Munster Med-inn
Inspection Findings
F-Tag F0658
F 0658
moistened gauze and cover with a dry dressing every day and evening shift.
Level of Harm - Minimal harm or potential for actual harm
A Physician's Order, dated 9/26/25, indicated to clean the left heel with normal saline or wound cleanser, pat dry, apply skin prep to the surrounding skin, and apply Dakin's solution moistened gauze to the wound bed and wrap with kerlix every day and evening shift.
Residents Affected - Few
The Treatment Administration Record (TAR) for 9/2025 indicated the following treatments were signed out as being completed by a QMA: Left hip Days: 9/26/25 and 9/28/25 Evenings: 9/26/25 Left Heel Days: 9/26/25 and 9/28/25 Evenings: 9/26/25
The 10/2025 TAR indicated the following treatments were signed out as being completed by a QMA: Left hip Days: 10/1/25, 10/7/25, and 10/25/25 Evenings: 10/3/25, 10/8/25, 10/17/25, and 10/25/25 Left Heel Days: 10/1/25, 10/7/25, and 10/25/25 Evenings: 10/3/25, 10/8/25, and 10/17/25
During an interview on 10/28/25 at 11:00 a.m., the Director of Nursing (DON) indicated QMAs were not allowed to perform any pressure ulcer treatments.
During a confidential interview on 10/27/25, a family member indicated they had witnessed QMAs doing pressure ulcer treatments while they were visiting their loved one.
The current 9/1/2020 Job Description and Performance Monitoring System for a Qualified Medication Aide (QMA) policy, provided by the DON on 10/28/25 at 2:50 p.m., indicated a QMA can perform minor skin treatments such as a Stage 1 pressure ulcer. 3.1-35(g)(1)
FORM CMS-2567 (02/99) Previous Versions Obsolete
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
10/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Munster Med-Inn
7935 Calumet Ave Munster, IN 46321
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 F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
The record for Resident C was reviewed on 10/28/25 at 11:35 a.m. Diagnoses included, but were not limited to, vascular dementia, major depressive disorder, dysphagia, high blood pressure, cardiac pacemaker, atrial fibrillation, and acute kidney failure.
The Annual Minimum Data Set (MDS) assessment, dated 9/19/25, indicated the resident was not cognitively intact for daily decision making, The resident had one Stage 3 (a full-thickness skin loss that extended into the subcutaneous tissue but did not involve muscle, tendon, or bone) pressure ulcer, and two Stage 4 pressure ulcers (a severe form of pressure injury that involved full-thickness tissue loss, exposing muscle, tendon, or bone).
The Care Plan, revised on 10/24/25, indicated the resident had a skin tear to the left finger and palm.
A Physician's Order, dated 10/17/25, indicated to clean the left medial first finger with wound cleanser or normal saline, apply skin prep to the surrounding skin, apply oil emulsion to the wound bed and cover with
a dry dressing every day shift on Monday, Wednesday, and Friday.
A Physician's Order, dated 10/24/25, indicated to clean the left lateral knee wound with normal saline or wound cleanser, pat dry, apply skin prep to the surrounding skin, apply oil emulsion, and cover with a dry dressing every day shift every Monday, Wednesday, and Friday.
A Physician's Order, dated 10/25/25, indicated to clean the left palm with wound cleanser or normal saline and apply skin prep.
The Treatment Administration Record (TAR) for 10/2025, indicated the treatments to the left lateral knee and left medial first finger were signed out as completed on 10/24/25.
During an interview on 10/28/25 at 11:00 a.m., the Director of Nursing indicated the wound and skin treatments should be done as ordered by the physician.
This citation relates to Intake 2651009. 3.1-37(a)
FORM CMS-2567 (02/99) Previous Versions Obsolete
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
10/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Munster Med-Inn
7935 Calumet Ave Munster, IN 46321
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
F 0686
unmeasurable. The wound was 100% maroon and purple.
Level of Harm - Minimal harm or potential for actual harm
A Wound Physician's Note, dated 10/13/25, indicated the right lateral foot measured 1.7 cm in length, 1.0 cm in width, and 0.3 cm in depth with 80% granulation and 20% viable tissue.
Residents Affected - Few
A Wound Physician's Note, dated 10/16/25, indicated the right distal medial foot was 100% intact purple maroon color and measured 2 cm in length and 1.5 cm in width by unmeasurable.
A Wound Physician's Note, dated 10/20/25, indicated the right distal lateral foot measured 1.5 cm in length, 1.2 cm in width, and 0.3 cm in depth. The wound bed was 90% granulation tissue and 10% other viable tissue.
A Wound Physician's Note, dated 10/23/25, indicated the right medial distal foot measured 2.0 cm in length by 2.5 cm in width by unmeasurable. The wound bed was 60% adhered necrotic black tissue, 20% granulation tissue, and 20% other viable tissue. The treatment was changed to Mupirocin 2% ointment daily and as needed. The right distal lateral foot measured 1.5 cm in length by 1.3 cm in width, by 0.3 cm in depth. The wound bed was 90% granulation tissue and 10% other viable tissue.
During an interview on 10/27/25 at 12:35 p.m. the Wound Nurse indicated she was unaware the treatment to the right medial distal foot had changed. She administered the wrong treatment and did not apply the Mupirocin ointment. She indicated the bandages were old and outdated. The Wound Physician was in the facility on 10/23/25 and she did the treatments with him, as those were her initials on the bandages from 10/23/25.
During an interview on 10/28/25 at 11:00 a.m., the Director of Nursing indicated the wound and skin treatments should be done as ordered by the physician.
This citation relates to Intake 2651009. 3.1-40(a)(2)
FORM CMS-2567 (02/99) Previous Versions Obsolete
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
10/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Munster Med-Inn
7935 Calumet Ave Munster, IN 46321
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 F0880
F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
wound cleanser, patted it dry and removed her gloves and donned clean gloves to both hands and did not perform hand hygiene. She opened a package of Skin Prep and applied it around the wound, applied Mupirocin (an ointment to treat skin infections) ointment to the wound base, and placed a bordered gauze bandage over the left heel. She removed her gloves and washed her hands with soap and water. The Wound Nurse then removed the bandage from the left hip and there was a heavy amount of dried and fresh bloody drainage observed. She removed her gloves and donned a pair of clean gloves to both hands and did not perform hand hygiene.
During an interview on 10/27/25 at 3:45 p.m., the Wound Nurse indicated she was unaware she had to perform hand hygiene every time she removed her gloves.
During an interview on 10/28/25 at 11:00 a.m., the Director of Nursing indicated hand hygiene was to be performed before and after glove removal.
- 3. During an observation on 10/27/25 at 11:41 a.m., the Wound Nurse and the Second Floor Unit Manager
were asked to change and provide the treatments to Resident C's pressure ulcers. The Wound Nurse washed her hands with soap and water and donned a clean isolation gown and gloves to both hands. She removed the old bandage to the right distal lateral and medial foot. She removed her gloves, washed her hands with soap and water, and donned clean gloves to both hands. The Wound Nurse cleaned the pressure ulcer to the right distal lateral foot with wound cleanser, patted it dry, removed her gloves, donned clean gloves to both hands and did not perform hand hygiene. She performed the treatment to the lateral foot, removed her gloves and performed hand hygiene. She donned a clean pair of gloves to both hands, and cleaned the right distal medial foot wound with wound cleanser, patted it dry, and removed her gloves, donned clean gloves to both hands and did not perform hand hygiene. She put the ointments on the wound bed, removed her gloves, donned clean gloves to both hands and did not perform hand hygiene. She then covered the wound with a piece of oil emulsion bandage and secured it with a dry bordered bandage. She removed her gloves, washed her hands with soap and water, and donned clean gloves to both hands. She removed the bandage from the coccyx pressure ulcer, discarded her gloves, donned a clean pair of gloves to both hands and did not perform hand hygiene. She cleaned the wound with wound cleanser, patted it dry, removed her gloves, donned clean ones, and did not perform hand hygiene. She completed the treatment and performed hand hygiene. She donned clean gloves to both hands, and removed the bandage from the left lateral knee. She discarded the old gloves, donned clean gloves to both hands and did not perform hand hygiene. She cleaned the wound, removed her gloves, donned clean gloves and did not perform hand hygiene and proceeded to the complete the treatment. She performed hand hygiene, donned clean gloves to both hands and removed the kerlix bandage from the resident's left hand. She then removed her gloves, donned clean gloves and did not perform hand hygiene. She cleaned the wound and palm of the resident's hand, discarded her gloves, donned clean gloves and did not perform hand hygiene and completed the treatment.
During an interview on 10/27/25 at 3:45 p.m., the Wound Nurse indicated she was unaware she had to perform hand hygiene every time she removed her gloves.
During an interview on 10/28/25 at 11:00 a.m., the Director of Nursing (DON) indicated hand hygiene was to be performed before and after glove removal.
The current 9/1/2020 Hand Hygiene/Handwashing policy, provided by the DON on 10/28/25 at 2:50 p.m., indicated hand hygiene was to be performed before and after glove removal. 3.1-18(b)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
MUNSTER MED-INN in MUNSTER, 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 MUNSTER, 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 MUNSTER MED-INN or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.