Indiana State Department of Health


Division of Long Term Care

 

CONSUMER REPORT

 

MAJESTIC CARE OF GOSHEN

 

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: 2400 COLLEGE AVE
City: GOSHEN
Telephone: (574) 533-0351
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 25-000091-1
  License effective date: 02/01/2025
  License expiration date: 01/31/2026
 




Administration and Staff


Administrator: TIFFANY SHEPPERD
  Start date: 09/30/2024
 
Director of Nursing: JOETTA YODER
  Start date: 11/06/2024
 
Medical director: Dr. Lenora Hirschler
  Start date:   /  /  
 
Wound care specialist: Leslie Ogan
  Start date:   /  /  
 
Infection preventionist: Amy Manning
  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: LRC MANAGEMENT INC
Date of last change of ownership:  
 




Bed Counts and Census


COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    15
Number of Medicare/Medicaid beds (SNF/NF):        171
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     186
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            186
 
CENSUS:
Facility census:  125
As reported by the facility on: 07/01/2024
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/01/2024
 
Residential care beds occupied:  0
As reported by the facility on: 07/01/2024
 
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: 112
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 0
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 112
 
  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 - CALEY NIXON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 03/22/2023
 




Nurse Aide Training


NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 08/04/2022
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2024
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 04/01/2026
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     EMERGENCY MEDICAL SOLUTIONS, LLC
         Approved: 01/27/2009
         Terminated: 08/01/2009
     HEALTH CAREERS TRAINING & DEVELOPMENT
         Approved: 02/21/2019
         Terminated: 04/02/2024
     MAJESTIC CARE OF GOSHEN
         Approved: 07/26/2013
         Terminated: 02/16/2017
     IVY TECH COMMUNITY COLLEGE
         Approved: 11/23/2015
         Terminated: 04/02/2024
     PREMIER NURSING ACADEMY
         Approved: 07/06/2017
         Terminated: 08/04/2021
     EXCEL CNA AND QMA TRAINING CENTER
         Approved: 09/27/2020
         Terminated: 04/02/2024
     WAWASEE COMMUNITY SCHOOL CORPORATION
         Approved: 10/20/2020
         Terminated: 04/02/2024
     HOOSIER HEALTHCARE TRAINING CENTER, LLC
         Approved: 04/21/2021
         Terminated: 04/02/2024
     MAJESTIC CARE OF GOSHEN
         Approved: 08/04/2022
         Terminated: 04/02/2024
     LEGACY MEDICAL ACADEMY
         Approved: 02/06/2024
         Terminated: 04/02/2024
 




Complaints



NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  4


 




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
332
371
389
266




Rank of Score
57
41
36
79




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
No
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
     Discretionary Deny Pay for New Admits
     Date Imposed: 04/02/2024  Date Ended: 04/15/2024
     Civil Money Penalty
     Date Imposed: 03/02/2024  Date Ended: 03/02/2024
     Amount proposed per day: 
     Amount proposed per day: 
 
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


GBSQ11
Complaint
04/16/2025




H1T022
Follow Up, Life Safety Code, Recertification
04/10/2025




H1T021
Recertification, Life Safety Code
02/25/2025




H1T012
Recertification, Complaint, Follow Up, State Licensure
02/24/2025




H1T011
Recertification, Complaint, State Licensure
01/23/2025




3VJY11
Complaint
12/19/2024




NXXX12
Complaint, Follow Up
12/12/2024




NXXX11
Complaint
11/14/2024




YYG912
Complaint, Follow Up
10/07/2024




PLCW12
Complaint, Follow Up
09/13/2024




YYG911
Complaint
09/12/2024




27C512
Complaint, Follow Up
08/27/2024




PLCW11
Complaint
08/16/2024




27C511
Complaint
08/01/2024




6Y7Y22
Recertification, Follow Up, Life Safety Code
05/22/2024




6Y7Y12
Recertification, Complaint, Follow Up, State Licensure
04/16/2024




MUR611
Complaint
04/16/2024




6Y7Y21
Recertification, Life Safety Code
03/26/2024




6Y7Y11
Recertification, Complaint, State Licensure
03/02/2024




ZO0G12
Complaint, Follow Up
02/07/2024




ZO0G11
Complaint
01/04/2024




OOKB12
Complaint, Follow Up
12/13/2023




6KOR11
Complaint
11/13/2023




OOKB11
Complaint
10/23/2023




6YK411
Complaint
08/17/2023




3ILC12
Complaint, Follow Up
08/16/2023




3ILC11
Complaint
07/26/2023




IYMV12
Complaint, Follow Up
06/30/2023




CNFW12
Complaint, Follow Up
06/29/2023




CNFW11
Complaint
06/01/2023




IYMV11
Complaint
05/01/2023




WPUV23
Recertification, Follow Up, Life Safety Code
04/18/2023




WPUV22
Recertification, Follow Up, Life Safety Code
04/10/2023




WPUV12
Recertification, Complaint, Follow Up, State Licensure
03/28/2023




WPUV21
Recertification, Life Safety Code
02/01/2023




WPUV11
Recertification, Complaint, State Licensure
01/18/2023




D7IS12
Complaint, Follow Up
09/06/2022




D7IS11
Complaint
08/11/2022





 
 




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.