Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
CATHERINE KASPER HOME
 
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: 9601 S UNION RD
City: DONALDSON
Telephone: (574) 935-1742
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 18-002982-2
  License effective date: 03/15/2018
  License expiration date: 02/28/2019
 


Administration and Staff

Administrator: ROBERTA SCOTT
  Start date: 12/30/2017
 
Director of Nursing: THERESA RIGHTER
  Start date: 01/12/2018
 
Medical director: Byron Holm
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: WOODLAWN HOSPITAL
1400 E NINTH STREET
ROCHESTER IN 46975
 
Ownership type:  NON-PROFIT
 
Officer(s): NANCY DAY
            CHERYL MUSSELMAN
            STEVE FURNIVALL
            RICHARD BELCHER
            JOHN ALLEY
            JAMES MULLIGAN
            JIM STRAETER
            JOHN KRAFT
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: CATHERINE KASPER LIFE CENTER INC
Date of last change of ownership: 03/15/2018
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    32
Number of Medicare/Medicaid beds (SNF/NF):        50
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     82
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            82
 
CENSUS:
Facility census:  73
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:  0
As reported by the facility on: 01/03/2018
 
Alzheimer Beds:  9
Alzheimer Beds Occupied:  9
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: 81
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: 81
 
  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 - BRIAN P. DIXON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. FGS MANAGER
Date form completed - 02/15/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 03/07/2005
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2009
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: 
     CATHERINE KASPER HOME
         Approved: 03/07/2005
         Terminated: N/A
     ANCILLA COLLEGE
         Approved: 09/17/2012
         Terminated: N/A
     KNOX HIGH SCHOOL
         Approved: 09/19/2016
         Terminated: N/A
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  2
  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 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
Yes
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

 
Federal Certification Actions Imposed
     Civil Money Penalty
     Date Imposed: 07/17/2017  Date Ended: 07/17/2017
     Amount proposed per day: 0
     Amount proposed per day: 
 
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

KMW011
Complaint
05/18/2018


X3J612
Complaint, Follow Up
01/03/2018


DSK821
Life Safety Code, Other
01/03/2018


X3J611
Complaint
12/05/2017


4US511
Complaint
10/12/2017


C3XN22
Follow Up, Life Safety Code, Recertification
09/25/2017


C3XN12
Follow Up, Recertification, State Licensure
08/29/2017


FHQO12
Complaint, Follow Up
08/29/2017


C3XN21
Recertification, Life Safety Code
08/14/2017


FHQO11
Complaint
07/17/2017


C3XN11
Recertification, State Licensure
07/17/2017


1Q7L11
Complaint
02/14/2017


3RME11
Complaint
12/13/2016


4MUR22
Recertification, Follow Up, Life Safety Code
08/26/2016


4MUR12
Recertification, Follow Up, State Licensure
08/16/2016


HYD311
Complaint
08/05/2016


4MUR21
Life Safety Code, Recertification
07/19/2016


4MUR11
Recertification, State Licensure
06/21/2016


NIZX11
Complaint
05/09/2016


VSCR22
Follow Up, Life Safety Code, Recertification
10/07/2015


Q5O112
Complaint, Follow Up
10/07/2015


Q5O111
Complaint
08/19/2015


VSCR12
Recertification, Follow Up, State Licensure
07/16/2015


VSCR21
Recertification, Life Safety Code
06/30/2015


VSCR11
Recertification, State Licensure
06/09/2015


 
 


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.