Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
HANOVER NURSING CENTER
 
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: 410 W LAGRANGE RD
City: HANOVER
Telephone: (812) 866-2625
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 18-000115-1
  License effective date: 04/01/2018
  License expiration date: 03/31/2019
 


Administration and Staff

Administrator: MARKIETTA BURNS
  Start date: 02/21/2018
 
Director of Nursing: CARRIE LEACH
  Start date: 01/26/2018
 
Medical director: Mark Totten
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: DAVIESS COUNTY HOSPITAL
1314 E WALNUT ST
WASHINGTON IN 47501
 
Ownership type:  NON-PROFIT
 
Officer(s): ANTHONY SHOWALTER
            SHELLY DEEM
            DERON STEINER
            DANIEL MCCARTHY, M.D.
            STEVE MYERS
            TYSON WAGLER
            MICHAEL TAYLOR
            NATHAN GABHART
            DOUG ROBERTS
            CARA VEALE
            TINA DURNIL
            TOM MCCRACKEN
            TRACY CONROY
            AMANDA RODEWALD
            RANDY RUSSELL
            NANCY CASE
            KEITH MILLER
            JEFF SAUNDERS
            RICK ELMON
            GARY BRINLEY
            RODNEY MANN
            CARL CULMANN
            RANDALL HAMMOND
            WILLIAM REINERS
            ROBERT HEUCHAN
            LORETTA RIEHL
            RONALD BUSKIRK
            RICHARD LENTZ
            PAUL ST PIERRE
            JERALD MILLER
            JEFFREY ZARING
            WILLIAM LUDLOW
            DENNIS SHEETS
            JAMES CASH
            JAMES ROWINGS
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: BOARD OF TRUSTEES OF THE FLAVIUS J WITHAM MEMORIAL
Date of last change of ownership: 04/01/2018
 


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):        125
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     125
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            12
 
Total number of beds in facility:            137
 
CENSUS:
Facility census:  63
As reported by the facility on: 01/03/2018
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/03/2018
 
Residential care beds occupied:  8
As reported by the facility on: 01/03/2018
 
Alzheimer Beds:  32
Alzheimer Beds Occupied:  21
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: 65
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 65
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 65
 
  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 - MARKIETTA BURNS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINSTRATOR
Date form completed - 04/17/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 01/13/2016
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2018
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 01/23/2020
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     INDIANA HEALTHCARE PROFESSIONALS LLC
         Approved: 11/12/2009
         Terminated: 01/24/2018
     SOUTHEASTERN CAREER CENTER
         Approved: 03/27/2012
         Terminated: 01/24/2018
     IVY TECH COMMUNITY COLLEGE
         Approved: 03/18/2010
         Terminated: 01/24/2018
     HANOVER NURSING CENTER
         Approved: 01/13/2016
         Terminated: 01/24/2018
     TRI-STATE HEALTH CARE TRAINING CENTER, LLC
         Approved: 09/22/2014
         Terminated: 01/24/2018
     INDIANA HEALTH CAREERS VOCATIONAL TRAINING &  TEST
         Approved: 03/17/2015
         Terminated: 01/24/2018
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  1
  Previous year:  2
  2 years previous:  2

 


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 grid
 
View the scoring methodology
 



Overview of Survey findings




 
 The Most Recent Set
 2ND Most Recent Set
 3RD Most Recent Set

Immediate Jeopardy
Yes
No
No


 Substandard Quality of Care 
Yes
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

Event ID: LH3G11
  Action - Emergency order ban on admissions
  Notice to facility: 09/23/2005
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $0
Event ID: LH3G11
  Action - Emergency order placement of monitor
  Notice to facility: 09/23/2005
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $0
Event ID: LH3G11
  Notice to facility: 09/23/2005
             Appeal: N/A
  Action Cease/Recind: 07/24/2006
         Case Closed: 07/24/2006
  Initial Amount: $0
Event ID: 3H8I11
  Action - Citation / Fine
  Notice to facility: 05/18/2004
             Appeal: N/A
  Action Cease/Recind: 12/19/2004
         Case Closed: 12/19/2004
  Initial Amount: $2250
Event ID: 
  Action - Citation / Fine
  Notice to facility: 04/30/1999
             Appeal: 05/21/1999
  Action Cease/Recind: 02/03/2000
         Case Closed: N/A
  Initial Amount: $3500
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

VLZT11
Complaint
05/30/2018


22GY12
Complaint, Follow Up
05/15/2018


3FF311
Complaint
05/15/2018


1EVQ22
Follow Up, Life Safety Code, Recertification
04/19/2018


22GY11
Complaint
03/29/2018


1EVQ21
Recertification, Life Safety Code
03/14/2018


1VAQ12
Complaint, Follow Up
03/08/2018


1EVQ12
Follow Up, Recertification, State Licensure
03/08/2018


1VAQ11
Complaint
02/23/2018


1EVQ11
Recertification, State Licensure
01/24/2018


Z0BU12
Complaint, Follow Up
01/10/2018


Z0BU11
Complaint
12/06/2017


XO1011
Complaint
08/15/2017


L0HY11
Complaint
06/14/2017


RMVD11
Complaint
05/03/2017


XJ9G22
Follow Up, Life Safety Code, Recertification
04/27/2017


XJ9G12
Follow Up, Recertification, State Licensure
03/31/2017


XJ9G21
Recertification, Life Safety Code
03/20/2017


XJ9G11
Recertification, State Licensure
02/15/2017


91BY12
Complaint, Follow Up
12/12/2016


91BY11
Complaint
11/29/2016


D61F11
Complaint
11/02/2016


ENF522
Recertification, Follow Up, Life Safety Code
03/16/2016


ENF512
Follow Up, Recertification, State Licensure
03/11/2016


ENF521
Life Safety Code, Recertification
02/16/2016


ENF511
Recertification, State Licensure
01/15/2016


RWO211
Complaint
11/23/2015


6IDL11
Complaint
09/30/2015


XX4O11
Complaint
09/14/2015


 
 


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
   
Legal Disclaimer for Long Term Care Reports.