Lutheran Community Home
Inspection Findings
F-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm
10/16/2025, indicated the resident was severely cognitively impaired. The resident's diagnoses included, but were not limited to, heart disease, hypertension, and stroke.
A Progress Note, dated 10/17/2025 at 6:17 P.M., indicated the resident had returned from the local emergency room. A roam alert bracelet was placed on the resident's left ankle.
Residents Affected - Few
During an observation on 10/23/2025 at 1:14 P.M., the resident was in bed, and the roam alert bracelet was
on his left ankle.
The resident's Care Plans were reviewed and lacked a Care Plan for the roam alert system.
The resident's orders lacked orders for the roam alert bracelet, monitoring the functionality of the device, and monitoring the skin under the device.
During an interview on 10/23/2025 at 2:04 P.M., the Assistant Director of Nursing indicated if a resident was determined to be an elopement risk, a roam alert bracelet would be placed on them. The computer would be updated with their name and picture, and an order would be placed in the Electronic Medication Administration Record (EMAR) to monitor the resident and the device. A Care Plan should also be written for the use of the device. There should have been a Care Plan for the roam alert device, and an order added to his EMAR.
The current facility policy, titled Resident Alarms was provided by the DON on 10/23/2025 at 2:33 P.M. The policy indicated, .When alarms are utilized, additional monitoring shall be provided, including but not limited to: Verifying alarms are working properly. Monitoring for adverse consequences associated with the use of
the alarms.
The current facility policy, titled Comprehensive Care Plans was provided by the Administrator on 10/23/2025 at 2:10 P.M. The policy indicated, .It is the policy of this facility to develop and implement a comprehensive person – centered care for each resident.
This citation relates to Intake 2642237. 3.1-31(a)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
LUTHERAN COMMUNITY HOME in SEYMOUR, 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 SEYMOUR, 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 LUTHERAN COMMUNITY HOME or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.