COUNTRYSIDE MANOR HEALTH & LIVING COMMUNITY
CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility ProfileReturn to Search Page
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Basic Information Address: 205 MARINE DR City: ANDERSON Telephone: (765) 649-4558 View location on map Most recent name change: N/A Date of most recent name change: N/A Owning corporation: RIVERVIEW HOSPITAL 395 WESTFIELD ROAD NOBLESVILLE IN 46060 Ownership type: NON-PROFIT Officer(s): PATRICIA FOX LARRY CHRISTMAN PAT FOX WILLIAM KIRSCH Name of previous owner: COUNTRYSIDE MANOR HEALTH & LIVING COMMUNITY LLC Date of last change of ownership: 03/01/2011 Administrator: STEPHANIE INGRAM Administrator start date: 12/27/2010 License number: 12-000160-1 License effective date: 03/01/2012 License expiration date: 02/28/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 65 Number of comprehensive care resident rooms with battery operated smoke detectors: 65 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - STEPHANIE INGRAM Title - ADMINISTRATOR Date form completed - / / Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 02/26/2004 NATCEP expires: 04/01/2006 NATCEP banned: YES NATCEP ban expires: 04/15/2010 This facility is a Clinical training site for the following NAT classroom sites: EBBERTT EDUCATION CENTER Approved: 08/17/1998 Terminated: 04/18/2005 IVY TECH COMMUNITY COLLEGE REGION 6 Approved: 05/12/2010 Terminated: N/A RAWLINS HOUSE HEALTH & LIVING COMMUNITY Approved: 07/31/1998 Terminated: 04/18/2005 HIS SOLUTIONS HEALTHCARE Approved: 04/26/2012 Terminated: N/A COUNTRYSIDE MANOR HEALTH & LIVING COMMUNITY Approved: 02/26/2004 Terminated: 04/26/2006 Beds # of Medicaid beds (NF): 0 # of Medicare beds (SNF): 22 # of Medicare/Medicaid beds (SNF/NF): 87 Total number of comprehensive care beds: 109 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 109 Facility census: 97 as of: 07/23/2012 Results of Surveys Date of last annual health survey: 07/20/2012 In substantial compliance on most recent annual health survey? NO If no, date facility achieved substantial compliance from annual health survey: 08/20/2012 Currently found in substantial compliance? Yes # of substantiated complaints: current year 0 # of substantiated complaints: previous year 0 # of substantiated complaints: 2 years previous 0 Substandard quality of care designations: N/A Immediate jeopardy designations: N/A 01/18/2005 State Licensure Actions Event ID: Action - Citation / Fine Notice to facility: 06/07/1999 Appeal: 11/17/1999 Action Cease/Recind: 10/22/1999 Case Closed: N/A Initial Amount: $3000 Event ID: Action - Citation / Fine Notice to facility: 11/16/1998 Appeal: 12/03/1998 Action Cease/Recind: N/A Case Closed: N/A Initial Amount: $3000 Federal Certification Actions Imposed Date terminated from Medicare.Medicaid: N/A COUNTRYSIDE MANOR HEALTH & LIVING COMMUNITY
CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility ProfileReturn to Search Page