Indiana State Department of Health

INTERMEDIATE CARE FACILITY (ICF) CONSUMER REPORT

Created on: 10/24/2019 Posted to the Web on: 11/06/2019
INTERMEDIATE CARE FACILITY INFORMATION
Name and address of licensed ICF RES CARE SOUTHEAST INDIANA
16613 SIMA GRAY RD
HENRYVILLE, IN 47126
Telephone (812) 258-2370
Fax ( ) -
Name and address of licensee RES-CARE INC
9901 LINN STATION RD
LOUISVILLE, KY 40223
Telephone (502) 394-2100
Fax (502) 394-2285
Type of Ownership PRIVATE NON-PR
Name of administrator BLAKE BUCKMAN
Community based ICF Yes
Age range of clients served 18 to 22
Number of off-campus day program sites used by ICF clients 2
Number of discrete living units 1
Is the ICF a distinct part of a hospital, SNF or NF? No
Type of distinct part N/A
ICF Website
 
   
   
STATE LICENSURE SURVEYS
11/27/2018 Most Recent 10/26/2017 2nd Most Recent 09/14/2016 3rd Most Recent
Number of Deficiencies 2 1 6
State Average for the year of the survey (rounded to nearest whole integer.) 5 6 6
   
OWNERSHIP/ADMISTRATOR CHANGES
Type of Change 11/27/2018 Most Recent 10/26/2017 2nd Most Recent 09/14/2016 3rd Most Recent
Ownership Change No No No
Administrator Change No No No
   
   
SUBSTANTIATED COMPLAINTS
Any person may file a complaint with the ISDH about an ICF.  The ISDH 
investigates all complaints.  If in the course of the investigation a violation of 
state or federal rules or regulations is found by surveyors, the complaint is said 
'to be substantiated with findings.'  If the surveyor verifies the facts of the 
complaint but finds that no violation occurred of state rules or federal 
regulations, the complaint is said to be 'substantiated without findings.'  If 
deficiencies are cited on a complaint survey, the ICF may be requested by the
ISDH to complete a plan of correction on how and when they will correct each 
deficiency 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 
ICF and reviewed by the ISDH within fifteen (15) days of the survey.
   
The following is a summary of the number of substantiated complaint 
investigations for the past three years.  This only indicates whether the complaint 
was substantiated and does not indicate whether the ICF was found in 
compliance with state rules or federal regulations. 
Current Year 01/01/2018 to 12/31/2018 01/01/2017 to 12/31/2017
0 0 0
     
   
FEDERAL MEDICARE CERTIFICATION SURVEY RESULTS
Federal Medicare certification surveys are conducted to determine ICF 
compliance with the Federal Conditions of Participation.  For non-accredited 
federally certified ICF's, a federal Medicare certification survey is completed 
annually.  A federal certification survey may also be completed if 
the Center for Medicare and Medicaid Services (CMS) finds the ICF to be out 
of compliance with a federal condition of participation and CMS requests that a 
certification survey be completed.  The table below is a summary of the most 
recent federal certification survey.
Date of Last Federal Certification Survey 11/27/2018
Number of Standards not in compliance during the last federal certification survey 0
Number of Conditions not in compliance during the last federal certification survey 0
   
   
SURVEY HISTORY
 
The following is a list of state licensure, complaint, and federal 
surveys completed at the ICF in the past five years. 
 
The survey report is not posted until the report has been provided to the facility 
and their plan of correction submitted and approved, if required.
 
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
0MOV11 Complaint 07/15/2019
3ASE21 Recertification, Life Safety Code 12/20/2018
3ASE11 Recertification, State Licensure 11/27/2018
PQ4Y11 Complaint 11/01/2018
SSJ423 Recertification, Follow Up, Life Safety Code 03/28/2018
SSJ412 Recertification, Follow Up, State Licensure 03/09/2018
WOYP12 Complaint, Follow Up 03/09/2018
SSJ422 Recertification, Follow Up, Life Safety Code 02/14/2018
WOYP11 Complaint 02/06/2018
SSJ421 Recertification, Life Safety Code 12/21/2017
SSJ411 Recertification, State Licensure 10/26/2017
SFLR11 Complaint 01/25/2017
W81F12 Recertification, Follow Up, State Licensure 01/25/2017
W81F21 Recertification, Life Safety Code 10/20/2016
W81F11 Recertification, State Licensure 09/14/2016
JTRW21 Recertification, Life Safety Code 11/23/2015
JTRW11 Recertification, Complaint, State Licensure 11/02/2015
OTNW11 Complaint 04/06/2015
 
 
LINKS AND RESOURCES
Choosing an ICF facility. Resources. Legal disclaimer for ICF reports.