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: 502 W JACKSON ST
City: MULBERRY
Telephone: (765) 296-2911
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 25-000470-1
License effective date: 01/01/2025
License expiration date: 12/31/2025
Administration and Staff
Administrator: HEIDI WALLAR
Start date: 04/01/2023
Director of Nursing: ASHTYN KOCH
Start date: 05/26/2022
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: OTHER
Officer(s): JOHN PIDGEON
SHELDON DYNES
DEBI WARE
BUD SHORE
BRIAN RING
MARK DICE
DAVID BARR
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: MULBERRY HEALTH & RETIREMENT COMMUNITY INC
Date of last change of ownership: 01/01/2013
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 33
Number of Medicare/Medicaid beds (SNF/NF): 126
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 159
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 159
CENSUS:
Facility census: 138
As reported by the facility on: 01/02/2020
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/02/2020
Residential care beds occupied: 5
As reported by the facility on: 01/02/2020
Alzheimer Beds: 34
Alzheimer Beds Occupied: 27
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: 88
Number of comprehensive care resident rooms with battery
operated smoke detectors: 59
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 27
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 - MATT MYERS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIRECTOR
Date form completed - 04/08/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 10/12/2005
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2027
Nurse aide training and competency evaluation program (NATCEP) banned: No
Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
MULBERRY HEALTH & REHABILITATION CENTER
Approved: 10/12/2005
Terminated: N/A
WESLEY MANOR HEALTH CENTER
Approved: 07/24/2013
Terminated: N/A
TIPPECANOE SCHOOL CORPORATION
Approved: 08/04/2005
Terminated: N/A
DELPHI COMMUNITY HIGH SCHOOL
Approved: 02/22/2012
Terminated: N/A
MED ED INCORPORATED
Approved: 03/06/2012
Terminated: 02/24/2020
LIGHTSTONE EDUCATION CENTER
Approved: 02/19/2018
Terminated: N/A
WILDCAT CREEK CAREER CORPORATION
Approved: 12/04/2020
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
389
398
389
389
Rank of Score
33
28
36
36
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
Yes
No
No
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
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.
