01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-06-02 | 6 | 2025-06-02 | 16 |
| Cycle 2 | 2024-06-21 | 9 | 2024-06-21 | 14 |
| Cycle 3 | 2023-06-06 | 14 | 2023-06-06 | 4 |
CMS CCN 1558562026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Restoracy Of Goshen, The
1510 Sandpiper Ln · Goshen, IN 46526 · Elkhart County
Certified beds48CMS provider file
Recent citation rows63current CMS citation release
Penalty rows1current 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
63 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 12 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-08-27 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-09-19 · complaint2025-06-02 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREE0006Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREE0013Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop Emergency Preparedness policies and procedures.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREE0029Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop a communication plan.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREE0036Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish emergency prep training and testing.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · 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 · 2025-06-202025-06-02 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-06-202025-06-02 · HEALTHF0771Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Ensure laboratory services, blood blanks and transfusion services provided on-site meet requirements for certified laboratories.
Correction field: Deficient, Provider has date of correction · 2025-06-202025-06-02 · HEALTHF0773Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
Correction field: Deficient, Provider has date of correction · 2025-06-202025-06-02 · 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 · 2025-06-202025-06-02 · FIREK0222Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREK0346Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · 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 · 2025-07-312025-06-02 · FIREK0354Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREK0374Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2025-10-022025-06-02 · FIREK0712Severity C · widespread; potential for minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-09-242025-06-02 · 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 · 2025-07-312025-06-02 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2025-07-312025-06-02 · FIREK0921Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that testing and maintenance of electrical equipment is performed.
Correction field: Deficient, Provider has date of correction · 2025-09-242024-08-09 · HEALTHF0580Severity D · isolated; 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 · 2024-08-30 · complaint2024-08-09 · HEALTHF0659Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Provide care by qualified persons according to each resident's written plan of care.
Correction field: Deficient, Provider has date of correction · 2024-08-30 · complaint03 / 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 |
|---|---|---|---|
| 2025-06-24 | Payment Denial | $0 | 8 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- DAVIESS COUNTY HOSPITALOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 06/01/2021
- SETTLES, APRILIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2025
- DAVIESS COUNTY HOSPITALOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/10/2024
- EUSON LINDSAY NORTH LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/24/2024
- RSCR MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/24/2024
- EUSON, MATTHEWIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/24/2024
- LINDSAY, BRYANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/24/2024
- RIDDELL, KARAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/24/2024
- RIDDELL, KARAIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 01/06/2026
- DAVIESS COUNTY HOSPITALOrganization · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- EUSON LINDSAY NORTH LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- GOSHEN SENIOR NURSING LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- RSCR MANAGEMENT LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- CARDOSO, AMBERIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/05/2025
- EUSON, MATTHEWIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- LINDSAY, BRYANIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
- OFFERLE, ANDREWIndividual · ADP OF THE SNFNOT APPLICABLE · since 02/01/2025
- RIDDELL, KARAIndividual · ADP OF THE SNFNOT APPLICABLE · since 10/24/2024
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 hours5.70per resident day
RN hours0.62per resident day
Weekend nurse hours5.11per resident day
Staff turnover50.6%CMS reported field