Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
MEADOWOOD HEALTH PAVILION
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 12/3/2021
 
Posted to the Web on: 12/15/2021
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 2455 TAMARACK TRAIL
City: BLOOMINGTON
Telephone: (812) 336-7060
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 21-000156-1
  License effective date: 1/1/2021
  License expiration date: 12/31/2021
 


Administration and Staff

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


Ownership

CURENT OWNERSHIP:
 
Owning corporation: SNH INDY TENANT LLC
N/A
N/A N/A N/A
 
Ownership type:  OTHER
 
Officer(s): VERNON  RICHARD MILLER
            R JAMES MILLER
            BARBARA MILLER
            BEVERLY MARSHALL
            PATRICK BOYLE
            LORI HAUG
            TINA ROBINSON
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: SNH INDY TENANT LLC
Date of last change of ownership:   /  /  
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    56
Number of Medicare/Medicaid beds (SNF/NF):        10
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     66
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            66
 
CENSUS:
Facility census:  31
As reported by the facility on: 12/4/2020 
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 12/4/2020 
 
Residential care beds occupied:  0
As reported by the facility on: 12/4/2020 
 
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:  
 
Number of comprehensive care resident rooms: 45
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 23
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 22
 
  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 - LARRY DIERSING
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 2/20/2020
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 10/20/2020
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2022
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: 
     IVY TECH STATE COLLEGE
         Approved: 11/21/1996
         Terminated: 11/14/2008
     BLOOMINGTON HOSPITAL - SUBACUT
         Approved: 2/20/1997
         Terminated: 11/14/2008
     AMERICAN RED CROSS
         Approved: 2/5/1999
         Terminated: 11/14/2008
     BLOOMINGTON HOSPITAL AND HEALTHCARE SYSTEMS
         Approved: 5/28/1999
         Terminated: 11/14/2008
     IVY TECH COMMUNITY COLLEGE
         Approved: 8/11/2015
         Terminated: N/A
     MEADOWOOD HEALTH PAVILION
         Approved: 10/20/2020
         Terminated: N/A
 


Complaints

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

 


Enforcement Actions

 
Federal Certification Actions Imposed
     Civil Money Penalty
     Date Imposed: 5/10/2021  Date Ended: 5/10/2021
     Amount proposed per day: 1000
 
Date terminated from Medicare/Medicaid: 6/15/2021
 


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

1ZO611
Other
2/8/2021


JG2E11
Complaint
2/2/2021


NTDJ11
Complaint, Other
1/8/2021


IBQC11
Other
12/9/2020


DS2311
Other
11/20/2020


UWTQ11
Other
10/21/2020


8HOU11
Complaint
9/9/2020


3LXM11
Other
8/4/2020


YLTN11
Other
6/15/2020


EUUP12
Complaint, Follow Up
5/13/2020


EUUP11
Complaint
3/11/2020


PB2K22
Recertification, Follow Up, Life Safety Code
12/6/2019


PB2K21
Recertification, Life Safety Code
10/15/2019


PB2K12
Recertification, Follow Up, State Licensure
9/27/2019


PB2K11
Recertification, State Licensure
8/28/2019


66JU11
Complaint
7/2/2019


D77Y11
Complaint
4/25/2019


6MG011
Complaint
3/14/2019


FH9922
Recertification, Follow Up, Life Safety Code
12/14/2018


 
 


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.