Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
SERENITY SPRING SENIOR LIVING AT JASONVILLE
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 07/25/2025
 
Posted to the Web on: 08/06/2025
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 800 E OHIO ST
City: JASONVILLE
Telephone: (812) 665-2226
Web Site:  
 
NAME CHANGES:
Most recent name change: GOOD SAMARITAN SOCIETY SHAKAMAK RETIREMENT COMM
Date of most recent name change: 05/09/2024 11:57:35 AM
 
LICENSE INFORMATION:
  License number: 24-000200-1
  License effective date: 11/01/2024
  License expiration date: 10/31/2025
 


Administration and Staff

Administrator: DEBORAH DAVIS
  Start date: 10/11/2021
 
Director of Nursing: SHEA GRIFFITH
  Start date: 06/04/2025
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: GREENE COUNTY GENERAL HOSPITAL
1185 N 1000 W
LINTON IN 47441
 
Ownership type:  OTHER
 
Officer(s): BRENDA REETZ
            RICK GRAVES
            NATHAN ABRAMS
            ED MICHAEL
            PETER POWERS
            MICHAEL CRANE
            TIMOTHY R WARRICK
            HARRY BEDWELL
            JIMMY FULLER
            MICHAEL GAMBLE
            CHERYL HAMILTON
            NANCY HUDSON
            REBECCA WITTMER
            LEVI BAYSINGER
            MATTHEW UBELHOR
            AMY GUM
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Date of last change of ownership: 11/01/2014
 


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):        60
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     60
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            60
 
CENSUS:
Facility census:  43
As reported by the facility on: 07/20/2020
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/20/2020
 
Residential care beds occupied:  0
As reported by the facility on: 07/20/2020
 
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: 43
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: 43
 
  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 - DEBORAH E DAVIS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. LHFA
Date form completed - 04/08/2025
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 12/09/2003
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2005
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 01/27/2024
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     TWIN RIVERS AREA MEDICAL CAREERS
         Approved: 07/10/1998
         Terminated: 10/05/2005
     SERENITY SPRING SENIOR LIVING AT JASONVILLE
         Approved: 06/03/2003
         Terminated: 08/12/2005
 


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
428
458
446
446


Rank of Score
15
5
7
7


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
Yes


 Substandard Quality of Care 
No
No
Yes


Administrator Change
No
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

Event ID: 1S8O11
  Action - Citation / Fine
  Notice to facility: 01/24/2023
             Appeal: N/A
  Action Cease/Recind: 02/06/2023
         Case Closed: 02/06/2023
  Initial Amount: $250
 
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

7J7S11
Complaint
04/29/2025


SZCV22
Recertification, Follow Up, Life Safety Code
04/15/2025


SZCV12
Recertification, Follow Up, State Licensure
03/04/2025


SZCV21
Recertification, Life Safety Code
02/18/2025


SZCV11
Recertification, State Licensure
02/10/2025


U1KL22
Recertification, Follow Up, Life Safety Code
02/20/2024


U1KL12
Recertification, Follow Up, State Licensure
02/09/2024


U1KL21
Recertification, Life Safety Code
01/31/2024


U1KL11
Recertification, State Licensure
01/16/2024


YBM711
Complaint
09/06/2023


PHXD11
Complaint
02/21/2023


R6UC22
Recertification, Follow Up, Life Safety Code
01/25/2023


R6UC12
Recertification, Follow Up, State Licensure
12/20/2022


R6UC21
Recertification, Life Safety Code
12/19/2022


1S8O11
State Licensure, Other
12/13/2022


R6UC11
Recertification, State Licensure
11/18/2022


 
 


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.