The Waters of Wakarusa Skilled Nursing Facility
Nursing Home, Assisted Living, Palliative Care, Respite Care & Skilled Nursing · Wakarusa, IN
CMS overall rating Info CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.

The Waters of Wakarusa Skilled Nursing Facility

Nursing Home, Assisted Living, Palliative Care, Respite Care & Skilled Nursing · Wakarusa, IN
CMS overall rating Info CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
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The Waters of Wakarusa Skilled Nursing Facility accepts Medicaid, Medicare, and private pay.

Inspection History

In Indiana, the Department of Health, Division of Long Term Care is the primary regulatory body that performs onsite inspections and quality of care reviews for all licensed facilities.

Since 2023 · 3 years of data 101 deficiencies 4 complaints 24 inspections
Inspection Score Info A composite 0–100 score combining this facility's inspections, deficiencies, complaints, and enforcement actions relative to the Indiana state average. The score below shows how many points this facility sits above or below the typical Indiana assisted living residence score (the benchmark); higher is better.This is a proprietary Assisted Living Magazine score.

8 points below the Indiana average for assisted living residences (83/100)

Rank #256 / 384 in Indiana Inspection Score — State benchmarked This home is ranked 256th out of 384 homes in Indiana. Shows this facility's inspection score compared to the Indiana average among 384 comparable communities in the ranking pool. Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking. This is a proprietary Assisted Living Magazine score. Inspection score: 75 out of 100. Letter grade C. 8 points below the Indiana average for assisted living residences (83/100)

Inspection Scorecard Info This scorecard compares key inspection, deficiency, and complaint metrics at this facility against the Indiana state average. Metrics rated ≥15% worse than average are highlighted in red; those ≥15% better are highlighted in green.

Since 2023 vs. Indiana state average
Overall vs. IN average 5 Worse Metrics worse than Indiana average:
• Total deficiencies (181% above)
• Deficiencies per year (181% above)
• Deficiencies per inspection (121% above)
• Inspections with deficiencies (57% above)
• Inspection deficiency rate (24% above)
1 At Avg Metrics at Indiana average:
• Inspections (at IN avg)
2 Better Metrics better than Indiana average:
• Total complaints (20% below)
• Complaints per year (24% below)
Latest Inspection June 19, 2025 Plan Of Correction

Deficiencies Info Deficiencies are formal regulatory issues recorded during state inspections.

This FacilityIN Averagevs. IN Avg
Total deficiencies Info Formal regulatory issues recorded by inspectors across all inspection types. 10136 This facility has 181% more total deficiencies than a typical Indiana assisted living residence (101 vs. IN avg 36).↑ 181% worse Rank #293 / 317 Total deficiencies — State benchmarked This home is ranked 293rd out of 317 homes in Indiana. Shows this facility's deficiencies compared to the Indiana average among 317 comparable communities in the ranking pool. Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.
Deficiencies per year Info Average deficiencies per year since 2023. 33.712 This facility has 181% more deficiencies per year than a typical Indiana assisted living residence (33.7 vs. IN avg 12).↑ 181% worse
Deficiencies per inspection Info Average deficiencies per inspection. 4.21.9 This facility has 121% more deficiencies per inspection than a typical Indiana assisted living residence (4.2 vs. IN avg 1.9).↑ 121% worse Rank #286 / 317 Deficiencies per inspection — State benchmarked This home is ranked 286th out of 317 homes in Indiana. Shows this facility's deficiencies per inspection compared to the Indiana average among 317 comparable communities in the ranking pool. Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.

Inspections Info State inspections evaluate whether the facility meets health and safety standards.

This FacilityIN Averagevs. IN Avg
Total visits Info Combined count of all on-site visits — routine inspections, complaint visits, follow-ups, and other focused visits. 2419 This facility has had 26% more total visits than the Indiana average (24 vs. IN avg 19). More inspections can mean more regulatory scrutiny rather than worse care.↑ 26% more
Inspections with deficiencies Info Inspections that resulted in at least one regulatory deficiency. 117 This facility has 57% more inspections with deficiencies than a typical Indiana assisted living residence (11 vs. IN avg 7).↑ 57% worse
Inspection deficiency rate Info Percentage of inspections that resulted in at least one deficiency. 46%37% This facility has 9 percentage points higher inspection deficiency rate than a typical Indiana assisted living residence (46% vs. IN avg 37%).↑ 9% worse
Inspections Info Routine, scheduled inspections conducted by state regulators. 1313 This facility has inspections in line with the Indiana average (13 vs. IN avg 13).— At avg

Complaints & Investigations Info Complaints are formal concerns filed by residents, families, or staff. Investigations are on-site follow-ups.

This FacilityIN Averagevs. IN Avg
Total complaints Info Formal expressions of concern made by residents, families, or staff. 45 This facility has 20% fewer total complaints than a typical Indiana assisted living residence (4 vs. IN avg 5).↓ 20% better Rank #128 / 293 Total complaints — State benchmarked This home is ranked 128th out of 293 homes in Indiana. Shows this facility's total complaints compared to the Indiana average among 293 comparable communities in the ranking pool. Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.
Complaints per year Info Average complaints per year since 2023. 1.31.7 This facility has 24% fewer complaints per year than a typical Indiana assisted living residence (1.3 vs. IN avg 1.7).↓ 24% better

Inspection Reports Summary Info An editor-reviewed summary of the themes and findings across this facility's recent inspection reports.

  • The June 19, 2025 revisit found the facility in full compliance with Medicare/Medicaid, Life Safety Code, and state regulations, with no deficiencies or complaints noted.
  • The April 21, 2025 survey cited 12 deficiencies including emergency preparedness failures, fire safety issues, and unsafe smoking area maintenance.
  • The January 8, 2025 complaint investigation identified immediate jeopardy for unsafe discharge practices and multiple care deficiencies, including missed treatments and improper food handling.

Health Inspection History

Inspections since 2023
Total health inspections 5

State average N/A


Last Health inspection on Mar 2025

Total health citations
30 Rank #191 / 292Health citations — State benchmarkedThis home is ranked 191st out of 292 homes in Indiana. Shows this facility's total health deficiency citations benchmarked to the Indiana State average, with a ranking across all 292 IN facilities. Lower citation counts earn a better rank.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

State average N/A

Citations per inspection
6 Rank #230 / 292Citations per inspection — State benchmarkedThis home is ranked 230th out of 292 homes in Indiana. Shows average deficiency citations per CMS inspection for this facility versus the Indiana mean across 292 facilities with citation data. Lower is better.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

State average N/A


Health citations are formal notices following inspections when they fail to comply with safety and care standards.

20 of 30 citations resulted from standard inspections; 9 of 30 resulted from complaint investigations; and 1 of 30 came from combined inspections (standard and complaint).

Breakdown of citation severity (last 3 years)
Critical health citations
1
In line with State average

State average: N/A


Serious health citations
0
In line with State average

State average: N/A

1 critical citation State average: N/A

0 serious citations State average: N/A

28 moderate citations State average: N/A

1 minor citation State average: N/A
Citations history (last 3 years)
Administration moderate citation Mar 14, 2025
Corrected

Infection Control moderate citation Mar 14, 2025
Corrected

Nutrition moderate citation Mar 14, 2025
Corrected

Nutrition moderate citation Mar 14, 2025
Corrected

Staffing Data

Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.

Total staff 100
Employees 88
Contractors 12
Staff to resident ratio 1.20 : 1
0% compared with State average

State average ratio: 0 : 0

Avg staff/day 39
Average shift 8.3 hours
0% compared with State average

State average: 0 hours

Total staff hours (quarter) 29,940

Nursing staff breakdown

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Registered Nurse

Manages medical care and health needs.

RN Staff Info All 12 RN Staff are full-time employees. No contractors work on this role. 12
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 8 hours
Licensed Practical Nurse

Assists with medical care and medications.

LPN Staff Info All 13 LPN Staff are full-time employees. No contractors work on this role. 13
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 9.5 hours
Certified Nursing Assistant

Helps with daily care and mobility.

CNA Staff Info All 40 CNA Staff are full-time employees. No contractors work on this role. 40
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 8.6 hours

Contractor staffing

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.

Total hours from contractors

3.6%

1,082 contractor hours this quarter

Speech Language Pathologist: 4 Physical Therapy Aide: 2 Physical Therapy Assistant: 2 Respiratory Therapy Technician: 2 Medical Director: 1 Qualified Social Worker: 1

Staff by category

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Certified Nursing Assistant4004013,03792100%8.6
Registered Nurse120124,23092100%8
Licensed Practical Nurse130133,88692100%9.5
Medication Aide/Technician120122,7859199%9.5
Other Dietary Services Staff3031,1388693%7.6
Clinical Nurse Specialist2029797278%7.7
Mental Health Service Worker2029687177%7.7
Dietitian1015366672%8.1
Nurse Practitioner1015206470%8.1
Administrator1014995863%8.6
Physical Therapy Aide0224706975%6.4
RN Director of Nursing1012823740%7.6
Speech Language Pathologist0442585863%4.4
Physical Therapy Assistant0221663538%4.8
Respiratory Therapy Technician0221124549%2.5
Qualified Social Worker011482628%1.9
Medical Director011281415%2
40 Certified Nursing Assistant
% of Days 100%
12 Registered Nurse
% of Days 100%
13 Licensed Practical Nurse
% of Days 100%
12 Medication Aide/Technician
% of Days 99%
3 Other Dietary Services Staff
% of Days 93%
2 Clinical Nurse Specialist
% of Days 78%
2 Mental Health Service Worker
% of Days 77%
1 Dietitian
% of Days 72%
1 Nurse Practitioner
% of Days 70%
1 Administrator
% of Days 63%
2 Physical Therapy Aide
% of Days 75%
1 RN Director of Nursing
% of Days 40%
4 Speech Language Pathologist
% of Days 63%
2 Physical Therapy Assistant
% of Days 38%
2 Respiratory Therapy Technician
% of Days 49%
1 Qualified Social Worker
% of Days 28%
1 Medical Director
% of Days 15%

Penalties and fines

Includes penalties issued in 2025

Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.

Source: CMS Penalties Database (Data as of Jan 2026)

Total fines amount $15K Rank #260 / 293Federal fines — State benchmarkedThis home is ranked 260th out of 293 homes in Indiana. Shows this facility's cumulative CMS federal fine dollars versus the Indiana average among facilities with fines, and where it ranks among 293 facilities in the pool. Lower total dollars mean a better rank.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
46% lower than State average

State average: $27K

Number of fines 1
28% fewer fines than State average

State average: 1.4

Payment Denials Info Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed. 0
100% fewer payment denials than State average

State average: 0.4

Fines amount comparison
Fines amount comparison
This facility $15K
State average $27K
Penalty History

Penalties are imposed by CMS for violations of federal nursing home regulations.

1 penalty in the past 3 years

Jan 8, 2025 · $15K

Civil Money Penalty Info Fines imposed for noncompliance, which can be assessed per day or per instance of violation. Jan 8, 2025
$15K

Last updated: Jan 2026

Quality of care over time

These measures show how residents usually do over time at this home, based on health outcomes and preventive care.

High-risk clinical events score Info A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline. 8.4
5% worse than State average

State average: 8.0

Functional decline score Info A composite score based on activities of daily living decline, walking ability decline, and incontinence. 18.6
9% worse than State average

State average: 17.1

Long-stay resident measures
Significantly above average State avg: 4.1 Info CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Need for Help with Daily Activities Increased Info Percent of long-stay residents whose need for help with daily activities has increased 9.5%
21% better than State average

State average: 12.0%

Walking Ability Worsened Info Percent of long-stay residents whose ability to move independently worsened 14.6%
In line with State average

State average: 14.4%

Low Risk Residents with Bowel/Bladder Incontinence Info Percent of low risk long-stay residents who lose control of their bowels or bladder 31.8%
29% worse than State average

State average: 24.6%

Falls with Major Injury Info Percent of long-stay residents experiencing one or more falls with major injury 3.9%
In line with State average

State average: 3.9%

High Risk Residents with Pressure Ulcers Info Percent of long-stay high risk residents with pressure ulcers 5.6%
29% worse than State average

State average: 4.4%

Urinary Tract Infection Info Percent of long-stay residents with a urinary tract infection 2.0%
60% worse than State average

State average: 1.2%

Lost Too Much Weight Info Percent of long-stay residents who lose too much weight 8.4%
49% worse than State average

State average: 5.7%

Depressive Symptoms Info Percent of long-stay residents who have depressive symptoms 19.3%
20% better than State average

State average: 24.1%

Antipsychotic Use Info Percent of long-stay residents who received an antipsychotic medication 6.5%
48% better than State average

State average: 12.4%

Pneumococcal Vaccine Info Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine 100.0%
7% better than State average

State average: 93.7%

Influenza Vaccine Info Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine 100.0%
5% better than State average

State average: 95.4%

Hospitalizations per 1,000 days Info Number of hospitalizations per 1,000 long-stay resident days. 2.51
57% worse than State average

State average: 1.60

ED visits per 1,000 days Info Number of outpatient emergency department visits per 1,000 long-stay resident days. 0.55
63% better than State average

State average: 1.48

Short-stay resident measures
Above average State avg: 2.9 Info CMS star rating based on short-stay quality measure performance. 5 stars = much above average, 1 star = much below average.
Pneumococcal Vaccine Info Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine 89.0%
9% better than State average

State average: 81.7%

Antipsychotic medication increase Info Percent of short-stay residents who newly received an antipsychotic medication 1.5%
8% worse than State average

State average: 1.4%

Influenza Vaccine Info Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine 83.7%
6% better than State average

State average: 79.0%

Re-hospitalized after SNF stay Info Percentage of short-stay residents who were re-hospitalized after their nursing home admission. 20.2%
10% better than State average

State average: 22.4%

Emergency department visits Info Percentage of short-stay residents who had an outpatient emergency department visit. 9.6%
9% better than State average

State average: 10.5%

Falls with major injury Info Percentage of SNF residents who experience falls with major injury during their stay. 0.0%
100% better than State average

State average: 0.8%

Ability to care for self at discharge Info Percentage of residents at or above expected ability to care for themselves at discharge. 47.4%
12% worse than State average

State average: 53.7%

Successful return to home or community Info Rate of successful return to home or community from a skilled nursing facility. 53.6%
6% better than State average

State average: 50.6%

Breakdown by payment type

Medicare

28% of new residents, usually for short-term rehab.

Typical stay 18 days

Private pay

64% of new residents, often for short stays.

Typical stay 2 - 3 months

Medicaid

8% of new residents, often for long-term daily care.

Typical stay 2 - 3 years

Facility Characteristics

Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)

Total residents 83
Medicare
12
14.5% of residents
Medicaid
59
71.1% of residents
Private pay or other
12
14.5% of residents
Programs & Services
Residents Group

Residents meet regularly to discuss policies, care quality, and activities

Nurse Aide Training

State-approved Nurse Aide Training and Competency Evaluation Program on-site

Active Resident Council

Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.

Finances and operations

Based on CMS SNF Cost Report for fiscal year ending in 12/2023.

For-profit
Operated by a business corporation.
Net patient revenue Info Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
$12.7M
Net patient income Info Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
$1.6M
For-profit Operated by a business corporation.
Net patient revenue Info Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
$12.7M Rank #110 / 294Revenue — State benchmarkedThis home is ranked 110th out of 294 homes in Indiana. Shows this facility's annual revenue compared to the Indiana average. Higher revenue generally means more resources for staffing and capital — read alongside Payroll %.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Net patient income Info Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
$1.6M
Other income Info Money the home earns outside of resident care — such as investments, grants, rentals and other non-operating sources (CMS cost report, Worksheet G-3). It is tracked separately from net patient revenue: it is not part of that figure, and it is not included in net patient income.
$2.1K
Payroll costs Info Staff salaries plus wage-related costs — benefits such as payroll taxes, health insurance and retirement — from the home's own accounting records (CMS cost report, Worksheet A). Contract or agency labor is counted separately, under other operating costs. Rank #146 / 294Payroll — State benchmarkedThis home is ranked 146th out of 294 homes in Indiana. Shows total annual staff payroll benchmarked to the Indiana average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
$5.3M 42% of net patient revenue Info Payroll as a share of revenue: staff salaries and wage-related benefits divided by net patient revenue. A higher figure means more of each revenue dollar goes to staff pay. Rank #244 / 294Payroll % — State benchmarkedThis home is ranked 244th out of 294 homes in Indiana. Shows payroll as a percentage of revenue versus the Indiana average. Well-run Indiana facilities typically land around 54–68% — the top third Statewide. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings.Rankings are based only on facilities in Indiana that report data for that category. Facilities without available data are excluded from the ranking.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
Other operating costs Info Everything it costs to run the home apart from payroll — food, utilities, supplies, maintenance, contract labor and administration. Calculated as total operating expense minus payroll (staff salaries and wage-related benefits).
$5.7M
Total costs Info The home's total operating expense for the year — all the costs of running it, salaries included (CMS cost report, Worksheet G-3).
$11.1M

Who this home usually serves

TYPE OF STAY

Primarily short stays

Residents typically stay for brief periods, with frequent admissions and discharges throughout the year.

Most new residents arrive under private pay (64% of admissions), and a typical private pay stay runs around 2 - 3 months.

Admissions
257 total

Coverage residents most often arrive under.

Medicare 28%
Private pay 64%
Medicaid 8%
Discharges
248 total

Coverage residents most often leave under.

Medicare 20%
Private pay 65%
Medicaid 16%

Places of interest near The Waters of Wakarusa Skilled Nursing Facility

Address 0.0 miles from city center Info Estimated distance in miles from Wakarusa's city center to The Waters of Wakarusa Skilled Nursing Facility's address, calculated via Google Maps.

Calculate Travel Distance to The Waters of Wakarusa Skilled Nursing Facility

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The information below is reported by the Indiana Department of Health, Division of Long Term Care.

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Frequently Asked Questions about The Waters of Wakarusa Skilled Nursing Facility

Who is the Director of Nursing at The Waters of Wakarusa Skilled Nursing Facility?

Mary Damm is the Director of Nursing at The Waters of Wakarusa Skilled Nursing Facility.

Who is the owner of The Waters of Wakarusa Skilled Nursing Facility?

The Waters of Wakarusa Skilled Nursing Facility is legally operated by Johnson Memorial Hospital, and administered by David Henke.

Is The Waters of Wakarusa Skilled Nursing Facility in a walkable area?

The Waters of Wakarusa Skilled Nursing Facility has a walk score of 37. Somewhat walkable. A few nearby services may be reachable on foot, but most trips require transportation.

What is the license number of The Waters of Wakarusa Skilled Nursing Facility?

According to IN state health department records, The Waters of Wakarusa Skilled Nursing Facility's license number is 25-000521-1.

When does The Waters of Wakarusa Skilled Nursing Facility's license expire?

According to IN state health department records, The Waters of Wakarusa Skilled Nursing Facility's license expires on February 28, 2027.

What is the occupancy rate at The Waters of Wakarusa Skilled Nursing Facility?

The Waters of Wakarusa Skilled Nursing Facility's occupancy is 59%.

Does The Waters of Wakarusa Skilled Nursing Facility operate as a for-profit or non-profit?

The Waters of Wakarusa Skilled Nursing Facility is registered as a for-profit in IN.

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