SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART
Created on: 11/15/2024
Posted to the Web on: 11/27/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 635 OAKHILL AVE
City: PLYMOUTH
Telephone: (574) 936-9981
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-000041-1
License effective date: 7/1/2024
License expiration date: 6/30/2025
Administration and Staff
Administrator: BRYAN ZEHR
Start date: 5/1/2018
Director of Nursing: KELLY CLARY
Start date: 5/24/2021
Medical director: Byron Holm
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist: Ashlyn Householder
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: JOHNSON MEMORIAL HOSPITAL
1125 W JEFFERSON ST
FRANKLIN IN 46131
Ownership type: NON-PROFIT
Officer(s): SAUNDRA (SANDI) HUDDLESTON
R MARTIN UMBARGER
JERRY ENGLE
STEVE BERKHOUSE
KEVIN MCGINNIS
DAVID WIESMAN
RICK KESTER
ROBERT DECOLA
DAVID DUNKLE
ANNE-MARIE SCHENK
WILLIAM MINK
ADAM PUTVIN
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: MILLER'S HEALTH SYSTEMS INC
Date of last change of ownership: 7/1/2012
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 16
Number of Medicare/Medicaid beds (SNF/NF): 115
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 131
RESIDENTIAL CARE BEDS:
Total number of residential beds: 4
Total number of beds in facility: 135
CENSUS:
Facility census: 73
As reported by the facility on: 7/2/2024 1
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/2/2024 1
Residential care beds occupied: 0
As reported by the facility on: 7/2/2024 1
Alzheimer Beds: 20
Alzheimer Beds Occupied: 18
As reported by the facility on: / /
Ventilator Beds: 0
Ventilator Beds Occupied: 0
As reported by the facility on: / /
Sprinklers and Smoke Detectors
This facility is: FULLY SPRINKLERED
Number of comprehensive care resident rooms: 75
Number of comprehensive care resident rooms with battery
operated smoke detectors: 75
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 0
Person completing form - BRYAN ZEHR
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. ADMINISTRATOR
Date form completed - 3/17/2023
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved: 1/17/2006
Nurse aide training and competency evaluation program (NATCEP) expires: 4/1/2026
Nurse aide training and competency evaluation program (NATCEP) banned: No
Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
PLYMOUTH COMUNITY SCHOOL CORPORATION
Approved: 3/30/2000
Terminated: N/A
MILLER'S MERRY MANOR
Approved: 8/9/1996
Terminated: N/A
HAGEN HEALTH EDUCATION
Approved: 4/17/2015
Terminated: N/A
KNOX HIGH SCHOOL
Approved: 12/7/2010
Terminated: N/A
ANCILLA COLLEGE
Approved: 9/17/2012
Terminated: 1/4/2019
MILLER'S MERRY MANOR
Approved: 2/22/2008
Terminated: N/A
MILLER'S MERRY MANOR
Approved: 10/1/2013
Terminated: N/A
MILLER'S HEALTH & REHAB BY MILLER'S MERRY MANOR
Approved: 8/1/2016
Terminated: N/A
WATERS OF WAKARUSA SKILLED NURSING FACILITY, THE
Approved: 7/29/2016
Terminated: N/A
MILLER'S MERRY MANOR
Approved: 12/19/2022
Terminated: N/A
LEGACY MEDICAL ACADEMY
Approved: 1/12/2021
Terminated: N/A
MILLER'S MERRY MANOR
Approved: 4/27/2023
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
Facility Report Card
3/1/2020 Current QTR
12/1/2019 Previous QTR
9/1/2019 Previous QTR
6/1/2019 Previous QTR
Report Card Score
428
428
392
392
Rank of Score
15
13
34
34
Average Score
302
296
295
296
*Facility report card scores have not been updated since March 1, 2020 due to changes in the survey process during the ongoing COVID-19 pandemic.
The facility report card score is calculated four times per calendar year
for the two most recent nursing home health surveys. The facility report card score
also includes all complaint surveys, life safety code surveys, emergency preparedness surveys,
and any follow-up surveys that occur within the two most recent nursing home health surveys.
The facility report card score ranges from 500 to 0, with 500 being the best score possible.
View the Scope and Severity gridView the scoring methodology
Overview of Survey findings
The Most Recent Set
2ND Most Recent Set
3RD Most Recent Set
Immediate Jeopardy
No
No
No
Substandard Quality of Care
No
No
No
Administrator Change
No
No
No
Owner Change
No
No
No
Number of Substantiated Complaints With Deficiencies
0
0
0
Deficiency Free Standard Health Survey
No
No
No
The term 'Recent Set' referenced above relates to the referenced annual survey,
and any other surveys performed between it and the previous annual survey.
Enforcement Actions
Federal Certification Actions Imposed
Date terminated from Medicare/Medicaid: N/A
Survey History
The survey report is not posted until the report has been provided to the facility and their plan of correction submitted and approved.
The survey report therefore will likely not be posted until four to six weeks after the exit date.
In the grid below click on an event ID that is underlined to see the survey report for that event.
