COVINGTON MANOR HEALTH AND REHABILITATION CENTER
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: 5700 WILKIE DR City: FORT WAYNE Telephone: (260) 432-7556 View location on map 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: KEITH WILSON Administrator start date: 09/24/2012 License number: 12-000476-1 License effective date: 12/01/2012 License expiration date: 11/30/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 82 Number of comprehensive care resident rooms with battery operated smoke detectors: 82 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 0 Person completing form - KEITH M WILSON Title - EXECUTIVE DIRECTOR Date form completed - 10/31/2012 Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 02/15/2000 NATCEP expires: 04/01/2002 NATCEP banned: YES NATCEP ban expires: 04/10/2010 This facility is a Clinical training site for the following NAT classroom sites: FORT WAYNE COMMUNITY SCHOOLS NEIGHBORHOOD CONNECTI Approved: 09/15/2005 Terminated: 04/11/2008 IVY TECH COMMUNITY COLLEGE Approved: 01/25/2011 Terminated: N/A COVINGTON MANOR HEALTH AND REHABILITATION CENTER Approved: 03/10/1998 Terminated: 04/11/2008 FORT WAYNE COMMUNITY SCHOOLS-ANTHIS CAREER CTR Approved: 02/17/1998 Terminated: 04/11/2008 UNIVERSITY OF SAINT FRANCIS Approved: N/A Terminated: 04/11/2008 Beds # of Medicaid beds (NF): 0 # of Medicare beds (SNF): 0 # of Medicare/Medicaid beds (SNF/NF): 149 Total number of comprehensive care beds: 149 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 149 Facility census: 134 as of: 01/20/2012 Results of Surveys Date of last annual health survey: 01/13/2012 In substantial compliance on most recent annual health survey? NO If no, date facility achieved substantial compliance from annual health survey: N/A Currently found in substantial compliance? Yes # of substantiated complaints: current year 0 # of substantiated complaints: previous year 4 # of substantiated complaints: 2 years previous 5 Substandard quality of care designations: N/A Immediate jeopardy designations: N/A State Licensure Actions Event ID: ORYN11 Action - Citation / Fine Notice to facility: 12/01/2004 Appeal: N/A Action Cease/Recind: 03/08/2005 Case Closed: 03/08/2005 Initial Amount: $2800 Event ID: 2YQX11 Action - Citation / Fine Notice to facility: 07/25/2002 Appeal: N/A Action Cease/Recind: 07/31/2002 Case Closed: 07/31/2002 Initial Amount: $3750 Federal Certification Actions Imposed Civil Money Penalty Date Imposed: 12/21/2011 Date Ended: 02/28/2012 Amount proposed per day: 100 Date terminated from Medicare.Medicaid: N/A COVINGTON MANOR HEALTH AND REHABILITATION CENTER
CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility ProfileReturn to Search Page