Created on: 3/8/2024
Posted to the Web on: 3/20/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 4904 WAR ADMIRAL DRIVE
City: INDIANAPOLIS
Telephone: (317) 885-3333
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-013126-1
License effective date: 3/1/2024
License expiration date: 2/28/2025
Administration and Staff
Administrator: SARA SUZANNE KELLEY
Start date: 10/24/2022
Director of Nursing: ANGEL CRAWFORD
Start date: 12/7/2020
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: HANCOCK REGIONAL HOSPITAL
801 NORTH STATE STREET
GREENFIELD IN 46140
Ownership type: OTHER
Officer(s): TIMOTHY CLARK
ROY WILSON
DEAN FELKER
STEVEN LONG
SARA JOYNER
JOSH DAUGHERTY
MARIA BOND
LACEY WILLARD
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: KINDRED NURSING CENTERS LIMITED PARTNERSHIP
Date of last change of ownership: 3/1/2016
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): 100
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 100
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 100
CENSUS:
Facility census: 87
As reported by the facility on: 1/14/2020
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 1/14/2020
Residential care beds occupied: 0
As reported by the facility on: 1/14/2020
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: 100
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: 100
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 - HEATHER SOOTS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. EXECUTIVE DIRECTOR
Date form completed - 3/23/2021
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 4/15/2021
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2023
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 5/12/2024
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
KINDRED HEALTHCARE
Approved: 6/16/2016
Terminated: 10/1/2019
SOUTHPOINTE HEALTHCARE CENTER
Approved: 4/21/2021
Terminated: 5/13/2022
INDIAN CREEK HEALTHCARE CENTER
Approved: 4/18/2023
Terminated: 5/13/2022
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
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
349
335
335
338
Rank of Score
52
55
57
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
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
Federal Certification Actions Imposed
Civil Money Penalty
Date Imposed: 11/15/2021 Date Ended: 12/15/2021
Amount proposed per day: 760
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.
