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AUTUMN RIDGE REHABILITATION CENTRE

CONSUMER REPORT Created on: 01/10/2013 Posted to the Web on: 01/23/2013 Facility Profile
Basic Information Address: 600 WASHINGTON AVE City: WABASH Telephone: (260) 563-8402 View location on map Most recent name change: N/A Date of most recent name change: N/A Owning corporation: HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY 3838 N RURAL ST INDIANAPOLIS IN 46205 Ownership type: OTHER Officer(s): JAMES MINER LULA JOURNEY GREGORY FEHRIBACH ROBERT PFEIFER DAVID CRABB JOYCE IRWIN MATT GUTWEIN DAN SELLERS MAJORIE OLAUGHLIN Name of previous owner: AUTUMN RIDGE GROUP LLC Date of last change of ownership: 12/15/2009 Administrator: MATT ELWELL Administrator start date: 11/05/2012 License number: 12-000081-1 License effective date: 12/01/2012 License expiration date: 11/30/2013 This facility is: FULLY SPRINKLERED Number of comprehensive care resident rooms: 47 Number of comprehensive care resident rooms with battery operated smoke detectors: 38 Number of comprehensive care resident rooms with hard wired and/or wireless smoke detectors: 9 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 - MATT ELWELL Title - EXECUTIVE DIRECTOR Date form completed - 11/15/2012 Nurse Aide Training Competency Evaluation Program (NATCEP) NATCEP approved: 03/22/2006 NATCEP expires: 04/01/2008 NATCEP banned: YES NATCEP ban expires: 12/13/2012 This facility is a Clinical training site for the following NAT classroom sites: IVY TECH COMMUNITY COLLEGE Approved: 03/16/2005 Terminated: 07/04/2008 AUTUMN RIDGE REHABILITATION CENTRE Approved: 05/21/2002 Terminated: 12/14/2010 Beds # of Medicaid beds (NF): 0 # of Medicare beds (SNF): 0 # of Medicare/Medicaid beds (SNF/NF): 80 Total number of comprehensive care beds: 80 # of non-certified comprehensive care beds: 0 Total number of residential beds: 0 Total number of beds in facility: 80 Facility census: 60 as of: 09/28/2012 Results of Surveys Date of last annual health survey: 09/28/2012 In substantial compliance on most recent annual health survey? YES If no, date facility achieved substantial compliance from annual health survey: N/A Currently found in substantial compliance? No # of substantiated complaints: current year 0 # of substantiated complaints: previous year 1 # of substantiated complaints: 2 years previous 0 Substandard quality of care designations: 09/23/2010 Immediate jeopardy designations: N/A 09/23/2010 06/13/2007 State Licensure Actions Event ID: MDWD11 Notice to facility: N/A Appeal: N/A Action Cease/Recind: N/A Case Closed: N/A Initial Amount: $0 Event ID: W73U11 Action - Citation / Fine Notice to facility: 01/09/2004 Appeal: N/A Action Cease/Recind: 10/14/2004 Case Closed: 10/14/2004 Initial Amount: $2500 Federal Certification Actions Imposed Mand. Deny Pay for New Admits-3 Mo. Date Imposed: 12/23/2010 Date Ended: 01/06/2011 Directed Inservice Training Date Imposed: 12/14/2010 Date Ended: 12/14/2010 Civil Money Penalty Date Imposed: 11/04/2010 Date Ended: 01/06/2011 Amount proposed per day: 3550 Amount proposed per day: 100 Date terminated from Medicare.Medicaid: N/A

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