Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
SANCTUARY AT ST PAUL'S
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 09/27/2019
 
Posted to the Web on: 10/09/2019
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 3602 S IRONWOOD DR
City: SOUTH BEND
Telephone: (574) 284-9000
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 18-000104-2
  License effective date: 08/01/2018
  License expiration date: 07/31/2019
 


Administration and Staff

Administrator: 
  Start date: N/A
 
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: ADAMS COUNTY MEMORIAL HOSPITAL
N/A
N/A N/A N/A
 
Ownership type:  OTHER
 
Officer(s): STEPHEN MOORE
            DANIEL MOORE
            DAVID MOORE
            KATHY HEADLEY
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: ADAMS COUNTY MEMORIAL HOSPITAL
Date of last change of ownership:   /  /  
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    13
Number of Medicare/Medicaid beds (SNF/NF):        65
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     78
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            157
 
Total number of beds in facility:            235
 
CENSUS:
Facility census:  184
As reported by the facility on: 01/16/2019
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/16/2019
 
Residential care beds occupied:  116
As reported by the facility on: 01/16/2019
 
Alzheimer Beds:  16
Alzheimer Beds Occupied:  16
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: 40
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 40
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - ANTHONY BROWN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ENVIRONMENTAL SERVIC
Date form completed - 03/07/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 03/23/2006
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2014
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: 
     SANCTUARY AT ST PAUL'S
         Approved: 05/11/2004
         Terminated: N/A
     HOLY CROSS CARE SERVICES
         Approved: 03/11/1998
         Terminated: N/A
     MICHIANA HEALTHCARE TRAINING INC
         Approved: 07/21/2000
         Terminated: N/A
     SANCTUARY AT HOLY CROSS
         Approved: 02/26/1996
         Terminated: 08/16/2008
     HAMILTON SCHOOL - HEALTH OCCUPATIONS
         Approved: 01/30/1996
         Terminated: N/A
     LEGACY CNA TRAINING, LLC
         Approved: 12/10/2013
         Terminated: N/A
     HARTZ CNA TRAINING CENTER
         Approved: 12/12/2014
         Terminated: N/A
     ELKHART AREA CAREER CENTER-HEALTH
         Approved: 08/13/2012
         Terminated: N/A
     IVY TECH COMMUNITY COLLEGE NORTH-CENTRAL
         Approved: 01/06/2015
         Terminated: N/A
     PREMIER NURSING ACADEMY
         Approved: 05/31/2018
         Terminated: N/A
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  1
  2 years previous:  1

 


Enforcement Actions

Event ID: MZTG11
  Action - Citation / Fine
  Notice to facility: 02/25/2019
             Appeal: N/A
  Action Cease/Recind: 03/14/2019
         Case Closed: 03/14/2019
  Initial Amount: $2500
 
Federal Certification Actions Imposed
 
Date terminated from Medicare/Medicaid: 04/01/2019
 


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

C3TE11
Complaint
03/07/2019


CTKO11
Complaint
03/05/2019


EAWQ11
Complaint
01/03/2019


MZTG11
Complaint
10/30/2018


FHZG11
Complaint
10/16/2018


YU6M12
Recertification, Follow Up, State Licensure
05/17/2018


YU6M22
Recertification, Follow Up, Life Safety Code
05/15/2018


W6Q011
Complaint
05/10/2018


YU6M21
Recertification, Life Safety Code
04/26/2018


YU6M11
Recertification, Complaint, State Licensure
04/17/2018


1LDX11
Complaint
02/22/2018


DM0W12
Complaint, Follow Up
07/10/2017


DM0W11
Complaint
06/08/2017


GV0322
Recertification, Follow Up, Life Safety Code
06/01/2017


GV0312
Recertification, Follow Up, State Licensure
05/24/2017


GV0321
Recertification, Life Safety Code
05/15/2017


JN0S11
Complaint
03/03/2017


JQYB11
Complaint
11/28/2016


 
 


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.