Created on: 06/08/2018
Posted to the Web on: 06/20/2018
Basic Information
FACILITY CONTACT INFORMATION:
Address: 2860 CHURCHMAN AVE
City: INDIANAPOLIS
Telephone: (317) 787-3451
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 17-000063-1
License effective date: 09/01/2017
License expiration date: 08/31/2018
Administration and Staff
Administrator: GOODWELL CHAVUNDUKA
Start date: 04/15/2017
Director of Nursing: DONNA MCCORMICK
Start date: 08/15/2015
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HENDRICKS COUNTY HOSPITAL
1000 EAST MAIN STREET
DANVILLE IN 46122
Ownership type: OTHER
Officer(s): KEVIN SPEER
TERRY DILLON
MIKE EDMONDSON
ERIN ENGELS
YVONNE CULPEPPER
DENNIS RESSLER
WESLEY ROGERS
TINA CHAVIS
LARRY JOSEPH
SALVATORE SALAMONE
HOLLY RASMUSSAN-JONES
ANN TRUITT
GREG SWARTZ
ROBERTA WILLIAMS
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: INDIANAPOLIS OPERATING LLC
Date of last change of ownership: 09/01/2012
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): 115
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 115
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 115
CENSUS:
Facility census: 63
As reported by the facility on: 05/24/2018
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 05/24/2018
Residential care beds occupied: 0
As reported by the facility on: 05/24/2018
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: 59
Number of comprehensive care resident rooms with battery
operated smoke detectors: 59
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - GOODWELL CHAVUNDWKA
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECTUTIVE DIRECTOR
Date form completed - 02/23/2018
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 07/26/2002
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2004
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 12/08/2012
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
NURSE AIDE TRAINING CENTER INC
Approved: 10/20/2005
Terminated: 08/22/2006
BENCHMARQ MEDICAL EDUCATION,INC
Approved: 08/10/2006
Terminated: 08/22/2006
HEALTH CARE INSTITUTE
Approved: 02/10/1998
Terminated: 08/22/2006
IVY TECH COMMUNITY COLLEGE
Approved: 09/21/1999
Terminated: 08/22/2006
GOLDEN LIVING TRAINING CENTER
Approved: 05/07/2015
Terminated: N/A
GOLDEN LIVING CENTER-BROOKVIEW
Approved: 12/23/1996
Terminated: 06/28/2006
GOLDEN LIVING CENTER-INDIANAPOLIS
Approved: 05/18/1998
Terminated: 12/09/2010
HARCOURT TERRACE NURSING AND REHABILITATION
Approved: 03/10/1998
Terminated: 08/22/2006
GOLDEN LIVING TRAINING CENTER
Approved: 01/10/2013
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 3
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 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
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
Federal Certification Actions Imposed
Civil Money Penalty
Date Imposed: 08/24/2017 Date Ended: 08/24/2017
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.
