Created on: 5/17/2024
Posted to the Web on: 5/29/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 34 SOUTH MAIN STREET
City: CLOVERDALE
Telephone: (765) 795-4260
Web Site:
NAME CHANGES:
Most recent name change: SUMMERFIELD HEALTH CARE CENTER
Date of most recent name change: 3/26/2024 3:04:35 PM
LICENSE INFORMATION:
License number: 23-000415-2
License effective date: 7/1/2023
License expiration date: 6/30/2024
Administration and Staff
Administrator: TASHEENA DUNCAN
Start date: 8/14/2017
Director of Nursing: MARGARET HAYNE
Start date: 7/1/2021
Medical director: Thomas Black
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: DAVIESS COUNTY HOSPITAL
1314 E WALNUT ST
WASHINGTON IN 47501
Ownership type: OTHER
Officer(s): SHELLY DEEM
DERON STEINER
TYSON WAGLER
RANDY RUSSELL
KENT NORRIS
SURESH LOHANO
ANTHONY SHOWALTER
DANIEL MCCARTHY
TRACY CONROY
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: PUTNAM COUNTY HOSPITAL
Date of last change of ownership: 7/1/2017
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): 43
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 43
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 43
CENSUS:
Facility census: 39
As reported by the facility on: 1/2/2024 3
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/2/2024 3
Residential care beds occupied: 0
As reported by the facility on: 1/2/2024 3
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: 25
Number of comprehensive care resident rooms with battery
operated smoke detectors: 1
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 24
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 - JIM BOLES
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DIRECTOR OF MAINTENA
Date form completed - 3/21/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/3/2005
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2007
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 7/8/2015
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
APERION CARE SUMMERFIELD
Approved: 11/3/2003
Terminated: 7/9/2013
ADVANCED HEALTHCARE TRAINING SERVICES
Approved: 8/5/2005
Terminated: 5/4/2007
BEN HUR HEALTH AND REHABILITATION
Approved: N/A
Terminated: 11/21/2005
AREA 30 CAREER CENTER
Approved: N/A
Terminated: 5/9/2002
QUALITY HEALTHCARE TRAINING INC
Approved: 12/23/2020
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
422
434
416
419
Rank of Score
18
12
20
18
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
No
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.
