Mason Health Care Center
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm
The blood sugar documentation, dated 4/2/2025 through 4/18/2025 indicated the lowest blood sugar level result was 112 to the highest result of 313.
The blood sugar documentation, dated 4/19/2025, indicated the following results: 329 at 4:38 A.M., 320 at 11:36 A.M., and 323 at 4:03 P.M.
Residents Affected - Few
The blood sugar documentation, dated 4/20/2025, indicated the following results: blood glucose level was 319 at 7:13 A.M., the blood glucose level was 352 at 11:01 A.M., and the blood glucose level was 397 at 4:25 P.M.
During an interview, on 8/26/25 at 9:12 A.M., LPN 11 indicated if a resident had a high blood glucose level,
she would first call the NP (Nurse Practitioner) to get orders and go from there. If the resident had no insulin orders, she would call the NP and put this in the progress notes and let the Director of Nursing and Assistant Director of Nursing know.
During an interview, in 8/26/2025 at 9:48 A.M., the Director of Nursing indicated the physician should have been notified of the elevated blood glucose levels and a progress note should have been completed at the time of the notification.
Progress Notes, dated on 4/18 and 4/19/2025, lacked the documentation of the physician being notified of
the abnormal levels.
On 8/25/2025 at 11:29 A.M., the Administrator provided the policy titled, Following Physician Orders/Parameters, and indicated it was the policy currently being used by the facility. The policy indicated, .Purpose: To administer resident care in a safe and effective manner and following physicians orders and ordered parameters. 2. Licensed healthcare personnel will consult and follow the physician/clinician order when performing any resident procedures
This deficiency is related to intake 2594043. 3.1-37
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
08/26/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mason Health Care Center
900 Provident Drive Warsaw, IN 46580
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 F0690
F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
dated [DATE REDACTED] at 2:21 P.M., indicated resident voided yellow urine with no issues. Incontinent of bowel/bladder.A Nursing Progress Note, dated [DATE REDACTED] at 9:17 A.M., indicated no change in urine output.
Urine is clear. Has indwelling catheter draining to gravity.A Nurses Progress Note, dated [DATE REDACTED] at 12:22 P.M., indicated Resident B had urinary pain and had been medicated with the Pyridium medication.A Nurse Progress Note, dated [DATE REDACTED] at 7:14 P.M., indicated Resident B had requested the Pyridium medication for urinary pain.A Nurse Progress Note, dated [DATE REDACTED] at 10:25 P.M., indicated Resident B had requested the Pyridium medication for urinary pain.A Nurses Progress Note, dated [DATE REDACTED] at 9:20 A.M., indicated the Foley catheter was discontinued due to soiled and dislodged.A Nursing Progress Note, dated [DATE REDACTED] at 1:24 P. M., indicated no change in urine output. Urine is clear. Has indwelling catheter draining to gravity.A Nursing Progress Note, dated [DATE REDACTED] at 10:23 A.M., indicated no change in urine output. Urine is clear. Has indwelling catheter draining to gravity.A Nurse Progress Note, dated [DATE REDACTED] at 2:33 P.M., indicated Resident B had requested the Pyridium medication for urinary pain.A Nursing Progress Note, dated [DATE REDACTED] at 9:59 A. M., indicated no change in urine output. Urine is yellow colored. Is continent of bladder.A Nurse Progress Note, dated [DATE REDACTED] at 10:32 A.M., indicated Resident B had requested the Pyridium medication for urinary pain.A Nursing Progress Note, dated [DATE REDACTED] at 5:13 A.M., indicated no change in urine output.
Urine is yellowed color. Is continent of bladder.The clinical record lacked the documentation, from 4/18 to [DATE REDACTED], to show the physician was notified of the continued urethral pain.During an interview, on [DATE REDACTED] at 11:39 A.M, the Director of Nursing indicated the resident had an indwelling Foley catheter when he was transferred to the hospital on [DATE REDACTED].Resident B was transferred to the the hospital emergency room on [DATE REDACTED] because of a change in condition.The Emergency Department documentation, dated [DATE REDACTED], indicated the following: chief complaint: sepsis (potentially life threatening infection) alert, recent stroke and apnic (loss of respiration) spells. Temperature was 100.2 degrees; blood pressure was 91/59; and his heart rate was 120 beats per minute. A urinalysis test (examination of the urine) obtained in the ER indicated the urine had a high number (41-99) of WBC (white blood cells), a high number (11-40) of RBC (red blood cells) and a high number (4+) of bacteria in the urine, which indicated a urinary infection. At 3:55 P.M., on [DATE REDACTED], other Emergency documentation indicated the following: 1. Marked increase in the findings of active pneumonia in the lungs, and an element of pulmonary edema (liquid in the lungs) could also be present. 2. Findings of acute jejunitis (inflammation of the lining in the small intestine), and low grade colonic inflammation. 3. Bladder wall thickening could relate to cystitis or outlet obstruction. Residuals despite the presence of a Foley catheter, catheter dysfunction is suspected Emergency Department discharge instructions, dated [DATE REDACTED] at 12:52.A.M indicated the resident had expired. A request for documentation of Resident B's urine outputs from [DATE REDACTED] through [DATE REDACTED] was made on [DATE REDACTED] at 1:56 P.M.The facility indicated on [DATE REDACTED] at 2:10 P.M., they could not provide Resident B's urine output amounts and indicated there should have been documentation of urine outputs for any resident with a Foley (urinary) catheter. During an interview, on [DATE REDACTED] at 2:15 P.M., the Corporate Nurse indicated they did not have a policy regarding obtaining and documenting urine outputs for residents with urinary catheters.\This deficiency is related to intake 2594043.3.1-41(a)(2)
Event ID:
Facility ID:
If continuation sheet
MASON HEALTH CARE CENTER in WARSAW, 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 WARSAW, 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 MASON HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.