Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
PILGRIM MANOR
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 07/25/2025
 
Posted to the Web on: 08/06/2025
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 222 PARKVIEW ST
City: PLYMOUTH
Telephone: (574) 936-9943
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 25-000030-1
  License effective date: 07/01/2025
  License expiration date: 06/30/2026
 


Administration and Staff

Administrator: JAMES COMBS
  Start date: 09/03/2024
 
Director of Nursing: CONNIE BENNETT
  Start date: 08/27/2022
 
Medical director: Byron Holm, Jr.
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: ADAMS COUNTY MEMORIAL HOSPITAL
1100 MERCER AVENUE
DECATUR IN 46733
 
Ownership type:  OTHER
 
Officer(s): RUSSELL FLUECKIGER
            DANE WHEELER
            SCOTT SMITH
            LARRY MACKLIN
            DAVID MCINTIRE
            SCOTT LEHMAN
            KYLE SPRUNGER
            TIFFANY WILLIAMS
            ELIZABETH FISHER
            ADAM MILLER, J.D.
            AMBER LAUTZENHEISE
            CANDICE BORNE-BAUMAN
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: CAREAGE OF LOGANSPORT INC
Date of last change of ownership: 07/01/2024
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    6
Number of Medicare/Medicaid beds (SNF/NF):        72
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     78
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            78
 
CENSUS:
Facility census:  64
As reported by the facility on: 07/10/2025
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/10/2025
 
Residential care beds occupied:  0
As reported by the facility on: 07/10/2025
 
Alzheimer Beds:  0
Alzheimer Beds Occupied:  0
As reported by the facility on:   /  /  
 
Ventilator Beds:  0
Ventilator Beds Occupied:  0
As reported by the facility on:   /  /  
 


Sprinklers and Smoke Detectors

This facility is: FULLY SPRINKLERED
 
Number of comprehensive care resident rooms: 59
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 29
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 30
 
  If hard wired and/or wireless smoke detectors are provided in resident's room, do they:
    (A) Provide a visual and audible signal at the nurses'stations that attend each room? - Yes
    (B) Transmit to a central station service - Yes
    (C) Connect to the health facility's fire alarm system - Yes
 
Person completing form - RODNEY BLISS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENACE DIRECTOR
Date form completed - 06/10/2025
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 04/05/2019
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2027
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 12/15/2018
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     PLYMOUTH COMUNITY SCHOOL CORPORATION
         Approved: 03/30/2000
         Terminated: 12/16/2016
     PILGRIM MANOR
         Approved: 04/05/2019
         Terminated: N/A
     CHASE CENTER
         Approved: 06/09/2022
         Terminated: 09/27/2022
     CHASE CENTER
         Approved: 03/31/2025
         Terminated: N/A
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  1
  2 years previous:  1

 


Facility Report Card



 


 
03/01/2020 Current QTR
12/01/2019 Previous QTR
09/01/2019 Previous QTR
06/01/2019 Previous QTR


Report Card Score
419
422
422
276


Rank of Score
20
16
17
78


Average Score
302
296
295
296


 
*Facility report card scores have not been updated since March 1, 2020 due to changes in the survey process during the ongoing COVID-19 pandemic. 
The facility report card score is calculated four times per calendar year 
for the two most recent nursing home health surveys.  The facility report card score 
also includes all complaint surveys, life safety code surveys, emergency preparedness surveys, 
and any follow-up surveys that occur within the two most recent nursing home health surveys. 
The facility report card score ranges from 500 to 0, with 500 being the best score possible. 
 
View the Scope and Severity grid
 
View the scoring methodology
 



Overview of Survey findings




 
 The Most Recent Set
 2ND Most Recent Set
 3RD Most Recent Set

Immediate Jeopardy
No
No
No


 Substandard Quality of Care 
No
No
No


Administrator Change
Yes
No
Yes


Owner Change
No
Yes
No


Number of Substantiated Complaints With Deficiencies
0
0
0


Deficiency Free Standard Health Survey
No
No
No


 
    The term 'Recent Set' referenced above relates to the referenced annual survey,
    and any other surveys performed between it and the previous annual survey.
 

 


Enforcement Actions

 
Federal Certification Actions Imposed
 
Date terminated from Medicare/Medicaid: N/A
 


Survey History


    The survey report is not posted until the report has been provided to the facility and their plan of correction submitted and approved.
    The survey report therefore will likely not be posted until four to six weeks after the exit date.
        
    In the grid below click on an event ID that is underlined to see the survey report for that event.


 
Event ID
Survey Type
Exit Date

YX3F11
Complaint
05/16/2025


73J913
Recertification, Complaint, Follow Up, State Licensure
01/23/2025


73J922
Recertification, Follow Up, Life Safety Code
01/09/2025


73J912
Recertification, Complaint, Follow Up, State Licensure
01/03/2025


73J921
Recertification, Life Safety Code
01/02/2025


73J911
Recertification, Complaint, State Licensure
11/27/2024


CXJS12
Complaint, Follow Up
10/03/2024


CXJS11
Complaint
08/28/2024


6HG222
Recertification, Follow Up, Life Safety Code
02/27/2024


RYTT11
Complaint
02/19/2024


OQXX22
Complaint, Follow Up, Life Safety Code
02/12/2024


6HG212
Recertification, Follow Up, State Licensure
01/30/2024


OQXX21
Complaint, Life Safety Code
01/22/2024


6HG221
Recertification, Life Safety Code
01/17/2024


6HG211
Recertification, State Licensure
12/22/2023


USU022
Recertification, Follow Up, Life Safety Code
03/29/2023


USU012
Recertification, Complaint, Follow Up, State Licensure
03/27/2023


USU021
Recertification, Life Safety Code
03/06/2023


USU011
Complaint, Recertification, State Licensure
02/15/2023


 
 


Links and Resources

 
CMS nursing home compare page 
 
    In addition to the information provided on this 
    web site, the Centers for Medicare & Medicaid Services (CMS) has a web site 
    which contains information on every Medicare and Medicaid certified nursing 
    home in the country. The CMS nursing home survey results contain summary information 
    about a facility's noncompliance of regulations regarding the care of residents 
    found in the nursing homes. You can locate nursing homes in your area and find 
    information about compliance with federal regulations.
 
Resources and links to other organizations
 
Choosing a Nursing Home
 
Overview of the Survey Process
 
State Wide Grouping of all Scores
   
Overview of current comprehensive facility scores
   
Spreadsheet of current comprehensive facility names and scores
   
Legal Disclaimer for Long Term Care Reports.