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PARKVIEW MEMORIAL HOSPITAL-CCC
CONSUMER REPORT
Created on: 01/10/2013
Posted to the Web on: 01/23/2013
 
Facility Profile
 

Basic Information
Address: 2200 RANDALLIA DR
City: FORT WAYNE
Telephone: (260) 373-6524
 
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Most recent name change: N/A
Date of most recent name change: N/A
Owning corporation: PARKVIEW HOSPITAL INC
2200 RANDALLIA DR
FORT WAYNE IN 46805
Ownership type:  NON-PROFIT
Officer(s): MIKE PACKNETT
            SUE EHINGER
            MIKE BROWNING
 
Name of previous owner: N/A
Date of last change of ownership: N/A
Administrator: KELLY BORROR
Administrator start date: 02/19/2001
License number: 10-001203-1
License effective date: 01/01/2010
License expiration date: 12/31/2012
 
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 35
Number of comprehensive care resident rooms with battery
                    operated smoke detectors: 10
Number of comprehensive care resident rooms
             with hard wired and/or wireless smoke detectors: 25
  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 - KELLY BORROR
  Title - ADMINISTRATOR
Date form completed - 10/18/2012
 
Nurse Aide Training Competency Evaluation Program (NATCEP)
NATCEP approved: 10/03/2000
NATCEP expires:  04/01/2002
NATCEP banned: NO
NATCEP ban expires: N/A
This facility is a Clinical training site for the following NAT classroom sites: 
     FORT WAYNE COMMUNITY SCHOOLS-ANTHIS CAREER CTR
         Approved: 12/27/1999
       Terminated: N/A
     PARKVIEW MEMORIAL HOSPITAL-CCC
         Approved: 10/03/2000
       Terminated: N/A
 
Beds
# of Medicaid beds (NF):                     0
# of Medicare beds (SNF):                    41
# of Medicare/Medicaid beds (SNF/NF):        0
Total number of comprehensive care beds:     41
# of non-certified comprehensive care beds:  0
Total number of residential beds:            0
Total number of beds in facility:            41
Facility census:  25 as of: 05/31/2012
 
Results of Surveys
Date of last annual health survey: 05/11/2012
In substantial compliance on most recent annual health survey? NO
If no, date facility achieved substantial compliance
from annual health survey: 06/06/2012
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: N/A
 
Immediate jeopardy designations: N/A
 
 
State Licensure Actions
 
Federal Certification Actions Imposed
 
Date terminated from Medicare.Medicaid: N/A
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