BROOKSIDE HAVEN
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: 505 N GAVIN ST City: MUNCIE Telephone: (765) 289-1915 View location on map Most recent name change: N/A Date of most recent name change: N/A Owning corporation: NEWBERRY GROUP INC 130 FAIRWAY LAKES DR FRANKLIN IN 46131 Ownership type: PROFIT Officer(s): DAPHNA TOBEY Name of previous owner: N/A Date of last change of ownership: N/A Administrator: PAULA SMITH Administrator start date: 11/05/2007 License number: 12-000311-1 License effective date: 04/01/2012 License expiration date: 03/31/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 42 Number of comprehensive care resident rooms with battery operated smoke detectors: 22 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - PAULA SMITH Title - ADMINISTRATOR Date form completed - 07/10/2012 Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 04/01/2012 NATCEP expires: 03/31/2013 NATCEP banned: YES NATCEP ban expires: 09/22/2012 This facility is a Clinical training site for the following NAT classroom sites: Beds # of Medicaid beds (NF): 42 # of Medicare beds (SNF): 0 # of Medicare/Medicaid beds (SNF/NF): 0 Total number of comprehensive care beds: 42 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 42 Facility census: 40 as of: 11/20/2012 Results of Surveys Date of last annual health survey: 11/20/2012 In substantial compliance on most recent annual health survey? NO If no, date facility achieved substantial compliance from annual health survey: 12/19/2012 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: 09/23/2010 06/11/2007 04/08/2005 Immediate jeopardy designations: N/A 09/23/2010 06/11/2007 State Licensure Actions Event ID: HEVQ11 Action - Citation / Fine Notice to facility: 11/08/2002 Appeal: 12/03/2002 Action Cease/Recind: 08/04/2003 Case Closed: 08/04/2003 Initial Amount: $2500 Event ID: HNGI11 Action - Citation / Fine Notice to facility: 08/02/2002 Appeal: 08/14/2002 Action Cease/Recind: 08/04/2003 Case Closed: 08/04/2003 Initial Amount: $6000 Event ID: Action - Citation / Fine Notice to facility: 06/23/1999 Appeal: 07/08/1999 Action Cease/Recind: 03/30/2000 Case Closed: N/A Initial Amount: $2500 Federal Certification Actions Imposed Date terminated from Medicare.Medicaid: N/A BROOKSIDE HAVEN
CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility ProfileReturn to Search Page