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Survey dates were January 21-28 2015 Facility number IN002640 Medicaid Vendor number 200305630 Surveyor Michelle Weiss RN MSN Public Health Nurse Surveyor Census Unduplicated last 12 months 43 Skilled patients 17 Quality Review Joyce Elder MSN BSN RN February 19 2015 G 110 484. PRINTED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES STATEMENT OF DEFICIENCIES X1 PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER 15K009 03/17/2015 FORM APPROVED...

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