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: 3150 ST CHARLES ST
City: JASPER
Telephone: (812) 634-6570
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-002628-1
License effective date: 11/01/2024
License expiration date: 10/31/2025
Administration and Staff
Administrator: JON HOWARD
Start date: 09/29/2019
Director of Nursing: ALLISON BRAUN
Start date: 08/26/2019
Medical director: Ryan Flamion
Start date: / /
Wound care specialist: Toni Clifton
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: GOOD SAMARITAN HOSPITAL
520 S SEVENTH STREET
VINCENNES IN 47561
Ownership type: OTHER
Officer(s): ROBERT MCLIN
MARY CAY MARTIN
ADAM THACKER
MATT SCHUCKMAN
JAMES ZEIGLER
TRENT HINKLE
SUSAN BROCKSMITH
KELLIE STREETER
RACHEL SPALDING
STAN DEWEESE
T.J. BRINK
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: TRILOGY HEALTH SERVICES LLC
Date of last change of ownership:
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 28
Number of Medicare/Medicaid beds (SNF/NF): 40
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 68
RESIDENTIAL CARE BEDS:
Total number of residential beds: 40
Total number of beds in facility: 108
CENSUS:
Facility census: 85
As reported by the facility on: 07/17/2025
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/17/2025
Residential care beds occupied: 34
As reported by the facility on: 07/17/2025
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: 36
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: 36
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 - JON HOWARD
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 04/08/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 03/21/2014
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2016
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 07/31/2020
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
ST CHARLES HEALTH CAMPUS
Approved: 03/21/2014
Terminated: 08/01/2018
AMBER MANOR CARE CENTER
Approved: 08/08/2017
Terminated: 08/01/2018
IVY TECH COMMUNITY COLLEGE
Approved: 09/19/2017
Terminated: 08/01/2018
IVY TECH COMMUNITY COLLEGE
Approved: 10/27/2020
Terminated: N/A
AMBER MANOR CARE CENTER
Approved: 09/22/2022
Terminated: N/A
CNA TRAINING PROGRAM PATOKA VALLEY CTE COOPERATIVE
Approved: 08/22/2022
Terminated: N/A
VINCENNES UNIVERSITY-NURSING DEPARTMENT
Approved: 01/09/2023
Terminated: N/A
LEFFLER ACADEMY
Approved: 07/26/2022
Terminated: N/A
VINCENNES UNIVERSITY JASPER CAMPUS
Approved: 08/30/2024
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
420
420
414
429
Rank of Score
20
17
22
14
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
No
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.
