Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

ENGLEWOOD HEALTH & REHABILITATION CENTER

FORT WAYNE, IN · 64 certified beds · Last Life Safety survey August 16, 2024

CMS Certification Number 155654 · first certified July 1998

Ownership

Operated by TLC MANAGEMENT · Non profit - Corporation

No change of ownership on CMS record since January 1, 2016, when the records begin.

11
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
6
Inspection & testing records
Of the citations on file

Position within IN

11 citations — more than 34% of the 507 certified nursing homes in IN. Compared within IN rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 0 citations; the earlier surveys in the window averaged 5.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (July 2025 to October 2025), and past the point by which nine in ten IN facilities have been surveyed. This facility’s last Life Safety survey was August 2024. Facilities in IN are typically surveyed 11–14 months after the last one (median 13), measured over 883 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

2 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

2 of the 11 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

1 physical-environment citation on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 11 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IN, and nationally. Surveyors differ markedly between states, so the IN figure is the meaningful one.

This facility11IN median15National median11
Citations on file over three years, compared
MeasureCitations
This facility11
Median facility in IN15
Median facility nationally11

Survey history

Citations at each Life Safety survey
52022-0962023-0702024-08
Citations at each Life Safety survey
Survey dateCitations
September 13, 20225
July 20, 20236
August 16, 20240

Most-cited tags

Most-cited tags at this facility
K-05112K-03632K-09111K-02111K-09201K-03551K-09231E-00391
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0511Have properly installed electrical wiring and gas equipment.22023-07-20
K-0363Install corridor and hallway doors that block smoke.22023-07-20
K-0911Meet requirements for the installation and maintenance of electrical systems.12023-07-20
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.12022-09-13
K-0920Ensure proper usage of power strips and extension cords.12022-09-13
K-0355Properly select, install, inspect, or maintain portable fire extinguishes.12022-09-13
K-0923Have proper medical gas storage and administration areas.12023-07-20
E-0039Conduct testing and exercise requirements.12023-07-20

What the citations cover

Citations by CMS category
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Smoke Deficiencies 3
  • Services Deficiencies 2
  • Emergency Preparedness Deficiencies 2
  • Other 1
Citations by CMS category
CategoryCitations
Gas, Vacuum, and Electrical Systems Deficiencies3
Smoke Deficiencies3
Services Deficiencies2
Emergency Preparedness Deficiencies2
Egress Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

July 20, 2023 — 6 citations

Citations issued on July 20, 2023
TagWhat the surveyor checksStatus
E-0037Establish staff and initial training requirements.Deficient, Provider has date of correction (August 3, 2023)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (August 3, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (August 3, 2023)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (August 3, 2023)
K-0911Meet requirements for the installation and maintenance of electrical systems.Deficient, Provider has date of correction (August 3, 2023)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (August 3, 2023)

September 13, 2022 — 5 citations

Citations issued on September 13, 2022
TagWhat the surveyor checksStatus
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (November 25, 2022)
K-0355Properly select, install, inspect, or maintain portable fire extinguishes.Deficient, Provider has date of correction (November 25, 2022)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (November 25, 2022)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (November 25, 2022)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (November 25, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.