Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
MITCHELL MANOR
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 06/08/2018
 
Posted to the Web on: 06/20/2018
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 24 TEKE BURTON DR
City: MITCHELL
Telephone: (812) 849-2221
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 18-000217-1
  License effective date: 01/01/2018
  License expiration date: 12/31/2018
 


Administration and Staff

Administrator: KATHERINE HIGNITE OWENS
  Start date: 03/05/2018
 
Director of Nursing: AMANDA DAWN SIMMERMAN
  Start date: 01/09/2009
 
Medical director: Pratap Singh
  Start date:   /  /  
 
Wound care specialist: Tammy Fickas
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: MITCHELL MEDICAL INVESTORS LLC
3570 KEITH ST NW
CLEVELAND TN 37312
 
Ownership type:  PROFIT
 
Officer(s): FORREST PRESTON
            CINDY CROSS
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: HART MEDICAL INVESTORS LIMITED PARTNERSHIP
Date of last change of ownership:  
 


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):        171
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     171
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            171
 
CENSUS:
Facility census:  50
As reported by the facility on: 01/29/2018
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/29/2018
 
Residential care beds occupied:  0
As reported by the facility on: 01/29/2018
 
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: 79
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 79
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - MONICA OGDEN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ED
Date form completed - 02/28/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 02/16/2017
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2019
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 08/15/2013
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     IVY TECH COMMUNITY COLLEGE
         Approved: 05/16/2002
         Terminated: 01/11/2007
     MITCHELL MANOR
         Approved: 02/16/2017
         Terminated: N/A
     NORTH LAWRENCE VOCATIONAL TECHNICAL CENTER
         Approved: N/A
         Terminated: 04/06/2005
     LOST RIVER CAREER COOPERATIVE
         Approved: N/A
         Terminated: 01/11/2007
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  0

 


Facility Report Card



 
   We are experiencing technical issues with the consumer report card system.
   We are working to resolve the issue.

 
The statewide average line is being provided to give you a reference
for looking at the scores of the selected facility.  This row 
contains the mean average calculated scores for all facilities as of
above date resulting in a scoring range of 0 to 587.
Scores are considered to be better the closer to zero they are.
Percentile rank of 100 represents the lowest report card score or best performing facility,
with a rank of 1 being the highest report card score.
 
View the Scope and Severity grid
 
View the scoring methodology
 



Overview of Survey findings




 
 The Most Recent Set
 2ND Most Recent Set
 3RD Most Recent Set

Immediate Jeopardy
No
No
No


 Substandard Quality of Care 
No
No
No


Administrator Change
Yes
No
No


Owner Change
No
No
No


Number of Substantiated Complaints With Deficiencies
0
0
0


Deficiency Free Standard Health Survey
No
No
No


 
    The term 'Recent Set' referenced above relates to the referenced annual survey,
    and any other surveys performed between it and the previous annual survey.
 

 


Enforcement Actions

Event ID: Z5ZQ11
  Action - Citation / Fine
  Notice to facility: 07/30/2008
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: 10/10/2008
  Initial Amount: $2500
Event ID: P4GX11
  Action - Citation / Fine
  Notice to facility: 09/21/2004
             Appeal: N/A
  Action Cease/Recind: 05/10/2005
         Case Closed: 05/10/2005
  Initial Amount: $7500
 
Federal Certification Actions Imposed
 
Date terminated from Medicare/Medicaid: N/A
 


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.

        
          

          

 
Event ID
Survey Type
Exit Date

EKNU22
Follow Up, Life Safety Code, Recertification
02/08/2018


EKNU21
Recertification, Life Safety Code
12/11/2017


EKNU12
Recertification, Follow Up, State Licensure
12/01/2017


EKNU11
Recertification, State Licensure
11/03/2017


RY3E22
Follow Up, Life Safety Code, Recertification
01/13/2017


RY3E12
Recertification, Follow Up, State Licensure
12/08/2016


RY3E21
Life Safety Code, Recertification
12/01/2016


T6ZT11
Complaint
12/01/2016


RY3E11
Recertification, State Licensure
11/02/2016


U5SD11
Complaint
06/29/2016


8I2J12
Follow Up, Recertification, State Licensure
10/27/2015


8I2J22
Follow Up, Life Safety Code, Recertification
10/13/2015


8I2J21
Life Safety Code, Recertification
09/11/2015


8I2J11
Recertification, State Licensure
09/04/2015


 
 


Links and Resources

 
CMS nursing home compare page 
 
    In addition to the information provided on this 
    web site, the Centers for Medicare & Medicaid Services (CMS) has a web site 
    which contains information on every Medicare and Medicaid certified nursing 
    home in the country. The CMS nursing home survey results contain summary information 
    about a facility's noncompliance of regulations regarding the care of residents 
    found in the nursing homes. You can locate nursing homes in your area and find 
    information about compliance with federal regulations.
 
Resources and links to other organizations
 
Choosing a Nursing Home
 
Overview of the Survey Process
 
State Wide Grouping of all Scores
   
Overview of current comprehensive facility scores
   
Spreadsheet of current comprehensive facility names and scores
   
Legal Disclaimer for Long Term Care Reports.