SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 06/08/2018
Posted to the Web on: 06/20/2018
Basic Information
FACILITY CONTACT INFORMATION:
Address: 3400 STOCKER DR
City: EVANSVILLE
Telephone: (812) 424-8100
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 18-000442-1
License effective date: 04/01/2018
License expiration date: 03/31/2019
Administration and Staff
Administrator: RACHEL MOLT
Start date: 09/05/2017
Director of Nursing: GLEN DAVID KILLION
Start date: 08/21/2017
Medical director: William Sutton
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: DEARBORN COUNTY HOSPITAL
600 WILSON CREEK RD
DEARBORN IN 47025
Ownership type: OTHER
Officer(s): ALBERT KEN INGRAM
ROBERT SCHROEDER
RONALD DENNEY
CARL PETTY
BETTY BISCHOFF
WILLIAM RITZMANN
ROBERT MOORHEAD
MICHAEL SCHWEBLER
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: CBH II INC
Date of last change of ownership: 04/01/2014
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 31
Number of Medicare/Medicaid beds (SNF/NF): 82
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 113
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 113
CENSUS:
Facility census: 84
As reported by the facility on: 01/29/2018
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/29/2018
Residential care beds occupied: 0
As reported by the facility on: 01/29/2018
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: 70
Number of comprehensive care resident rooms with battery
operated smoke detectors: 37
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 33
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 - RACHEL MOLT
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 02/16/2018
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 03/13/2001
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2003
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 11/29/2018
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
IVY TECH COMMUNITY COLLEGE
Approved: 03/26/2002
Terminated: 06/25/2009
SIGNATURE HIGH SCHOOL LEARNING CENTER
Approved: 10/14/1998
Terminated: 06/25/2009
PINE HAVEN HEALTH AND REHABILITATION CENTER
Approved: 05/20/1997
Terminated: 06/25/2009
VISITING NURSE PLUS
Approved: N/A
Terminated: 06/25/2009
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 2
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 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
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
Discretionary Deny Pay for New Admits
Date Imposed: 07/25/2018 Date Ended: Still in effect
Civil Money Penalty
Date Imposed: 07/26/2016 Date Ended: 09/22/2016
Amount proposed per day: 703
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.
