Indiana State Department of Health
Division of Long Term Care
 
CONSUMER REPORT
 
 
THIS FACILITY HAS CLOSED
 
CATHERINE KASPER HOME
 
NURSING HOME
SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 9/8/2023
 
Posted to the Web on: 9/20/2023
 
 



Basic Information

FACILITY CONTACT INFORMATION:
Address: 9601 S UNION RD
City: DONALDSON
Telephone: (574) 935-1742
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-002982-1
  License effective date: 3/1/2023
  License expiration date: 2/29/2024
 


Administration and Staff

Administrator: 
  Start date: N/A
 
 
Medical director: Byron Holm
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist: Rachel Weeks
  Start date:   /  /  
 


Ownership

CURENT OWNERSHIP:
 
Owning corporation: WOODLAWN HOSPITAL
N/A
N/A N/A N/A
 
Ownership type:  OTHER
 
Officer(s): RANDALL BUFFORD
            PAUL PLEVYAK
            PHILIP CALDWELL
            LEIGH BARNEY
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: WOODLAWN HOSPITAL
Date of last change of ownership:   /  /  
 


Bed Counts and Census

COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     0
Number of Medicare beds (SNF):                    14
Number of Medicare/Medicaid beds (SNF/NF):        68
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     82
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            82
 
CENSUS:
Facility census:  67
As reported by the facility on: 7/10/2020
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/10/2020
 
Residential care beds occupied:  0
As reported by the facility on: 7/10/2020
 
Alzheimer Beds:  9
Alzheimer Beds Occupied:  9
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:  
 
Number of comprehensive care resident rooms: 82
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 0
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 82
 
  If hard wired and/or wireless smoke detectors are provided in resident's room, do they:
    (A) Provide a visual and audible signal at the nurses'stations that attend each room? - Yes
    (B) Transmit to a central station service - Yes
    (C) Connect to the health facility's fire alarm system - Yes
 
Person completing form - JEFF BRINKMAN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ED
Date form completed - 3/28/2022
 


Nurse Aide Training

NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 3/7/2005
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: 12/23/2022
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     CATHERINE KASPER HOME
         Approved: 3/7/2005
         Terminated: 12/24/2020
     ANCILLA COLLEGE
         Approved: 9/17/2012
         Terminated: 4/29/2019
     SANCTUARY AT ST PAUL'S
         Approved: 6/4/2019
         Terminated: 12/24/2020
     KNOX HIGH SCHOOL
         Approved: 9/19/2016
         Terminated: 12/24/2020
     PARKVIEW HAVEN
         Approved: 8/17/2020
         Terminated: 12/24/2020
 


Complaints

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

 


Enforcement Actions

 
Federal Certification Actions Imposed
     Directed Plan of Correction
     Date Imposed: 1/21/2021  Date Ended: 1/15/2021
     Discretionary Deny Pay for New Admits
     Date Imposed: 12/24/2020  Date Ended: 1/14/2021
     Directed Plan of Correction
     Date Imposed: 12/16/2020  Date Ended: 1/15/2021
     Directed Plan of Correction
     Date Imposed: 11/24/2020  Date Ended: 1/15/2021
     Civil Money Penalty
     Date Imposed: 10/26/2020  Date Ended: 12/28/2020
     Amount proposed per day: 5000
     Amount proposed per day: 15000
     Amount proposed per day: 
     Amount proposed per day: 
     Amount proposed per day: 
 
Date terminated from Medicare/Medicaid: 4/1/2023
 


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

6RH311
Complaint
3/6/2023


DF6Q12
Recertification, Follow Up, State Licensure
1/5/2023


DF6Q22
Recertification, Follow Up, Life Safety Code
1/3/2023


DF6Q21
Recertification, Life Safety Code
11/28/2022


DF6Q11
Recertification, State Licensure
10/24/2022


IC6O11
Other
2/7/2022


VQ5J11
Other
3/25/2021


23PC12
Follow Up, Other
1/19/2021


97O612
Follow Up, Other
1/19/2021


B10J11
Complaint
1/11/2021


ZDUC11
Other
1/5/2021


97O611
Other
12/28/2020


4FK612
Follow Up, Other
12/4/2020


MSWL11
Complaint, Other
11/25/2020


23PC11
Other
11/8/2020


4FK611
Other
10/26/2020


 
 


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.