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: 220 E DUNN RD
City: NEW CARLISLE
Telephone: (574) 654-7244
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 18-000527-1
License effective date: 06/01/2018
License expiration date: 05/31/2019
Administration and Staff
Administrator: JARRETT MITCHELL
Start date: 04/30/2018
Director of Nursing: KAREN SHOUP
Start date: 07/16/2017
Medical director: RALPH INABNIT
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: JOHNSON MEMORIAL HOSPITAL
1125 W JEFFERSON ST
FRANKLIN IN 46131
Ownership type: OTHER
Officer(s): GREGORY SPAULDING
LARRY HEYDON
STEVE WOHLFORD
ELIZABETH HEDDEN
SAUNDRA HUDDLESTON
STEVE JAROSINSKI
MICHAEL PAUSZEK
R MARTIN UMBARGER
JERRY ENGLE
R J MCCONNELL
ANITA KELLER (TRACKWELL)
TIMOTHY BALASIA
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: MILLER'S HEALTH SYSTEMS INC
Date of last change of ownership:
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 19
Number of Medicare/Medicaid beds (SNF/NF): 51
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 70
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 70
CENSUS:
Facility census: 58
As reported by the facility on: 01/02/2018
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/02/2018
Residential care beds occupied: 0
As reported by the facility on: 01/02/2018
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: 38
Number of comprehensive care resident rooms with battery
operated smoke detectors: 38
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - BRYAN ZEHR
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 02/08/2018
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 10/01/2013
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2019
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 07/11/2013
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
MILLER'S MERRY MANOR
Approved: 10/01/2013
Terminated: N/A
MILLER'S HEALTH & REHAB BY MILLER'S MERRY MANOR
Approved: 10/03/2014
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
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
No
Yes
No
Owner Change
No
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
No
Yes
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: DN5211
Action - Citation / Fine
Notice to facility: N/A
Appeal: N/A
Action Cease/Recind: N/A
Case Closed: 11/05/2009
Initial Amount: $3000
Event ID: BMKK21
Action - Citation / Fine
Notice to facility: 01/28/2004
Appeal: N/A
Action Cease/Recind: 12/19/2004
Case Closed: 12/19/2004
Initial Amount: $2500
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.
