Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

FOREST PARK HEALTH CAMPUS

NURSING HOME

SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART

Created on: 11/19/2021

Posted to the Web on: 12/1/2021
Basic Information
FACILITY CONTACT INFORMATION: Address: 2401 SOUTH L ST City: RICHMOND Telephone: (765) 966-5705 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 21-011387-1 License effective date: 5/1/2021 License expiration date: 4/30/2022
Administration and Staff
Administrator: ROBIN L HUSTON Start date: 11/17/2021 Director of Nursing: DENISE EMMONS Start date: 10/12/2021 Medical director: William Black Start date: / / Wound care specialist: Jean Varner Start date: / / Infection preventionist: Start date: / /
Ownership
CURENT OWNERSHIP: Owning corporation: HENRY COUNTY MEMORIAL HOSPITAL 798 NORTH 16TH ST NEW CASTLE IN 47362 Ownership type: OTHER Officer(s): JOHN PIDGEON SHELDON DYNES PAUL JANSSEN BENJAMIN FRENCH MARION SHORE KAY VAUGHT ANDY MOSIER JOSH MERKEL DEBI WARE BUD SHORE PREVIOUS OWNERSHIP CHANGES: Name of previous owner: TRILOGY HEALTH SERVICES LLC Date of last change of ownership:
Bed Counts and Census
COMPREHENSIVE CARE BEDS: Number of Medicaid beds (NF): 0 Number of Medicare beds (SNF): 24 Number of Medicare/Medicaid beds (SNF/NF): 46 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 70 RESIDENTIAL CARE BEDS: Total number of residential beds: 42 Total number of beds in facility: 112 CENSUS: Facility census: 79 As reported by the facility on: 7/2/2021 8 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 7/2/2021 8 Residential care beds occupied: 28 As reported by the facility on: 7/2/2021 8 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: 70 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: 70 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 - WILLIAM AMYX Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DIRECTOR OF PLANT OP Date form completed - 4/30/2021
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: 11/22/2011 CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: WHITEWATER CAREER CENTER Approved: 8/13/2009 Terminated: 11/23/2009 IVY TECH COMMUNITY COLLEGE Approved: 7/24/2017 Terminated: N/A NEW CASTLE CAREER CENTER Approved: 8/3/2020 Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  1
  Previous year:  0
  2 years previous:  0
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 398 374 401 410
Rank of Score 28 40 29 24
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 No No No
Substandard Quality of Care No No No
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: 10/19/2020 Date Ended: 10/19/2020 Amount proposed per day: 3500 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
9U5T11 Complaint 10/27/2021
4UK311 Complaint, Other 1/13/2021
FVW711 Other 12/22/2020
50HR11 Other 11/18/2020
P71111 Other 11/4/2020
QW1811 Other 10/22/2020
SQN111 Complaint, Other 10/8/2020
VLUS11 Other 10/1/2020
Y2BQ11 Other 9/28/2020
ECW311 Other 9/14/2020
FCNM11 Other 9/3/2020
ES7N11 Other 7/10/2020
DMKW11 Other 6/22/2020
W4ZR22 Recertification, Follow Up, Life Safety Code 9/25/2019
NRTF11 Complaint 8/30/2019
W4ZR21 Recertification, Life Safety Code 8/26/2019
W4ZR12 Recertification, Follow Up, State Licensure 8/12/2019
IJJF11 Complaint 7/12/2019
W4ZR11 Recertification, State Licensure 6/26/2019
 
 
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. [an error occurred while processing this directive]