Federal inspectors cited Signature Healthcare of Terre Haute in November for failing to promptly revise the comprehensive care plan for Resident B, whose smoking access was revoked on August 31 following the physical altercation.
The resident's clinical record showed diagnoses of nicotine dependence and major depressive disorder. His profile page listed him as a "current everyday smoker," and his care plan from May 2022, last edited in October, still indicated he "chose to smoke and was a risk for injury related to smoking."
The plan detailed extensive smoking protocols: Resident B had to be at the dining room door on time to join supervised smoking breaks, was allowed two cigarettes or 15 minutes per session, could only smoke in a designated courtyard area, and required staff to light his cigarettes. The plan noted he had been "evaluated and was deemed a safe smoker."
But those protocols became meaningless after the August incident.
During an interview with inspectors on November 5, Resident B said he was no longer allowed to participate in smoke breaks. He explained that he had hit another resident in the nose and was subsequently told he could no longer smoke.
The facility's administrator confirmed the details during a separate interview the same day. She told inspectors that Resident B lost his smoking privileges after the physical altercation and that she had spoken with him multiple times about his behavior during smoke breaks.
The administrator said they had reviewed the facility's Smoking Agreement with the resident repeatedly due to his "crowding behaviors" before the August 31 incident when "he became physical and he lost his privilege to smoke."
Despite revoking his smoking access over two months earlier, neither his care plan nor his profile indicating everyday smoker status had been updated.
"This should have been done following the revocation of his smoking privileges," the administrator told inspectors.
Federal regulations require nursing homes to develop complete care plans within seven days of comprehensive assessments and ensure they are "prepared, reviewed, and revised by a team of health professionals." The plans must reflect residents' current conditions and care needs.
The citation represents a breakdown in the facility's care planning process. While Resident B's smoking privileges were appropriately revoked following his aggressive behavior, the failure to update his official care documentation left a significant gap between his actual care and what was recorded in his file.
The administrator indicated the facility followed CMS guidelines but acknowledged no specific facility policy regarding care planning was provided to inspectors.
Inspectors classified the violation as causing "minimal harm or potential for actual harm" and affecting "few" residents. The citation was issued as part of a complaint investigation conducted on November 5.
The case highlights how administrative oversights can persist long after care decisions are made. Resident B's smoking status remained officially unchanged in facility records for more than two months after his privileges were revoked, creating potential confusion for staff and regulatory reviewers about his actual care needs and restrictions.
The facility's detailed smoking protocols — requiring supervision, limiting cigarette quantities, and designating specific areas — suggest a structured approach to managing smoking privileges for residents with nicotine dependence. However, the failure to update documentation when those privileges were revoked undermines the integrity of the care planning system.
Federal nursing home regulations emphasize that care plans must be living documents that accurately reflect residents' current status and needs. When significant changes occur — such as the revocation of previously approved activities — facilities are required to promptly update all relevant documentation to ensure continuity of appropriate care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Signature Healthcare of Terre Haute from 2025-11-05 including all violations, facility responses, and corrective action plans.
Additional Resources
- View all inspection reports for Signature Healthcare of Terre Haute
- Browse all IN nursing home inspections