01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-07 | 7 | 2025-03-07 | 17 |
| Cycle 2 | 2024-02-23 | 11 | 2024-02-23 | 5 |
| Cycle 3 | 2023-01-30 | 11 | 2023-01-30 | 7 |
CMS CCN 1552292026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Woodlands The
3820 W Jackson St · Muncie, IN 47304 · Delaware County
Certified beds108CMS provider file
Recent citation rows58current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
58 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 11 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-05-07 · HEALTHF0607Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has date of correction · 2025-06-02 · complaint2025-04-01 · HEALTHF0561Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Correction field: Deficient, Provider has date of correction · 2025-04-08 · complaint2025-04-01 · HEALTHF0603Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).
Correction field: Deficient, Provider has date of correction · 2025-04-08 · complaint2025-03-07 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREE0013Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop Emergency Preparedness policies and procedures.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREE0025Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Create arrangements with other facilities to receive patients.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREE0029Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop a communication plan.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREE0036Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish emergency prep training and testing.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREE0037Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish staff and initial training requirements.
Correction field: Deficient, Provider has date of correction · 2025-06-252025-03-07 · HEALTHF0568Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0732Severity C · widespread; potential for minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0758Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-04-082025-03-07 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0346Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0354Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0511Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2025-05-012025-03-07 · FIREK0741Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2025-06-2503 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- ENGELS, ERINIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/01/2018
- GENTRY, MARKIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/12/2022
- STARKEY, TYLERIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 08/01/2020
- WAITE, JOHNIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 08/01/2020
- WHICKER, TIMOTHYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/12/2022
- FENOUGHTY, DEANNAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/10/2023
- LIFE CARE CENTERS OF AMERICA, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- MUNCIE MEDICAL INVESTORS LIMITED PARTNERSHIPOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- FENOUGHTY, DEANNAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/10/2023
- FLETCHER, TODDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- HENRY, TERRYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- HILTZ, JEFFREYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2024
- LAY, LISAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- PRESTON, AUBREYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/06/2025
- PRESTON, FORRESTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- SPAUGH, KEVINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/27/2023
- SWANKER, RICHARDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- THURMOND, JOANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.47per resident day
RN hours0.65per resident day
Weekend nurse hours3.16per resident day
Staff turnover44.4%CMS reported field
06 / LOCAL RECORDS
Open the Muncie ledger →Other published facilities nearby
Bethel Pointe Health And Rehab114 beds · CMS overall 5/522 citation rowsBrickyard Healthcare - Muncie Care Center117 beds · CMS overall 3/541 citation rowsBrookside Care Strategies42 beds · CMS overall —/581 citation rowsCardinal Care Strategies104 beds · CMS overall 1/578 citation rowsEnvive Of Muncie60 beds · CMS overall 2/537 citation rowsMorrison Woods Health Campus68 beds · CMS overall 4/524 citation rowsSignature Healthcare Of Muncie140 beds · CMS overall 1/580 citation rowsWaters Edge Village74 beds · CMS overall 4/518 citation rows