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RENAISSANCE VILLAGE
CONSUMER REPORT
Created on: 01/10/2013
Posted to the Web on: 01/23/2013
 
Facility Profile
 

Basic Information
Address: 6050 S CR 800 E 92
City: FORT WAYNE
Telephone: (260) 625-3545
 
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Most recent name change: N/A
Date of most recent name change: N/A
Owning corporation: RENAISSANCE HEALTH CARE LLC
6050 S CR 800 E-92
FORT WAYNE IN 46814
Ownership type:  PROFIT
Officer(s): MICHAEL MOHRMAN
            BILL EHINGER
            GARY PROBST
 
Name of previous owner: N/A
Date of last change of ownership: N/A
Administrator: DEBORAH MILLS
Administrator start date: 01/01/1998
License number: 12-000215-1
License effective date: 04/01/2012
License expiration date: 03/31/2013
 
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 48
Number of comprehensive care resident rooms with battery
                    operated smoke detectors: 40
Number of comprehensive care resident rooms
             with hard wired and/or wireless smoke detectors: 8
  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 - JOHN CHERNESLY
  Title - LEAD MAINTENANCE
Date form completed - 11/07/2012
 
Nurse Aide Training Competency Evaluation Program (NATCEP)
NATCEP approved: 03/23/2006
NATCEP expires:  04/01/2014
NATCEP banned: NO
NATCEP ban expires: N/A
This facility is a Clinical training site for the following NAT classroom sites: 
     MANNIA GREEN HEALTHCARE ADVANTAGE, INC
         Approved: 09/07/2001
       Terminated: 03/12/2003
     IVY TECH COMMUNITY COLLEGE
         Approved: 05/30/2002
       Terminated: N/A
     FORT WAYNE COMMUNITY SCHOOLS NEIGHBORHOOD CONNECTI
         Approved: 09/15/2005
       Terminated: N/A
     RENAISSANCE VILLAGE
         Approved: 03/03/2006
       Terminated: N/A
     FORT WAYNE COMMUNITY SCHOOLS-ANTHIS CAREER CTR
         Approved: 02/17/1998
       Terminated: N/A
     UNIVERSITY OF SAINT FRANCIS
         Approved: N/A
       Terminated: 04/01/2003
 
Beds
# of Medicaid beds (NF):                     64
# of Medicare beds (SNF):                    0
# of Medicare/Medicaid beds (SNF/NF):        32
Total number of comprehensive care beds:     96
# of non-certified comprehensive care beds:  0
Total number of residential beds:            0
Total number of beds in facility:            96
Facility census:  81 as of: 10/29/2012
 
Results of Surveys
Date of last annual health survey: 10/29/2012
In substantial compliance on most recent annual health survey? NO
If no, date facility achieved substantial compliance
from annual health survey: 11/28/2012
Currently found in substantial compliance? Yes
 
# of substantiated complaints: current year  0
# of substantiated complaints: previous year  2
# of substantiated complaints: 2 years previous  0
Substandard quality of care designations: N/A
 
Immediate jeopardy designations: N/A
 
 
State Licensure Actions
 
Federal Certification Actions Imposed
 
Date terminated from Medicare.Medicaid: N/A
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