Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
NORTH RIDGE VILLAGE NURSING & REHABILITATION CENTE
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 2/11/2022
 
Posted to the Web on: 2/23/2022
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 600 TRAIL RIDGE RD
City: ALBION
Telephone: (260) 636-1000
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 20-011296-1
  License effective date: 9/1/2020
  License expiration date: 8/31/2021
 


Administration and Staff

Administrator: 
  Start date: N/A
 
 
Medical director: Christopher Frazier
  Start date:   /  /  
 
Wound care specialist: Kasey Pieper
  Start date:   /  /  
 
Infection preventionist: Carla Frymier
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: DAVIESS COUNTY HOSPITAL
N/A
N/A N/A N/A
 
Ownership type:  OTHER
 
Officer(s): PAUL PLEVYAK
            RANDALL BUFFORD
            PHILIP CALDWELL
            STEVEN VAN CAMP
            LEIGH BARNEY
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: DAVIESS COUNTY HOSPITAL
Date of last change of ownership:   /  /  
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     4
Number of Medicare beds (SNF):                    0
Number of Medicare/Medicaid beds (SNF/NF):        73
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     77
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            18
 
Total number of beds in facility:            95
 
CENSUS:
Facility census:  16
As reported by the facility on: 7/1/2021 1
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/1/2021 1
 
Residential care beds occupied:  6
As reported by the facility on: 7/1/2021 1
 
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: 39
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 39
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 12
 
  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 - MARLENE POWELL
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. REG DIR OF OPS
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: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 4/14/2023
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     IMPACT INSTITUTE
         Approved: 2/14/2012
         Terminated: 4/17/2017
     FREEDOM ACADEMY
         Approved: 2/3/2015
         Terminated: 4/17/2017
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  1
  2 years previous:  0

 


Enforcement Actions

 
Federal Certification Actions Imposed
     Directed Plan of Correction
     Date Imposed: 5/26/2021  Date Ended: 6/4/2021
     Civil Money Penalty
     Date Imposed: 5/5/2021  Date Ended: 5/5/2021
     Amount proposed per day: 600
     Amount proposed per day: 
     Discretionary Deny Pay for New Admits
     Date Imposed: 4/15/2021  Date Ended: 6/3/2021
     Civil Money Penalty
     Date Imposed: 12/28/2020  Date Ended: 12/28/2020
     Amount proposed per day: 6000
     Civil Money Penalty
     Date Imposed: 12/21/2020  Date Ended: 12/21/2020
     Amount proposed per day: 5500
     Civil Money Penalty
     Date Imposed: 12/14/2020  Date Ended: 12/14/2020
     Amount proposed per day: 5000
     Civil Money Penalty
     Date Imposed: 12/7/2020  Date Ended: 12/7/2020
     Amount proposed per day: 4500
     Civil Money Penalty
     Date Imposed: 11/30/2020  Date Ended: 11/30/2020
     Amount proposed per day: 4000
     Civil Money Penalty
     Date Imposed: 11/23/2020  Date Ended: 11/23/2020
     Amount proposed per day: 3500
     Directed Plan of Correction
     Date Imposed: 11/21/2020  Date Ended: 11/19/2020
     Civil Money Penalty
     Date Imposed: 11/16/2020  Date Ended: 11/16/2020
     Amount proposed per day: 3000
     Civil Money Penalty
     Date Imposed: 11/9/2020  Date Ended: 11/9/2020
     Amount proposed per day: 2500
     Civil Money Penalty
     Date Imposed: 11/2/2020  Date Ended: 11/2/2020
     Amount proposed per day: 2000
     Civil Money Penalty
     Date Imposed: 10/26/2020  Date Ended: 10/26/2020
     Amount proposed per day: 1500
     Civil Money Penalty
     Date Imposed: 10/19/2020  Date Ended: 10/19/2020
     Amount proposed per day: 1000
     Civil Money Penalty
     Date Imposed: 9/3/2019  Date Ended: 10/26/2019
     Amount proposed per day: 7150
     Amount proposed per day: 515
     Directed Plan of Correction
     Date Imposed: 2/28/2019  Date Ended: 2/21/2019
 
Date terminated from Medicare/Medicaid: 8/13/2021
 


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

UJCT11
Complaint
6/25/2021


L3V612
Complaint, Follow Up, Other
6/8/2021


L3V611
Complaint, Other
5/5/2021


03JN12
Complaint, Follow Up
5/5/2021


03JN11
Complaint
3/19/2021


KTU711
Complaint
1/27/2021


9SSJ12
Follow Up, Other
12/17/2020


XKOM11
Other
12/10/2020


P9X411
Other
11/25/2020


RI3U11
Complaint
11/9/2020


9SSJ11
Other
10/20/2020


F7OE11
Complaint, Other
7/15/2020


K3VX22
Recertification, Follow Up, Life Safety Code
7/2/2020


HOCH11
Complaint, Other
6/17/2020


4SIU11
Complaint, Other
5/27/2020


3DL111
Complaint, Other
5/9/2020


ZGC611
Other
4/30/2020


K3VX21
Recertification, Life Safety Code
1/21/2020


7KM811
Complaint
1/13/2020


K3VX12
Recertification, Follow Up, State Licensure
1/3/2020


K3VX11
Recertification, State Licensure
11/15/2019


2D8K12
Complaint, Follow Up
11/1/2019


HKB711
Complaint
11/1/2019


2D8K11
Complaint
9/27/2019


FF4Z12
Complaint, Follow Up
3/13/2019


C04B13
Recertification, Follow Up, State Licensure
3/13/2019


C04B23
Recertification, Follow Up, Life Safety Code
2/21/2019


 
 


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.