Created on: 07/25/2025
Posted to the Web on: 08/06/2025
Basic Information
FACILITY CONTACT INFORMATION:
Address: 10820 PARK PLACE
City: SAINT JOHN
Telephone: (219) 525-4658
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 25-017974-1
License effective date: 01/01/2025
License expiration date: 12/31/2025
Administration and Staff
Administrator: NATHAN WOLF
Start date: 05/05/2025
Director of Nursing: TERESA VERCEL
Start date: 08/27/2024
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: PARK PLACE CHRISTIAN COMMUNITY OF ST. JOHN INC
10820 PARK PLACE
ST. JOHN IN 46373
Ownership type: PROFIT
Officer(s): RICHARD SCHUTT
WILLIAM DEYOUNG
ROBERT (BOB) WORKMAN
DAVE LARSEN
WILLIAM (BILL) ZANDSTRA
ROGER BOEREMA
BARRY VANDERGENUGTEN
KEVIN BOTMA
CHRISTIAN CVST REST HAVEN ILLIANA
RICH VAN HATTEM
AL DIEPSTRA
PAUL KATS
HOWARD RYNBERK (JR)
GARY SMIT
RICH VANDYKEN
TIM SMIT
BOB VAN STAALDUINEN
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: N/A
Date of last change of ownership: N/A
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 0
Number of Medicare/Medicaid beds (SNF/NF): 0
Number of non-certified comprehensive care beds (State Licensed only): 26
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 30
Total number of beds in facility: 56
CENSUS:
Facility census: 0
As reported by the facility on: / /
Number of comprehensive care beds occupied in this facility.0
As reported by the facility on: / /
Residential care beds occupied: 0
As reported by the facility on: / /
Alzheimer Beds: 0
Alzheimer Beds Occupied: 0
As reported by the facility on: / /
Ventilator Beds: 0
Ventilator Beds Occupied: 0
As reported by the facility on: / /
Sprinklers and Smoke Detectors
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 20
Number of comprehensive care resident rooms with battery
operated smoke detectors: 0
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 20
If hard wired and/or wireless smoke detectors are provided in resident's room, do they:
(A) Provide a visual and audible signal at the nurses'stations that attend each room? - Yes
(B) Transmit to a central station service - Yes
(C) Connect to the health facility's fire alarm system - Yes
Person completing form - JACQUELYN TERPSTRA
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 04/02/2025
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:
Nurse aide training and competency evaluation program (NATCEP) expires:
Nurse aide training and competency evaluation program (NATCEP) banned: No
Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
Enforcement Actions
Survey History
The survey report is not posted until the report has been provided to the facility and their plan of correction submitted and approved.
The survey report therefore will likely not be posted until four to six weeks after the exit date.
In the grid below click on an event ID that is underlined to see the survey report for that event.
