Created on: 9/23/2022
Posted to the Web on: 10/5/2022
Basic Information
FACILITY CONTACT INFORMATION:
Address: 8809 MADISON AVENUE
City: INDIANAPOLIS
Telephone: (317) 885-3461
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 21-013367-1
License effective date: 7/1/2021
License expiration date: 6/30/2022
Administration and Staff
Administrator: TIMOTHY SKINNER
Start date: 12/6/2021
Director of Nursing: MARCELLA R CHRISTIAN
Start date: 1/11/2021
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: CRESTWOOD VILLAGE SOUTH APARTMENTS LLC
1398 N SHADELAND AVE PO BOX 19409
INDIANAPOLIS IN 46219
Ownership type: PROFIT
Officer(s): ANGELA MILLER
WALTER E JUSTUS TRUST
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: WALTER E JUSTUS TRUST
Date of last change of ownership: 7/22/2015
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): 0
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 181
Total number of beds in facility: 181
CENSUS:
Facility census: 83
As reported by the facility on: 1/3/2022
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/3/2022
Residential care beds occupied: 83
As reported by the facility on: 1/3/2022
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: / /
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:
WOODLAND TERRACE OF NEW PALESTINE LLC
Approved: 6/9/2021
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
State Licensure Surveys
The ISDH conducts a state licensure survey at each licensed residential facility
approximately once per year. If state findings are cited on a survey, the
residential facility may be requested by the ISDH to complete a plan of
correction on how and when they will correct each state finding and who will be
responsible to ensure the corrections are made and will not reoccur in the future.
The plan of correction is generally submitted by the residential facility and
reviewed by the ISDH within fifteen (15) days of the survey.
To read an overview of the survey process, click hereNOTE:
The residential consumer report survey information begins with surveys that
have been completed on or after December 1, 2008. Any survey performed prior
to that date will not have any information in the state findings count rows or
columns or will show zero.
8/10/2021 Most Recent
8/7/2019 2nd Most Recent
10/4/2018 3rd Most Recent
Number of state findings
1
2
2
State Average for the year of the survey (rounded to nearest whole integer).
