Signature Healthcare Of Bremen
Inspection Findings
F-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Based on interview and record review, the facility failed to ensure a care plan related to food allergies was followed for 1 of 3 residents reviewed for dietary needs. (Resident B)Finding includes:On 10/8/25 at 12:12 P.M., Resident B's clinical record was reviewed. Diagnoses included but were not limited to dementia, feeding difficulties, stroke, gastro-esophageal reflux, chronic obstructive pulmonary disease, anxiety, and atrial fibrillation.Resident B's most recent Face Sheet, dated 10/4/25, indicated the resident had an allergy to Tomatoes. Physician's orders included but were not limited to, a dietary order dated 2/28/25, that indicated the resident was allergic to tomatoes.Resident B's Care Plans included but were not limited to,1.
Resident B had cognitive loss and dementia with impaired decision-making skills, dated 7/18/23. 2.
Resident had an allergy to tomato, dated 2/20/24, and indicated the resident would not be served tomato at meals. 3. Resident B was at nutritional risk due to dementia, dated 7/26/23, and indicated the facility would provide his diet as ordered, and notify the physician as needed. A Nursing Progress Notes, dated 8/22/25 at 7:11 P.M., indicated Resident B was accidentally given tomato ketchup for his hotdog sandwich.On 8/24/25 a Grievance Report was filed by Resident B's family member that indicated the resident had received ketchup on his hotdog and that he was allergic to the ketchup. The grievance investigation by the facility indicated the resident was given ketchup, and that the ketchup came out of the kitchen on the resident's tray.Review of a written statement from CNA (Certified Nursing Assistant) 5, dated 8/24/25, indicated CNA 5 took Resident B his dinner tray and asked if he wanted ketchup and mustard n his hot dog and the resident indicated he did. CNA 5 gave him a few bites of the hotdog with ketchup and then noted his meal ticket indicated an allergy to tomatoes.On 10/10/25 at 1:07 P.M., the Administrator provided the policy titled, Comprehensive Care Plans, dated 4/6/15 and revised on 2/9/24, indicating it was the facilities current policy. The policy indicated, .The facility will. implement a comprehensive person-centered care plan for each resident This citation relates to Intake 2633300.3.1-35(a)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
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
10/10/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Signature Healthcare of Bremen
316 Woodies Lane Bremen, IN 46506
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 F0686
Federal health inspectors cited SIGNATURE HEALTHCARE OF BREMEN in BREMEN, IN for a deficiency under regulatory tag F-F0686 during a complaint investigation conducted on 2025-10-10.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 2 deficiencies cited during this inspection of SIGNATURE HEALTHCARE OF BREMEN.
Correction Status: Deficient, Provider has no plan of correction.
SIGNATURE HEALTHCARE OF BREMEN in BREMEN, 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 BREMEN, 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 SIGNATURE HEALTHCARE OF BREMEN or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.