Albany, IN

Albany Health Care & Rehabilitation Center

2-star overall rating with 2-star inspections with 13 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle

910 W Walnut St, Albany, IN

(765) 789-4423

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

3 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

102

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Tlc Management

Operator or chain grouping

Approved since

1992-03-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

20 facilities

Chain averages 4 overall / 3 health / 3 staffing / 5 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.70

Registered nurse staffing · state 0.66 · national 0.68

LPN hours / resident day

0.42

Licensed practical nurse staffing · state 0.77 · national 0.87

Aide hours / resident day

2.73

Nurse aide staffing · state 2.27 · national 2.35

Total nurse hours

3.85

All reported nurse hours · state 3.71 · national 3.89

Licensed hours

1.12

RN + LPN hours · state 1.44 · national 1.54

Weekend hours

3.22

Weekend nurse staffing · state 3.24 · national 3.43

Weekend RN hours

0.61

Weekend registered nurse coverage · state 0.45 · national 0.47

Physical therapist

0.05

Reported PT staffing · state 0.06 · national 0.07

Adjusted RN hours

0.63

CMS adjusted RN staffing hours

Adjusted total hours

3.48

CMS adjusted total nurse staffing hours

Case-mix index

1.51

Higher values indicate more complex resident acuity

RN turnover

38%

Annual RN turnover · state 42% · national 45%

Total nurse turnover

43%

Annual nurse turnover · state 47% · national 46%

SNF VBP

Value-based purchasing

Program rank

5,123

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

37.32

Composite VBP score used to determine payment impact.

Payment multiplier

0.9906

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

5.59

Baseline 19.74% · Performance 18.84% · Measure score 5.59 · Achievement 5.59 · Improvement 2.82

Healthcare-associated infections

2.23

Baseline 6.00% · Performance 7.17% · Measure score 2.23 · Achievement 2.23 · Improvement 0

Total nurse turnover

6.02

Baseline 59.78% · Performance 39.08% · Measure score 6.02 · Achievement 6.02 · Improvement 5.43

Adjusted total nurse staffing

1.09

Baseline 3.24 hours · Performance 3.39 hours · Measure score 1.09 · Achievement 1.09 · Improvement 0.09

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.57%	10.72% 0.2 pts better	No Different than the National Rate · Eligible stays 85 · Observed rate 9.41% · Lower 95% interval 7.04%
Discharge to community	48.55%	50.57% 2 pts worse	No Different than the National Rate · Eligible stays 66 · Observed rate 43.94% · Lower 95% interval 36.77%
Medicare spending per beneficiary	1.05	1.02 About the same
Drug regimen review with follow-up	98.41%	95.27% 3.1 pts better	Numerator 62 · Denominator 63
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 63
Discharge self-care score	65.85%	53.69% 12.2 pts better	Numerator 27 · Denominator 41
Discharge mobility score	63.41%	50.94% 12.5 pts better	Numerator 26 · Denominator 41
Pressure ulcers or injuries, new or worsened	1.59%	2.29% 0.7 pts better	Numerator 1 · Denominator 63 · Adjusted rate 1.31%
Healthcare-associated infections requiring hospitalization	7.17%	7.12% About the same	No Different than the National Rate · Eligible stays 54 · Observed rate 7.41% · Lower 95% interval 3.59%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 180
Staff flu vaccination coverage	10%	42% 32 pts worse	Numerator 18 · Denominator 180
Discharge function score	73.17%	56.45% 16.7 pts better	Numerator 30 · Denominator 41
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	22.58%	25.2% 2.6 pts worse	Numerator 7 · Denominator 31

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.3	1.6 0.3 pts better	1.9 0.6 pts better	Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.1 · Expected 1.7 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	1.7	1.5 0.2 pts worse	1.8 0.1 pts better	Long Stay · 20240701-20250630 · Adjusted 1.7 · Observed 1.5 · Expected 1.5 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	100.0%	93.6% 6.4 pts better	93.4% 6.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	100.0%	95.4% 4.6 pts better	95.5% 4.5 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0%
Percentage of long-stay residents experiencing one or more falls with major injury	2.8%	3.8% 1 pts better	3.3% 0.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 2.8% · Q3 1.4% · Q4 5.4% · 4Q avg 2.8% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	43.6%	24.6% 19 pts worse	11.4% 32.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 35.9% · Q2 36.2% · Q3 36.2% · Q4 64.8% · 4Q avg 43.6%
Percentage of long-stay residents who lose too much weight	9.9%	5.6% 4.3 pts worse	5.4% 4.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 12.5% · Q2 12.3% · Q3 6.7% · Q4 7.8% · 4Q avg 9.9%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	17.0%	23.5% 6.5 pts better	19.6% 2.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.4% · Q2 20.0% · Q3 20.0% · Q4 18.8% · 4Q avg 17.0%
Percentage of long-stay residents who received an antipsychotic medication	19.8%	14.8% 5 pts worse	16.7% 3.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 21.6% · Q2 20.8% · Q3 20.0% · Q4 17.0% · 4Q avg 19.8% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.0% About the same	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	23.5%	13.3% 10.2 pts worse	16.3% 7.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 26.6% · Q2 35.3% · Q3 11.1% · Q4 20.6% · 4Q avg 23.5% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	20.8%	11.7% 9.1 pts worse	14.9% 5.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 15.5% · Q2 35.0% · Q3 3.3% · Q4 29.0% · 4Q avg 20.8% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	1.1%	0.4% 0.7 pts worse	1.0% 0.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.3% · Q2 1.2% · Q3 0.8% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	1.7%	1.2% 0.5 pts worse	1.7% About the same	Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 1.4% · Q3 4.2% · Q4 0.0% · 4Q avg 1.7% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	25.5%	24.2% 1.3 pts worse	19.8% 5.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 28.4% · Q2 20.6% · Q3 31.1% · Q4 21.9% · 4Q avg 25.5%
Percentage of long-stay residents with pressure ulcers	9.5%	4.1% 5.4 pts worse	5.1% 4.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 14.9% · Q2 13.7% · Q3 4.2% · Q4 5.2% · 4Q avg 9.5% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	86.6%	81.6% 5 pts better	81.7% 4.9 pts better	Short Stay · 2024Q4-2025Q3 · Q1 72.6% · Q2 85.5% · Q3 96.1% · Q4 97.6% · 4Q avg 86.6%
Percentage of short-stay residents who had an outpatient emergency department visit	10.1%	10.5% 0.4 pts better	12.0% 1.9 pts better	Short Stay · 20240701-20250630 · Adjusted 10.1% · Observed 10.4% · Expected 11.6% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	3.1%	1.3% 1.8 pts worse	1.6% 1.5 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 4.7% · Q2 4.3% · Q3 2.4% · Q4 0.0% · 4Q avg 3.1% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	83.1%	79.0% 4.1 pts better	79.7% 3.4 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 83.1%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	29.5%	22.4% 7.1 pts worse	23.9% 5.6 pts worse	Short Stay · 20240701-20250630 · Adjusted 29.5% · Observed 31.2% · Expected 25.3% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-01-14 · Fire 2025-01-14

13 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (4 deficiencies)

5 fire-safety deficiencies

Top issue: Egress (2 deficiencies)

Cycle 2 Health 2024-01-22 · Fire 2024-01-22

4 health deficiencies

Top issue: Nursing and Physician Services (1 deficiency)

6 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (3 deficiencies)

Cycle 3 Health 2022-12-19 · Fire 2022-12-19

5 health deficiencies

Top issue: Pharmacy Service (2 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-01-14

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2025-02-21

F · Potential for more than minimal harm 2025-01-14

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2025-02-21

E · Potential for more than minimal harm 2025-01-14

K293 · Egress Deficiencies

Fire Safety

Have properly located and lighted "Exit" signs.

Corrected 2025-02-21

E · Potential for more than minimal harm 2025-01-14

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-02-21

D · Potential for more than minimal harm 2025-01-14

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2025-02-21

F · Potential for more than minimal harm 2024-01-22

E41 · Emergency Preparedness Deficiencies

Fire Safety

Implement emergency and standby power systems.

Corrected 2024-03-19

F · Potential for more than minimal harm 2024-01-22

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-03-19

F · Potential for more than minimal harm 2024-01-22

K914 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

Corrected 2024-03-19

F · Potential for more than minimal harm 2024-01-22

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2024-03-19

E · Potential for more than minimal harm 2024-01-22

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2024-03-19

D · Potential for more than minimal harm 2024-01-22

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2024-03-19

Inspection history

Recent health citations

D · Potential for more than minimal harm 2026-01-15

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2026-01-29

D · Potential for more than minimal harm 2025-12-15

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2026-01-13

D · Potential for more than minimal harm 2025-12-15

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Corrected 2026-01-13

E · Potential for more than minimal harm 2025-07-02

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2025-06-27

D · Potential for more than minimal harm 2025-07-02

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Corrected 2025-06-27

F · Potential for more than minimal harm 2025-01-14

F576 · Resident Rights Deficiencies

Health

Ensure residents have reasonable access to and privacy in their use of communication methods.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F644 · Resident Assessment and Care Planning Deficiencies

Health

Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F657 · Resident Assessment and Care Planning Deficiencies

Health

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F688 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2025-02-10

D · Potential for more than minimal harm 2025-01-14

F710 · Nursing and Physician Services Deficiencies

Health

Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.

Corrected 2025-02-10

C · Minimal harm 2025-01-14

F577 · Resident Rights Deficiencies

Health

Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.

Corrected 2025-02-10

D · Potential for more than minimal harm 2024-01-22

F623 · Resident Rights Deficiencies

Health

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

Corrected 2024-02-09

D · Potential for more than minimal harm 2024-01-22

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2024-02-09

D · Potential for more than minimal harm 2024-01-22

F728 · Nursing and Physician Services Deficiencies

Health

Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.

Corrected 2024-02-09

D · Potential for more than minimal harm 2024-01-22

F755 · Pharmacy Service Deficiencies

Health

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Corrected 2024-02-09

G · Actual harm 2023-08-16

F760 · Pharmacy Service Deficiencies

Health

Ensure that residents are free from significant medication errors.

Corrected 2023-09-04

D · Potential for more than minimal harm 2023-03-06

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2023-03-27

D · Potential for more than minimal harm 2023-03-06

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Corrected 2023-03-27

D · Potential for more than minimal harm 2023-03-06

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2023-03-27

D · Potential for more than minimal harm 2022-12-19

F758 · Pharmacy Service Deficiencies

Health

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Corrected 2023-01-06

Penalties and ownership