Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 802 US HIGHWAY 20 EAST
City: MICHIGAN CITY
Telephone: (219) 872-7251
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 23-000236-1
License effective date: 10/1/2023
License expiration date: 9/30/2024
Administration and Staff
Administrator: TERRI PHILLIPS
Start date: 8/26/2011
Director of Nursing: CHRIS BIRDSONG
Start date: 4/15/2016
Medical director: Bikash Agarwal
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist: Jackie Nelson
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HENDRICKS COUNTY HOSPITAL
1000 EAST MAIN STREET
DANVILLE IN 46122
Ownership type: OTHER
Officer(s): KEVIN SPEER
ERIN ENGELS
TODD DAVIS
YVONNE CULPEPPER
D. MICHELLE FENOUGHTY
STANTON "STAN" RISSER
LISA IMLAY
GARY EVERLING
MICHAEL KIRSCHNER
TYLER STARKEY
JOHN WAITE
MARK GENTRY
TIM WHICKER
SHANE SOMMERS
NANCY FOSTER
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: MICHIGAN CITY MEDICAL INVESTORS LIMITED PARTNERSHI
Date of last change of ownership: 10/1/2018
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): 120
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 120
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 120
CENSUS:
Facility census: 86
As reported by the facility on: 1/9/2024
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/9/2024
Residential care beds occupied: 0
As reported by the facility on: 1/9/2024
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: 59
Number of comprehensive care resident rooms with battery
operated smoke detectors: 59
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - DANE HIGHTSHOE
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE
Date form completed - 3/22/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 11/28/2022
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2024
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 10/26/2007
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
MICHIANA HEALTHCARE TRAINING INC
Approved: 10/10/2002
Terminated: 9/9/2004
IN TRAINING COLLEGE OF ADULT EDUCATION
Approved: 8/12/1997
Terminated: 9/9/2004
PROFESSIONAL RESOURCES
Approved: 4/26/1996
Terminated: 9/9/2004
VICTORY TRAINING
Approved: 6/11/2015
Terminated: 1/11/2021
A K SMITH CAREER CENTER
Approved: 9/30/2015
Terminated: 1/11/2021
CNA ACADEMY
Approved: 10/24/2011
Terminated: 1/11/2021
MED ED INCORPORATED
Approved: 11/10/2011
Terminated: 1/11/2021
MIDWEST HEALTHCARE CAREER TRAINING AND DEVELOPMENT
Approved: 4/26/2021
Terminated: N/A
IVY TECH COMMUNITY COLLEGE
Approved: 6/10/2015
Terminated: 1/11/2021
LEGACY CNA TRAINING, LLC
Approved: 12/4/2020
Terminated: 1/11/2021
LIFE CARE CENTER OF MICHIGAN CITY
Approved: 11/28/2022
Terminated: N/A
A K SMITH CAREER CENTER
Approved: 9/12/2022
Terminated: N/A
IVY TECH COMMUNITY COLLEGE
Approved: 9/22/2022
Terminated: N/A
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
281
281
350
338
Rank of Score
75
77
51
56
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
No
No
Substandard Quality of Care
No
No
No
Administrator Change
No
No
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
Federal Certification Actions Imposed
Directed Plan of Correction
Date Imposed: 12/16/2021 Date Ended: 12/15/2021
Civil Money Penalty
Date Imposed: 11/23/2021 Date Ended: 11/23/2021
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.
