FOUR SEASONS RETIREMENT CENTER Nursing Home


FOUR SEASONS RETIREMENT CENTER (CCN: 155471) is a Non profit - Corporation facility located in COLUMBUS, IN (47203). The facility has an overall rating of 5/5, health inspection rating of 5/5, and a staffing rating of 5/5. It offers 30 certified beds and maintains an average of 13.3 residents per day. The nursing staff includes Nurse Aides, LPNs, and RNs working 4.35294 total hours per resident per day. It has been certified since December 1, 1992 and the last listed health inspection was on February 7, 2023, The facility is located in Bartholomew county and provides senior and nursing home care.

FOUR SEASONS RETIREMENT CENTER Summary


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Provider Name: FOUR SEASONS RETIREMENT CENTER

Address: 1901 TAYLOR RD, COLUMBUS, IN 47203

Phone: (812) 372-8481

County: Bartholomew (020)

Ownership Type: Non profit - Corporation

Certified Beds: 30

Average Residents Per Day: 13.3 ()

Provider Type: Medicare, Resides in Hospital: No

Legal Business Name: BHI SENIOR LIVING, INC.

First Approved Date: December 1, 1992

Affiliated Entity: BHI SENIOR LIVING (80)

Retirement Community: Y, Special Focus Status:

Ownership Change in Last 12 Months: N

Resident Family Council: Resident

Sprinkler System Status: Yes

Overall Rating: 5 ()

Health Inspection Rating: 5 ()

QM Rating: 5 ()

Long Stay QM Rating: (2)

Short Stay QM Rating: 5 ()

Staffing Rating: 5 ()

Staffing Report Note:

PT Staffing Note:

Nurse Aide Staff Hours Per Day, per resident: 1.47059, LPN Staff Hours Per Day: 1.3116, RN Staff Hours Per Day: 1.5706, Licensed Staff Hours Per Day: 2.8823

Total Nurse Staff Hours Per Day, per resident: 4.35294

Weekend Nurse Staff Hours: 3.18732, Weekend RN Staff Hours: 1.0092

PT Staff Hours Per Day, per resident: 0.3079

Nurse Staff Turnover: 38.5, Nurse Turnover Note:

RN Turnover: 14.3, RN Turnover Note:

Admin Left Number: , Admin Turnover Note: 6

Case Mix Nurse Aide Hours Per Day, per resident: 2.0239, Case Mix LPN Hours Per Day: 0.7978, Case Mix RN Hours Per Day: 0.3850

Adjusted Nurse Aide Hours Per Day, per resident: 1.48024, Adjusted LPN Hours Per Day: 1.2132, Adjusted RN Hours Per Day: 1.5370

Total Adjusted Nurse Hours Per Day, per resident: 4.27851

Adjusted Weekend Nurse Hours Per Day, per resident: 3.13282

Health Survey Dates and Scores: Cycle 1: 2023-02-07 (Score: 16), Cycle 2: 2022-02-18 (Score: 12), Cycle 3: 2019-10-21 (Score: 4)

Total Weighted Health Score: 12.667

Reported Incidents: 0, Substantiated Complaints: 0

Infection Control Citations: 0

Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0

Location and GPS: 1901 TAYLOR RD,COLUMBUS,IN,47203 (39.2174, -85.876)

Process Date: 2024-03-01


Health Inspection Citations Details

Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:

Citation on 2023-02-07

Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-02-24

Citation on 2023-02-07

Type: Health, Deficiency: Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-02-24

Citation on 2023-02-07

Type: Health, Deficiency: Provide timely, quality laboratory services/tests to meet the needs of residents.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-02-24

Citation on 2023-02-07

Type: Health, Deficiency: Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-02-24

Citation on 2022-02-18

Type: Health, Deficiency: Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-03-17

Citation on 2022-02-18

Type: Health, Deficiency: Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-03-17

Citation on 2022-02-18

Type: Health, Deficiency: Provide and implement an infection prevention and control program.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-03-17

Citation on 2019-10-21

Type: Health, Deficiency: Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2019-11-01


Fire Safety Citations Details

Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:

Citation on 2023-02-20

Type: Fire Safety, Tag: 0041, Version: New

Description: Implement emergency and standby power systems.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-03-02

Citation on 2023-02-20

Type: Fire Safety, Tag: 0321, Version: New

Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-03-02

Citation on 2023-02-20

Type: Fire Safety, Tag: 0522, Version: New

Description: Have an externally vented heating system.

Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-03-02

Citation on 2023-02-20

Type: Fire Safety, Tag: 0918, Version: New

Description: Have generator or other power source capable of supplying service within 10 seconds.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2023-03-02

Citation on 2022-03-14

Type: Fire Safety, Tag: 0131, Version: New

Description: Meet requirements for sections of health care facilities separated by fire resistive construction.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0211, Version: New

Description: Keep aisles, corridors, and exits free of obstruction in case of emergency.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0321, Version: New

Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0331, Version: New

Description: Construct fire resistant interior walls.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0341, Version: New

Description: Install a fire alarm system that can be heard throughout the facility.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0351, Version: New

Description: Install an approved automatic sprinkler system.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0353, Version: New

Description: Inspect, test, and maintain automatic sprinkler systems.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0363, Version: New

Description: Install corridor and hallway doors that block smoke.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0522, Version: New

Description: Have an externally vented heating system.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0916, Version: New

Description: Have a battery powered remote alarm panel in a location accessible by operating personnel.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0918, Version: New

Description: Have generator or other power source capable of supplying service within 10 seconds.

Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2022-03-14

Type: Fire Safety, Tag: 0920, Version: New

Description: Ensure proper usage of power strips and extension cords.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2022-04-13

Citation on 2019-12-17

Type: Fire Safety, Tag: 0324, Version: New

Description: Provide properly protected cooking facilities.

Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2019-12-31

Citation on 2019-12-17

Type: Fire Safety, Tag: 0511, Version: New

Description: Have properly installed electrical wiring and gas equipment.

Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.

Corrected: Deficient, Provider has date of correction on 2019-12-31