SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 9/6/2024
Posted to the Web on: 9/18/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 503 OTIS R BOWEN DR
City: MUNSTER
Telephone: (219) 934-0590
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-010758-1
License effective date: 2/1/2024
License expiration date: 1/31/2025
Administration and Staff
Administrator: SUSAN SEYDEL
Start date: 6/20/2014
Director of Nursing: ANNE DEEDRICK
Start date: 11/15/2020
Medical director: AHMED SHARIF
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist: Anne Deedrick
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: COMMUNITY VILLAGE INC
907 RIDGE RD
MUNSTER IN 46321
Ownership type: NON-PROFIT
Officer(s): FRANKIE FESKO
RICHARD SCHUMACHER
DONALD TORRENGA
DONALD FESKO
LESLIE DARROW
JOHN DUNN
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): 96
Number of Medicare/Medicaid beds (SNF/NF): 16
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 112
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 112
CENSUS:
Facility census: 99
As reported by the facility on: 7/22/2024
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/22/2024
Residential care beds occupied: 0
As reported by the facility on: 7/22/2024
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: 83
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: 83
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 - SUSAN SEYDEL
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 4/6/2022
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: 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:
MED ED INCORPORATED
Approved: 6/30/2004
Terminated: 10/4/2011
HEALTH PRO STAFFING, INC
Approved: 9/20/2004
Terminated: N/A
PURDUE UNIV CALUMET/RESOURCE CENTER
Approved: 10/20/1999
Terminated: N/A
CADECEUS MEDICAL SCHOOL
Approved: 9/3/2000
Terminated: 5/5/2021
SPECIALIZED MEDICAL EDUCATION AND TRAINING
Approved: 3/22/2001
Terminated: N/A
EVEREST COLLEGE
Approved: 6/6/2013
Terminated: 5/6/2021
AREA CAREER CENTER-HAMMOND
Approved: 4/24/2012
Terminated: N/A
DIXIE MEDICAL EDUCATION TRAINING
Approved: 8/27/2012
Terminated: 5/6/2021
THE COMMUNITY HOSPITAL
Approved: 6/22/2017
Terminated: N/A
DESTINATION UNLIMITED TRAINING CENTER
Approved: 10/1/2021
Terminated: N/A
MERRILLVILLE HIGH SCHOOL
Approved: 8/15/2022
Terminated: N/A
IVY TECH COMMUNITY COLLEGE-LAKE COUNTY
Approved: 7/10/2024
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
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
338
335
359
359
Rank of Score
55
55
48
48
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 gridView 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
Directed Plan of Correction
Date Imposed: 4/8/2023 Date Ended: 3/31/2023
Directed Plan of Correction
Date Imposed: 1/28/2022 Date Ended: 1/23/2022
Civil Money Penalty
Date Imposed: 1/3/2022 Date Ended: 1/3/2022
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.
