Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
SKILLED CARING CENTER OF MEMORIAL HOSPITAL
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 11/15/2024
 
Posted to the Web on: 11/27/2024
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 800 W NINTH ST
City: JASPER
Telephone: (812) 482-0674
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 22-000202-1
  License effective date: 7/1/2022
  License expiration date: 6/30/2024
 


Administration and Staff

Administrator: 
  Start date: N/A
 
 
Medical director: Dean Beckman
  Start date:   /  /  
 
Wound care specialist: Nancy Salb
  Start date:   /  /  
 
Infection preventionist: Amy Weisman
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
N/A
N/A N/A N/A
 
Ownership type:  OTHER
 
Officer(s): GWEN WAGSTROM HALAAS
            SHARON ST MARY
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC
Date of last change of ownership:   /  /  
 


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):        14
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     14
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            14
 
CENSUS:
Facility census:  3
As reported by the facility on: 7/1/2024 1
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/1/2024 1
 
Residential care beds occupied:  0
As reported by the facility on: 7/1/2024 1
 
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: FULLY SPRINKLERED
 
Number of comprehensive care resident rooms: 14
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: 14
 
  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 - CHERYL WELP
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMIN
Date form completed - 3/21/2022
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/10/2005
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2009
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: 
     SERENITY SPRING SENIOR LIVING AT NORTHWOOD
         Approved: 10/6/1997
         Terminated: 4/1/2013
     SKILLED CARING CENTER OF MEMORIAL HOSPITAL
         Approved: 2/17/1997
         Terminated: N/A
     CNA TRAINING PROGRAM PATOKA VALLEY CTE COOPERATIVE
         Approved: 6/22/2016
         Terminated: N/A
     VINCENNES UNIVERSITY JASPER CAMPUS
         Approved: 8/31/2020
         Terminated: N/A
     VINCENNES UNIVERSITY-NURSING DEPARTMENT
         Approved: 3/23/2021
         Terminated: N/A
 


Complaints

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

 


Enforcement Actions

 
Federal Certification Actions Imposed
 
Date terminated from Medicare/Medicaid: 7/6/2024
 


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

JZE112
Recertification, Follow Up, State Licensure
6/23/2023


JZE122
Recertification, Follow Up, Life Safety Code
6/2/2023


JZE121
Recertification, Life Safety Code
5/22/2023


JZE111
Recertification, State Licensure
5/5/2023


Z6QG21
Recertification, Life Safety Code
7/6/2022


Z6QG11
Recertification, State Licensure
6/3/2022


 
 


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.