Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
SELLERSBURG HEALTHCARE CENTER
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED
Created on: 3/8/2024
 
Posted to the Web on: 3/20/2024
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 7823 OLD HWY # 60
City: SELLERSBURG
Telephone: (812) 246-4272
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-010613-2
  License effective date: 7/1/2023
  License expiration date: 6/30/2024
 


Administration and Staff

Administrator: WILLIAM GREGORY JACKSON
  Start date: 10/18/2023
 
Director of Nursing: TIFFANY EMBRY
  Start date: 2/14/2022
 
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):        110
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     110
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            110
 
CENSUS:
Facility census:  99
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:  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: 57
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 57
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 57
 
  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 - MONICA J DIRBAS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ED
Date form completed - 3/29/2023
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 10/31/2016
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2022
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 7/28/2025
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     PROSSER SCHOOL OF TECHNOLOGY
         Approved: 8/17/2017
         Terminated: 6/30/2021
     NURSES ON CALL NURSING AGENCY
         Approved: 10/9/2003
         Terminated: 1/11/2012
     NURSE TECH
         Approved: 11/14/2003
         Terminated: 1/11/2012
     SELLERSBURG HEALTHCARE CENTER
         Approved: 10/31/2016
         Terminated: 6/30/2021
     IVY TECH COMMUNITY COLLEGE
         Approved: 7/20/2011
         Terminated: 1/11/2012
     SHANNON GIBBS AIDE TRAINING
         Approved: 9/6/2011
         Terminated: 1/11/2012
     INDIANA HEALTH CAREERS VOCATIONAL TRAINING &  TEST
         Approved: 3/1/2016
         Terminated: 6/11/2021
     KAISER HEALTHCARE CERTIFICATION LLC
         Approved: 5/25/2022
         Terminated: 11/5/2021
     KAISER HEALTHCARE CERTIFICATION LLC
         Approved: 10/5/2021
         Terminated: 11/5/2021
 


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
287
290
317


Rank of Score
69
75
75
64


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 grid
 
View the scoring methodology
 



Overview of Survey findings




 
 The Most Recent Set
 2ND Most Recent Set
 3RD Most Recent Set

Immediate Jeopardy
Yes
Yes
No


 Substandard Quality of Care 
Yes
Yes
Yes


Administrator Change
No
Yes
Yes


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
     Civil Money Penalty
     Date Imposed: 7/8/2023  Date Ended: 7/29/2023
     Amount proposed per day: 8025
     Amount proposed per day: 245
     Civil Money Penalty
     Date Imposed: 5/24/2022  Date Ended: 5/24/2022
     Amount proposed per day: 
     Civil Money Penalty
     Date Imposed: 3/18/2022  Date Ended: 3/18/2022
     Amount proposed per day: 
     Discretionary Deny Pay for New Admits
     Date Imposed: 11/5/2021  Date Ended: 11/28/2021
     Directed Plan of Correction
     Date Imposed: 10/21/2021  Date Ended: 11/29/2021
     Civil Money Penalty
     Date Imposed: 9/24/2021  Date Ended: 9/24/2021
     Amount proposed per day: 
     Civil Money Penalty
     Date Imposed: 4/27/2021  Date Ended: 7/22/2021
     Amount proposed per day: 15000
     Amount proposed per day: 1675
     Directed Plan of Correction
     Date Imposed: 3/25/2021  Date Ended: 3/25/2021
 
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.


 
Event ID
Survey Type
Exit Date

JXFN11
Complaint
2/20/2024


II4L11
Complaint
1/12/2024


UEXB12
Complaint, Follow Up
12/18/2023


UEXB11
Complaint
11/21/2023


ZK7H22
Recertification, Follow Up, Life Safety Code
11/13/2023


ZK7H12
Recertification, Follow Up, State Licensure
10/12/2023


2PHH11
Complaint
10/12/2023


ZK7H21
Recertification, Life Safety Code
9/13/2023


ZK7H11
Recertification, State Licensure
8/17/2023


YHK212
Complaint, Follow Up
8/11/2023


YHK211
Complaint
7/29/2023


7V1E11
Complaint
6/19/2023


600X11
Complaint
5/10/2023


MW6S11
Complaint
2/1/2023


FGJ412
Complaint, Follow Up
1/12/2023


FGJ411
Complaint
12/13/2022


UZ6M22
Recertification, Follow Up, Life Safety Code
11/3/2022


O5HG11
Complaint
10/27/2022


UZ6M12
Recertification, Complaint, Follow Up, State Licensure
10/4/2022


UZ6M21
Recertification, Life Safety Code
9/12/2022


M6IT11
Complaint
8/30/2022


UZ6M11
Recertification, Complaint, State Licensure
8/16/2022


ZXMH12
Complaint, Follow Up
6/21/2022


ZXMH11
Complaint
5/24/2022


DC0T11
Complaint, Other
5/5/2022


3ETK12
Complaint, Follow Up
4/19/2022


3ETK11
Complaint, Other
3/18/2022


HUF812
Complaint, Follow Up, Other
2/28/2022


0GEE12
Complaint, Follow Up
2/28/2022


HUF811
Complaint, Other
1/20/2022


0GEE11
Complaint
1/7/2022


AJ7O13
Complaint, Follow Up
12/1/2021


LRZG12
Complaint, Follow Up
12/1/2021


LRZG11
Complaint
11/10/2021


AJ7O12
Complaint, Follow Up, Other
11/10/2021


AJ7O11
Complaint, Other
9/24/2021


3NQ011
Other
9/7/2021


P82B22
Recertification, Follow Up, Life Safety Code
8/11/2021


P82B12
Recertification, Complaint, Follow Up, State Licensure
8/4/2021


QJIU11
Complaint
7/30/2021


P82B21
Recertification, Life Safety Code
7/16/2021


P82B11
Recertification, Complaint, State Licensure
6/30/2021


RQ6B12
Complaint, Follow Up
5/31/2021


Z3MB11
Complaint
5/21/2021


RQ6B11
Complaint
4/9/2021


W7VN12
Follow Up, Other
4/4/2021


 
 


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.