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F0689
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Electrical Cord Left in Walkway Creates Accident Hazard for Cognitively Impaired Residents

Indianapolis, Indiana Survey Completed on 06-26-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency was identified when an electrical cord from a floor buffer machine was observed lying in the middle of a walkway in the Memory Care Unit, used by residents, including those who are cognitively impaired and self-mobile. The cord, approximately 20 feet long and one inch in circumference, was curled and raised above the floor by eight to ten inches at multiple points, creating a tripping hazard. No caution signs were posted in the area during the floor technician's use of the buffer. The technician instructed a resident to step over the cord without moving it or ensuring the area was safe. The technician also stated that he did not believe a caution sign was necessary since the floor was not wet, but acknowledged the cord should be kept near the wall due to the high number of ambulatory residents in the unit. A resident with a diagnosis of dementia, who was moderately cognitively impaired and at risk for falls, was observed stepping over the cord as instructed by the technician. The resident's care plan indicated a risk of falls related to weakness and medications. Interviews with staff confirmed that the cord should not have been left in the middle of the hallway and that a caution sign should have been posted. Additionally, the facility did not have a policy for the prevention of accidents or potential hazards, as confirmed by the Regional Director of Operations.

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