Envive Of Sullivan
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
informed. 2. The resident's attending physician, the facility's medical director, or the director of nursing services is responsible for informing the resident of his or her medical condition. Such information includes providing the resident/representative with information about the resident's.g. psychosocial status.i. type of care or treatment recommended.4. Information about the resident's health status is presented at times.when a change of treatment is proposed. This citation relates to Intake 1841129. 3.1-5(a)(2)3.1-5(a)(3)
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
09/29/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Envive of Sullivan
325 W Northwood Dr Sullivan, IN 47882
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-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
On 9/29/25 at 1:53 p.m., the DON provided an incident report from the risk management, dated 9/13/25.
The bottom of the report indicated, Privileged and confidential-not part of the medical record. The report indicated the resident was found on the floor on her knees. There was an abrasion to the right knee. The report lacked documentation an intervention was put in place at the time of the fall. At the same time, the DON indicated they were not aware the risk management incident reports were not part of the resident's medical record. The DON indicated there was no further documentation of the resident's fall, on 6/13/25, in
the resident's medical record.
On 9/29/25 at 2:00 p.m., the DON provided a document titled, Falls-Clinical Protocol, last revised in August
- 2024. The policy indicated, .Assessment and Recognition.2. In addition, the nurse shall assess and
document/report the following: a. Vital signs; b. Recent injury, especially forehead or head injury; c.
Musculoskeletal function, observing for change in normal range of motion, weight bearing, etc.; d. Change
in cognition or level of consciousness; e. Neurological status; f. Pain; g. Freqeuncy and number of falls since last physician visit; h. Precipitating factors, details on how fall occurred; i. All current medications, especially those associated with dizziness or lethargy; and j. All active diagnoses.5. The staff will evaluate and document falls that occur while the individual is in the facility; for example, when and where they happen, any observations of the events, etc.Cause Identification: 1. For an individual who has fallen the staff and practitioner will begin to try to identify possible causes within 24 hours of the fall.Treatment/Management: 4.
Based on the preceding assessment, the staff and physician will identify pertinent interventions to try to prevent subsequent falls and to address the risks of clinically significant consequences of falling.
This citation relates to the Intake 1841129 3.1-45(a)(2)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
ENVIVE OF SULLIVAN in SULLIVAN, 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 SULLIVAN, 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 ENVIVE OF SULLIVAN or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.