Created on: 06/08/2018
Posted to the Web on: 06/20/2018
Basic Information
FACILITY CONTACT INFORMATION:
Address: 5865 SUGAR LN
City: PLAINFIELD
Telephone: (317) 839-7900
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 17-012394-1
License effective date: 12/01/2017
License expiration date: 11/30/2018
Administration and Staff
Administrator: JACQUELINE MULLINS
Start date: 04/12/2016
Director of Nursing: TRISHA LYNN ABDON
Start date: 04/12/2016
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: CSL PLAINFIELD LLC
14160 DALLAS PARKWAY, STE 300
DALLAS TX 75254
Ownership type: PROFIT
Officer(s): KEVIN WILBUR
GLORIA HOLLAND
DAVID BEATHARD
JOSEPH SOLARI
DAN KENYON
ROBERT HOLLISTER
MICHAEL W SCHUMACHER
JANA MILLER
LISA HOLLOWAY
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: SUGAR GROVE RETIREMENT COMMUNITY
Date of last change of ownership: 12/24/2013
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): 0
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 164
Total number of beds in facility: 164
CENSUS:
Facility census: 110
As reported by the facility on: 02/08/2018
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 02/08/2018
Residential care beds occupied: 110
As reported by the facility on: 02/08/2018
Alzheimer Beds: 40
Alzheimer Beds Occupied: 20
As reported by the facility on: / /
Ventilator Beds: 0
Ventilator Beds Occupied: 0
As reported by the facility on: / /
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 12/01/2017
Nurse aide training and competency evaluation program (NATCEP) expires: 11/30/2018
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:
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 2
2 years previous: 1
State Licensure Surveys
The ISDH conducts a state licensure survey at each licensed residential facility
approximately once per year. If state findings are cited on a survey, the
residential facility may be requested by the ISDH to complete a plan of
correction on how and when they will correct each state finding and who will be
responsible to ensure the corrections are made and will not reoccur in the future.
The plan of correction is generally submitted by the residential facility and
reviewed by the ISDH within fifteen (15) days of the survey.
To read an overview of the survey process, click hereNOTE:
The residential consumer report survey information begins with surveys that
have been completed on or after December 1, 2008. Any survey performed prior
to that date will not have any information in the state findings count rows or
columns or will show zero.
11/30/2017 Most Recent
10/21/2016 2nd Most Recent
10/20/2015 3rd Most Recent
Number of state findings
2
2
0
State Average for the year of the survey (rounded to nearest whole integer).
