Created on: 7/15/2022
Posted to the Web on: 7/27/2022
Basic Information
FACILITY CONTACT INFORMATION:
Address: 3104 BLACKISTON BLVD - PROGRESSIVE CARE UNIT
City: NEW ALBANY
Telephone: (812) 941-8300
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 18-005649-2
License effective date: 7/1/2020
License expiration date: 6/30/2022
Administration and Staff
Administrator: DIANA CHAVIS
Start date: 8/24/2021
Director of Nursing: VANESSA CHAVEZ
Start date: 4/22/2021
Medical director: Muhammad Masroor
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: VIBRA REHABILITATION HOSPITAL OF SOUTHERN INDIANA
4600 LENA DRIVE
MECHANICSBURG PA 17055
Ownership type: PROFIT
Officer(s): BRAD HOLLINGER
CLINT FEGAN
STEPHEN MARCUS
MICHAEL THOMAS
DAVID HAUCK
DOUGLAS YOHE
MICHAEL LONG
GP, LLC VIBRA IRFCO HDLGS
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: CLARK MEMORIAL HOSPITAL
Date of last change of ownership: 6/27/2018
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 22
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: 22
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 22
CENSUS:
Facility census: 19
As reported by the facility on: 1/9/2020 7
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/9/2020 7
Residential care beds occupied: 0
As reported by the facility on: 1/9/2020 7
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: 11
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: 11
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 - CRAIG MONTELEONE
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DIRECTOR OF PLANT OP
Date form completed - 3/15/2021
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:
NURSE TECH
Approved: 7/31/2007
Terminated: N/A
INDIANA HEALTH CAREERS VOCATIONAL TRAINING & TEST
Approved: 3/1/2016
Terminated: 6/11/2021
KAISER HEALTHCARE CERTIFICATION LLC
Approved: 8/30/2021
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
Enforcement Actions
Federal Certification Actions Imposed
Civil Money Penalty
Date Imposed: 8/2/2021 Date Ended: 8/2/2021
Amount proposed per day: 1000
Date terminated from Medicare/Medicaid: 1/22/2022
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.
