Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 1620 N LINCOLN ST
City: GREENSBURG
Telephone: (812) 663-7503
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 23-000244-1
License effective date: 8/1/2023
License expiration date: 7/31/2024
Administration and Staff
Administrator: BROOKE ANNE THIES
Start date: 12/28/2022
Director of Nursing: LINDA M YOUNG
Start date: 3/18/2022
Medical director: Nicole Boersma
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HENRY COUNTY MEMORIAL HOSPITAL
798 NORTH 16TH ST
NEW CASTLE IN 47362
Ownership type: OTHER
Officer(s): STEVEN VAN CAMP
JOHN PIDGEON
SHELDON DYNES
PAUL JANSSEN
BENJAMIN FRENCH
DEBI WARE
BUD SHORE
DARIN BROWN
BRIANNA CHAPMAN
SCOTT KOONTZ
KYLE SIEWERT
DUKE HAMM
JANA LUELLEN
TODD MYERS
BRENDA WILKINSON
NATHAN RICH
DEBBIE MARGISON
JOSH ESTELLE
WYLIE MCGLOTHLIN
JOEL HARVEY
DAVE WEIMER
VANESSA TUCKER
BRIAN RING
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: HICKORY CREEK HEALTHCARE FOUNDATION INC
Date of last change of ownership: 8/1/2013
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): 36
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 36
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 36
CENSUS:
Facility census: 28
As reported by the facility on: 1/13/2022
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/13/2022
Residential care beds occupied: 0
As reported by the facility on: 1/13/2022
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: 18
Number of comprehensive care resident rooms with battery
operated smoke detectors: 18
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - RICHARD HENDERICKSON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINT DIR
Date form completed - 4/7/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/22/2002
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2004
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 9/20/2020
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
HICKORY CREEK AT NEW CASTLE
Approved: 2/21/2002
Terminated: 5/30/2002
HICKORY CREEK AT FRANKLIN
Approved: 6/5/2001
Terminated: 5/30/2002
Approved: 4/24/1998
Terminated: 5/30/2002
INDIANA HEALTHCARE PROFESSIONALS LLC
Approved: 6/4/2010
Terminated: 7/15/2016
HICKORY CREEK AT COLUMBUS
Approved: 3/4/2003
Terminated: 5/30/2002
WHITEWATER CAREER CENTER
Approved: 12/2/2014
Terminated: 7/15/2016
ASC TRAINING CENTER
Approved: 10/1/2021
Terminated: N/A
SOUTHEASTERN CAREER CENTER
Approved: 3/8/2023
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
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
396
366
366
372
Rank of Score
29
43
45
44
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
Yes
Substandard Quality of Care
No
No
Yes
Administrator Change
Yes
Yes
No
Owner Change
No
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
No
No
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
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.