6 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
6 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Columbus, IN
2-star overall rating with 3-star inspections with 6 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
3550 Central Ave, Columbus, IN
(812) 379-9669
Overall
2 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
1 / 5
Resident outcomes and process measures
Quick facts
Beds
112
Certified beds
Average residents
99
Average occupied residents
Ownership
Government
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1994-06-30
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.49
Registered nurse staffing · state 0.66 · national 0.68
LPN hours / resident day
0.56
Licensed practical nurse staffing · state 0.77 · national 0.87
Aide hours / resident day
2.67
Nurse aide staffing · state 2.27 · national 2.35
Total nurse hours
3.72
All reported nurse hours · state 3.71 · national 3.89
Licensed hours
1.05
RN + LPN hours · state 1.44 · national 1.54
Weekend hours
2.81
Weekend nurse staffing · state 3.24 · national 3.43
Weekend RN hours
0.16
Weekend registered nurse coverage · state 0.45 · national 0.47
Physical therapist
0.13
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.39
CMS adjusted RN staffing hours
Adjusted total hours
3.00
CMS adjusted total nurse staffing hours
Case-mix index
1.70
Higher values indicate more complex resident acuity
RN turnover
20%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
47%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Program rank
11,242
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
17.55
Composite VBP score used to determine payment impact.
Payment multiplier
0.9818
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
2.32
Baseline 19.69% · Performance 20.36% · Measure score 2.32 · Achievement 2.32 · Improvement 0
Healthcare-associated infections
0
Baseline 5.24% · Performance 7.75% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
4.70
Baseline 68.92% · Performance 46.00% · Measure score 4.70 · Achievement 4.33 · Improvement 4.70
Adjusted total nurse staffing
0
Baseline 2.88 hours · Performance 3 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.47% |
10.72%
0.8 pts worse
|
No Different than the National Rate · Eligible stays 99 · Observed rate 14.14% · Lower 95% interval 7.66% |
| Discharge to community | 38.99% |
50.57%
11.6 pts worse
|
No Different than the National Rate · Eligible stays 50 · Observed rate 28% · Lower 95% interval 27.03% |
| Medicare spending per beneficiary | 0.85 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 63 · Denominator 63 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 63 |
| Discharge self-care score | 47.62% |
53.69%
6.1 pts worse
|
Numerator 20 · Denominator 42 |
| Discharge mobility score | 52.38% |
50.94%
1.4 pts better
|
Numerator 22 · Denominator 42 |
| Pressure ulcers or injuries, new or worsened | 3.17% |
2.29%
0.9 pts worse
|
Numerator 2 · Denominator 63 · Adjusted rate 2.32% |
| Healthcare-associated infections requiring hospitalization | 7.75% |
7.12%
0.6 pts worse
|
No Different than the National Rate · Eligible stays 46 · Observed rate 10.87% · Lower 95% interval 4.43% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 109 |
| Staff flu vaccination coverage | 19.85% |
42%
22.1 pts worse
|
Numerator 26 · Denominator 131 |
| Discharge function score | 45.24% |
56.45%
11.2 pts worse
|
Numerator 19 · Denominator 42 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 21 · Denominator 21 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 16.67% |
25.2%
8.5 pts worse
|
Numerator 6 · Denominator 36 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
1.6
0.2 pts worse
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.8 · Expected 1.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.8 |
1.5
0.3 pts worse
|
1.8
About the same
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 2.0 · Expected 1.9 · 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 | 6.8% |
3.8%
3 pts worse
|
3.3%
3.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.8% · Q2 7.8% · Q3 4.4% · Q4 6.2% · 4Q avg 6.8% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 80.4% |
24.6%
55.8 pts worse
|
11.4%
69 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 80.3% · Q2 75.7% · Q3 80.3% · Q4 85.1% · 4Q avg 80.4% |
| Percentage of long-stay residents who lose too much weight | 7.9% |
5.6%
2.3 pts worse
|
5.4%
2.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 4.9% · Q2 14.5% · Q3 9.2% · Q4 3.3% · 4Q avg 7.9% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 35.9% |
23.5%
12.4 pts worse
|
19.6%
16.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 34.5% · Q2 35.7% · Q3 36.8% · Q4 36.6% · 4Q avg 35.9% |
| Percentage of long-stay residents who received an antipsychotic medication | 19.0% |
14.8%
4.2 pts worse
|
16.7%
2.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 19.1% · Q2 18.0% · Q3 19.4% · Q4 19.4% · 4Q avg 19.0% · 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 | 20.4% |
13.3%
7.1 pts worse
|
16.3%
4.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.4% · Q2 20.6% · Q3 19.0% · Q4 24.0% · 4Q avg 20.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 28.4% |
11.7%
16.7 pts worse
|
14.9%
13.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 27.3% · Q2 30.0% · Q3 27.4% · Q4 29.1% · 4Q avg 28.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.3% |
0.4%
0.1 pts better
|
1.0%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 1.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 3.6% |
1.2%
2.4 pts worse
|
1.7%
1.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.6% · Q2 6.7% · Q3 0.0% · Q4 2.1% · 4Q avg 3.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.7% |
24.2%
0.5 pts worse
|
19.8%
4.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 35.9% · Q2 20.1% · Q3 17.5% · Q4 25.4% · 4Q avg 24.7% |
| Percentage of long-stay residents with pressure ulcers | 2.2% |
4.1%
1.9 pts better
|
5.1%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 3.1% · Q3 1.7% · Q4 0.8% · 4Q avg 2.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.7% |
81.6%
17.1 pts better
|
81.7%
17 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 97.5% · Q2 97.6% · Q3 100.0% · Q4 100.0% · 4Q avg 98.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 18.6% |
10.5%
8.1 pts worse
|
12.0%
6.6 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 18.6% · Observed 20.5% · Expected 12.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 4.7% |
1.3%
3.4 pts worse
|
1.6%
3.1 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q2 8.3% · Q3 0.0% · 4Q avg 4.7% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 97.7% |
79.0%
18.7 pts better
|
79.7%
18 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 97.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.3% |
22.4%
1.1 pts better
|
23.9%
2.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.3% · Observed 23.1% · Expected 25.8% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (3 deficiencies)
6 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Top issue: Quality of Life and Care (5 deficiencies)
4 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Pharmacy Service (5 deficiencies)
15 fire-safety deficiencies
Top issue: Egress (4 deficiencies)
Fire safety
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-03-21
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2025-03-21
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2025-03-21
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2025-03-21
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2025-03-21
Fire Safety
Meet other general requirements.
Corrected 2025-03-21
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-05-31
Fire Safety
Ensure that waiting areas, nurse’s stations, gift shops, and cooking facilities, open to the corridor are properly protected.
Corrected 2024-05-31
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2024-05-31
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-05-31
Fire Safety
Conduct testing and exercise requirements.
Corrected 2023-04-07
Fire Safety
Implement emergency and standby power systems.
Corrected 2023-04-07
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2023-04-07
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-04-07
Fire Safety
Meet other general requirements.
Corrected 2023-04-07
Fire Safety
Have ramps, exits, fire escape ladders, steps, and areas of refuge that meet safety requirements.
Corrected 2023-04-07
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-04-07
Fire Safety
Install proper backup exit lighting.
Corrected 2023-04-07
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2023-04-07
Fire Safety
Install a fire alarm system that can be heard throughout the facility.
Corrected 2023-04-07
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-04-07
Fire Safety
Properly provide smoke detection systems in areas open to corridors.
Corrected 2023-04-07
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-04-07
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-04-07
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2023-04-07
Inspection history
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-03-06
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-03-06
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2025-03-06
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2025-03-06
Health
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected 2025-03-06
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-03-06
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-07-16
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2024-05-09
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-09
Health
Keep residents' personal and medical records private and confidential.
Corrected 2024-05-09
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2024-01-01
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-05-09
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-05-09
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-05-09
Health
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected 2024-05-09
Health
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Corrected 2023-11-13
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2023-11-13
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2023-11-13
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-10-18
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2023-03-24
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2023-03-24
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2023-03-24
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2023-03-24
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-03-24
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-03-24
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-03-24
Health
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected 2023-03-24
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2023-03-24
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2023-03-24
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 2023-03-24
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-03-24
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
Corporate Director · Individual
Corporate Director · Individual
Corporate Officer · Individual
Corporate Director · Individual
Corporate Director · Individual
Corporate Director · Individual
Operational/Managerial Control · Organization
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Corporate Director · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
Nearby options
Columbus, IN
4-star overall rating with 3-star inspections with $8,824 in total fines with 6 recent health deficiencies
Columbus, IN
5-star overall rating with 5-star inspections with 2 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
Columbus, IN
5-star overall rating with 4-star inspections with 3 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
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