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: 1109 E NATIONAL HIGHWAY
City: WASHINGTON
Telephone: (812) 254-7159
Web Site:
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
LICENSE INFORMATION:
License number: 24-000303-1
License effective date: 8/1/2024
License expiration date: 7/31/2025
Administration and Staff
Administrator: JULIE CHAPMAN
Start date: 9/16/2010
Director of Nursing: LISA ALLEY
Start date: 10/3/2023
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: MAJOR HOSPITAL
2451 INTELLPLEX DR
SHELBYVILLE IN 46176
Ownership type: OTHER
Officer(s): DANA CALDWELL
DOUGLAS CARTER
JEFF BEATY
JOHN COFFIN
JAN SANDMAN
SHERRI TANDY
STEVE MIRETZKY
JOHN HORNER
PAULA GUSTAFSON
GENE JONES
SCOTT MILLER
RALPH MERCURI
LINDA WESSIC
ILYA SHUMAN
ROB KINDER
DONALD KUMP
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: HILLSIDE MANOR INC
Date of last change of ownership:
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 3
Number of Medicare/Medicaid beds (SNF/NF): 45
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 48
RESIDENTIAL CARE BEDS:
Total number of residential beds: 0
Total number of beds in facility: 48
CENSUS:
Facility census: 37
As reported by the facility on: 9/28/2023
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 9/28/2023
Residential care beds occupied: 0
As reported by the facility on: 9/28/2023
Alzheimer Beds: 0
Alzheimer Beds Occupied: 0
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: 26
Number of comprehensive care resident rooms with battery
operated smoke detectors: 26
Number of comprehensive care resident rooms
with hard wired and/or wireless smoke detectors: 26
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 - JULIE CHAPMAN
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. HFA
Date form completed - 4/29/2024
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:
Nurse aide training and competency evaluation program (NATCEP) expires:
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 10/24/2023
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
NURSE AIDE TRAINING BY DIXIE
Approved: 11/9/2006
Terminated: 8/30/2007
TWIN RIVERS AREA MEDICAL CAREERS
Approved: 8/14/1996
Terminated: 10/5/2005
HILLSIDE MANOR NURSING HOME
Approved: N/A
Terminated: 1/10/2011
FIRST CHOICE TRAINING SERVICES
Approved: 2/8/2013
Terminated: 6/21/2013
VINCENNES UNIVERSITY
Approved: 9/10/2010
Terminated: 1/10/2011
TWIN RIVERS HEALTH CAREERS
Approved: 12/21/2015
Terminated: 10/25/2021
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 1
2 years previous: 3
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
344
401
419
419
Rank of Score
53
26
18
18
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
Directed Plan of Correction
Date Imposed: 1/6/2024 Date Ended: 11/7/2023
Civil Money Penalty
Date Imposed: 6/12/2023 Date Ended: 6/12/2023
Amount proposed per day: 6993
Civil Money Penalty
Date Imposed: 5/23/2023 Date Ended: 6/5/2023
Amount proposed per day: 5917
Amount proposed per day: 6455
Amount proposed per day: 6993
Directed Plan of Correction
Date Imposed: 8/20/2022 Date Ended: 8/15/2022
Civil Money Penalty
Date Imposed: 7/26/2022 Date Ended: 7/26/2022
Amount proposed per day:
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.
