wheelchair, and was able to make his needs known. The resident should have had a call light at the bedside at all times. During an observation with RN 2 in Resident C's room she confirmed there was no call light plugged into the wall above the residents bed. She identified where it should have been and asked Resident C if he had ever had a call light. Resident C replied he had not ever had a call light. During an interview, on 9/22/2025 at 10:40 A.M., the Maintenance Supervisor indicated he was aware there was no call light in Resident C's room. He said the room was a single room initially, so a second call light was never installed.

A facility documented email was provided on 9/22/2025 at 1:50 P.M. by the Administrator, the email document titled call light boxes indicated that on 7/22/2025 they had not received the call light boxes yet and asked if they were on backorder. The next email was dated 9/22/2025 at 10:48 A.M. and stated following up here. An email reply was returned on 9/22/2025 at 1:01 P.M. and indicated the boxes were being shipped out that day. During an interview, on 9/22/2025 at 1:50 P.M., the Administrator indicated Resident C had a functioning call light now. The old call light for the room was hooked up. There were no additional emails from 7/22/2025 to 9/22/2025 about the call light boxes order.During an observation, on 9/22/2025 at 3:30 P.M., Resident C pressed his call light button while laying in bed. The light above the residents room door did not light up nor was there a sound. Resident C then hit the bell now placed on his bedside table three times, and then dropped the bell onto the floor. No staff responded from the sound.

During an interview, on 9/22/2025 at 3:35 P.M., the Administrator indicated Resident C's call light was on and indicated the light overtop of the stairwell beside his room was the light associated with his call light not

the light over his room. She also indicated there was no sound at the nurses station from the resident hitting

the call light like the other call lights. The clinical record for Resident C was reviewed on 9/22/2025 at 3:00 P.M. A Quarterly Minimum Data Set (MDS) assessment, dated 6/26/2025, indicated the Resident was cognitively intact. The resident's diagnoses included, but were not limited to, hypertension, stroke, and depression. The resident was impaired on one side for upper and lower extremities. He used a wheelchair, and required moderate assistance with lower body dressing.The current facility policy, titled Answering the Call Light, with a revision date of August 2024, was provided by the Administrator on 9/22/2025 at 4:20 P.M.

The policy indicated, .Be sure that the call light is plugged in and functioning at all time . Ensure that the call light is accessible to the resident when in bed .Report all defective call lights to the nurse supervisor promptly .3.1-19(u)

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet