Pulaski Health Care Center
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm
opioid, and hypoglycemic medication. The resident was frequently incontinent of bowel and bladder and required substantial to maximal assistance with toileting hygiene.
The August 2025 Physician Order Summary indicated the resident received hydrocodone-acetaminophen 5-325 milligram tablet twice daily and iron tablet 325 milligrams daily.
Residents Affected - Few
A Care Plan, dated 11/12/24, indicated the resident was at risk for low hemoglobin (protein in red blood cells) and hematocrit (percentage of red blood cells) related to iron deficiency anemia. Interventions included, but were not limited to, administer medications as ordered and monitor effectiveness.
A Care Plan, dated 11/12/24, indicated the resident was at risk for pain related to a history of right humerus fracture and chronic pain which the resident received routine pain management to address. Interventions included, but were not limited to, analgesics as ordered and observe for effectiveness of medications.
The Output: Bowel Movement documentation was reviewed from 7/1/25 thru 8/19/25. Bowel movements were documented on 7/15/25, 7/19/25, 7/22/25, 7/27/25, 8/2/25, 8/4/25, 8/5/25, 8/8/25, 8/11/25, and 8/17/25.
There was no documentation related to acquiring orders for treatment or intervention attempts related to
the lack of bowel movements.
During an interview on 8/22/25 at 1:00 p.m., the Director of Nursing and Regional Nurse Consultant were notified of the concern and provided no further information.
A policy related to bowel protocols and monitoring was requested and was not received.
This citation relates to Intake 1759620. 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
08/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pulaski Health Care Center
624 E 13th St Winamac, IN 46996
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 F0842
F 0842
Breakfast: 8/2, 8/3, 8/4, 8/5, 8/6, 8/8, 8/10, 8/11, 8/12, 8/15, 8/17.
Level of Harm - Minimal harm or potential for actual harm
Lunch: 8/3, 8/4, 8/6, 8/8, 8/9, 8/10, 8/11, 8/15, 8/18, 8/21.
Dinner: 8/1, 8/2, 8/3, 8/4, 8/5, 8/6, 8/7, 8/8, 8/9, 8/10, 8/12, 8/14, 8/17, 8/18, 8/20, 8/21.
Residents Affected - Few
During an interview on 8/21/25 at 3:25 p.m., the Administrator was made aware of the missing documentation, there was no additional information provided.
- 3. Record review for Resident C was completed on 8/19/25 at 12:33 p.m. Diagnoses included, but were not
limited to, Parkinson’s disease, Lewy body dementia, and anxiety.
The Quarterly Minimum Data Set (MDS) assessment, dated 6/5/25, indicated the resident was severely cognitively impaired. The resident was dependent on staff for eating and drinking.
A Care Plan, dated 3/20/25 and revised 8/18/25, indicated the resident was on a mechanically altered diet texture related to Lewy body dementia. An intervention included to monitor and record intakes.
The August 2025 Physician’s Order Summary (POS) indicated orders for the following:-Chart morning snack intake daily-Chart afternoon snack intake daily-Chart evening snack daily at bedtime -Chart breakfast intake daily-Chart lunch intake daily-Chart dinner intake daily
The Task Meal Consumption Logs were documented with percentage of snacks and meals eaten. The last 30 days lacked documentation for the following snacks and meals:-Morning snack: 7/22, 7/24, 7/25, 7/27, 7/31, 8/3, 8/4, 8/6, 8/7, 8/8, 8/13, and 8/17/25-Afternoon snack: 7/19, 7/20, 7/22, 7/23, 7/24, 7/26, 7/27, 7/29, 7/30, 8/2, 8/3, 8/4, 8/5, 8/7, 8/8, 8/9, 8/10, 8/12, 8/14, 8/15, 8/16, 8/17, 8/18, and 8/19/25-Evening snack: 8/7/25-Breakfast: 7/22, 7/24, and 8/8/25-Lunch: 7/25, 8/8, and 8/10/25-Dinner: 7/19, 7/20, 7/23, and 8/18/25
During an interview on 8/20/25 at 3:59 p.m., the Director of Nursing (DON) indicated she was unable to provide any documentation the resident's meal consumption logs were completed on the above dates.
This citation relates to Intake 1759620. 3.1-50(a)(1)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
PULASKI HEALTH CARE CENTER in WINAMAC, 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 WINAMAC, 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 PULASKI HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.