Created on: 3/22/2024
Posted to the Web on: 4/3/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 1121 E LASALLE AVE
City: SOUTH BEND
Telephone: (574) 287-6501
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-000048-1
License effective date: 2/1/2024
License expiration date: 1/31/2025
Administration and Staff
Administrator: JAMIE CORPE
Start date: 8/22/2023
Director of Nursing: ANTOINETTE R WAITE
Start date: 7/3/2022
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
3838 N RURAL ST
INDIANAPOLIS IN 46205
Ownership type: OTHER
Officer(s): GREGORY FEHRIBACH
CHARLES EBERHARDT II
CARL DRUMMER
SHELIA GUENIN
TED NOLTING
PAUL BABCOCK
ROBERT LAZARD
GEETA MANTRAVADI
MONICA CRAIN
BEVERLY MUKES-GAITHER
THOMAS HANIFY
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: N/A
Date of last change of ownership: N/A
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): 144
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 144
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 144
CENSUS:
Facility census: 80
As reported by the facility on: 1/11/2022
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/11/2022
Residential care beds occupied: 0
As reported by the facility on: 1/11/2022
Alzheimer Beds: 32
Alzheimer Beds Occupied: 28
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: 69
Number of comprehensive care resident rooms with battery
operated smoke detectors: 69
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - ANNE MORGAN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 3/28/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 4/28/1998
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2000
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 1/29/2025
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
CARDINAL NURSING AND REHABILITATION CENTER
Approved: 4/28/1998
Terminated: 10/23/2020
EXCEL CNA AND QMA TRAINING CENTER
Approved: 9/27/2020
Terminated: 10/23/2020
LEGACY CNA TRAINING, LLC
Approved: 10/1/2020
Terminated: 10/23/2020
ASC TRAINING CENTER
Approved: 11/18/2020
Terminated: 1/30/2023
LEFFLER ACADEMY, LLC
Approved: 5/10/2021
Terminated: 10/23/2020
ASC TRAINING CENTER
Approved: 6/14/2021
Terminated: 1/30/2023
ASC TRAINING CENTER
Approved: 2/9/2023
Terminated: 1/30/2023
HOOSIER HEALTHCARE TRAINING CENTER, LLC
Approved: 4/21/2021
Terminated: 10/23/2020
ASC TRAINING CENTER
Approved: 7/26/2022
Terminated: 1/30/2023
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 2
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
328
311
197
226
Rank of Score
59
67
91
87
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 gridView the scoring methodology
Overview of Survey findings
The Most Recent Set
2ND Most Recent Set
3RD Most Recent Set
Immediate Jeopardy
No
Yes
No
Substandard Quality of Care
No
No
No
Administrator Change
Yes
No
No
Owner Change
No
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
No
Yes
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: 1/30/2023 Date Ended: 1/30/2023
Amount proposed per day:
Directed Plan of Correction
Date Imposed: 3/24/2022 Date Ended: 3/25/2022
Civil Money Penalty
Date Imposed: 2/21/2022 Date Ended: 2/21/2022
Amount proposed per day:
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.
