HICKORY CREEK AT MADISON
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: 1945 CRAGMONT ST City: MADISON Telephone: (812) 273-4696 View location on map Most recent name change: N/A Date of most recent name change: N/A Owning corporation: HICKORY CREEK HEALTHCARE FOUNDATION INC 6081 E 82ND ST STE 120 INDIANAPOLIS IN 46250 Ownership type: NON-PROFIT Officer(s): FRANCIS CROSBY JOHN STODDARD GARY WAYMIRE Name of previous owner: N/A Date of last change of ownership: N/A Administrator: CHRISTI WOLFSCHLAG-RISK Administrator start date: 12/21/2004 License number: 12-000348-1 License effective date: 11/01/2012 License expiration date: 10/31/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 18 Number of comprehensive care resident rooms with battery operated smoke detectors: 18 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - CHRISTI RISK Title - HFA Date form completed - 10/02/2012 Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 11/01/2012 NATCEP expires: 10/31/2013 NATCEP banned: NO NATCEP ban expires: N/A This facility is a Clinical training site for the following NAT classroom sites: INDIANA HEALTHCARE PROFESSIONALS LLC Approved: 06/03/2006 Terminated: N/A HICKORY CREEK AT FRANKLIN Approved: 07/28/1999 Terminated: N/A HICKORY CREEK AT NEW CASTLE Approved: 01/27/2000 Terminated: N/A HICKORY CREEK AT SCOTTSBURG Approved: 03/13/2001 Terminated: 07/07/2004 HICKORY CREEK AT GREENSBURG Approved: N/A Terminated: N/A HICKORY CREEK AT NORTH VERNON Approved: N/A Terminated: N/A HANOVER NURSING CENTER Approved: N/A Terminated: 09/21/2005 Beds # of Medicaid beds (NF): 0 # of Medicare beds (SNF): 0 # of Medicare/Medicaid beds (SNF/NF): 36 Total number of comprehensive care beds: 36 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 36 Facility census: 36 as of: 12/05/2011 Results of Surveys Date of last annual health survey: 12/01/2011 In substantial compliance on most recent annual health survey? NO If no, date facility achieved substantial compliance from annual health survey: 12/05/2011 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 State Licensure Actions Event ID: GOCO11 Action - Citation / Fine Notice to facility: 10/29/2004 Appeal: N/A Action Cease/Recind: 11/17/2004 Case Closed: 11/17/2004 Initial Amount: $7000 Federal Certification Actions Imposed Date terminated from Medicare.Medicaid: N/A HICKORY CREEK AT MADISON
CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility ProfileReturn to Search Page