Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 2075 RIPLEY ST
City: LAKE STATION
Telephone: (219) 962-9437
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 23-001136-1
License effective date: 10/1/2023
License expiration date: 9/30/2024
Administration and Staff
Administrator: JOELYNN MILLER-JOHNSON
Start date: 8/2/2008
Director of Nursing: MARTHA GORDON
Start date: 8/30/2011
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: SOUTHLAKE/TRI-CITY RBA CORPORATION
3903 INDIANAPOLIS BOULEVARD
EAST CHICAGO IN 46312
Ownership type: PROFIT
Officer(s): HERBERT CRUZ
TERRENCE QUINN
WENDY ACEVEDO
RON BORTO
AUGUSTUS "GUS" FIORES
CAROL DRASGA
EDMUND GUNN
GINA JONES
DANIEL KLEIN
DANNY LACKEY
BRIAN MILLER
TAMEKA MULLINGS
THOMAS O'DONNELL
ROBERT KRUMWIED
WILLIAM TROWBRIDGE
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: LAKE PARK RESIDENTIAL CARE INC
Date of last change of ownership: 8/24/2006
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): 0
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 151
Total number of beds in facility: 151
CENSUS:
Facility census: 109
As reported by the facility on: 1/16/2019
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/16/2019
Residential care beds occupied: 109
As reported by the facility on: 1/16/2019
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: / /
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:
Nurse aide training and competency evaluation program (NATCEP) expires:
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:
SAVING A GENERATION (SAG) INC
Approved: 9/28/2011
Terminated: N/A
BEGINNING OF A START TRAINING CENTER
Approved: 1/30/2023
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 1
State Licensure Surveys
The ISDH conducts a state licensure survey at each licensed residential facility
approximately once per year. If state findings are cited on a survey, the
residential facility may be requested by the ISDH to complete a plan of
correction on how and when they will correct each state finding and who will be
responsible to ensure the corrections are made and will not reoccur in the future.
The plan of correction is generally submitted by the residential facility and
reviewed by the ISDH within fifteen (15) days of the survey.
To read an overview of the survey process, click hereNOTE:
The residential consumer report survey information begins with surveys that
have been completed on or after December 1, 2008. Any survey performed prior
to that date will not have any information in the state findings count rows or
columns or will show zero.
1/18/2024 Most Recent
5/19/2021 2nd Most Recent
4/16/2019 3rd Most Recent
Number of state findings
9
6
7
State Average for the year of the survey (rounded to nearest whole integer).
