Signature Healthcare of Muncie

In the surveyor’s words

From the most serious findings on record at Signature Healthcare of Muncie, in the surveyor’s own words.

• Actual harm, isolatedF684Apr 16, 2024

  Based on interview and record review, the facility failed to ensure effective monitoring and services were provided when Resident B requested to be transferred to the hospital after experiencing acute abdominal pain with nausea for 1 of 3 residents reviewed for change in condition. This deficient practice resulted in the resident a delay in treatment that required emergent hospitalization for treatment of a perforated bowel with sepsis (severe infection throughout body), a hemicolectomy (a surgical intervention to permanently open the bowel), intravenous (IV) antibiotic therapy via a PICC (a central intravenous line) line, and a permanent colostomy. Findings include: Resident B's closed clinical record was reviewed on 4/15/24 at 11:00 a.m. […]

• Actual harm, isolatedF689Sep 23, 2021

  Based on interview and record review, the facility failed to ensure fall prevention interventions and adequate supervision were in place for 1 of 3 residents reviewed for falls (Resident C). This deficient practice resulted in Resident C sustaining a fracture of the neck of the humerus bone. Findings include: The clinical record for Resident C was reviewed on 9/23/21 at 10:29 a.m. Diagnoses included but were not limited to, left humerus fracture, [CONDITION(S)], [CONDITION(S)], [CONDITION(S)], muscle weakness and lack of coordination. The most recent significant change Minimum Data Set (MDS) assessment, dated 5/19/21, indicated the resident was moderately cognitively impaired. She required two-person assistance with bed mobility and transfers. […]

• Actual harm, isolatedF689May 17, 2021

  Based on record review and interview, the facility failed to ensure adequate supervision and interventions were in place to prevent multiple falls for 1 of 3 residents reviewed for falls (Resident B). This deficient practice resulted in Resident B sustaining multiple rib fractures, pain and hospitalization . Findings include: The clinical record for Resident B was reviewed on 5/14/21 at 9:50 a.m. Diagnoses included but were not limited to, multiple fractures of ribs on left side, [CONDITION(S)], [CONDITION(S)], [CONDITION(S)] (CVA), muscle weakness and lack of coordination. The most recent quarterly Minimum Data Set (MDS) assessment, dated 4/19/21, indicated the resident was moderately cognitively impaired. […]

• No harm, potential for more than minimal, widespreadF812Mar 20, 2026

  Based on observation, interview, and record review, the facility failed to ensure dishware and utensils were washed in a method to ensure proper sanitization. This deficient practice had the potential to impact 111 of 111 residents who consumed food prepared in the facility's kitchen. Findings include: During an observation of dishwasher testing, on 3/16/26 at 10:35 a.m., the Dietary Manager tested the dishwasher on three separate occasions. Each attempt registered no sanitizing solution in the final rinse water. The Dietary Manager obtained a second container of sanitation test strips and ran the dishwasher cycle again, which resulted in an indication of no sanitizing solution in the final rinse. […]

• No harm, potential for more than minimal, widespreadF812Feb 24, 2026

  Based on observation, interview, and record review, the facility failed to distribute food with the correct temperatures for safety and palatability. This deficient practice had the potential to affect 114 of 114 residents who received food from the facility kitchen. Findings include:During a test meal tray temperature check observation on 2/20/26 at 12:47 p.m., accompanied by the Dietary Manager, the following was observed: Milk temperature was 46 degrees Fahrenheit (F) and coleslaw was 64.2 degrees F. The Dietary Manager indicated the temperature was too high for the milk to be served.During an interview on 2/20/26 at 11:40 a.m., the Dietary Manger indicated food had temperature checks prior to plating and placed in the meal carts. […]