E J Noble Hospital Samaritan

Total Number of Beds: 27	Percent of Occupied Beds: 100%
Total Number of Residents: 27	Located Within a Hospital: Yes
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 06/27/2002

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.95

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.16

Number of CNA Hours per Nursing Home Resident per Day: 2.58

Number of Staff Hours per Nursing Home Resident per Day: 4.69

Nursing Home Resident Information**:

** Details Last Reported on: 6/27/2002

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-06-22	2000-09-15	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
2001-04-05	2001-07-12	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
2001-04-05	2001-07-12	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Actual harm
2001-04-05	2001-07-12	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Pattern	Minimal harm or potential for actual harm
2001-04-05	2001-07-12	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Isolated	Minimal harm or potential for actual harm
2001-04-05	2001-07-12	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2001-04-05	2001-07-12	Environmental Deficiencies	Provide enough emergency electricity.	Pattern	Minimal harm or potential for actual harm
2002-06-27	2002-08-05	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Pattern	Minimal harm or potential for actual harm
2002-06-27	2002-08-05	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Pattern	Minimal harm or potential for actual harm
2002-06-27	2002-08-05	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm

*** All violations listed are based on federal government records.