Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

COUNTRYSIDE MEADOWS

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: 762 N DAN JONES RD City: AVON Telephone: (317) 495-7200 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 24-012534-1 License effective date: 08/01/2024 License expiration date: 07/31/2025
Administration and Staff
Administrator: KARSEN RAUCH Start date: 06/03/2024 Director of Nursing: TIFFANY ELLIOTT Start date: 03/02/2022 Medical director: Luke Nelligan Start date: / / Wound care specialist: Start date: / / Infection preventionist: Cheryl Sigman Start date: / /
Ownership
CURENT OWNERSHIP: Owning corporation: HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY 3838 N RURAL ST INDIANAPOLIS IN 46205 Ownership type: OTHER Officer(s): GREGORY FEHRIBACH CHARLES EBERHARDT II CARL DRUMMER SHELIA GUENIN TED NOLTING PAUL BABCOCK ROBERT LAZARD GEETA MANTRAVADI MONICA CRAIN BEVERLY MUKES-GAITHER THOMAS HANIFY LISA HARRIS DAVID CRABB ROBERTY LAZARD BRENDA HORN PREVIOUS OWNERSHIP CHANGES: Name of previous owner: COUNTRYSIDE MEADOWS LLC Date of last change of ownership: 08/01/2012
Bed Counts and Census
COMPREHENSIVE CARE BEDS: Number of Medicaid beds (NF): 0 Number of Medicare beds (SNF): 24 Number of Medicare/Medicaid beds (SNF/NF): 147 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 171 RESIDENTIAL CARE BEDS: Total number of residential beds: 0 Total number of beds in facility: 171 CENSUS: Facility census: 103 As reported by the facility on: 01/11/2022 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 01/11/2022 Residential care beds occupied: 0 As reported by the facility on: 01/11/2022 Alzheimer Beds: 40 Alzheimer Beds Occupied: 36 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 - KARSEN RAUCH Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR Date form completed - 06/09/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS: Nurse aide training and competency evaluation program (NATCEP) approved: Nurse aide training and competency evaluation program (NATCEP) expires: Nurse aide training and competency evaluation program (NATCEP) banned: Yes Nurse aide training and competency evaluation program (NATCEP) ban expires: 02/17/2023 CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: HEALTH EDUCATION SERVICES OF INDIANA Approved: 07/22/2015 Terminated: 04/01/2017 AREA 31 CAREER CENTER Approved: 02/05/2013 Terminated: 04/29/2019 VINCENNES UNIVERSITY JASPER CAMPUS Approved: 02/25/2013 Terminated: 04/29/2019 ZIONSVILLE MEADOWS Approved: 06/20/2018 Terminated: 04/29/2019 MEADOW LAKES Approved: 06/20/2018 Terminated: 04/29/2019 ASC TRAINING CENTER Approved: 11/18/2020 Terminated: 02/18/2021 LEFFLER ACADEMY Approved: 05/10/2021 Terminated: 02/18/2021 ASC TRAINING CENTER Approved: 06/14/2021 Terminated: 02/18/2021 DIAMOND MEDICAL TRAINING CENTER Approved: 09/27/2023 Terminated: N/A AREA 31 CAREER CENTER Approved: 12/22/2023 Terminated: N/A ASC TRAINING CENTER Approved: 02/24/2023 Terminated: N/A CARDINAL RITTER HIGH SCHOOL Approved: 08/05/2024 Terminated: N/A INDY INSTITUTE Approved: 05/21/2024 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 425 413 419 443
Rank of Score 17 19 18 8
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 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
Y48T11 Complaint 05/21/2025
SCO611 Complaint 01/30/2025
O26X22 Recertification, Follow Up, Life Safety Code 12/20/2024
YLSR11 Complaint 12/12/2024
O26X12 Recertification, Follow Up, State Licensure 11/13/2024
O26X21 Recertification, Life Safety Code 10/30/2024
O26X11 Recertification, State Licensure 10/07/2024
E8S211 Complaint 09/24/2024
F7T712 Complaint, Follow Up 08/27/2024
U5TO12 Complaint, Follow Up 08/20/2024
F7T711 Complaint 08/01/2024
U5TO11 Complaint 06/18/2024
VD8V12 Complaint, Follow Up 03/25/2024
VD8V11 Complaint 01/19/2024
IHEM12 Recertification, Complaint, Follow Up, State Licensure 11/14/2023
IHEM22 Follow Up, Life Safety Code, Recertification 11/02/2023
IHEM21 Recertification, Life Safety Code 09/11/2023
IHEM11 Recertification, Complaint, State Licensure 08/31/2023
YP2V12 Complaint, Follow Up 07/26/2023
DO8012 Complaint, Follow Up 07/26/2023
DO8011 Complaint 06/19/2023
YP2V11 Complaint 05/25/2023
VQNO11 Complaint 04/05/2023
5WWQ11 Complaint 01/24/2023
UQ9R12 Complaint, Follow Up 12/02/2022
UQ9R11 Complaint 09/26/2022
FYNK11 Complaint 08/23/2022
I28U12 Complaint, Follow Up 08/19/2022
U6QG22 Recertification, Follow Up, Life Safety Code 08/10/2022
 
 
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.