Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
RESTORACY OF CARMEL
 
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: 616 GREEN HOUSE WAY
City: CARMEL
Telephone: (317) 401-8888
Web Site:  
 
NAME CHANGES:
Most recent name change: GREEN HOUSE COTTAGES OF CARMEL
Date of most recent name change: 12/30/2022 4:36:36 PM
 
LICENSE INFORMATION:
  License number: 24-013753-1
  License effective date: 1/1/2024
  License expiration date: 12/31/2024
 


Administration and Staff

Administrator: RYAN LEVENGOOD
  Start date: 8/8/2023
 
Director of Nursing: CINDY ADAMS
  Start date: 11/13/2023
 
Medical director: Leo Solito
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: MAJOR HOSPITAL
2451 INTELLPLEX DR
SHELBYVILLE IN 46176
 
Ownership type:  OTHER
 
Officer(s): DANA CALDWELL
            DOUGLAS CARTER
            JEFF BEATY
            JOHN COFFIN
            JAN SANDMAN
            SHERRI TANDY
            STEVE MIRETZKY
            JOHN HORNER
            PAULA GUSTAFSON
            GENE JONES
            SCOTT MILLER
            RALPH MERCURI
            LINDA WESSIC
            ILYA SHUMAN
            ROB KINDER
            DONALD KUMP
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: GREEN HOUSE SENIOR LIVING LLC
Date of last change of ownership: 1/1/2019
 


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):        72
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     72
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            72
 
CENSUS:
Facility census:  62
As reported by the facility on: 8/29/2022
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 8/29/2022
 
Residential care beds occupied:  0
As reported by the facility on: 8/29/2022
 
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: 72
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: 72
 
  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 BROWN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIRECTOR
Date form completed - 3/31/2023
 


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: 12/7/2024
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
 


Complaints

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

 


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
77
77


Rank of Score
100
100
98
98


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
No
No


 Substandard Quality of Care 
Yes
No
No


Administrator Change
Yes
Yes
No


Owner Change
No
No
Yes


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

Event ID: UDD711
  Action - Citation / Fine
  Notice to facility: 3/5/2024
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $250
Event ID: E48Z11
  Action - Citation / Fine
  Notice to facility: 7/14/2021
             Appeal: N/A
  Action Cease/Recind: 9/3/2021
         Case Closed: 9/3/2021
  Initial Amount: $1500
Event ID: HZVY11
  Action - Citation / Fine
  Notice to facility: 7/14/2021
             Appeal: N/A
  Action Cease/Recind: 9/3/2021
         Case Closed: 9/3/2021
  Initial Amount: $3000
 
Federal Certification Actions Imposed
     Directed Plan of Correction
     Date Imposed: 1/6/2023  Date Ended: 2/7/2023
     Discretionary Deny Pay for New Admits
     Date Imposed: 1/6/2023  Date Ended: 2/6/2023
     Civil Money Penalty
     Date Imposed: 11/28/2022  Date Ended: 11/28/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/28/2022  Date Ended: 2/6/2023
     Amount proposed per day: 8605
     Amount proposed per day: 470
     Civil Money Penalty
     Date Imposed: 11/21/2022  Date Ended: 11/21/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/15/2022  Date Ended: 11/15/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/7/2022  Date Ended: 11/7/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 10/17/2022  Date Ended: 10/31/2022
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 9/6/2022  Date Ended: 9/19/2022
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 8/22/2022  Date Ended: 8/22/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 8/16/2022  Date Ended: 8/16/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 8/8/2022  Date Ended: 8/8/2022
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 7/18/2022  Date Ended: 8/2/2022
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 3/21/2022  Date Ended: 3/21/2022
     Amount proposed per day: 6500
     Directed Plan of Correction
     Date Imposed: 1/6/2022  Date Ended: 1/5/2022
     Civil Money Penalty
     Date Imposed: 12/10/2021  Date Ended: 12/10/2021
     Amount proposed per day: 
     Civil Money Penalty
     Date Imposed: 11/15/2021  Date Ended: 11/15/2021
     Amount proposed per day: 6500
     Directed Plan of Correction
     Date Imposed: 10/30/2021  Date Ended: 10/30/2021
     Civil Money Penalty
     Date Imposed: 9/27/2021  Date Ended: 10/29/2021
     Amount proposed per day: 
     Amount proposed per day: 1520
     Civil Money Penalty
     Date Imposed: 9/27/2021  Date Ended: 9/27/2021
     Amount proposed per day: 6500
     Directed Plan of Correction
     Date Imposed: 9/23/2021  Date Ended: 9/21/2021
     Civil Money Penalty
     Date Imposed: 9/20/2021  Date Ended: 9/20/2021
     Amount proposed per day: 6500
     Directed Plan of Correction
     Date Imposed: 9/17/2021  Date Ended: 9/21/2021
     Civil Money Penalty
     Date Imposed: 9/13/2021  Date Ended: 9/13/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 9/6/2021  Date Ended: 9/6/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/30/2021  Date Ended: 8/30/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/24/2021  Date Ended: 9/1/2021
     Amount proposed per day: 
     Amount proposed per day: 
     Civil Money Penalty
     Date Imposed: 8/23/2021  Date Ended: 8/23/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/16/2021  Date Ended: 8/16/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/9/2021  Date Ended: 8/9/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/2/2021  Date Ended: 8/2/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 7/26/2021  Date Ended: 7/26/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 7/12/2021  Date Ended: 7/12/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 7/5/2021  Date Ended: 7/5/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 6/28/2021  Date Ended: 6/28/2021
     Amount proposed per day: 6000
     Civil Money Penalty
     Date Imposed: 6/21/2021  Date Ended: 6/21/2021
     Amount proposed per day: 5500
     Directed Plan of Correction
     Date Imposed: 6/18/2021  Date Ended: 7/29/2021
     Discretionary Deny Pay for New Admits
     Date Imposed: 6/18/2021  Date Ended: 7/28/2021
     Civil Money Penalty
     Date Imposed: 6/14/2021  Date Ended: 6/14/2021
     Amount proposed per day: 5000
     Civil Money Penalty
     Date Imposed: 6/7/2021  Date Ended: 6/7/2021
     Amount proposed per day: 4500
     Civil Money Penalty
     Date Imposed: 5/31/2021  Date Ended: 5/31/2021
     Amount proposed per day: 4000
     Civil Money Penalty
     Date Imposed: 5/24/2021  Date Ended: 5/24/2021
     Amount proposed per day: 3500
     Civil Money Penalty
     Date Imposed: 5/17/2021  Date Ended: 5/17/2021
     Amount proposed per day: 3000
     Civil Money Penalty
     Date Imposed: 5/14/2021  Date Ended: 7/28/2021
     Amount proposed per day: 1090
     Amount proposed per day: 
     Amount proposed per day: 500
     Civil Money Penalty
     Date Imposed: 4/26/2021  Date Ended: 4/26/2021
     Amount proposed per day: 2500
     Civil Money Penalty
     Date Imposed: 4/12/2021  Date Ended: 4/12/2021
     Amount proposed per day: 2000
     Civil Money Penalty
     Date Imposed: 4/5/2021  Date Ended: 4/5/2021
     Amount proposed per day: 1500
     Civil Money Penalty
     Date Imposed: 3/29/2021  Date Ended: 3/29/2021
     Amount proposed per day: 1000
 
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

UDD711
State Licensure, Other
1/23/2024


6CPS11
Complaint
12/13/2023


A7OZ12
Complaint, Follow Up
9/19/2023


OJM712
Complaint, Follow Up
9/19/2023


A7OZ11
Complaint
8/3/2023


OJM711
Complaint
7/5/2023


UG5212
Complaint, Follow Up
5/25/2023


HNES11
Complaint
5/4/2023


UG5211
Complaint
3/23/2023


2BD411
Complaint
3/9/2023


LL8022
Recertification, Follow Up, Life Safety Code
3/2/2023


LL8012
Recertification, Complaint, Follow Up, State Licensure
2/7/2023


LL8021
Recertification, Life Safety Code
1/11/2023


LL8011
Recertification, Complaint, State Licensure
12/8/2022


J96Y11
Complaint
7/19/2022


3KLN11
Complaint, Other
6/8/2022


FV1I12
Complaint, Follow Up, Other
1/21/2022


HTUQ22
Recertification, Follow Up, Life Safety Code
12/16/2021


FV1I11
Complaint, Other
12/10/2021


HTUQ12
Recertification, Complaint, Follow Up, State Licensure
11/23/2021


HTUQ21
Recertification, Life Safety Code
10/20/2021


HTUQ11
Recertification, Complaint, State Licensure
10/4/2021


K5UJ12
Complaint, Follow Up
9/22/2021


ZDK712
Complaint, Follow Up, Other
9/22/2021


FUNO12
Complaint, Follow Up
9/22/2021


K5UJ11
Complaint
9/1/2021


ZDK711
Complaint, Other
8/24/2021


FUNO11
Complaint
8/9/2021


HZVY12
Complaint, Follow Up, Other
7/29/2021


OOLJ12
Complaint, Follow Up
7/29/2021


P9W012
Complaint, Follow Up
7/29/2021


OOLJ11
Complaint, Other
7/7/2021


P9W011
Complaint
6/24/2021


HZVY11
Complaint, Other
5/20/2021


E48Z12
Complaint, Follow Up
4/23/2021


 
 


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.