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: 1108 KINGWOOD DRIVE
City: AVON
Telephone: (317) 271-7052
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-012901-1
License effective date: 12/01/2024
License expiration date: 11/30/2025
Administration and Staff
Administrator: JESSICA WILSON
Start date: 12/20/2024
Director of Nursing: LISA GUSTUS
Start date: 06/19/2025
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist: Brandon Hunt
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): C ARCHIBALD HAWKINS
JOHN BRAND
KELLY L. P. BRAVERMAN
BRETT BAYSTON
ANDREA CASTETTER
MICHAEL JASON HORNBECKER
DANIEL SELLERS
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: DAVIESS COUNTY HOSPITAL
Date of last change of ownership: 12/01/2021
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 17
Number of Medicare/Medicaid beds (SNF/NF): 100
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 117
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 117
CENSUS:
Facility census: 84
As reported by the facility on: 07/16/2025
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/16/2025
Residential care beds occupied: 0
As reported by the facility on: 07/16/2025
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: 64
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: 64
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 - JEFF JARUIS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DIRECTOR OF MAINTENA
Date form completed - 03/17/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 09/19/2022
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2026
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 12/30/2026
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
AREA 31 CAREER CENTER
Approved: 12/06/2021
Terminated: 12/31/2024
ENVIVE OF INDIANAPOLIS
Approved: 04/12/2018
Terminated: 08/05/2019
GRAND VALLEY HEALTH & REHAB
Approved: 09/16/2021
Terminated: 12/31/2024
TIDINGS NURSE AIDE TRAINING INSTITUTE
Approved: 05/08/2017
Terminated: 08/05/2019
INDIANA NURSING ACADEMY LLC
Approved: 07/08/2022
Terminated: 12/31/2024
BROOKE KNOLL VILLAGE
Approved: 09/19/2022
Terminated: 12/31/2024
KEYSTONE NURSING ACADEMY INC
Approved: 02/23/2023
Terminated: 12/31/2024
HOPE TRAINING CENTER
Approved: 11/05/2021
Terminated: 12/31/2024
FAITH HEALTHCARE TRAINING CENTER
Approved: 09/23/2021
Terminated: 12/31/2024
WARMING HEARTS INSTITUTE, INC
Approved: 06/02/2025
Terminated: N/A
GRAND VALLEY HEALTH & REHAB
Approved: 06/05/2025
Terminated: N/A
KEYSTONE NURSING ACADEMY INC
Approved: 06/05/2025
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
434
416
426
438
Rank of Score
13
19
15
11
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
Yes
Substandard Quality of Care
No
No
No
Administrator Change
Yes
No
Yes
Owner Change
No
No
Yes
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: 11/05/2022 Date Ended: 10/07/2022
Civil Money Penalty
Date Imposed: 10/06/2022 Date Ended: 10/06/2022
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.
