Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

SOUTH SHORE HEALTH & REHABILITATION CENTER

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: 353 TYLER ST City: GARY Telephone: (219) 886-7070 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 24-000369-1 License effective date: 1/1/2024 License expiration date: 12/31/2024
Administration and Staff
Administrator: PHILIP BIRN Start date: 2/2/2022 Director of Nursing: CAITLIN SANDERS Start date: 1/8/2024 Medical director: Asad Zaman Start date: / / Wound care specialist: Tiara Smalley Start date: / / Infection preventionist: Start date: / /
Ownership
CURENT OWNERSHIP: Owning corporation: PULASKI MEMORIAL HOSPITAL 616 E 13TH STREET WINAMAC IN 46996 Ownership type: NON-PROFIT Officer(s): MICHAEL MCKAY VALERIE LEMAN LINDA WEBB CHARLES HUTTON GREGG MALOTT CLINT KAUFFMAN STEVE JAROSINSKI ADAM BENNETT JENNIFER SMITH CAITLIN BARRY TAYLOR WHITE PREVIOUS OWNERSHIP CHANGES: Name of previous owner: DECATUR COUNTY MEMORIAL HOSPITAL Date of last change of ownership: 1/1/2024
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): 100 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 100 RESIDENTIAL CARE BEDS: Total number of residential beds: 0 Total number of beds in facility: 100 CENSUS: Facility census: 84 As reported by the facility on: 8/18/2023 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 8/18/2023 Residential care beds occupied: 0 As reported by the facility on: 8/18/2023 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: 47 Number of comprehensive care resident rooms with battery operated smoke detectors: 47 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - PHILIP M, BIRN Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ED Date form completed - 3/14/2022
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: Yes Nurse aide training and competency evaluation program (NATCEP) ban expires: 9/22/2020 CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: NORTHWEST INDIANA INSTITUTE Approved: 11/13/2008 Terminated: 6/2/2011 MED ED INCORPORATED Approved: 7/12/2004 Terminated: 6/19/2006 GERIC HOME HEALTH CARE INC Approved: 6/19/1998 Terminated: 4/4/2002 IN TRAINING COLLEGE OF ADULT EDUCATION Approved: 8/23/1999 Terminated: 6/19/2006 JASMINE HOME CARE TRAINING PROGRAM, LLC Approved: 9/21/2021 Terminated: N/A GARY AREA CAREER CENTER Approved: 2/25/2005 Terminated: 6/19/2006 OLYMPIA COLLEGE Approved: 6/30/1997 Terminated: 4/4/2002 IVY TECH STATE COLLEGE NORTHWEST Approved: 3/21/1997 Terminated: 4/4/2002 HEALTHCARE TRAINING CENTER Approved: 4/11/2014 Terminated: 1/29/2014 AMBASSADOR NURSES AIDE TRAINING Approved: 5/9/2014 Terminated: 1/29/2014 ALR EDUCATIONAL HEALTH SERVICES, INC Approved: 11/30/2020 Terminated: N/A HEALTHCARE TRAINING SOLUTIONS Approved: 12/6/2021 Terminated: N/A DESTINATION UNLIMITED TRAINING CENTER Approved: 6/20/2022 Terminated: N/A TRAVAIL WITH US LLC Approved: 1/23/2023 Terminated: N/A HEALTH DYNAMICS Approved: 4/28/2023 Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  4
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 171 171 132 159
Rank of Score 93 92 95 94
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 Yes Yes
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 Directed Plan of Correction Date Imposed: 6/23/2022 Date Ended: 7/19/2022 Directed Plan of Correction Date Imposed: 12/31/2021 Date Ended: 1/12/2022 Civil Money Penalty Date Imposed: 12/9/2021 Date Ended: 12/9/2021 Amount proposed per day: Civil Money Penalty Date Imposed: 11/15/2021 Date Ended: 11/15/2021 Amount proposed per day: 1000 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
TIVH12 Complaint, Follow Up 2/27/2024
3VF011 Complaint 2/12/2024
TIVH11 Complaint, Other 1/30/2024
JOFF11 Complaint 12/5/2023
ZZPV12 Complaint, Follow Up 12/5/2023
ZZPV11 Complaint 9/28/2023
Z80G22 Recertification, Follow Up, Life Safety Code 8/24/2023
Z80G12 Recertification, Complaint, Follow Up, State Licensure 8/3/2023
Z80G21 Recertification, Life Safety Code 7/10/2023
Z80G11 Recertification, Complaint, State Licensure 6/9/2023
C8LB12 Complaint, Follow Up 4/25/2023
C8LB11 Complaint 3/1/2023
M6ZZ12 Complaint, Follow Up 10/21/2022
M6ZZ11 Complaint 9/15/2022
YQE222 Recertification, Follow Up, Life Safety Code 8/9/2022
YQE212 Recertification, Follow Up, State Licensure 7/19/2022
1TDJ11 Complaint 7/19/2022
YQE221 Recertification, Life Safety Code 7/5/2022
YQE211 Recertification, State Licensure 5/31/2022
KKB512 Complaint, Follow Up 5/5/2022
KKB511 Complaint, Other 4/8/2022
1PWR11 Complaint 3/23/2022
RG1311 Complaint, Other 2/15/2022
KK0Y12 Complaint, Follow Up 1/24/2022
2XG312 Follow Up, Other 1/6/2022
KK0Y11 Complaint 1/6/2022
2XG311 Complaint, Other 12/9/2021
2RGV11 Other 10/22/2021
3JU612 Complaint, Follow Up 8/16/2021
3JU611 Complaint 7/12/2021
 
 
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.