Signature Healthcare Of Muncie

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

resident was to be non-weight bearing on the left lower extremity. She was encouraged to elevate the affected area when in bed to manage swelling. A follow-up appointment was scheduled for 8/19/25. The resident was made aware.The clinical record lacked documentation to indicate the residents' family or representative were notified of the x-ray report and/or the follow-up appointment.An NP progress note, dated 8/13/25, indicated Resident M complained of left ankle pain and was seen by the MD who ordered an x-ray. The x-ray came back positive for fracture, so the resident was sent to the orthopedic clinic and received another x-ray of her left ankle. She was placed in a hard splint with no weight bearing orders. The resident stated she could not believe she broke her ankle. Staff reported the resident hit her left foot on the wheel of the wheelchair after coming back from the shower.During an interview with Resident M's Emergency Contact 1 on 9/15/25 at 11:43 a.m., she indicated the facility did not contact her about the accident or fracture. She did now know if treatment was provided until the day after the accident when a fracture was confirmed. Resident M was at the facility for rehabilitation after a total right knee replacement.

The fracture happened within a week of her entering the facility for rehabilitation. During an interview with

the DON on 9/16/25 at 9:51 a.m., she indicated she was told by RN 7 of a phone conversation Resident M had with her relative about the accident. Since RN 7 knew family was aware, he did not contact the family or the representative.During an interview with Resident M's second emergency contact on 9/16/25 at 10:40 a.m., she indicated Resident M was able to understand medical information, but it depended on how it was explained to her. The day her foot was hurt, Resident M called her and told her about the accident. Resident M was at the orthopedic clinic when she contacted her. The resident thought her foot was broken. Nobody from the facility communicated with the emergency contact. She contacted the facility and was told by a nurse that the resident's foot was fractured. The emergency contact left several messages for the DON. She called at 7:40 p.m. (she did not remember the date) and was told to call back at 10:00 p.m. because the nurse was busy providing care for another resident.During an interview with RN 7 on 9/16/25 at 2:50 p.m.,

he indicated he was aware of the accident on 8/11/25. The next morning, during rounds, the MD ordered an x-ray of the left ankle. The facility transportation took the resident to the orthopedic clinic for evaluation. On

the day of the accident, Resident M told her relative about what happened. Facility policy was to contact family and/or resident representative(s), but unfortunately, he did not. In retrospect, he should have contacted the resident's representative and/or family about the accident/injury.A current facility policy, titled Accidents and Incidents, provided by the DON on 9/16/25 at 2:47 p.m., indicated the following: . The intent is to ensure the facility provides an environment that is free from accidents and incidents that are avoidable,

the facility investigates these occurrences with applicable documentation, and appropriate reporting is completed as applicable .2. The following data, as applicable, shall be included in the residence medical record.f. The resident's representative, as applicable, notification.A current facility policy, titled Notification of Change of Condition, provided by the DON on 9/16/25 at 2:42 p.m., indicated the following: . To ensure appropriate individuals are notified of changes in condition.The facility must inform the resident, consult with the residents physician, and notify, consistent with his or her authority, the resident's representatives when there is. B. A significant change in the resident's physical, mental, or psychosocial status. 2.

Documentation of notification or notification attempts should be recorded in the resident's electronic medical record. 3. The resident and/ or representative, and the medical providers, should be notified of a change in condition. The medical provider will provide guidance related to the changing conditions.This citation relates to Intake 2607823.3.1-5(a)(2)

Event ID:

Facility ID:

If continuation sheet

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Signature Healthcare of Muncie

4301 N Walnut St Muncie, IN 47303

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)

Federal health inspectors cited SIGNATURE HEALTHCARE OF MUNCIE in MUNCIE, IN for a deficiency under regulatory tag F-F0600 during a complaint investigation conducted on 2025-09-17.

Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies

The facility was found deficient in the following area: Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

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 MUNCIE.

Correction Status: Past Non-Compliance.

The facility reported correction as of 2025-08-24.