Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
PARKVIEW MEMORIAL HOSPITAL-CCC
 
NURSING HOME
SKILLED NURSING FACILITY
Created on: 09/27/2019
 
Posted to the Web on: 10/09/2019
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 2200 RANDALLIA DR
City: FORT WAYNE
Telephone: (260) 373-6524
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 19-001203-1
  License effective date: 01/01/2019
  License expiration date: 12/31/2019
 


Administration and Staff

Administrator: 
  Start date: N/A
 
 
Medical director: Harin Chhatiawala
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: PARKVIEW HOSPITAL INC
N/A
N/A N/A N/A
 
Ownership type:  PROFIT
 
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: PARKVIEW HOSPITAL 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):                    41
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:     41
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            41
 
CENSUS:
Facility census:  29
As reported by the facility on: 01/14/2019
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 01/14/2019
 
Residential care beds occupied:  0
As reported by the facility on: 01/14/2019
 
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:   /  /  
 


Sprinklers and Smoke Detectors

This facility is: FULLY SPRINKLERED
 
Number of comprehensive care resident rooms: 35
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: 35
 
  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 - CAROLYN DAVIDSON
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 02/15/2018
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 10/03/2000
Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2002
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: 
     FWCS CAREER ACADEMY AT ANTHIS
         Approved: 12/27/1999
         Terminated: N/A
     PARKVIEW MEMORIAL HOSPITAL-CCC
         Approved: 10/03/2000
         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: 04/09/2019
 


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

N3CO11
Complaint
10/23/2018


H94L11
Complaint
08/08/2018


S5CD12
Recertification, Follow Up, State Licensure
06/18/2018


S5CD21
Recertification, Life Safety Code
06/05/2018


S5CD11
Recertification, State Licensure
05/16/2018


DQQN11
Complaint
08/23/2017


O91422
Recertification, Follow Up, Life Safety Code
07/31/2017


O91412
Recertification, Follow Up, State Licensure
07/10/2017


O91421
Life Safety Code, Recertification
07/07/2017


O91411
Recertification, State Licensure
06/09/2017


HRMM12
Complaint, Follow Up
01/03/2017


HRMM11
Complaint
12/02/2016


 
 


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.