Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
MAJESTIC CARE OF CONNERSVILLE
 
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: 1029 E 5TH STREET
City: CONNERSVILLE
Telephone: (765) 825-0543
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-000316-1
  License effective date: 8/1/2023
  License expiration date: 7/31/2024
 


Administration and Staff

Administrator: BEN MEIER
  Start date: 6/23/2023
 
Director of Nursing: AMBER PEARSON
  Start date: 7/22/2023
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: DAVIESS COUNTY HOSPITAL
1314 E WALNUT ST
WASHINGTON IN 47501
 
Ownership type:  OTHER
 
Officer(s): SHELLY DEEM
            DERON STEINER
            TYSON WAGLER
            RANDY RUSSELL
            KENT NORRIS
            SURESH LOHANO
            ANTHONY SHOWALTER
            DANIEL MCCARTHY
            TRACY CONROY
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: LINCOLN CENTER HEALTHCARE LLC
Date of last change of ownership: 8/1/2016
 


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):        166
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     166
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            166
 
CENSUS:
Facility census:  70
As reported by the facility on: 8/28/2019
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 8/28/2019
 
Residential care beds occupied:  0
As reported by the facility on: 8/28/2019
 
Alzheimer Beds:  57
Alzheimer Beds Occupied:  43
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: 105
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 105
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - MARSHELL BOWMER
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. MAINTENANCE DIRECTOR
Date form completed - 3/25/2022
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 2/17/2005
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2009
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 3/28/2024
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     IVY TECH COMMUNITY COLLEGE
         Approved: 9/18/2002
         Terminated: 5/31/2007
     MAJESTIC CARE OF CONNERSVILLE
         Approved: 9/27/1999
         Terminated: 2/3/2016
     WHITEWATER CAREER CENTER
         Approved: 4/7/2010
         Terminated: 2/3/2016
     NELLIS ADULT DAY CARE LLC
         Approved: 3/4/2013
         Terminated: 2/3/2016
     ALL HEART NURSE'S AIDE TRAINING CENTER, LLC
         Approved: 8/28/2014
         Terminated: 2/3/2016
 


Complaints

NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  0
  2 years previous:  9

 


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
201
70
76
98


Rank of Score
89
98
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
No
No
Yes


 Substandard Quality of Care 
No
No
Yes


Administrator Change
No
Yes
Yes


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

Event ID: X19Z11
  Action - Probationary license
  Notice to facility: 7/25/2022
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $0
 
Federal Certification Actions Imposed
     Directed Plan of Correction
     Date Imposed: 7/16/2022  Date Ended: 7/7/2022
     Civil Money Penalty
     Date Imposed: 6/22/2022  Date Ended: 6/22/2022
     Amount proposed per day: 
     Discretionary Deny Pay for New Admits
     Date Imposed: 4/23/2022  Date Ended: 5/17/2022
     Civil Money Penalty
     Date Imposed: 3/17/2022  Date Ended: 5/17/2022
     Amount proposed per day: 7450
     Amount proposed per day: 
     Amount proposed per day: 
     Amount proposed per day: 
     Amount proposed per day: 550
     Civil Money Penalty
     Date Imposed: 2/2/2022  Date Ended: 2/2/2022
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 1/6/2022  Date Ended: 1/17/2022
     Civil Money Penalty
     Date Imposed: 12/9/2021  Date Ended: 12/9/2021
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 11/16/2021  Date Ended: 11/18/2021
     Mand. Deny Pay for New Admits-3 Mo.
     Date Imposed: 11/3/2021  Date Ended: 11/17/2021
     Civil Money Penalty
     Date Imposed: 10/21/2021  Date Ended: 10/21/2021
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 7/10/2021  Date Ended: 7/1/2021
     Civil Money Penalty
     Date Imposed: 6/11/2021  Date Ended: 6/11/2021
     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.


 
Event ID
Survey Type
Exit Date

1BYU21
Life Safety Code, Recertification
2/22/2024


1BYU11
Recertification, Complaint, State Licensure
2/12/2024


N9TH11
Complaint
12/7/2023


V0ZB11
Complaint
11/15/2023


ICQ522
Follow Up, Life Safety Code, Recertification
10/13/2023


ICQ512
Complaint, Follow Up, Recertification, State Licensure
10/5/2023


NF4J12
Complaint, Follow Up
10/5/2023


ICQ521
Recertification, Life Safety Code
9/7/2023


ICQ511
Recertification, Complaint, State Licensure
8/24/2023


NF4J11
Complaint
8/24/2023


YFLW11
Complaint
6/29/2023


RYM012
Complaint, Follow Up
5/30/2023


YL7O12
Complaint, Follow Up
4/17/2023


RYM011
Complaint
4/12/2023


YL7O11
Complaint
3/13/2023


6R4F11
Complaint, Other
2/10/2023


L49Q11
Complaint
2/3/2023


2NCD11
Complaint
11/9/2022


NV2U11
Complaint
10/19/2022


E2BG22
Recertification, Follow Up, Life Safety Code
8/30/2022


E2BG12
Recertification, Complaint, Follow Up, State Licensure
7/28/2022


E2BG21
Recertification, Life Safety Code
7/18/2022


E2BG11
Recertification, Complaint, State Licensure
6/22/2022


0IXW12
Complaint, Follow Up
6/1/2022


X19Z12
Complaint, Follow Up
6/1/2022


VX7F11
Complaint
6/1/2022


S33A11
Complaint
5/18/2022


0IXW11
Complaint
4/29/2022


X19Z11
Complaint
3/29/2022


BLYP11
Complaint, Other
3/9/2022


TYZL12
Complaint, Follow Up
2/18/2022


VA7J11
Complaint, Other
2/17/2022


TYZL11
Complaint
2/2/2022


NB6H12
Complaint, Follow Up, Other
1/18/2022


SXS011
Complaint, Other
1/13/2022


KBFZ12
Complaint, Follow Up, Other
1/6/2022


NB6H11
Complaint, Other
12/21/2021


KBFZ11
Complaint, Other
12/9/2021


979H11
Complaint
12/6/2021


ZS3B12
Complaint, Follow Up
11/29/2021


M6PQ12
Complaint, Follow Up
11/29/2021


M6PQ11
Complaint
11/16/2021


B8DX12
Complaint, Follow Up
10/27/2021


20WR12
Complaint, Follow Up
10/27/2021


ZS3B11
Complaint
10/21/2021


PN3F22
Recertification, Follow Up, Life Safety Code
9/8/2021


B8DX11
Complaint
8/19/2021


20WR11
Complaint
8/10/2021


PN3F21
Recertification, Life Safety Code
8/3/2021


Q2M612
Complaint, Follow Up
7/15/2021


PN3F12
Recertification, Complaint, Follow Up, State Licensure
7/15/2021


Q2M611
Complaint
6/11/2021


PN3F11
Recertification, Complaint, State Licensure
6/11/2021


VZOT23
Follow Up, Life Safety Code, Other
5/13/2021


0IN612
Complaint, Follow Up
5/5/2021


VZOT22
Follow Up, Life Safety Code, Other
5/5/2021


LUR311
Complaint
4/6/2021


0IN611
Complaint
3/18/2021


VZOT21
Life Safety Code, Other
3/16/2021


 
 


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.