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: 601 N BOEKE RD
City: EVANSVILLE
Telephone: (812) 476-4912
Web Site:
NAME CHANGES:
Most recent name change: GOOD SAMARITAN HOME HEALTH CENTER AND RESIDENTIAL
Date of most recent name change: 07/19/2023 4:45:13 PM
LICENSE INFORMATION:
License number: 25-000439-1
License effective date: 07/01/2025
License expiration date: 06/30/2026
Administration and Staff
Administrator: TARA TREVINO
Start date: 07/01/2023
Director of Nursing: AMY GRANNAN
Start date: 01/07/2025
Medical director: David Schultz
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: PROFIT
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: GOOD SAMARITAN HOME 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): 32
Number of Medicare/Medicaid beds (SNF/NF): 168
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 200
RESIDENTIAL CARE BEDS:
Total number of residential beds: 28
Total number of beds in facility: 228
CENSUS:
Facility census: 134
As reported by the facility on: 01/02/2025
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/02/2025
Residential care beds occupied: 12
As reported by the facility on: 01/02/2025
Alzheimer Beds: 46
Alzheimer Beds Occupied: 40
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: 103
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: 103
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 - TARA TREVINO
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 04/07/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 04/27/2018
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2022
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 09/18/2023
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
IVY TECH COMMUNITY COLLEGE
Approved: 08/17/2010
Terminated: 04/23/2021
ENVIVE OF EVANSVILLE
Approved: 04/27/2018
Terminated: 04/23/2021
CYPRESS GROVE REHABILITATION CENTER
Approved: N/A
Terminated: 07/20/2007
VISITING NURSE PLUS
Approved: N/A
Terminated: 07/20/2007
EXTENDACARE TRAINING CENTER
Approved: N/A
Terminated: 07/20/2007
SOUTHWESTERN INDIANA HEALTH SERVICES ACADEMY
Approved: 02/23/2018
Terminated: 04/23/2021
IVY TECH COMMUNITY COLLEGE
Approved: 03/29/2022
Terminated: 04/23/2021
IVY TECH COMMUNITY COLLEGE
Approved: 06/28/2023
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
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
339
327
297
297
Rank of Score
55
60
73
72
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 gridView 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
No
Yes
No
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
Civil Money Penalty
Date Imposed: 05/14/2024 Date Ended: 05/14/2024
Amount proposed per day:
Civil Money Penalty
Date Imposed: 02/20/2024 Date Ended: 02/20/2024
Amount proposed per day: 7527
Civil Money Penalty
Date Imposed: 02/12/2024 Date Ended: 02/12/2024
Amount proposed per day: 7527
Civil Money Penalty
Date Imposed: 01/22/2024 Date Ended: 02/06/2024
Amount proposed per day: 7527
Amount proposed per day: 7527
Amount proposed per day: 7527
Civil Money Penalty
Date Imposed: 01/08/2024 Date Ended: 01/08/2024
Amount proposed per day: 7527
Civil Money Penalty
Date Imposed: 01/02/2024 Date Ended: 01/02/2024
Amount proposed per day: 6993
Civil Money Penalty
Date Imposed: 12/11/2023 Date Ended: 12/26/2023
Amount proposed per day: 5917
Amount proposed per day: 6455
Amount proposed per day: 6993
Civil Money Penalty
Date Imposed: 11/20/2023 Date Ended: 11/20/2023
Amount proposed per day: 5379
Civil Money Penalty
Date Imposed: 10/30/2023 Date Ended: 11/13/2023
Amount proposed per day: 3765
Amount proposed per day: 4303
Amount proposed per day: 4841
Civil Money Penalty
Date Imposed: 08/07/2023 Date Ended: 08/07/2023
Amount proposed per day: 3227
Civil Money Penalty
Date Imposed: 07/17/2023 Date Ended: 07/31/2023
Amount proposed per day: 1613
Amount proposed per day: 2151
Amount proposed per day: 2689
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.
