Country Club Nursing and Rehab

Total Number of Beds: 102	Percent of Occupied Beds: 75%
Total Number of Residents: 77	Located Within a Hospital: No
Type of Ownership: For 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: 12/12/2002

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 3%
Percent of High-Risk Residents Who Have Pressure Sores: 12%
Percent of Residents Who Have Moderate to Severe Pain: 3%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 2%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 7%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 7%
Percent of Residents Who are More Depressed or Anxious: 6%
Percent of Residents Who Were Physically Restrained: 11%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 36%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 12%
Percent of Residents With a Urinary Tract Infection: 11%
** Details Last Reported on: 12/12/2002

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-12-13	2001-01-24	Mistreatment Deficiencies	Protect residents from mistreatment, neglect, and/or theft of personal property.	Pattern	Actual harm
2000-12-13	2001-01-24	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Isolated	Minimal harm or potential for actual harm
2000-12-13	2001-02-23	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2000-12-13	2001-04-16	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
2000-12-13	2001-02-23	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2000-12-13	2001-01-24	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
2000-12-13	2001-02-23	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2000-12-13	2001-01-24	Environmental Deficiencies	Put firmly secured handrails on each side of hallways.	Pattern	Potential for minimal harm
2001-11-29	2002-02-10	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Widespread	Potential for minimal harm
2001-11-29	2002-02-10	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Isolated	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Resident Assessment Deficiencies	Develop a plan with the resident and family for the resident's care after leaving the nursing home.	Isolated	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Resident Assessment Deficiencies	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Widespread	Potential for minimal harm
2001-11-29	2002-02-10	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
2001-11-29	2002-02-10	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Widespread	Potential for minimal harm
2001-11-29	2002-02-10	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Widespread	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2001-11-29	2002-02-10	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Isolated	Minimal harm or potential for actual harm
2002-12-12	2003-01-20	Resident Rights Deficiencies	Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.	Widespread	Potential for minimal harm
2002-12-12	2003-03-24	Mistreatment Deficiencies	Protect residents from mistreatment, neglect, and/or theft of personal property.	Isolated	Minimal harm or potential for actual harm
2002-12-12	2003-01-20	Mistreatment Deficiencies	1) Hire only people who have 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.	Isolated	Minimal harm or potential for actual harm
2002-12-12	2003-01-20	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Isolated	Minimal harm or potential for actual harm
2002-12-12	2003-03-24	Administration Deficiencies	Hire a qualified activities director.	Pattern	Minimal harm or potential for actual harm
2002-12-12	2003-01-20	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Pattern	Potential for minimal harm
2002-12-12	2003-01-20	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
2002-12-12	2003-03-24	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Pattern	Minimal harm or potential for actual harm
2002-12-12	2003-01-20	Quality Care Deficiencies	Give the right treatment and services to residents who have mental or social problems adjusting.	Isolated	Minimal harm or potential for actual harm

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