Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
MANOR CARE HEALTH SERVICES SUMMER TRACE
 
NURSING HOME
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: 12999 N PENNSYLVANIA ST
City: CARMEL
Telephone: (317) 848-2448
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 18-001149-1
  License effective date: 01/01/2018
  License expiration date: 12/31/2018
 


Administration and Staff

Administrator: DAVID DUVALL
  Start date: 04/19/2017
 
Director of Nursing: ANNE RICOTTA
  Start date: 07/31/2017
 
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: MANOR CARE-SUMMER TRACE OF CARMEL IN LLC
Date of last change of ownership: 01/01/2016
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    72
Number of Medicare/Medicaid beds (SNF/NF):        32
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     104
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            90
 
Total number of beds in facility:            194
 
CENSUS:
Facility census:  113
As reported by the facility on: 02/09/2018
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 02/09/2018
 
Residential care beds occupied:  71
As reported by the facility on: 02/09/2018
 
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: 0
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 59
 
  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 - DAVID E. DUVALL
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 02/12/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:  
Nurse aide training and competency evaluation program (NATCEP) expires:  
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 06/20/2009
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     J EVERETT LIGHT CAREER CENTER
         Approved: 01/28/2005
         Terminated: 07/13/2006
     STAFFING AND EDUCATION FOR EXCELLENCE
         Approved: 07/28/1999
         Terminated: 07/13/2006
     MEDTECH COLLEGE-GREENWOOD CAMPUS
         Approved: 08/23/2012
         Terminated: N/A
     MEDTECH COLLEGE-INDIANAPOLIS CAMPUS
         Approved: 08/23/2012
         Terminated: N/A
     IVY TECH COMMUNITY COLLEGE
         Approved: 06/02/1999
         Terminated: 07/13/2006
     LEGACY CNA TRAINING, LLC
         Approved: 07/01/2016
         Terminated: N/A
 


Complaints

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

 


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
No
No
No


 Substandard Quality of Care 
No
No
No


Administrator Change
Yes
Yes
Yes


Owner Change
No
Yes
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: 3BTB11
  Action - Citation / Fine
  Notice to facility: 06/16/2014
             Appeal: N/A
  Action Cease/Recind: 07/10/2014
         Case Closed: 07/10/2014
  Initial Amount: $5000
Event ID: 0DCC11
  Action - Citation / Fine
  Notice to facility: 09/30/2013
             Appeal: N/A
  Action Cease/Recind: 10/17/2013
         Case Closed: 10/17/2013
  Initial Amount: $2000
Event ID: U93411
  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: OQ6511
  Action - Citation / Fine
  Notice to facility: N/A
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: 09/15/2008
  Initial Amount: $4000
Event ID: BQI011
  Notice to facility: 03/15/2007
             Appeal: N/A
  Action Cease/Recind: 06/22/2007
         Case Closed: 06/22/2007
  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

FINM22
Recertification, Follow Up, Life Safety Code
03/27/2018


FINM12
Recertification, Complaint, Follow Up, State Licensure
03/22/2018


FINM21
Recertification, Life Safety Code
02/28/2018


FINM11
Recertification, Complaint, State Licensure
02/07/2018


UJYG11
Complaint
07/26/2017


YG9O22
Follow Up, Life Safety Code, Recertification
05/10/2017


YG9O12
Recertification, Complaint, Follow Up, State Licensure
04/03/2017


YG9O21
Recertification, Life Safety Code
03/20/2017


YG9O11
Recertification, Complaint, State Licensure
02/28/2017


R1D112
Complaint, Follow Up
02/10/2017


14K012
Complaint, Follow Up
02/10/2017


R1D111
Complaint
01/10/2017


14K011
Complaint
12/19/2016


179611
Complaint
04/27/2016


32NZ22
Follow Up, Life Safety Code, Recertification
03/02/2016


EQO611
Complaint
01/15/2016


0CNO12
Complaint, Follow Up
01/15/2016


32NZ12
Follow Up, Recertification, State Licensure
01/15/2016


32NZ21
Life Safety Code, Recertification
01/05/2016


32NZ11
Recertification, State Licensure
12/10/2015


0CNO11
Complaint
11/20/2015


T72111
Complaint
09/15/2015


 
 


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.