White Oak Health Campus: Medication Safety Failure - IN
Inspectors visiting White Oak Health Campus on May 27, 2026 found Resident 43 in her room with a tube of tacrolimus cream in her bedside drawer and a handwritten instruction sheet taped to her chest of drawers explaining how to use it. The second cream, triamcinolone, a corticosteroid prescribed to reduce inflammation, was already gone. She told inspectors she had been keeping both in the drawer herself.
Neither medication was supposed to be there. No one at the facility had ever assessed whether she was capable of safely managing her own medications. No physician had ever signed an order allowing her to do so.
The resident had two active prescriptions. A physician had ordered the tacrolimus ointment, used to treat skin conditions, on April 28, 2026, to be applied once every 12 hours as needed. The following day, a second order came through for the triamcinolone cream, to be applied every 12 hours as needed, with specific instructions to avoid the neck, face, skin folds, and genitals, and to be used for no more than 14 days each month. Those restrictions matter. Triamcinolone is a potent corticosteroid, and applying it to the wrong areas of the body, or for longer than directed, carries real risks.
The instruction sheet on her dresser did not reflect those limitations. It simply told her how to use both creams.
When the assigned nurse, identified in the inspection report as RN 2, looked inside the drawer on May 28, she found the tacrolimus tube. The pharmacy label had worn off. A piece of blue tape with the word "face" written on it had been stuck on the tube in its place. RN 2 told inspectors the resident was not permitted to keep any medications at the bedside for self-administration, and that the medication needed to be removed. She said the resident had not reported itchy skin until that morning and had been scratching her back. A cream had been applied to one area on her back. The resident kept an unmedicated lotion at the bedside, which was allowed. The prescription ointments were not.
The Director of Nursing, interviewed the same morning, offered an explanation. The resident's family had been bringing medications into the facility without authorization, and had done so before. When the resident previously lived in the facility's assisted living section, she had been permitted to self-administer creams. The family, the Director said, had continued bringing in medications even after being told that nursing staff needed to be notified of any new skin problems so the resident could be properly assessed first.
That education had not translated into compliance. And the facility, for its part, had not caught what was in the drawer.
The resident's own record showed she was cognitively intact, according to her admission assessment completed April 28, 2026. She was capable of understanding instructions. What she was not, under the facility's own written policy, was authorized. That policy requires that any resident who wants to self-administer medications be evaluated using a specific assessment tool, that the results be presented to a physician, and that the physician issue an order specifying which medications the resident may manage on her own. A self-medication care plan must then be created, updated as needed, and reviewed quarterly. None of that had happened.
The inspection report rated the violation at the minimal harm level, meaning inspectors found no evidence of actual injury. But the finding raises a narrower question about what the facility knew and when. The family had apparently brought medications in before. The Director of Nursing knew the history. The resident had been at the facility since at least late April. The tacrolimus tube, with its worn-off pharmacy label and handwritten blue tape, had been sitting in that drawer long enough for the label to deteriorate.
RN 2 said she had worked with the resident during previous stays and was assigned as her nurse that shift. She found the tube only after an inspector prompted her to look.
Triamcinolone has a 14-day monthly limit for a reason. The inspection report does not say how long the resident had been using it, or whether she had exceeded that window. It does not say whether the missing tube had been used up or simply removed at some earlier point. Those answers are not in the record.
What the record does show is a resident sitting in her room, scratching her arms, with prescription medications in her drawer and instructions on her dresser, and no formal system in place to make sure any of it was being used correctly.
The facility's policy exists precisely to prevent that situation. It describes a process for evaluating residents, getting physician approval, and monitoring use over time. The process was never started for Resident 43.
Her arms were still itching when the inspectors arrived.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for White Oak Health Campus from 2026-06-02 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
WHITE OAK HEALTH CAMPUS in MONTICELLO, IN was cited for violations during a health inspection on June 2, 2026.
The second cream, triamcinolone, a corticosteroid prescribed to reduce inflammation, was already gone.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.