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

Basic Information
Address: 31869 CHICAGO TR
City: NEW CARLISLE
Telephone: (574) 654-2200
 
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Most recent name change: N/A
Date of most recent name change: N/A
Owning corporation: HAVEN HUBBARD HOME OF THE UNITED METHODIST CHURCH
31869 CHICAGO TRAIL, PO BOX 0836
NEW CARLISLE IN 46552
Ownership type:  NON-PROFIT
Officer(s): ROBERT BONDURANT
            DALE GUCKENBERGER
            ROBERT POLLOCK
 
Name of previous owner: N/A
Date of last change of ownership: N/A
Administrator: DAVID THOMPSON
Administrator start date: 06/16/2005
License number: 12-000427-1
License effective date: 05/01/2012
License expiration date: 04/30/2013
 
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 57
Number of comprehensive care resident rooms with battery
                    operated smoke detectors: 0
Number of comprehensive care resident rooms
             with hard wired and/or wireless smoke detectors: 57
  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 - DAVE THOMPSON
  Title - ADMINISTRATOR
Date form completed - 09/05/2012
 
Nurse Aide Training Competency Evaluation Program (NATCEP)
NATCEP approved: 04/10/2000
NATCEP expires:  04/01/2002
NATCEP banned: YES
NATCEP ban expires: 09/11/2010
This facility is a Clinical training site for the following NAT classroom sites: 
     HAMILTON GROVE
         Approved: 03/10/1998
       Terminated: 09/12/2008
     NEW PRAIRIE HIGH SCHOOL
         Approved: 02/10/2011
       Terminated: N/A
 
Beds
# of Medicaid beds (NF):                     0
# of Medicare beds (SNF):                    0
# of Medicare/Medicaid beds (SNF/NF):        85
Total number of comprehensive care beds:     85
# of non-certified comprehensive care beds:  0
Total number of residential beds:            84
Total number of beds in facility:            169
Facility census:  73 as of: 06/18/2012
 
Results of Surveys
Date of last annual health survey: 05/25/2012
In substantial compliance on most recent annual health survey? NO
If no, date facility achieved substantial compliance
from annual health survey: 06/24/2012
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: 
     09/12/2008
 
Immediate jeopardy designations: N/A
     09/12/2008
 
 
State Licensure Actions
Event ID: Y4C611
  Action - Citation / Fine
 Notice to facility: N/A
             Appeal: N/A
Action Cease/Recind: N/A
         Case Closed: 10/04/2011
Initial Amount: $1500
Event ID: 3Y5W11
  Action - Citation / Fine
 Notice to facility: 04/26/2002
             Appeal: N/A
Action Cease/Recind: 05/01/2002
         Case Closed: 05/01/2002
Initial Amount: $5000
 
Federal Certification Actions Imposed
 
Date terminated from Medicare.Medicaid: N/A
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