Created on: 07/25/2025
Posted to the Web on: 08/06/2025
Basic Information
FACILITY CONTACT INFORMATION:
Address: 1205 N 14TH ST
City: LAFAYETTE
Telephone: (765) 423-4861
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 25-000535-1
License effective date: 01/01/2025
License expiration date: 12/31/2025
Administration and Staff
Administrator: DYLAN JOHNSON
Start date: 10/24/2022
Director of Nursing: NICOLE HARDY
Start date: 08/10/2017
Medical director:
Start date: / /
Wound care specialist: Garry Gumasung
Start date: / /
Infection preventionist: demitria Beach
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: MAJOR HOSPITAL
2451 INTELLPLEX DR
SHELBYVILLE IN 46176
Ownership type: OTHER
Officer(s): DANA CALDWELL
JEFF BEATY
JOHN COFFIN
JAN SANDMAN
SHERRI TANDY
PAULA GUSTAFSON
GENE JONES
RALPH MERCURI
LINDA WESSIC
ROB KINDER
RYAN CLAXTON
MELANIE STEVENS
PHILP MATTHEW HAEHL
ALEXANDER ISAKOVAN
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: SAINT ANTHONY HEALTHCARE INC
Date of last change of ownership: 01/08/2014
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): 120
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 120
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 120
CENSUS:
Facility census: 84
As reported by the facility on: 01/15/2025
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/15/2025
Residential care beds occupied: 0
As reported by the facility on: 01/15/2025
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: 60
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: 60
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 - DYLAN JOHNSON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 04/02/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 03/23/2006
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2008
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:
MED ED INCORPORATED
Approved: 03/06/2012
Terminated: 02/24/2020
LIGHTSTONE EDUCATION CENTER
Approved: 08/14/2019
Terminated: N/A
GREATER LAFAYETTE CAREER ACADEMY
Approved: 12/17/2021
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
411
411
390
390
Rank of Score
24
21
35
35
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
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
Yes
Yes
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.
