Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
HARBOR HEALTH & REHAB
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 3/8/2024
 
Posted to the Web on: 3/20/2024
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 5025 MCCOOK AVE
City: EAST CHICAGO
Telephone: (219) 397-0380
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-000108-1
  License effective date: 3/1/2023
  License expiration date: 2/29/2024
 


Administration and Staff

Administrator: RICKY L. WALWORTH
  Start date: 11/13/2023
 
Director of Nursing: CHRISTIE LONG
  Start date: 10/4/2022
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: MAJOR HOSPITAL
2451 INTELLPLEX DR
SHELBYVILLE IN 46176
 
Ownership type:  OTHER
 
Officer(s): DANA CALDWELL
            DOUGLAS CARTER
            JEFF BEATY
            JOHN COFFIN
            JAN SANDMAN
            SHERRI TANDY
            STEVE MIRETZKY
            JOHN HORNER
            PAULA GUSTAFSON
            GENE JONES
            SCOTT MILLER
            RALPH MERCURI
            LINDA WESSIC
            ILYA SHUMAN
            ROB KINDER
            DONALD KUMP
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: LAKE COUNTY NURSING AND REHABILITATION
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):        106
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     106
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            106
 
CENSUS:
Facility census:  67
As reported by the facility on: 7/10/2023 
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/10/2023 
 
Residential care beds occupied:  0
As reported by the facility on: 7/10/2023 
 
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: 56
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 56
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - SHERRI L. SHELBY
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 4/12/2023
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/23/2000
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2002
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 8/24/2025
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     SPECIALIZED MEDICAL EDUCATION AND TRAINING
         Approved: 7/14/2003
         Terminated: 11/25/2009
     CENTRAL HIGH SCHOOL-SCHOOL CITY OF EAST CHICAGO
         Approved: 2/22/2012
         Terminated: 10/15/2012
     OLYMPIA COLLEGE
         Approved: N/A
         Terminated: 1/22/2004
     HARBOR HEALTH & REHAB
         Approved: 3/10/1998
         Terminated: 8/1/2013
     CNA ACADEMY
         Approved: 10/26/2012
         Terminated: 10/15/2012
     DESTINATION UNLIMITED TRAINING CENTER
         Approved: 10/1/2021
         Terminated: 7/18/2021
     DESTINATION UNLIMITED TRAINING CENTER
         Approved: 10/1/2021
         Terminated: 7/18/2021
 


Complaints

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

 


Facility Report Card



 


 
3/1/2020 Current QTR
12/1/2019 Previous QTR
9/1/2019 Previous QTR
6/1/2019 Previous QTR


Report Card Score
16
112
109
129


Rank of Score
99
96
96
96


Average Score
302
296
295
296


 
*Facility report card scores have not been updated since March 1, 2020 due to changes in the survey process during the ongoing COVID-19 pandemic. 
The facility report card score is calculated four times per calendar year 
for the two most recent nursing home health surveys.  The facility report card score 
also includes all complaint surveys, life safety code surveys, emergency preparedness surveys, 
and any follow-up surveys that occur within the two most recent nursing home health surveys. 
The facility report card score ranges from 500 to 0, with 500 being the best score possible. 
 
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
No
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

 
Federal Certification Actions Imposed
     Discretionary Deny Pay for New Admits
     Date Imposed: 8/25/2023  Date Ended: 9/14/2023
     Civil Money Penalty
     Date Imposed: 7/28/2023  Date Ended: 7/28/2023
     Amount proposed per day: 
     Amount proposed per day: 
     Discretionary Deny Pay for New Admits
     Date Imposed: 10/12/2022  Date Ended: 10/17/2022
     Directed Plan of Correction
     Date Imposed: 9/27/2022  Date Ended: 10/18/2022
     Civil Money Penalty
     Date Imposed: 9/1/2022  Date Ended: 9/1/2022
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 8/28/2021  Date Ended: 9/7/2021
     Discretionary Deny Pay for New Admits
     Date Imposed: 7/18/2021  Date Ended: 9/6/2021
     Directed Plan of Correction
     Date Imposed: 7/3/2021  Date Ended: 9/7/2021
     Civil Money Penalty
     Date Imposed: 6/11/2021  Date Ended: 8/5/2021
     Amount proposed per day: 
     Amount proposed per day: 
 
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

Y4F412
Complaint, Follow Up
2/19/2024


Y4F411
Complaint
1/25/2024


46V713
Recertification, Follow Up, State Licensure
10/13/2023


46V722
Follow Up, Life Safety Code, Recertification
10/11/2023


2EML12
Complaint, Follow Up
9/28/2023


2EML11
Complaint
9/14/2023


46V712
Recertification, Complaint, Follow Up, State Licensure
9/14/2023


46V721
Recertification, Life Safety Code
8/14/2023


46V711
Recertification, Complaint, State Licensure
7/28/2023


I3I212
Complaint, Follow Up
4/10/2023


I3I211
Complaint
2/28/2023


YQ2W22
Recertification, Follow Up, Life Safety Code
11/2/2022


YQ2W12
Recertification, Complaint, Follow Up, State Licensure
10/18/2022


YQ2W21
Recertification, Life Safety Code
10/11/2022


YQ2W11
Recertification, Complaint, State Licensure
9/1/2022


Y5CT12
Complaint, Follow Up
6/28/2022


Y5CT11
Complaint
6/9/2022


22OI11
Complaint, Other
2/25/2022


W8Y811
Complaint, Other
2/7/2022


SOTS12
Complaint, Follow Up
1/24/2022


2YR911
Other
1/12/2022


SOTS11
Complaint
12/29/2021


JDV911
Complaint
11/23/2021


EMHP12
Complaint, Follow Up
11/4/2021


EMHP11
Complaint
10/8/2021


OR6L13
Recertification, Follow Up, State Licensure
9/7/2021


VGJG12
Complaint, Follow Up
9/7/2021


VGJG11
Complaint
8/5/2021


OR6L12
Recertification, Follow Up, State Licensure
8/5/2021


OR6L22
Recertification, Follow Up, Life Safety Code
7/15/2021


OR6L21
Recertification, Life Safety Code
6/21/2021


OR6L11
Recertification, State Licensure
6/11/2021


 
 


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.