SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 1900 JEANWOOD DR
City: ELKHART
Telephone: (574) 264-1133
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 23-000169-1
License effective date: 11/1/2023
License expiration date: 10/31/2024
Administration and Staff
Administrator: MCKENZIE DAVIS HARRIS
Start date: 6/27/2022
Director of Nursing: ELLENI BEHM
Start date: 11/27/2022
Medical director: Alan Bierlien
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist: Annette Trigg
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
3838 N RURAL ST
INDIANAPOLIS IN 46205
Ownership type: OTHER
Officer(s): GREGORY FEHRIBACH
CHARLES EBERHARDT II
CARL DRUMMER
SHELIA GUENIN
TED NOLTING
PAUL BABCOCK
ROBERT LAZARD
GEETA MANTRAVADI
MONICA CRAIN
BEVERLY MUKES-GAITHER
THOMAS HANIFY
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: EAST LAKE NURSING AND REHABILITATION CENTER LLC
Date of last change of ownership: 1/1/2007
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 12
Number of Medicare/Medicaid beds (SNF/NF): 140
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 152
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 152
CENSUS:
Facility census: 79
As reported by the facility on: 1/11/2022
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/11/2022
Residential care beds occupied: 0
As reported by the facility on: 1/11/2022
Alzheimer Beds: 24
Alzheimer Beds Occupied: 24
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: 78
Number of comprehensive care resident rooms with battery
operated smoke detectors: 78
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 78
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 - CALEY NIXON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ED
Date form completed - 3/8/2021
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 6/20/2018
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2020
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 2/17/2021
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
MED ED INCORPORATED
Approved: 6/28/2006
Terminated: 7/20/2006
EAST LAKE NURSING & REHABILITATION CENTER
Approved: 6/20/2018
Terminated: 2/18/2019
ELKHART AREA CAREER CENTER-HEALTH
Approved: 8/21/2013
Terminated: 2/18/2019
TRAILPOINT VILLAGE
Approved: 6/20/2018
Terminated: 2/18/2019
PREMIER NURSING ACADEMY
Approved: 10/27/2017
Terminated: 2/18/2019
IVY TECH COMMUNITY COLLEGE NORTH-CENTRAL
Approved: 1/26/2018
Terminated: 2/18/2019
ASC TRAINING CENTER
Approved: 11/18/2020
Terminated: N/A
EXCEL CNA AND QMA TRAINING CENTER
Approved: 5/7/2021
Terminated: N/A
LEFFLER ACADEMY, LLC
Approved: 5/10/2021
Terminated: N/A
LEGACY CNA TRAINING, LLC
Approved: 2/2/2021
Terminated: N/A
HOOSIER HEALTHCARE TRAINING CENTER, LLC
Approved: 4/21/2021
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 1
Facility Report Card
3/1/2020 Current QTR
12/1/2019 Previous QTR
9/1/2019 Previous QTR
6/1/2019 Previous QTR
Report Card Score
276
276
290
162
Rank of Score
77
79
75
94
Average Score
302
296
295
296
*Facility report card scores have not been updated since March 1, 2020 due to changes in the survey process during the ongoing COVID-19 pandemic.
The facility report card score is calculated four times per calendar year
for the two most recent nursing home health surveys. The facility report card score
also includes all complaint surveys, life safety code surveys, emergency preparedness surveys,
and any follow-up surveys that occur within the two most recent nursing home health surveys.
The facility report card score ranges from 500 to 0, with 500 being the best score possible.
View the Scope and Severity gridView 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
Yes
Owner Change
No
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
No
Yes
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
Directed Plan of Correction
Date Imposed: 12/31/2021 Date Ended: 12/26/2021
Civil Money Penalty
Date Imposed: 12/6/2021 Date Ended: 12/6/2021
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.
