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LAKELAND SKILLED NURSING AND REHABILITATION
CONSUMER REPORT
Created on: 01/10/2013
Posted to the Web on: 01/23/2013
 
Facility Profile
 

Basic Information
Address: 500 N WILLIAMS ST
City: ANGOLA
Telephone: (260) 665-2161
 
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Most recent name change: N/A
Date of most recent name change: N/A
Owning corporation: COVENANT CARE INDIANA INC
27071 ALISO CREEK RD   STE 100
ALISO VIEJO CA 92656
Ownership type:  PROFIT
Officer(s): ROBERT LEVIN
            CHRISTINE SIMS
            MARY EVANS
            ANDREW TOROK
 
Name of previous owner: N/A
Date of last change of ownership: N/A
Administrator: JUDITH PRIVETT
Administrator start date: 10/20/2010
License number: 12-000474-1
License effective date: 05/01/2012
License expiration date: 04/30/2013
 
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 42
Number of comprehensive care resident rooms with battery
                    operated smoke detectors: 15
Number of comprehensive care resident rooms
             with hard wired and/or wireless smoke detectors: 27
  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 - JUDY PRIVETT
  Title - ADMINISTRATOR
Date form completed - 08/02/2012
 
Nurse Aide Training Competency Evaluation Program (NATCEP)
NATCEP approved: 05/01/2012
NATCEP expires:  04/30/2013
NATCEP banned: NO
NATCEP ban expires: N/A
This facility is a Clinical training site for the following NAT classroom sites: 
     IVY TECH COMMUNITY COLLEGE
         Approved: 05/06/2002
       Terminated: N/A
     FOUR COUNTY AREA VOCATIONAL
         Approved: 12/09/2005
       Terminated: N/A
 
Beds
# of Medicaid beds (NF):                     0
# of Medicare beds (SNF):                    4
# of Medicare/Medicaid beds (SNF/NF):        71
Total number of comprehensive care beds:     75
# of non-certified comprehensive care beds:  0
Total number of residential beds:            0
Total number of beds in facility:            75
Facility census:  73 as of: 08/01/2012
 
Results of Surveys
Date of last annual health survey: 08/01/2012
In substantial compliance on most recent annual health survey? NO
If no, date facility achieved substantial compliance
from annual health survey: 09/01/2012
Currently found in substantial compliance? Yes
 
# of substantiated complaints: current year  0
# of substantiated complaints: previous year  1
# of substantiated complaints: 2 years previous  1
Substandard quality of care designations: N/A
 
Immediate jeopardy designations: N/A
 
 
State Licensure Actions
 
Federal Certification Actions Imposed
     Civil Money Penalty
     Date Imposed: 02/04/2011  Date Ended: 02/04/2011
     Amount proposed per day: 100
     Amount proposed per day: 
 
Date terminated from Medicare.Medicaid: N/A
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