Created on: 07/25/2025
Posted to the Web on: 08/06/2025
Basic Information
FACILITY CONTACT INFORMATION:
Address: 4915 CHARLESTOWN RD
City: NEW ALBANY
Telephone: (812) 945-5221
Web Site:
NAME CHANGES:
Most recent name change: DIVERSICARE OF PROVIDENCE
Date of most recent name change: 02/06/2023 11:55:57 AM
LICENSE INFORMATION:
License number: 24-001144-1
License effective date: 08/01/2024
License expiration date: 07/31/2025
Administration and Staff
Administrator: JESSE RAY
Start date: 02/06/2020
Director of Nursing: ANNA MARIE VOGT
Start date: 05/07/2025
Medical director: Waqar Saleem
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: DAVIESS COUNTY HOSPITAL
1314 E WALNUT ST
WASHINGTON IN 47501
Ownership type: OTHER
Officer(s): DERON STEINER
TYSON WAGLER
NATHAN GABHART
KENT NORRIS
TONY DUNCHEON
ANTHONY SHOWALTER
APRIL SETTLES
DANA MUNTZ
OTTO SUSEC
KRISTIN MILES
JENNA BEDWELL
DAVE GRABER
PETE PARSONS
TRACY COOK
MICHAEL KEITH
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
Date of last change of ownership: 08/01/2016
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): 158
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 158
RESIDENTIAL CARE BEDS:
Total number of residential beds: 14
Total number of beds in facility: 172
CENSUS:
Facility census: 130
As reported by the facility on: 07/18/2024
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 07/18/2024
Residential care beds occupied: 7
As reported by the facility on: 07/18/2024
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: 158
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: 114
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 - JESSE RAY
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 06/09/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 08/19/2003
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: 03/17/2026
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
INDIANA HEALTH CAREERS VOCATIONAL TRAINING & TEST
Approved: 10/26/2016
Terminated: 11/22/2019
CHARLESTOWN PLACE AT NEW ALBANY
Approved: 08/19/2003
Terminated: 03/10/2010
NURSE TECH
Approved: 11/14/2003
Terminated: 03/10/2010
NURSES ON CALL NURSING AGENCY
Approved: 11/20/2003
Terminated: 12/21/2004
NORTON ACADEMY
Approved: 12/19/2012
Terminated: 11/22/2019
EXCEL FIVE STAR TRAINING FOR CERTIFIED NURSE AIDES
Approved: 12/19/2012
Terminated: 11/22/2019
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 07/01/2021
Terminated: 08/23/2021
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 01/13/2022
Terminated: 08/23/2021
BENEVOLENT CARE ACADEMY
Approved: 06/24/2024
Terminated: 03/18/2024
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 1
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
395
357
357
355
Rank of Score
30
47
49
51
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
No
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
Civil Money Penalty
Date Imposed: 07/21/2023 Date Ended: 07/26/2023
Amount proposed per day:
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.
