Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
BRIARCLIFF HEALTH & REHABILITATION 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: 5024 WESTERN AVENUE
City: SOUTH BEND
Telephone: (574) 318-4600
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 24-013420-1
  License effective date: 1/1/2024
  License expiration date: 12/31/2024
 


Administration and Staff

Administrator: CHRISTOPHER GILL
  Start date: 2/28/2023
 
Director of Nursing: KIMBERLY CHRISMAN
  Start date: 7/6/2021
 
Medical director: Shaya Mokfi
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist: Diane Correa
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: PULASKI MEMORIAL HOSPITAL
616 E 13TH STREET
WINAMAC IN 46996
 
Ownership type:  NON-PROFIT
 
Officer(s): MICHAEL MCKAY
            VALERIE LEMAN
            LINDA WEBB
            CHARLES HUTTON
            GREGG MALOTT
            CLINT KAUFFMAN
            STEVE JAROSINSKI
            ADAM BENNETT
            JENNIFER SMITH
            CAITLIN BARRY
            TAYLOR WHITE
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: DECATUR COUNTY MEMORIAL HOSPITAL
Date of last change of ownership: 1/1/2024
 


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):        131
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     131
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            131
 
CENSUS:
Facility census:  92
As reported by the facility on: 11/4/2023
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 11/4/2023
 
Residential care beds occupied:  0
As reported by the facility on: 11/4/2023
 
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: 71
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: 71
 
  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 - JAMES ALLYN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ENVIRONMENTAL SERVIC
Date form completed - 3/16/2021
 


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: 5/2/2024
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     ALR EDUCATIONAL HEALTH SERVICES, INC
         Approved: 11/30/2020
         Terminated: 9/3/2020
     LEGACY CNA TRAINING, LLC
         Approved: 11/9/2020
         Terminated: 9/3/2020
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  4

 


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
0
0
162
174


Rank of Score
100
100
94
93


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
Yes


 Substandard Quality of Care 
No
No
Yes


Administrator Change
Yes
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
     Directed Plan of Correction
     Date Imposed: 11/24/2022  Date Ended: 12/2/2022
     Civil Money Penalty
     Date Imposed: 10/20/2022  Date Ended: 10/20/2022
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 10/13/2022  Date Ended: 11/1/2022
     Directed Plan of Correction
     Date Imposed: 7/14/2022  Date Ended: 6/23/2022
     Directed Plan of Correction
     Date Imposed: 6/18/2022  Date Ended: 6/16/2022
     Discretionary Deny Pay for New Admits
     Date Imposed: 5/3/2022  Date Ended: 6/15/2022
     Civil Money Penalty
     Date Imposed: 3/29/2022  Date Ended: 6/15/2022
     Amount proposed per day: 
     Amount proposed per day: 2410
     Directed Plan of Correction
     Date Imposed: 1/21/2022  Date Ended: 1/20/2022
     Civil Money Penalty
     Date Imposed: 12/29/2021  Date Ended: 12/29/2021
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 8/19/2021  Date Ended: 8/26/2021
     Directed Plan of Correction
     Date Imposed: 8/17/2021  Date Ended: 8/26/2021
     Discretionary Deny Pay for New Admits
     Date Imposed: 6/25/2021  Date Ended: 8/25/2021
     Civil Money Penalty
     Date Imposed: 5/23/2021  Date Ended: 8/6/2021
     Amount proposed per day: 1615
     Amount proposed per day: 10180
     Amount proposed per day: 540
 
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

8L7H12
Complaint, Follow Up
1/3/2024


8L7H11
Complaint
11/29/2023


MJWH12
Complaint, Follow Up
10/2/2023


SXF922
Recertification, Follow Up, Life Safety Code
9/8/2023


MJWH11
Complaint
9/1/2023


SXF912
Recertification, Follow Up, State Licensure
8/29/2023


SXF921
Recertification, Life Safety Code
7/31/2023


SXF911
Recertification, Complaint, State Licensure
7/14/2023


4JZD11
Complaint
1/5/2023


WPFT12
Complaint, Follow Up, Other
1/3/2023


4EQW23
Follow Up, Life Safety Code, Other
11/1/2022


WPFT11
Complaint, Other
10/20/2022


BUW612
Complaint, Follow Up
10/3/2022


4EQW22
Follow Up, Life Safety Code, Other
9/19/2022


BUW611
Complaint
8/17/2022


4EQW21
Life Safety Code, Other
8/3/2022


CVOO23
Recertification, Follow Up, Life Safety Code
7/6/2022


CVOO13
Recertification, Follow Up, State Licensure
6/30/2022


CVOO22
Recertification, Follow Up, Life Safety Code
6/17/2022


CVOO12
Recertification, Complaint, Follow Up, State Licensure
5/24/2022


CVOO21
Recertification, Life Safety Code
5/10/2022


QDV311
Complaint
5/1/2022


CVOO11
Recertification, Complaint, State Licensure
4/4/2022


VZ9B12
Follow Up, Other
1/25/2022


VZ9B11
Other
12/29/2021


NXNK23
Recertification, Follow Up, Life Safety Code
9/22/2021


NXNK22
Recertification, Follow Up, Life Safety Code
7/29/2021


NXNK12
Recertification, Complaint, Follow Up, State Licensure
7/15/2021


M9MY11
Complaint
7/15/2021


8LIB11
Complaint
6/22/2021


NXNK21
Recertification, Life Safety Code
6/3/2021


NXNK11
Recertification, Complaint, State Licensure
5/28/2021


OU2X12
Complaint, Follow Up, Other
3/23/2021


GF5Z12
Complaint, Follow Up
3/23/2021


 
 


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.