01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-05-12 | 4 | 2026-05-12 | 0 |
| Cycle 2 | 2025-03-19 | 0 | 2025-03-19 | 0 |
| Cycle 3 | 2024-02-26 | 2 | 2024-02-26 | 3 |
CMS CCN 1557032026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Brookside Village Inc
1111 Church Ave · Jasper, IN 47546 · Dubois County
Certified beds27CMS provider file
Recent citation rows9current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
9 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-12 · HEALTHF0550Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2026-05-312026-05-12 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2026-05-312026-05-12 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2026-05-312026-05-12 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2026-05-312024-02-26 · HEALTHF0580Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2024-03-112024-02-26 · FIREK0345Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2024-04-122024-02-26 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-04-182024-02-26 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-04-152023-10-10 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2023-10-30 · complaint · infection control03 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- MOORE OPERATING GROUP INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2004
- BEACHSIDE HOLDINGS CORPORATIONOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST100% · since 12/05/2019
- HEADLEY, KATHYIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2000
- MOORE, DANIELIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2000
- MOORE, DAVIDIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2000
- MOORE, STEPHENIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 05/01/2000
- HEADLEY, KATHYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/01/2000
- MOORE, DANIELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/01/2000
- MOORE, DAVIDIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/01/2000
- MOORE, STEPHENIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/01/2000
- CARDON AND ASSOCIATES INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/23/2013
- MOORE OPERATING GROUP INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/18/2020
- BALLA, MATTHEWIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/23/2022
- CATTELL, ZACHARYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/07/2025
- FAUTH, KENDRAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/26/2021
- GORMAL, GREGGIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2016
- GRANNAN, BRITTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/27/2007
- HAMBLEN, JUDYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.08per resident day
RN hours1.16per resident day
Weekend nurse hours3.68per resident day
Staff turnover62.8%CMS reported field
06 / LOCAL RECORDS
Open the Jasper ledger →