Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
GOLDEN LIVING CENTER-KNOX
 
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: 300 E CULVER RD
City: KNOX
Telephone: (574) 772-6248
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 17-000088-1
  License effective date: 09/01/2017
  License expiration date: 08/31/2018
 


Administration and Staff

Administrator: COLLEEN FOLKERS
  Start date: 03/12/2013
 
Director of Nursing: DAWN BAUM
  Start date: 02/13/2018
 
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: KNOX 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):        57
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     57
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            57
 
CENSUS:
Facility census:  40
As reported by the facility on: 03/15/2018
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 03/15/2018
 
Residential care beds occupied:  0
As reported by the facility on: 03/15/2018
 
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: 29
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 29
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - COLLEEN W. FOLKERS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 02/15/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 02/21/2017
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2019
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: 11/16/2005
         Terminated: 10/04/2011
     GOLDEN LIVING TRAINING CENTER-VALPARAISO
         Approved: 01/29/2015
         Terminated: N/A
     KNOX COMUNITY HIGH SCHOOL
         Approved: N/A
         Terminated: N/A
     GOLDEN LIVING CENTER-KNOX
         Approved: 02/21/2017
         Terminated: N/A
 


Complaints

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

 


Facility Report Card



 
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   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
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

Event ID: FI8G11
  Notice to facility: 05/20/2002
             Appeal: 05/24/2002
  Action Cease/Recind: 08/30/2003
         Case Closed: 08/30/2003
  Initial Amount: $0
Event ID: 
  Notice to facility: N/A
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $0
 
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

4MVC22
Follow Up, Life Safety Code, Recertification
05/17/2018


4MVC12
Recertification, Follow Up, State Licensure
03/22/2018


4MVC21
Recertification, Life Safety Code
03/20/2018


4MVC11
Recertification, State Licensure
02/09/2018


7TO212
Complaint, Follow Up
09/18/2017


7TO211
Complaint
08/01/2017


UEH212
Complaint, Follow Up
04/17/2017


UEH211
Complaint
03/14/2017


FZVP22
Recertification, Follow Up, Life Safety Code
02/08/2017


FZVP12
Recertification, Follow Up, State Licensure
02/01/2017


FZVP21
Recertification, Life Safety Code
01/24/2017


FZVP11
Recertification, State Licensure
12/30/2016


QH2D22
Follow Up, Life Safety Code, Recertification
12/31/2015


QH2D12
Complaint, Follow Up, Recertification, State Licensure
12/07/2015


QH2D21
Life Safety Code, Recertification
11/10/2015


QH2D11
Recertification, Complaint, State Licensure
11/02/2015


22UO11
Complaint
10/30/2015


M27E11
Complaint
07/08/2015


G3YU12
Complaint, Follow Up
06/30/2015


 
 


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
   
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