Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
ALEXANDRIA CARE CENTER
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 5/17/2024
 
Posted to the Web on: 5/29/2024
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 1912 S PARK AVE
City: ALEXANDRIA
Telephone: (765) 724-4478
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-000518-1
  License effective date: 11/1/2023
  License expiration date: 10/31/2024
 


Administration and Staff

Administrator: GLENN R BURKE
  Start date: 2/24/2023
 
Director of Nursing: SAMANTHA BARNES
  Start date: 2/17/2024
 
Medical director: STEVEN DELEE
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist: Constance Mock
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: BOARD OF TRUSTEES OF THE FLAVIUS J WITHAM MEMORIAL
2605 NORTH LEBANON STREET
LEBANON IN 46052
 
Ownership type:  OTHER
 
Officer(s): GEORGE POGAS
            C ARCHIBALD HAWKINS
            JACK JONES
            JOHN BRAND
            KELLY L. P. BRAVERMAN
            BRETT BAYSTON
            ANDREA CASTETTER
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: HOOSIER ENTERPRISES X LLC
Date of last change of ownership: 11/1/2012
 


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):        70
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     70
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            70
 
CENSUS:
Facility census:  38
As reported by the facility on: 1/2/2024 1
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/2/2024 1
 
Residential care beds occupied:  0
As reported by the facility on: 1/2/2024 1
 
Alzheimer Beds:  20
Alzheimer Beds Occupied:  15
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: 35
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 35
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - GLENN BURICE
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 4/3/2023
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 4/7/2016
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2020
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 8/16/2023
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     TOMORROWS ANGELS
         Approved: 11/10/2005
         Terminated: 11/19/2019
     JOHN H HINDS CAREER CENTER
         Approved: 8/16/2006
         Terminated: 11/19/2019
     ALEXANDRIA CARE CENTER
         Approved: 4/7/2016
         Terminated: 8/17/2021
     CARDINAL CARE STRATEGIES
         Approved: 4/26/2021
         Terminated: 11/18/2021
     CERTIFIED HEALTHCARE TRAINING
         Approved: 1/9/2019
         Terminated: 11/19/2019
     ENVIVE OF ANDERSON
         Approved: 5/11/2021
         Terminated: 11/18/2021
     ENVIVE OF HARTFORD CITY
         Approved: 6/4/2019
         Terminated: 8/17/2021
     ENVIVE OF HARTFORD CITY
         Approved: 7/22/2021
         Terminated: 8/17/2021
     TWIN CITY HEALTH CARE
         Approved: 8/30/2021
         Terminated: 8/17/2021
     TWIN CITY HEALTH CARE
         Approved: 8/30/2021
         Terminated: 8/17/2021
     PERSIMMON RIDGE REHABILITATION CENTRE
         Approved: 10/13/2021
         Terminated: 8/17/2021
     PERSIMMON RIDGE REHABILITATION CENTRE
         Approved: 10/13/2021
         Terminated: 8/17/2021
 


Complaints

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

 


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
273
321
315
312


Rank of Score
78
63
66
66


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
     Directed Plan of Correction
     Date Imposed: 2/10/2022  Date Ended: 1/26/2022
     Civil Money Penalty
     Date Imposed: 1/13/2022  Date Ended: 1/13/2022
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 9/30/2021  Date Ended: 9/30/2021
     Civil Money Penalty
     Date Imposed: 9/3/2021  Date Ended: 9/3/2021
     Amount proposed per day: 
     Amount proposed per day: 5000
 
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

X7TH11
Complaint
12/18/2023


USVV22
Recertification, Follow Up, Life Safety Code
12/1/2023


USVV12
Recertification, Follow Up, State Licensure
10/31/2023


USVV21
Recertification, Life Safety Code
10/24/2023


USVV11
Recertification, State Licensure
10/3/2023


GLWB22
Follow Up, Life Safety Code, Other
8/28/2023


GLWB21
Life Safety Code, Other
7/21/2023


TU5711
Complaint
3/10/2023


2VCM22
Recertification, Follow Up, Life Safety Code
11/15/2022


2VCM21
Recertification, Life Safety Code
9/21/2022


S5QG12
Complaint, Follow Up
9/7/2022


2VCM12
Recertification, Follow Up, State Licensure
9/6/2022


S5QG11
Complaint
8/19/2022


2VCM11
Recertification, State Licensure
8/12/2022


C7RP11
Complaint
7/13/2022


YENI11
Complaint
3/31/2022


O69P12
Follow Up, Other
3/14/2022


O69P11
Other
1/13/2022


2WF211
Other
11/15/2021


E7WX22
Recertification, Follow Up, Life Safety Code
11/3/2021


BIJ512
Complaint, Follow Up
10/14/2021


E7WX12
Recertification, Follow Up, State Licensure
10/14/2021


BIJ511
Complaint
9/23/2021


E7WX21
Recertification, Life Safety Code
9/17/2021


E7WX11
Recertification, State Licensure
9/3/2021


 
 


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.