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WATERS OF YORKTOWN THE

CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility Profile
Basic Information Address: 2000 S ANDREWS RD City: YORKTOWN Telephone: (765) 759-7740 View location on map Most recent name change: N/A Date of most recent name change: N/A Owning corporation: THE WATERS OF YORKTOWN LLC 2000 S ANDREWS ST YORKTOWN IN 47396 Ownership type: PROFIT Officer(s): JERRY KEMPER Name of previous owner: N/A Date of last change of ownership: N/A Administrator: LLOYD WHITE Administrator start date: 08/22/2011 License number: 12-000143-1 License effective date: 12/01/2012 License expiration date: 11/30/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 52 Number of comprehensive care resident rooms with battery operated smoke detectors: 52 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - LLOYD WHITE Title - ADMINISTRATOR Date form completed - 07/16/2012 Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 03/09/2004 NATCEP expires: 04/01/2006 NATCEP banned: YES NATCEP ban expires: 11/30/2012 This facility is a Clinical training site for the following NAT classroom sites: WATERS OF MUNCIE THE Approved: 08/24/2006 Terminated: 04/05/2007 WATERS OF NEW CASTLE THE Approved: 03/10/2003 Terminated: 05/11/2004 MUNCIE AREA CAREER CENTER Approved: 03/12/2007 Terminated: 04/05/2007 MUNCIE AREA CAREER CENTER Approved: 04/16/1998 Terminated: 05/11/2004 IVY TECH COMMUNITY COLLEGE REGION 6 Approved: 01/25/2010 Terminated: 12/01/2010 WATERS OF YORKTOWN THE Approved: 03/10/1998 Terminated: 12/01/2010 Beds # of Medicaid beds (NF): 0 # of Medicare beds (SNF): 0 # of Medicare/Medicaid beds (SNF/NF): 100 Total number of comprehensive care beds: 100 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 100 Facility census: 77 as of: 11/01/2011 Results of Surveys Date of last annual health survey: 10/11/2011 In substantial compliance on most recent annual health survey? NO If no, date facility achieved substantial compliance from annual health survey: 11/10/2011 Currently found in substantial compliance? No # of substantiated complaints: current year 0 # of substantiated complaints: previous year 0 # of substantiated complaints: 2 years previous 0 Substandard quality of care designations: 04/05/2007 Immediate jeopardy designations: N/A 04/05/2007 State Licensure Actions Federal Certification Actions Imposed Civil Money Penalty Date Imposed: 08/12/2010 Date Ended: 11/04/2010 Amount proposed per day: 300 Date terminated from Medicare.Medicaid: N/A

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