Clinton Gardens
375 S 11th St, Clinton, IN 47842 · Government - City/county · 100 certified beds · (765) 832-2491 Medicare & Medicaid certified
On the public record, this home looks stronger than most — but visit before you decide.
- a strong health-inspection score (4/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
- no federal fines or payment denials on record
- a high number of inspection citations overall (15) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 4 of 5 |
| StaffingFrom payroll records (PBJ) | 3 of 5 |
| Quality measuresSelf-reported by the facility | 4 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 4 of 5 |
| Long-stay residentspeople who live here | 5 of 5 |
| Short-stay residentsrehab / post-hospital | 3 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating held steady at 4 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 7.4% | 11.0% | 15.4% | better |
| Long-stay residents who lose too much weight | 4.6% | 5.5% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 0.6% | 0.4% | 0.9% | worse than state‡ — see note marked double-dagger below the table |
| Long-stay residents with a urinary tract infection | 0.0% | 1.1% | 2.0% | better |
| Long-stay residents with depressive symptoms | 24.8% | 25.2% | 6.5% | typical for the state‡ — see note marked double-dagger below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 3.8% | 3.9% | 3.3% | worse |
| Long-stay residents whose ability to walk worsened | 14.0% | 11.9% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 15.8% | 23.5% | 18.9% | better |
| Long-stay residents given the seasonal flu vaccine | 98.4% | 95.4% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 5.0% | 3.6% | 4.7% | typical |
| Long-stay residents with worsening bladder/bowel control | 18.0% | 23.3% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 5.0% | 13.6% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 2.6% | 1.2% | 1.4% | worse |
| Short-stay residents given the seasonal flu vaccine | 78.5% | 79.0% | 79.4% | typical |
| Short-stay residents rehospitalized after admission | 40.5% | 22.2% | 22.6% | worse |
| Short-stay residents with an outpatient ER visit | 12.7% | 10.8% | 12.0% | typical |
| Long-stay hospitalizations per 1,000 resident days | 1.85 | 1.61 | 1.67 | worse |
| Long-stay outpatient ER visits per 1,000 resident days | 1.57 | 1.44 | 1.80 | better |
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
50.6% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 81 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 65.1% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 43 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: this home’s payroll records show 0.22 therapist hours per resident per day in 2026Q1 — more than 27% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 8% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 50.6%CMS range 40.6–57.7 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 12.2%CMS range 8.1–18.5 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 65.1% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 55.8% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 55.8% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 84.1% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 100.0% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 1.6% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 0.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 6.5%CMS range 3.0–11.2 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.79 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 100 beds and averages 72.6 residents a day — about 73% occupied, or roughly 27 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.50 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.66 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 1.99 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 3.01 hrs/resident/day on weekends vs 3.70 on weekdays — 19% thinner on weekends. RN hours go from 0.75 to 0.42 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 50% is about the same as the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are unchanged from the previous inspection. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
15 citations, most serious first. The 10 most serious are shown; the remaining 5 are one tap away and print in full.
- Potential for harm · D2025-08-11 · tag F0697 — failed to manage pain — isolatedProvide safe, appropriate pain management for a resident who requires such services.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to ensure a resident had effective pain management for 1 of 2 residents reviewed for pain management (Resident 43). Findings include:On 8/05/2025 at 2:42 p.m., during an interview, Resident (43) indicated she received pain medication twice daily and indicated it was not helping to control her pain. The resident had asked for an increase in pain medication but was told she could not have more. She indicated they did administer Tylenol, but it was not effective. The resident demonstrated physical signs of pain during interview. On 8/08/2025 at 9:39 a.m., the medical record of Resident 43 was reviewed. The resident was admitted to the facility on [DATE]. Admitting diagnoses included but not limited to displaced intertrochanteric fracture of right femur (fracture of the right thigh bone), subsequent encounter for closed fracture with routine healing, Congestive Heart Failure (CHF) (a condition that develops when your heart doesn't pump enough…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-08-11 · tag F0760 — failed to prevent significant medication errors — isolatedEnsure that residents are free from significant medication errors.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to administer medication according to physician orders and held medications without a physician order for 1 of 5 residents reviewed for unnecessary medications (Resident 6). Findings include:On 8/7/25 at 11:00 a.m., the medical record of Resident 6 was reviewed. The resident was admitted to the facility on [DATE]. Diagnoses included but were not limited to, Cerebral Vascular Accident (CVA) (stroke), dementia (the loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities) and type 2 diabetes (a disease that occurs when your blood glucose, also called blood sugar, is too high).A physician order, dated 7/16/25, indicated to administer insulin glargine (the process of administering the hormone, insulin to a person, by injection to help regulate their blood sugar levels) 100 unit/mL (milliliter) (3 mL); amount: 10 units; subcutaneous (under the skin) twice a day.A…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-08-11 · tag F0761 — failed to label and store drugs safely — isolatedEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure a medication prescription label matched the physician's order for 1 of 35 medication administrations observed (Resident 28). Findings include:On 8/8/25 at 8:47 a.m. Qualified Medication Aide (QMA) 9 administered mirtazapine (antidepressant) 15 milligrams (mg), 2 tablets to Resident 28. The label on the mirtazapine medication card, dated 7/8/25, indicated mirtazapine 15 mg, 1 tablet by mouth daily. There was no directions changed sticker or indication that two tablets were ordered. At the same time, QMA 9 indicated the medication order was changed to two tablets on 8/4/25. Resident 28's record was reviewed on 8/8/25 at 2:39 p.m. A quarterly Minimum Data Set (MDS) assessment, dated 6/23/25, indicated the resident had a moderate cognitive impairment and received an antidepressant during the assessment look-back period. A physician's order, dated 7/9/25 and discontinued on 7/15/25, indicated mirtazapine 15 mg by mouth once daily for appetite stimulation A physician's order, dated 7/15/25 and discontinued…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-08-11 · tag F0883 — failed to offer flu and pneumonia vaccines — isolatedDevelop and implement policies and procedures for flu and pneumonia vaccinations.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure an influenza vaccination was offered or administered to 1 of 5 residents reviewed for immunizations (Resident 1). Findings include:Resident 1's record was reviewed on 8/11/25 at 10:39 a.m. Census information indicated the resident was hospitalized from [DATE] to 9/17/24, 10/31/24 to 11/1/24, and 11/17/24 to 11/18/24. The resident's preventative health care record, dated 10/31/24, indicated the influenza vaccine was not administered related to other-transferred to hospital for further evaluation. The preventative health care record lacked further documentation regarding the resident's influenza vaccine. Progress notes, dated September 2024 to December 2024, lacked documentation the influenza vaccine was offered or declined during the flu season, or evidence it was clinically contraindicated. During an interview, on 8/11/25 at 1:25 p.m., the Director of Nursing Services (DNS) indicated the resident was not given an influenza vaccine because of her…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-06-10 · tag F0755 — failed to provide safe pharmacy services — isolatedProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure a physician ordered medication was administered and documented appropriately for 1 of 3 residents reviewed for quality of care. (Resident B) Findings include: During an interview on 6/9/25 at 1:35 p.m., Resident B indicated he had not received his nicotine patch 3-4 days last week and then again today. During the interview with Resident B, QMA 3 entered the room with his pain medication and indicated she had not applied his nicotine patch this morning because he had been in therapy. During a follow-up interview on 6/9/25 at 2:20 p.m., Resident B indicated QMA 3 had returned to his room, around 1:40 p.m., shortly after the initial interview and applied his nicotine patch. The clinical record for Resident B was reviewed on 6/9/25 at 12:21 p.m. Diagnoses included displaced right hip fracture with routine healing following surgical intervention, chronic obstructive pulmonary disease, and adjustment disorder with depressed mood. Current signed physician's orders for the resident included, Nicotine patch 21…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2024-08-16 · tag F0554 — isolatedAllow residents to self-administer drugs if determined clinically appropriate.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure a self-administration assessment had been completed for a resident who was observed to self-administer her medications for 1 or 1 random observation (Resident 15). Findings include: During a random observation of the breakfast meal in the main dining room, on 8/12/24 at 7:40 a.m., a medication cup containing 4 pills sat on the table in front of Resident 15. She self-administered the medications when her tray was delivered. No staff were present to observe the resident self-administer her medications. Resident 15's record was reviewed on 8/15/24 at 9:19 a.m. The profile indicated the resident's diagnoses included, but were not limited to, essential hypertension (a condition in which the blood vessels have persistently raised pressure), heart failure (a condition that occurs when the heart can't pump enough blood and oxygen to the body) and age-related macular degeneration (an eye disease that causes a breakdown of cells in the center of the retina, which is the light-sensitive tissue at the back of the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2024-08-16 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews, the facility failed to ensure care plan meetings were completed timely for 2 of 24 residents reviewed for care plan meetings (Residents 12 and 24). Findings include: 1. During an interview on 8/12/24 at 11:10 a.m., Resident 12 indicated she could not remember having any care plan meeting in the last three years. On 8/13/24 at 2:24 p.m., Resident 12's record was reviewed. Care plan meeting documentation was located for 5/8/24, 2/13/24, and 9/11/23. The record lacked care plan meeting documentation from between 9/11/23 and 2/13/24. A quarterly Minimum Data Set (MDS) assessment, completed 7/29/24, indicated Resident 12 had a Brief Interview for Mental Status (BIMS) score of 14, indicating she was cognitively intact. During an interview on 8/14/24 at 10:39 a.m., the Social Services Director (SSD) indicated she might have done the assessment but did not complete the meeting note. During an interview on 8/14/24 at 11:17 a.m., the SSD indicated that she did not have any notes,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2024-08-16 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure the Qualified Medication Aide (QMA) followed proper standards of practice for 1 of 1 residents reviewed for pressure ulcer care (Resident 218). Findings include: During an interview, on 8/12/24 at 9:29 a.m., Resident 218 indicated she had several open areas to her bottom, and they had been there since before her admission to the facility. She acquired the areas while living at home. During an interview, on 8/14/24 at 7:50 a.m., QMA 3 indicated Resident 218 was getting ready to take a shower and therefore she would not be doing the dressing change until after her shower. She further indicated the dressing changes would be completed by the wound Nurse Practitioner, the Assistant Director of Nursing, or other staff working the hall. During an interview, on 8/14/24 at 8:30 a.m., Resident 218 indicated QMA 3 had completed her pressure ulcer dressing changes before to her bottom. Resident 218's record was reviewed on 8/13/24 at 2:23 p.m. The profile…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-08-16 · tag F0761 — failed to label and store drugs safely — isolatedEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure medication storage areas were free from personal drinks, and failed to ensure expired medication was disposed of (Resident 38) for 2 of 4 medication carts reviewed for medication storage. Findings include: 1. During observation of medication storage and labeling on 8/15/24 at 10:58 a.m., in the bottom drawer of the A-hall medication cart, observed a plastic restaurant cup with a label on the outside indicating it to be iced coffee from 8/15/24. The drink was stored amongst residents medications. During an interview with Licensed Practical Nurse (LPN) 16 on 8/15/24 at 10:59 a.m., she indicated the drink belonged to her, and food or drink were not to be stored inside the medication carts. During an interview with the Administrator (ADM) on 8/16/24 at 9:57 a.m., she indicated staff were not supposed to have personal drinks in patient care areas, including the medication carts, and were supposed to keep them in the break room. 2. During an observation of medication storage and labeling on 8/15/24 at 11:19…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2023-06-06 · tag F0812 — failed to store, cook, and serve food safely — patternProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure proper food handling for 1 of 2 dining observations and failed to ensure proper handwashing for 3 of 3 dining observations. Findings include: 1. During a dining observation, on 5/30/23 at 11:32 a.m., Activity Assistant 14 was preparing drinks for the residents. She scooped ice into 2 glasses and returned the scoop into the ice bucket. The Activity Assistant served the drinks to 2 residents and returned to the cart to prepare more drinks. At 11:41 a.m., the ice scoop remained in the ice bucket. At 11:43 a.m., another staff member approached the ice bucket and placed the ice scoop into an empty pitcher next to the ice bucket. During an interview, on 6/5/23 at 11:01 a.m., the Culinary Manager indicated staff were not to leave the ice scoop in the ice bucket. They were to return it to the empty pitcher on the cart by the ice bucket. On 6/5/23 at 1:37 p.m., the Executive Director provided a document, dated 2/02 with a revised date 5/23, titled. Food Storage, and indicated it was the policy currently used by…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 5 citations
- Potential for harm · D2023-06-06 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure residents were addressed in a dignified manner for 3 of 3 residents reviewed for dignity (Residents 18, 30, and 10). Findings Include: 1. During the lunch meal observation, on 5/30/23 at 12:20 p.m., Resident 18 was sitting at the lunch table and was being assisted with eating by Activity Assistant 5. Activity Assistant 5 addressed Resident 18 as Mama. She asked Resident 18, Mama, would you like to take a bite? Activity Assistant 5 proceeded to assist the Resident 18 with eating and asked, Mama, would you like to take a drink? Resident 18's record was reviewed on 6/1/23 at 10:00 a.m. The profile indicated the resident's diagnoses included, but were not limited to, Alzheimer's disease (a progressive disease that destroys memory and other important mental functions) with late onset, rheumatoid arthritis (a chronic inflammatory disorder affecting many joints, including those in the hands and feet), hyperlipidemia (a condition in which there are high levels of fat particles (lipids) in the blood. The record…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-06-06 · tag F0677 — failed to help fully-dependent residents with daily care — isolatedProvide care and assistance to perform activities of daily living for any resident who is unable.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure Activities of Daily Living (ADL, activities related to personal care) were completed for 4 of 24 residents reviewed for ADL care (Residents 57, 15, 34, and 38). Findings include: 1. During the initial observation of Resident 57, on 5/3/23 at 12:14 p.m., the resident was sitting in the dining room for her lunch meal. The resident was observed to have long chin hairs. During a random observation, on 5/31/23 at 10:10 a.m., the resident was observed during an activity in the dining room. The resident was observed to have long chin hairs. During a random observation, on 6/2/23 at 11:42 a.m., the resident was observed in dining room for her lunch meal. The resident was observed to have long chin hairs. During a random observation, on 6/5/23 at 9:31 a.m., the resident was observed sitting in the lounge area next to the bird aviary. The resident was observed to have long chin hairs. Resident 57's record was reviewed on 6/2/23 at 11:44 a.m. The profile indicated the resident's diagnoses included, but were not…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-06-06 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to document, report, and address a skin condition on a resident for 1 of 24 residents reviewed for skin conditions (Resident 28). Findings include: During an initial observation, on 5/30/23 at 12:11 p.m., a faded bruise-like discoloration was observed on Resident 28's left temple area. During a family telephone interview, on 5/31/23 at 9:44 a.m., the resident's family member indicated she was not aware of any incident or a discolored area on the resident's temple. She had visited the week prior and did not notice any skin issues at that time. During an interview, on 5/31/23 at 10:01 a.m., the Director of Nursing (DON) indicated she was not aware of the resident having a discolored area to the side of her head. During the initial pool record review, on 5/30/23 at 2:16 p.m., the record lacked documentation of any event where the resident had received an injury. Resident 28's record was reviewed on 6/2/23 at 10:19 a.m. The profile indicated the resident's diagnoses included, but were not limited to, encephalopathy…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-06-06 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure a resident's indwelling urinary catheter (a semi-flexible plastic tube with one end inserted into the bladder) which is attached to a urinary drainage bag did not touch the floor and staff failed to follow the proper procedure for changing a urinary drainage leg bag (a urinary drainage device attached to the resident's leg) to a standard urinary drainage bag for 1 of 1 resident reviewed for catheter care (Resident 55). Findings include: On 5/30/23 at 3:30 p.m., Resident 55 was observed sitting in a wheelchair with a urinary catheter drainage bag within a dignity bag (a cloth bag that covered the urinary catheter drainage bag) laying on the floor under the wheelchair. On 6/1/23 at 11:16 a.m., during an observation the resident was lying in a bed and the resident's catheter drainage bag and tubing was on the floor next to the bed. On 6/2/23 at 12:00 p.m., Certified Nurse Aide (CNA) 3 was observed removing an unbagged used urinary drainage bag from a grab bar in the resident's shared bathroom. CNA 3…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-06-06 · tag F0757 — failed to avoid unnecessary drugs — isolatedEnsure each resident’s drug regimen must be free from unnecessary drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure pharmacy recommendations were addressed and initiated for 2 of 5 residents reviewed for unnecessary medications (Residents 22 and 25). Findings include: 1. Resident 22's record was reviewed on 6/1/23 at 11:36 a.m. The profile indicated the resident's diagnoses included, but were not limited to, vascular dementia (changes to memory, thinking, and behavior resulting from conditions that affect the blood vessels in the brain), atrial fibrillation (an irregular heartbeat that occurs when the electrical signals in the atria [the two upper chambers of the heart] fire rapidly at the same time), and atherosclerotic heart disease ( a common condition that develops when a sticky substance called plaque builds up inside your arteries). An annual Minimum Data Set (MDS-a standardized assessment tool that measures health status in nursing home residents) assessment, dated 9/6/22, indicated the resident had moderate cognitive deficit and received an…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to AMERICAN SENIOR COMMUNITIES — 90 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 4 of 5 | 3.9 | +0.1 vs chain |
| Health inspection | 4 of 5 | 3.4 | +0.6 vs chain |
| Staffing | 3 of 5 | 2.3 | +0.7 vs chain |
| Quality measures | 4 of 5 | 4.7 | -0.7 vs chain |
The other 89 homes this chain runs (chain average 3.9★, per CMS)
Showing 40 of 89; lowest-rated first.
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| DRUMMER, CARL | Individual | CORPORATE DIRECTOR | since 01/01/2017 |
| HANIFY, THOMAS | Individual | CORPORATE DIRECTOR | since 01/01/2022 |
| HORN, BRENDA | Individual | CORPORATE DIRECTOR | since 12/01/2023 |
| LAZARD, ROBERT | Individual | CORPORATE DIRECTOR | since 01/29/2021 |
| MANTRAVADI, GEETA | Individual | CORPORATE DIRECTOR | since 07/21/2021 |
| PAYNE, MONICA | Individual | CORPORATE DIRECTOR | since 08/09/2021 |
| BABCOCK, PAUL | Individual | CORPORATE OFFICER | since 09/30/2020 |
| CAINE, VIRGINIA | Individual | CORPORATE OFFICER | since 01/10/1994 |
| HARRIS, LISA | Individual | CORPORATE OFFICER | since 12/22/2003 |
| AMERICAN SENIOR COMMUNITIES LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 01/01/2003 |
| BREWER, ANGELA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 03/23/2026 |
| DICE, MARK | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 06/01/2023 |
| PUPILLI, TAMARA | Individual | OPERATIONAL/MANAGERIAL CONTROL | since 04/08/2019 |
| VAN CAMP, STEVEN | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 06/01/2023 |
CMS files one row per role, so the 18 rows in the source record cover these 14 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
1 organizational owner listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 73% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $831K paid to related parties — landlords or management companies under common ownership — equal to about 11% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in IN
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Indiana Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 155319. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-08-11, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.