Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

AMBASSADOR HEALTHCARE

NURSING HOME

SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED

Created on: 3/8/2024

Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION: Address: 705 E MAIN ST City: CENTERVILLE Telephone: (765) 855-3424 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 23-000456-1 License effective date: 7/1/2023 License expiration date: 6/30/2024
Administration and Staff
Administrator: JARED GLAUB Start date: 6/23/2023 Director of Nursing: DAWN ANNETTE IMEL Start date: 3/24/2023 Medical director: David DeSantis Start date: / / Wound care specialist: Start date: / / Infection preventionist: 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): GEORGE POGAS C ARCHIBALD HAWKINS JACK JONES JOHN BRAND KELLY L. P. BRAVERMAN BRETT BAYSTON ANDREA CASTETTER PREVIOUS OWNERSHIP CHANGES: Name of previous owner: AMBASSADOR HEALTHCARE LLC Date of last change of ownership: 7/1/2011
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): 137 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 137 RESIDENTIAL CARE BEDS: Total number of residential beds: 0 Total number of beds in facility: 137 CENSUS: Facility census: 97 As reported by the facility on: 8/2/2023 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 8/2/2023 Residential care beds occupied: 0 As reported by the facility on: 8/2/2023 Alzheimer Beds: 52 Alzheimer Beds Occupied: 43 As reported by the facility on: / / Ventilator Beds: 16 Ventilator Beds Occupied: 15 As reported by the facility on: / /
Sprinklers and Smoke Detectors
This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 94 Number of comprehensive care resident rooms with battery operated smoke detectors: 92 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 2 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 - BILL AMYX Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIRECTOR Date form completed - 3/14/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS: Nurse aide training and competency evaluation program (NATCEP) approved: 9/8/2016 Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2024 Nurse aide training and competency evaluation program (NATCEP) banned: Yes Nurse aide training and competency evaluation program (NATCEP) ban expires: 3/22/2013 CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: AMBASSADOR HEALTHCARE Approved: 9/8/2016 Terminated: N/A WHITEWATER CAREER CENTER Approved: 11/20/2014 Terminated: N/A NELLIS ADULT DAY CARE LLC Approved: 8/31/2015 Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  0
Facility Report Card
  3/1/2020 Current QTR 12/1/2019 Previous QTR 9/1/2019 Previous QTR 6/1/2019 Previous QTR
Report Card Score 89 203 203 218
Rank of Score 97 89 90 89
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 No Yes No
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
27J611 Complaint 11/9/2023
WE0X11 Complaint 9/14/2023
FLCV11 Complaint 6/8/2023
B1BP11 Complaint 4/17/2023
4UIX11 Complaint 3/15/2023
K8CB11 Complaint 3/2/2023
LNJT22 Follow Up, Life Safety Code, Recertification 1/17/2023
LNJT12 Recertification, Follow Up, State Licensure 12/20/2022
LNJT21 Recertification, Life Safety Code 12/13/2022
X4SM11 Complaint, Other 12/6/2022
LNJT11 Recertification, Complaint, State Licensure 11/21/2022
I96K11 Complaint 2/8/2022
XBMH11 Complaint 1/7/2022
04VY11 Other 10/29/2021
V5UN11 Other 9/23/2021
HPW311 Complaint, Other 8/17/2021
X17M11 Complaint 8/3/2021
M08B12 Complaint, Follow Up 4/16/2021
 
 
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.