Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

ALPHA HOME - A WATERS COMMUNITY

NURSING HOME

SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED

Created on: 7/29/2022

Posted to the Web on: 8/10/2022
Basic Information
FACILITY CONTACT INFORMATION: Address: 2640 COLD SPRING RD City: INDIANAPOLIS Telephone: (317) 923-1518 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 21-000376-1 License effective date: 10/1/2021 License expiration date: 9/30/2022
Administration and Staff
Administrator: TWYLA SHAW Start date: 6/28/2021 Director of Nursing: PATRICIA HUBBARD Start date: 5/1/2021 Medical director: Start date: / / Wound care specialist: Start date: / / Infection preventionist: Start date: / /
Ownership
CURENT OWNERSHIP: Owning corporation: HENRY COUNTY MEMORIAL HOSPITAL 798 NORTH 16TH ST NEW CASTLE IN 47362 Ownership type: NON-PROFIT Officer(s): STEVEN VAN CAMP JOHN PIDGEON SHELDON DYNES PAUL JANSSEN BENJAMIN FRENCH DEBI WARE BUD SHORE DARIN BROWN BRIANNA CHAPMAN SCOTT KOONTZ KYLE SIEWERT DUKE HAMM JANA LUELLEN TODD MYERS BRENDA WILKINSON NATHAN RICH DEBBIE MARGISON JOSH ESTELLE WYLIE MCGLOTHLIN JOEL HARVEY DAVE WEIMER VANESSA TUCKER PREVIOUS OWNERSHIP CHANGES: Name of previous owner: DEARBORN COUNTY HOSPITAL Date of last change of ownership: 10/1/2020
Bed Counts and Census
COMPREHENSIVE CARE BEDS: Number of Medicaid beds (NF): 0 Number of Medicare beds (SNF): 0 Number of Medicare/Medicaid beds (SNF/NF): 86 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 86 RESIDENTIAL CARE BEDS: Total number of residential beds: 0 Total number of beds in facility: 86 CENSUS: Facility census: 58 As reported by the facility on: 12/31/2019 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 12/31/2019 Residential care beds occupied: 0 As reported by the facility on: 12/31/2019 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: 37 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: 37 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 - JOHN D FAULKNER Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIR Date form completed - 3/12/2021
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS: Nurse aide training and competency evaluation program (NATCEP) approved: Nurse aide training and competency evaluation program (NATCEP) expires: Nurse aide training and competency evaluation program (NATCEP) banned: Yes Nurse aide training and competency evaluation program (NATCEP) ban expires: 4/12/2024 CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: IVY TECH COMMUNITY COLLEGE Approved: 6/14/2000 Terminated: 8/20/2008 AMBASSADOR COMMUNITY COLLEGE Approved: N/A Terminated: 12/2/2005 PRIMEWAY INSTITUTE Approved: 6/23/2011 Terminated: 7/13/2012 AMBASSADOR COMMUNITY COLLEGE Approved: N/A Terminated: 12/2/2005
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  3
  Previous year:  10
  2 years previous:  5
Facility Report Card
  3/1/2020 Current QTR 12/1/2019 Previous QTR 9/1/2019 Previous QTR 6/1/2019 Previous QTR
Report Card Score 159 183 213 216
Rank of Score 94 91 88 89
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 Yes No No
Substandard Quality of Care Yes No No
Administrator Change Yes Yes Yes
Owner Change Yes 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 Directed Plan of Correction Date Imposed: 5/14/2022 Date Ended: Still in effect Directed Plan of Correction Date Imposed: 2/10/2022 Date Ended: 2/1/2022 Directed Plan of Correction Date Imposed: 1/18/2022 Date Ended: 2/1/2022 Civil Money Penalty Date Imposed: 12/16/2021 Date Ended: 1/12/2022 Amount proposed per day: Amount proposed per day: Directed Plan of Correction Date Imposed: 10/27/2021 Date Ended: 10/27/2021 Civil Money Penalty Date Imposed: 9/28/2021 Date Ended: 9/28/2021 Amount proposed per day: Directed Plan of Correction Date Imposed: 7/9/2021 Date Ended: 7/7/2021 Civil Money Penalty Date Imposed: 5/5/2021 Date Ended: 7/6/2021 Amount proposed per day: Amount proposed per day: 435 Amount proposed per day: 6920 Civil Money Penalty Date Imposed: 4/5/2021 Date Ended: 4/5/2021 Amount proposed per day: 1500 Directed Plan of Correction Date Imposed: 10/16/2020 Date Ended: 10/9/2020 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
V9S722 Follow Up, Life Safety Code, Recertification 7/11/2022
UOX612 Complaint, Follow Up, Other 6/7/2022
V9S712 Recertification, Complaint, Follow Up, State Licensure 6/7/2022
XKY611 Complaint 5/26/2022
V9S721 Recertification, Life Safety Code 5/12/2022
V9S711 Recertification, Complaint, State Licensure 4/13/2022
UOX611 Complaint, Other 3/2/2022
YB3K12 Complaint, Follow Up, Other 2/9/2022
BIOG12 Complaint, Follow Up, Other 2/9/2022
XWL711 Complaint 2/9/2022
NNHV11 Complaint, Other 1/24/2022
BIOG11 Complaint, Other 1/12/2022
YB3K11 Complaint, Other 12/16/2021
9XEH12 Complaint, Follow Up 11/12/2021
1B5G11 Other 10/28/2021
9XEH11 Complaint, Other 9/28/2021
Z8WB11 Complaint 9/1/2021
OHLX12 Complaint, Follow Up, Other 7/23/2021
ECJM12 Complaint, Follow Up 7/23/2021
OHLX11 Complaint, Other 6/12/2021
ECJM11 Complaint 4/23/2021
Q3U611 Other 12/18/2020
GIO012 Complaint, Follow Up, Other 11/19/2020
YQ5811 Other 10/22/2020
GIO011 Complaint, Other 9/17/2020
JTR012 Complaint, Follow Up 8/6/2020
C9J511 Other 8/3/2020
DQ2C12 Complaint, Follow Up 6/26/2020
JTR011 Complaint, Other 6/1/2020
DQ2C11 Complaint 2/27/2020
330Y22 Recertification, Follow Up, Life Safety Code 1/15/2020
02KJ12 Complaint, Follow Up 12/23/2019
330Y21 Recertification, Life Safety Code 12/16/2019
330Y12 Recertification, Follow Up, State Licensure 11/12/2019
02KJ11 Complaint 10/8/2019
330Y11 Recertification, Complaint, State Licensure 9/18/2019
C02G12 Complaint, Follow Up 9/6/2019
C02G11 Complaint 8/2/2019
KGR912 Complaint, Follow Up 7/30/2019
 
 
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.