Hickory Creek At New Castle

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

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

asked if Resident D would please not cuss at him. I did not point my finger at him at all. The reason he went back into the room with the SSD was to explain what was going on, so he would get full picture, and so that everyone was on the same page as to what was going on. He explained it in the room in front of Resident D. He'd been trained on abuse upon hire, in April 2025, and again after this incident. He was told he handled the situation appropriately, that he backed out of the situation, because he wasn't helping.An

interview was conducted with Resident D on 8/11/25 at 1:25 p.m. He indicated he did not recall an incident with the Maintenance Director. The 7/10/25 interview with Resident D, documented by the Administrator, indicated she spoke with Resident D at length regarding the incident between Resident D and the Maintenance Director. Resident D denied that the Maintenance Director yelled at him. Using the reasonable person concept, Resident D had the potential to experience ongoing anxiety, fear, agitation, and verbal outbursts in regards to the allegation involving the Maintenance Director. An interview was conducted with

the Administrator on 8/11/25 at 2:15 p.m. and 8/12/25 at 11:56 a.m. She indicated when she spoke with Resident D and Resident C, neither of them said anything happened, so she unsubstantiated the allegation of abuse. Resident C said it was not abusive in any way. The Maintenance Director was trying to talk to Resident D, but when Resident D was upset, you couldn't talk to him. The Maintenance Director, being a newer employee, didn't know that about Resident D. The Maintenance Director just needed to walk away, instead of continuing to try to explain. The Maintenance Director was in-serviced on abuse, zero tolerance, and better ways to handle resident behaviors. The Abuse Prohibition, Reporting, and Investigation policy was provided by the Administrator on 8/11/25 at 1:50 p.m. It indicated, It is the policy of [name of facility] to provide each resident with an environment that is free from abuse, neglect, or misappropriation of resident property, and exploitation. This includes but is not limited to verbal abuse, sexual abuse, physical abuse, mental abuse, corporal punishment, and involuntary seclusion.Willful, used in the definition of abuse, means the individual must have acted deliberately, not that the individual intended to inflict injury or harm.Verbal Abuse-The use of oral, written, and/or gestured language that willfully includes disparaging and derogatory terms to residents or their families or within their hearing distance, regardless of their age, ability to comprehend, or disability. This includes any episode of staff to resident.Mental Abuse-Verbal or nonverbal infliction of anguish, pain, or distress that results in psychological or emotional suffering. This includes any episode of staff to resident; and resident to resident if it appears to be willfully directed to a specific resident. Examples of mental abuse include but are not limited to: Harassing a resident.Yelling or hovering over a resident, with the intent to intimidate.This citation relates to Complaint 2568713. 3.1-27(a)(1)3.1-27(b)

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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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hickory Creek at New Castle

901 N 16th Street New Castle, IN 47362

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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

The Behavior Management policy was provided by the Administrator on 8/11/25 at 1:50 p.m. It indicated, “It is the policy of [name of facility] to provide behavior interventions for resident with problematic or distressing behaviors. Interventions provided are both individualized and non-pharmacological and part of a supportive physical and psychosocial environment that is directed toward preventing, relieving and/or accommodating a resident’s behavioral expressions….Direct care staff will be educated as to

the interventions for residents reviewed by the IDT (Interdisciplinary Team.)”

This citation relates to Complaint 2582411 and Complaint 2568713. 3.1-37(a)

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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hickory Creek at New Castle

901 N 16th Street New Castle, IN 47362

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 0745

Provide medically-related social services to help each resident achieve the highest possible quality of life.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to determine residents' ability to consent and establish individualized resident-centered care plans for a resident-to-resident relationships for 2 of 3 residents reviewed for resident-to-resident relationships. (Resident B and Resident C)Findings include: 1.

The clinical record for Resident B was reviewed on 8/11/2025 at 1:10 p.m. The medical diagnoses included stroke and behavioral disturbances.A Quarterly Minimum Data Set assessment, dated 7/16/2025, indicated Resident B had moderate cognitive impairments.During an interview with Resident B on 8/11/2025 at 12:38 p.m., Resident B indicated she was in a relationship with Resident C. The relationship entailed her holding hands, playing cards, and kissing Resident C.Review of clinical record did not establish an assessment of Resident B's ability to consent nor care plans for Resident B's sexuality and relationship with Resident C.2.

The clinical record for Resident C was reviewed on 8/11/2025 at 1:30 p.m. The medical diagnoses included chronic obstructive pulmonary disease and depression. A Quarterly Minimum Data Set assessment, dated 5/13/2025, indicated Resident C was cognitively intact.During an interview on 8/11/2025 at 12:52 p.m., Resident C indicated he was in a relationship with Resident B, but they had recently broken up. During the time they were together, they would spend time together, hold hands, and kiss each other. Resident C stated it did not go further than kissing in the mouth. Review of the clinical record did not establish an assessment for Resident C's ability to consent nor care plans for Resident C's sexuality and relationship with Resident B.An interview with the Executive Director, on 8/12/2025 at 12:20 p.m., indicated she was unable to find documentation of Resident B or C's capacity to consent and Resident B and C's care plans for resident-to-resident relationship. It was the responsibility of the Social Service Director to develop the care plans.A policy entitled, Resident Sexuality, was provided by the Executive Director on 8/11/2025 at 1:40 p.m. The policy indicated .A determination of the ability to consent to sexual activities must be made in conjunction with the IDT and physician.Determination of capacity to make decision regarding sexual activity will be documented by the physician in the medical record.This citation relates to Complaint 2582411.3.1-34(a)(1)

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet