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Waters of Dunkirk Skilled Nursing Facility, the

11563 W 300 S, Dunkirk, IN 47336 · Jay County · (765) 768-7537

46 certified beds, about 40 residents a day · For profit - Corporation · Medicare and Medicaid since 1995

CMS abuse icon: cited for abuse in a recent inspection Certified for Medicaid Certified for Medicare
Overall
2 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
5 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 155571 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on March 21, 2025, inspectors cited 5 health deficiencies (the Indiana average is 7.2, the national average 9.2).

Of 10 health citations since February 2023, 1 was rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).

CMS lists 1 fine totaling $59,240 in the last three years; the largest was $59,240, and the latest is dated March 30, 2026.

Nurses and nurse aides worked 3.37 hours per resident per day, against 3.69 across Indiana and 3.86 nationally. Registered nurses accounted for 0.60 of those hours.

25.8% of nursing staff left within the year CMS measured (Indiana average 45.9%).

CMS links it to Infinity Healthcare Consulting, an affiliated group of 70 nursing homes.

Health inspections

Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.

Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.

Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit

Where its citations fall on CMS's grid

CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 10 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
1J
0K
0L
Actual harm
0G
0H
0I
Potential for more than minimal harm
4D
2E
2F
Potential for minimal harm
0A
1B
0C
March 30, 2026Complaint inspection · 3 citations
  1. J
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    F600 · Freedom from Abuse, Neglect, and Exploitation · Immediate jeopardy to resident health or safety, isolated · found on a complaint visit · Corrected (the home has a date of correction) April 23, 2026
    Inspectors wroteBased on observation, interview, and record review, the facility failed ensure residents were protected from sexual abuse when Resident B, who had moderate cognitive impairment, was found performing oral sex on Resident C, who had severe cognitive impairment and a known history of sexually inappropriate behaviors. The facility failed to assess the residents' capacity to consent to sexual activity prior to the incident and did not implement interventions in place to mitigate Resident C's sexually inappropriate behaviors. Using the reasonable person concept, it can be determined this deficient practice resulted in severe psychosocial harm, including dehumanization and humiliation for 1 (Resident B) of 2 residents (Resident C) of 5 residents reviewed for abuse. [...]
  2. E
    Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
    F740 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) April 23, 2026
    Inspectors wroteBased on observation, interview, and record review, the facility failed to monitor for and develop individualized interventions for cognitively impaired residents with sexually focused behavior expressions for 5 of 5 residents reviewed for behavioral services. (Residents B, C, D, E and F)
  3. D
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    F609 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) April 23, 2026
    Inspectors wroteBased on record review and interview, the facility failed to ensure staff reported an allegation of abuse immediately to the Administrator, resulting in a delay in ensuring the allegation of abuse was reported to the State Agency within the required timeframe for 1 of 3 reportable incidents reviewed. (Resident B and Resident C)
March 21, 2025Standard inspection · 5 citations
  1. F
    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
    F803 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) April 17, 2025
    Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure menus and the resident's preferences were followed for 3 of 5 residents reviewed for dining services. (Resident 12, 14, and 26) This deficiency had the potential to affect 31 of 31 residents who receive meals from the facility's dining services.
  2. F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) April 17, 2025
    Inspectors wroteA. Based on observation, interview, and record review, the facility failed to ensure the high-temperature dishwasher functioned at a level to maintain proper sanitization requirements. This deficient practice had the potential to impact 31 of 31 residents who received meals from the facility kitchen. B. Based on observation and interview, the facility failed to properly store and distribute food under sanitary conditions while maintaining equipment cleanliness. This deficient practice had the potential to impact 31 of 31 residents who received meals from the facility kitchen.
  3. E
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    F804 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) April 17, 2025
    Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the palatability of the meals served for 7 of 7 residents reviewed for palatable meals. (Resident 77, 12, 26, 15, 23, 17, and 19).
  4. D
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    F623 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) April 17, 2025
    Inspectors wroteBased on record review and interview, the facility failed to ensure the resident's representative was notified in writing of the transfer/discharge appeal rights for 3 of 3 hospitalizations. (Resident 17, 77 and 127)
  5. B
    Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
    F577 · Resident Rights · No actual harm, potential for minimal harm, pattern · Corrected (the home has a date of correction) April 17, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the results from their last annual Indiana Department of Health (IDOH) survey report were posted at an accessible height for 1 of 1 residents interviewed (Resident 23). This deficient practice had the potential to impact 31 of 31 residents/or representatives for those residents who resided in the facility.
December 31, 2024Complaint inspection · 1 citation
  1. D
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) January 22, 2025
    Inspectors wroteBased on interview and record review, the facility failed to identify the number of staff needed for physical transfers and to ensure physical transfers were provided in a consistent manner for a resident who required extensive assistance for mobility for 1 of 3 residents reviewed for accidents. (Resident B) This deficient practice resulted in Resident B sustaining a fracture to her right ankle.
May 28, 2024Standard inspection · 0 citations
February 20, 2023Standard inspection · 1 citation
  1. D
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) March 15, 2023
    Inspectors wroteBased on observation, record review, and interview, the facility failed to develop and implement interventions to reduce the risk of falls for 1 of 3 residents reviewed for accidents, (Resident 93). This deficient practice resulted in a fall with a fracture requiring hospitalization.

Fire safety inspections

21 fire safety citations on file: 8 on March 21, 2025, 5 on May 28, 2024, 8 on February 20, 2023.

Every fire safety citation21 citations
  1. F
    Install emergency lighting that can last at least 1 1/2 hours.
    K 291 · March 21, 2025 · Corrected (the home has a date of correction)
  2. F
    Inspect, test, and maintain automatic sprinkler systems.
    K 353 · March 21, 2025 · Corrected (the home has a date of correction)
  3. F
    Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
    K 521 · March 21, 2025 · Corrected (the home has a date of correction)
  4. F
    Have simulated fire drills held at unexpected times.
    K 712 · March 21, 2025 · Corrected (the home has a date of correction)
  5. F
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · March 21, 2025 · Corrected (the home has a date of correction)
  6. F
    Ensure that testing and maintenance of electrical equipment is performed.
    K 921 · March 21, 2025 · Corrected (the home has a date of correction)
  7. E
    Install corridor and hallway doors that block smoke.
    K 363 · March 21, 2025 · Corrected (the home has a date of correction)
  8. D
    Have properly installed electrical wiring and gas equipment.
    K 511 · March 21, 2025 · Corrected (the home has a date of correction)
  9. E
    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.
    K 222 · May 28, 2024 · Corrected (the home has a date of correction)
  10. E
    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
    K 321 · May 28, 2024 · Corrected (the home has a date of correction)
  11. E
    Have properly installed electrical wiring and gas equipment.
    K 511 · May 28, 2024 · Corrected (the home has a date of correction)
  12. E
    Ensure proper usage of power strips and extension cords.
    K 920 · May 28, 2024 · Corrected (the home has a date of correction)
  13. E
    Have proper fire barriers, ventilation and signs for the transfilling of oxygen.
    K 927 · May 28, 2024 · Corrected (the home has a date of correction)
  14. F
    Conduct testing and exercise requirements.
    E 39 · February 20, 2023 · Corrected (the home has a date of correction)
  15. F
    Have approved installation, maintenance and testing program for fire alarm systems.
    K 345 · February 20, 2023 · Corrected (the home has a date of correction)
  16. F
    Meet other general requirements that are deficient.
    K 500 · February 20, 2023 · Corrected (the home has a date of correction)
  17. F
    To conduct inspection, testing and maintenance of fire doors by qualified individuals.
    K 761 · February 20, 2023 · Corrected (the home has a date of correction)
  18. E
    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.
    K 222 · February 20, 2023 · Corrected (the home has a date of correction)
  19. E
    Ensure proper usage of power strips and extension cords.
    K 920 · February 20, 2023 · Corrected (the home has a date of correction)
  20. D
    Have properly installed electrical wiring and gas equipment.
    K 511 · February 20, 2023 · Corrected (the home has a date of correction)
  21. D
    Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
    K 741 · February 20, 2023 · Corrected (the home has a date of correction)

Fines and payment denials

DatePenaltyAmount or length
March 30, 2026Fine $59,240

A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.

Staffing

Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.

MeasureThis homeIndianaUnited States
All nursing staff (RN, LPN and aides)3.373.693.86
Registered nurses0.600.670.69
All nursing staff on weekends3.003.253.42
Nurse aides1.98
Licensed practical nurses0.78
Nursing staff turnover (share who left in a year)25.8%45.9%45.8%
Registered nurse turnover0.0%40.3%42.9%
Administrators who left1

CMS expects 4.24 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.

Staffing by quarter, from daily payroll records

Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.51 on weekdays and 3.00 on weekends, 15% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.29 in April to June 2025 to 3.37 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20263.370.603.513.00 0.0%0 of 9040
Oct to Dec 20253.340.633.502.95 0.0%0 of 9240
Jul to Sep 20253.380.663.562.92 0.0%0 of 9238
Apr to Jun 20253.290.693.462.85 0.0%0 of 9135
United States, Jan to Mar 20263.750.623.923.335.3%0.5% of days
Indiana, Jan to Mar 20263.630.623.803.193.4%0.4% of days

Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.

Quality measures

The measures CMS uses for the quality star. Lower is better for every one of them.

MeasureThis homeIndianaUS
Percentage of long-stay residents whose need for help with daily activities has increased
Long Stay residents, 2025Q2-2026Q1
1.911.013.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.00.40.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
0.01.11.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
3.93.93.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
0.01.21.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
2.511.914.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
3.53.64.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
8.613.615.4
Number of hospitalizations per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
0.21.61.9
Number of outpatient emergency department visits per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
0.21.41.8

Owners and operators

Legal business name: JOHNSON MEMORIAL HOSPITAL. CMS links this home to Infinity Healthcare Consulting, a group of 70 nursing homes averaging 2.1 stars overall.

NameRoleTypeShareSince
Johnson Memorial Hospital5% or greater direct ownership interestOrganization100%03/01/2013
Minito, DanielleContracted managing employeeIndividual07/16/2020
Wheeler, TyishaContracted managing employeeIndividual08/01/2022
Decola, RobertW-2 managing employeeIndividual02/16/2019
Berkhouse, StevenCorporate directorIndividual10/18/2021
Dunkle, DavidCorporate directorIndividual03/01/2019
Berkhouse, StevenCorporate officerIndividual10/18/2021
Dunkle, DavidCorporate officerIndividual03/01/2019
The Waters of Dunkirk Skilled Nursing Facility LLCOperational/managerial controlOrganization11/01/2022
Berkhouse, StevenOperational/managerial controlIndividual10/18/2021
Dunkle, DavidOperational/managerial controlIndividual03/01/2019

As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.

Questions to ask on a visit

Chosen from this home's own inspection record.

  1. How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 3 problems in this area, most recently on March 30, 2026: "Ensure each resident must receive and the facility must provide necessary behavioral health care and services."
  2. Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 3 problems in this area, most recently on March 21, 2025: "Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident."
  3. How are allegations of abuse or neglect reported and investigated, and who tells the family?Inspectors cited 2 problems in this area, most recently on March 30, 2026: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody."
  4. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 2 problems in this area, most recently on March 21, 2025: "Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights."
  5. Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.00 hours per resident per day, below the Indiana average of 3.25.
  6. How long has the current administrator been here?CMS counts 1 administrator who left in the period it measured.

Other nursing homes nearby

Indiana contacts for a concern about a nursing home

These are the official offices in Indiana. NursingHomeClear cannot take or act on complaints.

Common questions

What is Waters of Dunkirk Skilled Nursing Facility, the's Medicare star rating?
CMS rates Waters of Dunkirk Skilled Nursing Facility, the 2 out of 5 stars overall, with 1 for health inspections, 3 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did Waters of Dunkirk Skilled Nursing Facility, the get at its last inspection?
5 health deficiencies at the standard inspection on March 21, 2025. The Indiana average is 7.2.
Has Waters of Dunkirk Skilled Nursing Facility, the been fined?
Yes. CMS lists 1 fine totaling $59,240 in the last three years.
Does Waters of Dunkirk Skilled Nursing Facility, the accept Medicaid?
It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
Who owns Waters of Dunkirk Skilled Nursing Facility, the?
CMS lists 11 owners and managers, and links the home to Infinity Healthcare Consulting. Legal business name: JOHNSON MEMORIAL HOSPITAL.

Sources

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