Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
KINGSTON CARE CENTER OF FORT WAYNE
 
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: 1010 W WASHINGTON CENTER RD
City: FORT WAYNE
Telephone: (260) 489-2552
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 24-000522-1
  License effective date: 10/01/2024
  License expiration date: 09/30/2025
 


Administration and Staff

Administrator: ALICIA HOLIFIELD
  Start date: 05/08/2023
 
Director of Nursing: PAMELA GRABBE
  Start date: 11/07/2023
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: PULASKI MEMORIAL HOSPITAL
616 E 13TH STREET
WINAMAC IN 46996
 
Ownership type:  
 
Officer(s): MICHAEL MCKAY
            LINDA WEBB
            CHARLES HUTTON
            GREGG MALOTT
            CLINT KAUFFMAN
            STEVE JAROSINSKI
            ADAM BENNETT
            JENNIFER SMITH
            TAYLOR WHITE
            JENNIFER MELLON
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: KINGSTON CARE CENTER OF FORT WAYNE LLC
Date of last change of ownership: 10/01/2015
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    54
Number of Medicare/Medicaid beds (SNF/NF):        83
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     137
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            137
 
CENSUS:
Facility census:  107
As reported by the facility on: 01/07/2025
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/07/2025
 
Residential care beds occupied:  0
As reported by the facility on: 01/07/2025
 
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: 89
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: 89
 
  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 - ALICIA HOLIFIELD
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 04/03/2025
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 08/29/2016
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2018
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 02/08/2025
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     IVY TECH COMMUNITY COLLEGE
         Approved: 03/10/2004
         Terminated: 02/09/2023
     QUALITY CARE TRAINING
         Approved: 07/12/2002
         Terminated: 09/29/2009
     MANNIA GREEN HEALTHCARE ADVANTAGE, INC
         Approved: 06/05/2001
         Terminated: 03/12/2003
     SAPONI HEALTH STAFFING
         Approved: 06/14/2001
         Terminated: 02/09/2023
     KINGSTON CARE CENTER OF FORT WAYNE
         Approved: 08/29/2016
         Terminated: 02/09/2023
     
         Approved: N/A
         Terminated: 02/09/2023
     QUALITY TRAINING OF FORT WAYNE INC
         Approved: 12/18/2012
         Terminated: 02/09/2023
     FORT WAYNE COMMUNITY SCHOOLS NEIGHBORHOOD CONNECTI
         Approved: 09/14/2010
         Terminated: 02/09/2023
     FWCS CAREER ACADEMY AT ANTHIS
         Approved: 02/17/1998
         Terminated: 02/09/2023
     
         Approved: N/A
         Terminated: 02/09/2023
     UNIVERSITY OF SAINT FRANCIS
         Approved: N/A
         Terminated: 02/09/2023
     UNIVERSITY OF SAINT FRANCIS
         Approved: 12/04/1997
         Terminated: 02/09/2023
     NURSES ETC STAFFING
         Approved: 02/23/2016
         Terminated: 02/09/2023
     PREMIER NURSING ACADEMY
         Approved: 04/19/2017
         Terminated: 08/04/2021
     LEGACY MEDICAL ACADEMY
         Approved: 11/17/2020
         Terminated: 02/09/2023
     COTTON CARE LLC
         Approved: 05/17/2021
         Terminated: 02/09/2023
     ESSENTIAL HEALTHCARE ACADEMY, LLC
         Approved: 09/09/2022
         Terminated: 02/09/2023
     CERTIFIED HEALTHCARE TRAINING
         Approved: 02/07/2023
         Terminated: 02/09/2023
     LEGACY MEDICAL ACADEMY
         Approved: 07/21/2022
         Terminated: 02/09/2023
 


Complaints

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

 


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
423
423
392
392


Rank of Score
18
15
34
34


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
No
Yes
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
     Civil Money Penalty
     Date Imposed: 02/09/2023  Date Ended: 02/09/2023
     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

DWK312
Recertification, Complaint, Follow Up, State Licensure
07/08/2025


OBOX12
Complaint, Follow Up
06/10/2025


OBOX11
Complaint
05/15/2025


D60F12
Complaint, Follow Up
03/25/2025


D60F11
Complaint
03/14/2025


MRPZ11
Complaint
02/10/2025


EJX411
Complaint
01/31/2025


ISWB11
Complaint
12/03/2024


ND7012
Complaint, Follow Up
11/06/2024


ND7011
Complaint
10/21/2024


MQY922
Recertification, Follow Up, Life Safety Code
10/10/2024


MQY912
Recertification, Follow Up, State Licensure
09/09/2024


MQY921
Recertification, Life Safety Code
09/05/2024


MQY911
Recertification, State Licensure
08/26/2024


PE8K11
Complaint
06/03/2024


WLUW11
Complaint
05/15/2024


SS6H12
Complaint, Follow Up
05/02/2024


SS6H11
Complaint
04/16/2024


RHSJ11
Complaint
02/28/2024


W66N12
Complaint, Follow Up
01/19/2024


BRVG11
Complaint
01/11/2024


W66N11
Complaint
12/22/2023


7CD622
Recertification, Follow Up, Life Safety Code
10/19/2023


27Y611
Complaint
10/12/2023


7CD612
Recertification, Follow Up, State Licensure
08/29/2023


1L7R21
Life Safety Code, Other
08/21/2023


7CD621
Recertification, Life Safety Code
08/21/2023


7CD611
Recertification, Complaint, State Licensure
08/08/2023


7Z2K12
Complaint, Follow Up
06/14/2023


7Z2K11
Complaint
05/30/2023


SD9E11
Complaint
04/28/2023


1PSH11
Complaint
03/21/2023


RRRO12
Complaint, Follow Up
02/28/2023


RRRO11
Complaint
02/09/2023


6WYV11
Complaint
01/19/2023


KU7I11
Complaint, Other
12/28/2022


LSYX12
Complaint, Follow Up
12/05/2022


6YLH22
Recertification, Follow Up, Life Safety Code
11/22/2022


LSYX11
Complaint
11/15/2022


6YLH21
Recertification, Life Safety Code
10/11/2022


6YLH12
Recertification, Follow Up, State Licensure
10/05/2022


TENJ11
Complaint
09/23/2022


6YLH11
Recertification, Complaint, State Licensure
09/02/2022


 
 


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.