| General |
| City |
| Shelbyville |
Seymour |
| State attribute explanation |
| In |
In |
| Street |
| 2309 S Miller St |
707 S Jackson Park Dr |
| Zip Code |
| 46,176 |
47,274 |
| Phone |
| 3,173,989,781 |
8,125,222,416 |
|
Overall Star Rating |
| 3 |
1 |
|
Health Inspections Star Rating |
| 5 |
2 |
|
Nurse Staffing Star Rating |
| 1 |
1 |
|
Quality Measures Star Rating |
| 1 |
3 |
|
RN Only Star Rating |
| 1 |
2 |
|
Number of Certified Beds |
| 141 |
115 |
|
Total Number of Residents |
| 85 |
73 |
|
Percent of Occupied Beds |
| 60 % |
63 % |
| Health Survey Date |
| 10/24/2011 |
5/25/2012 |
| Fire Survey Date |
| 10/24/2011 |
5/31/2012 |
| Sprinkler Status |
| Fully Sprinklered |
Fully Sprinklered |
| Program Participation |
| Medicare And Medicaid |
Medicare And Medicaid |
| Type of Ownership |
| For Profit - Corporation |
Government - County |
| Located Within a Hospital? |
| No |
No |
| Multi Nursing Home Ownership? |
| Yes |
Yes |
| Resident and Family Councils |
| Resident |
Resident |
| Continuing Care Retirement Community? |
| No |
No |
| Quality Indicator Survey? |
| No |
No |
| Special Focus Facility? |
| No |
No |
| Civil Money Penalty Count |
| 75.2 |
1 |
| Total Enforcement Actions Count |
| 75.2 |
1 |
| # of deficiencies |
| 3 |
31 |
|
| Staff Information |
| Number of Residents |
| 85 |
73 |
| Number of RN Hours Per Resident Per Day |
| 0.31 |
0.5 - 2.0 |
| Number of LPN/LVN Hours Per Resident Per Day |
| 1.16 |
0.96 |
| Total Number of Licensed Staff Hours Per Resident Per Day |
| 1.48 |
1.46 |
| Number of CNA Hours Per Resident Per Day |
| 0.07 |
0.16 |
| Number Therapy Hours Per Resident Per Day |
| 0.07 |
0.16 |
| Environmental Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 3deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 05/21/2009date Of Correction: 06/19/2009 |
Scope: Somelevel Of Harm: 2deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 01/03/2012date Of Correction: 01/20/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 3deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 07/07/2010date Of Correction: 07/16/2010 |
| Deficiency #3 |
|
Scope: Fewlevel Of Harm: 2deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Mistreatment Deficiencies |
| Deficiency #1 |
|
Scope: Somelevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 05/04/2012date Of Correction: 06/03/2012 |
| Deficiency #2 |
|
Scope: Somelevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 05/04/2012date Of Correction: 06/03/2012 |
| Deficiency #3 |
|
Scope: Somelevel Of Harm: 2deficiency: Protect Each Resident From All Abuse, Physical Punishment, And Being Separated From Others.survey Date: 05/04/2012date Of Correction: 06/03/2012 |
| Deficiency #4 |
|
Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 11/18/2011date Of Correction: 12/17/2011 |
| Deficiency #5 |
|
Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 11/18/2011date Of Correction: 12/17/2011 |
| Deficiency #6 |
|
Scope: Fewlevel Of Harm: 2deficiency: Write And Use Policies That Forbid Mistreatment, Neglect And Abuse Of Residents And Theft Of Residents' Property.survey Date: 11/18/2011date Of Correction: 12/17/2011 |
| Deficiency #7 |
|
Scope: Fewlevel Of Harm: 2deficiency: Protect Each Resident From All Abuse, Physical Punishment, And Being Separated From Others.survey Date: 11/18/2011date Of Correction: 12/17/2011 |
| Deficiency #8 |
|
Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #9 |
|
Scope: Fewlevel Of Harm: 2deficiency: Protect Each Resident From All Abuse, Physical Punishment, And Being Separated From Others.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Resident Rights Deficiencies |
| Deficiency #1 |
|
Scope: Somelevel Of Harm: 2deficiency: Give Each Resident A Notice Of Rights, Rules, Services And Charges. Tell Each Resident Who Can Get Medicaid Benefits About 1) Which Items And Services Medicaid Covers And Which The Resident Must Pay For.survey Date: 01/03/2012date Of Correction: 01/24/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #3 |
|
Scope: Somelevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 07/07/2009date Of Correction: 07/10/2009 |
| Quality Care Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Necessary Care And Services To Maintain The Highest Well Being Of Each Resident .survey Date: 03/01/2012date Of Correction: 03/31/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Necessary Care And Services To Maintain The Highest Well Being Of Each Resident .survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #3 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Medically-related Social Services To Help Each Resident Achieve The Highest Possible Quality Of Life.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #4 |
|
Scope: Somelevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 07/07/2009date Of Correction: 07/10/2009 |
| Resident Assessment Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured.survey Date: 01/03/2012date Of Correction: 01/20/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 2deficiency: Allow The Resident The Right To Participate In The Planning Or Revision Of The Resident's Care Plan.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #3 |
|
Scope: Fewlevel Of Harm: 2deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Administration Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 03/01/2012date Of Correction: 03/31/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 3deficiency: Make Sure That Nurse Aides Show They Have The Skills And Techniques To Be Able To Care For Residents' Needs.survey Date: 07/07/2010date Of Correction: 07/16/2010 |
| Deficiency #3 |
|
Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 04/01/2010date Of Correction: 05/01/2010 |
| Deficiency #4 |
|
Scope: Fewlevel Of Harm: 2deficiency: Tell The Attending Physician The Results Of X-rays And Other Tests, In A Timely Manner.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #5 |
|
Scope: Fewlevel Of Harm: 2deficiency: Quickly Tell The Resident's Doctor The Results Of Lab Tests.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Deficiency #6 |
|
Scope: Somelevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 07/07/2009date Of Correction: 07/10/2009 |
| Pharmacy Service Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: At Least Once A Month, Have A Licensed Pharmacist Review Each Resident's Medication(s) And Report Any Irregularities To The Attending Doctor.survey Date: 05/26/2010date Of Correction: 06/11/2010 |
Scope: Fewlevel Of Harm: 2deficiency: Safely Provide Drugs And Other Similar Products Available, Which Are Needed Every Day And In Emergencies, By A Licensed Pharmacist.survey Date: 03/01/2012date Of Correction: 03/31/2012 |
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Make Sure That Each Resident's Drug Regimen Is Free From Unnecessary Drugs; 2) Each Resident's Entire Drug/medication Is Managed And Monitored To Achieve Highest Well Being.survey Date: 05/26/2010date Of Correction: 06/11/2010 |
Scope: Somelevel Of Harm: 2deficiency: Safely Provide Drugs And Other Similar Products Available, Which Are Needed Every Day And In Emergencies, By A Licensed Pharmacist.survey Date: 07/07/2009date Of Correction: 07/10/2009 |
| Nutrition and Dietary Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Prepare Food That Is Nutritional, Appetizing, Tasty, Attractive, Well-cooked, And At The Right Temperature.survey Date: 11/05/2009date Of Correction: 12/05/2009 |
| Quality Measures Q1 |
| Percent of long-stay residents who received an antipsychotic medication |
| 30.6 % |
31.9 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 7.3 % |
75.2 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 1.50 % |
32 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 14.3 % |
3.7 % |
| Percent of long-stay residents who lose too much weight |
| 8.8 % |
7 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 41.9 % |
42.5 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 2.6 / 3 |
3.1 % |
| Percent of long-stay residents with a urinary tract infection |
| 16.3:1 |
8.5 % |
| Percent of long-stay residents who have depressive symptoms |
| 16.7 % |
23.2 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
75.2 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 17.4 % |
37 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 58.6 % |
88.6 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 72.4 % |
83.3 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 75.2 |
75.2 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 4.9 % |
5.6:1 |
| Quality Measures Q3 |
| Percent of long-stay residents who received an antipsychotic medication |
| 32 % |
25.9 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 7.4 % |
75.2 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 2.5 % |
20.2 (68.4) |
| Percent of long-stay high-risk residents with pressure ulcers |
| 14 % |
4.4 % |
| Percent of long-stay residents who lose too much weight |
| 8.6:1 |
7.6 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 39.4 % |
32.3 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 4.2 % |
2.8 % |
| Percent of long-stay residents with a urinary tract infection |
| 11.1 % |
5.8 % |
| Percent of long-stay residents who have depressive symptoms |
| 10.9 % |
8.2 % |
| Percent of long-stay residents who were physically restrained |
| 1.6 % |
0.4 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 6.5 % |
3.1 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 18.9 % |
33.8 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 75.3 % |
91.2 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 76.5 % |
86 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 28.3 % |
27.3 % |