Mitchell Manor
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Based on interview and record review, the facility failed to ensure a resident was supervised while riding on
the facility transportation van during a scheduled doctor's appointment for 1 of 3 residents reviewed for accidents. (Resident B) Findings include: Resident B's clinical record was reviewed on 8/18/25 at 10:48 a.m. The diagnoses included, but were not limited to, chronic obstructive pulmonary disease and depression. A nursing progress note, dated 7/28/25 at 8:32 p.m., indicated the resident's family and physician were notified of an alleged incident. No new orders received. No signs or symptoms of acute distress noted at this time. The clinical record lacked documentation of the alleged incident. A Fall/Accident
Interview Statement, dated 7/29/25, indicated on 7/28/25, a staff member took Resident B to a doctor's appointment in the facility transportation van. The staff member bought his wife lunch, took it to her at the hospital, and admitted ly left Resident B in the vehicle with the window rolled down. The staff member indicated he should not have left the resident unattended in the vehicle. During an interview on 8/18/25 at 10:35 a.m., the Administrator indicated the transportation driver drove Resident B to an appointment and
on the way back decided to stop at a restaurant drive through and get lunch for himself, his wife, and the resident. He then stopped at the nearby hospital and exited the vehicle to take his wife lunch. The transportation van had air-conditioning, however, Resident B indicated he rolled down the window and turned the van off. After approximately 15 minutes, Resident B left the vehicle and went into the hospital to try and locate the drive. A security guard from the hospital met her, provided a wheelchair, and sat with her until the transportation driver returned. When the transportation driver returned, he asked Resident B not to say anything because he had bought her lunch. The Administrator indicated Resident B did not report the incident for over a week. During an interview on 8/18/25 at 11:20 a.m., the DON indicated she was not sure of the exact date the above incident occurred because Resident B did not report it for over a week. The resident had an appointment on 7/24/25 at 9:15 a.m. and she believed it happened on that date during lunchtime. The Weather Underground website at www.wunderground.com, indicated during the week of 7/24/25 through 7/28/25, the average high temperature was 90 degrees. Resident B was out of the facility and unavailable for interview during the survey period. On 8/18/25 at 10:49 a.m., the Administrator provided
the policy titled, Transportation Coordination and Services with a revised date of 5/15/25, and indicated it was the policy currently being used by the facility. A review of the policy indicated, . Procedure: 3. The facility will ensure that safety and infection prevention procedures are followed in accordance to state and federal guidance .This citation relates to Complaint 2574607.3.1-45(a)(2)
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:
MITCHELL MANOR in MITCHELL, 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 MITCHELL, 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 MITCHELL MANOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.