Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 3625 ST JOSEPH RD
City: NEW ALBANY
Telephone: (812) 948-0670
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 23-000526-2
License effective date: 12/1/2023
License expiration date: 11/30/2024
Administration and Staff
Administrator: CHANTE WILLIAMS
Start date: 6/19/2023
Director of Nursing: CHERYL FAGUNDO
Start date: 6/28/2023
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: ADAMS COUNTY MEMORIAL HOSPITAL
1100 MERCER AVENUE
DECATUR IN 46733
Ownership type: OTHER
Officer(s): RUSSELL FLUECKIGER
DANE WHEELER
SCOTT SMITH
LARRY MACKLIN
CANDICE BAUMAN
DAVE MCINTIRE
SCOTT LEHMAN
KYLE SPRUNGER
BRENT KEPLINGER
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: COLUMBUS REGIONAL HOSPITAL
Date of last change of ownership: 12/1/2023
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): 115
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 115
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 115
CENSUS:
Facility census: 104
As reported by the facility on: 7/12/2022
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/12/2022
Residential care beds occupied: 0
As reported by the facility on: 7/12/2022
Alzheimer Beds: 42
Alzheimer Beds Occupied: 34
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: 60
Number of comprehensive care resident rooms with battery
operated smoke detectors: 51
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 9
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 - JAMES VOIGNIER
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIRECTOR
Date form completed - 3/24/2022
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/23/2006
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2008
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 10/26/2024
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
NURSES ON CALL NURSING AGENCY
Approved: 8/17/2004
Terminated: 11/21/2014
NURSE TECH
Approved: 5/31/2006
Terminated: 11/21/2014
PROSSER SCHOOL OF TECHNOLOGY
Approved: 12/8/2006
Terminated: 11/21/2014
INDIANA HEALTH CAREERS VOCATIONAL TRAINING & TEST
Approved: 4/20/2020
Terminated: 10/28/2020
HEALTHCARE EDUCATIONAL AND TRA
Approved: 5/31/2000
Terminated: 5/13/2002
ROLLING HILLS HEALTHCARE CENTER
Approved: 5/18/2004
Terminated: 10/27/2022
LONG TERM CARE NURSING NETWORK
Approved: N/A
Terminated: 5/13/2002
IVY TECH COMMUNITY COLLEGE
Approved: 1/8/2013
Terminated: 11/21/2014
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 10/5/2021
Terminated: 10/27/2022
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 1/6/2023
Terminated: 10/27/2022
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 10/5/2021
Terminated: 10/27/2022
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 7
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
303
243
243
261
Rank of Score
69
84
83
81
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
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
Directed Plan of Correction
Date Imposed: 5/13/2023 Date Ended: 5/30/2023
Directed Plan of Correction
Date Imposed: 3/31/2023 Date Ended: 4/14/2023
Civil Money Penalty
Date Imposed: 3/3/2023 Date Ended: 3/3/2023
Amount proposed per day:
Civil Money Penalty
Date Imposed: 2/14/2022 Date Ended: 3/22/2022
Amount proposed per day:
Amount proposed per day: 890
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.
