Indiana State Department of Health

Division of Long Term Care

CONSUMER REPORT

TIMBERCREST CHURCH OF THE BRETHREN HOME

NURSING HOME

SKILLED NURSING FACILITY / NURSING FACILITY DUALLY CERTIFIED

Created on: 11/23/2018

Posted to the Web on: 12/05/2018
Basic Information
FACILITY CONTACT INFORMATION: Address: 2201 EAST ST City: NORTH MANCHESTER Telephone: (260) 982-2118 Web Site: NAME CHANGES: Most recent name change: N/A Date of most recent name change: N/A LICENSE INFORMATION: License number: 18-000448-1 License effective date: 07/01/2018 License expiration date: 06/30/2019
Administration and Staff
Administrator: SABINE THOMAS Start date: 09/12/2018 Director of Nursing: STEPHANIE WESTENDORF Start date: 07/02/2018 Medical director: Pamela Higgins Start date: / / Wound care specialist: Karla Seward Start date: / / Infection preventionist: Start date: / /
Ownership
CURENT OWNERSHIP: Owning corporation: WOODLAWN HOSPITAL 1400 E NINTH STREET ROCHESTER IN 46975 Ownership type: OTHER Officer(s): NANCY DAY CHERYL MUSSELMAN STEVE FURNIVALL RICHARD BELCHER JOHN ALLEY JAMES MULLIGAN JIM STRAETER JOHN KRAFT THOMAS SMITH PREVIOUS OWNERSHIP CHANGES: Name of previous owner: CHURCH OF THE BRETHREN HOME INC Date of last change of ownership: 07/01/2014
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): 65 Number of non-certified comprehensive care beds (State Licensed only): 0 Total number of comprehensive care beds: 65 RESIDENTIAL CARE BEDS: Total number of residential beds: 261 Total number of beds in facility: 326 CENSUS: Facility census: 189 As reported by the facility on: 08/03/2018 Number of comprehensive care beds occupied in this facility. 0 As reported by the facility on: 08/03/2018 Residential care beds occupied: 128 As reported by the facility on: 08/03/2018 Alzheimer Beds: 16 Alzheimer Beds Occupied: 15 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: 60 Number of comprehensive care resident rooms with battery operated smoke detectors: 60 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - STEVE SEARLESS Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DIRECTOR OF MAINTENA Date form completed - 03/28/2018
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS: Nurse aide training and competency evaluation program (NATCEP) approved: 05/30/2007 Nurse aide training and competency evaluation program (NATCEP) expires: 04/01/2019 Nurse aide training and competency evaluation program (NATCEP) banned: No Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A CLINICAL TRAINING SITES: This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: IVY TECH COMMUNITY COLLEGE Approved: 03/16/2005 Terminated: N/A TIMBERCREST CHURCH OF THE BRETHREN HOME Approved: 05/30/2007 Terminated: N/A 2 NURSES HOME CARE, INC Approved: 01/09/2013 Terminated: N/A FREEDOM ACADEMY Approved: 04/30/2018 Terminated: N/A IVY TECH COMMUNITY COLLEGE Approved: 09/20/2018 Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  1
  Previous year:  0
  2 years previous:  0
Facility Report Card
 
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The statewide average line is being provided to give you a reference
for looking at the scores of the selected facility.  This row 
contains the mean average calculated scores for all facilities as of
above date resulting in a scoring range of 0 to 620.
Scores are considered to be better the closer to zero they are.
Percentile rank of 100 represents the lowest report card score or best performing facility,
with a rank of 1 being the highest report card score.
 
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 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 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 Civil Money Penalty Date Imposed: 10/04/2017 Date Ended: 10/04/2017 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.
Event ID Survey Type Exit Date
96G621 Recertification, Life Safety Code 09/28/2018
96G612 Recertification, Follow Up, State Licensure 09/28/2018
96G611 Recertification, State Licensure 08/15/2018
PGTB12 Complaint, Follow Up 07/06/2018
3PJ211 Complaint 07/06/2018
PGTB11 Complaint 06/06/2018
EH9Q22 Recertification, Follow Up, Life Safety Code 11/30/2017
EH9Q12 Follow Up, Recertification, State Licensure 11/09/2017
EH9Q21 Recertification, Life Safety Code 11/07/2017
EH9Q11 Recertification, State Licensure 10/04/2017
UCW512 Complaint, Follow Up 02/15/2017
UCW511 Complaint 01/19/2017
QVGP22 Recertification, Follow Up, Life Safety Code 09/08/2016
QVGP12 Recertification, Follow Up, State Licensure 08/30/2016
QVGP21 Recertification, Life Safety Code 08/22/2016
QVGP11 Recertification, State Licensure 07/26/2016
M80011 Complaint 12/09/2015
 
 
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.