Countryside Manor Healthcare Center

Total Number of Beds: 120	Percent of Occupied Beds: 99%
Total Number of Residents: 119	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 04/02/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.35

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.03

Number of CNA Hours per Nursing Home Resident per Day: 2.26

Number of Staff Hours per Nursing Home Resident per Day: 3.64

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 19%
Percent of High-Risk Residents Who Have Pressure Sores: 18%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 25%
Percent of Residents Who Have Moderate to Severe Pain: 16%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 35%
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: 34%
Percent of Residents Who are More Depressed or Anxious: 14%
Percent of Short-Stay Residents With Delirium: 6%
Percent of Residents Who Were Physically Restrained: 1%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 49%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 10%
Percent of Residents With a Urinary Tract Infection: 17%
** Details Last Reported on: 4/2/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-02-16	2001-03-16	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.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-03-16	Quality Care Deficiencies	Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-03-16	Pharmacy Service Deficiencies	1) Make sure that residents who take drugs are not given too many doses or for too long; 2) make sure that the use of drugs is carefully watched; or 3) stop or change drugs that cause unwanted effects.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-03-16	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2001-02-16	2001-05-29	Nutrition and Dietary Deficiencies	Make sure that the attending doctor orders special diets.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-03-16	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-03-16	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
2001-02-16	2001-05-29	Administration Deficiencies	Give or get lab tests to meet the needs of residents.	Isolated	Minimal harm or potential for actual harm
2001-02-16	2001-05-29	Administration Deficiencies	Give or get x-rays and other tests to meet the needs of residents.	Isolated	Minimal harm or potential for actual harm
2001-02-16	2001-05-29	Administration Deficiencies	Quickly tell the resident's doctor the results of x-rays and other tests.	Isolated	Minimal harm or potential for actual harm
2002-03-19	2002-04-18	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.	Pattern	Potential for minimal harm
2002-03-19	2002-04-18	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
2002-03-19	2002-04-18	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Pattern	Minimal harm or potential for actual harm
2002-03-19	2002-04-18	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Pattern	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Pattern	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	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
2003-04-02	2003-05-21	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Pattern	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Pattern	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Quality Care Deficiencies	Have enough nurses to care for every resident in a way that maximizes the resident's well being.	Pattern	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Pharmacy Service Deficiencies	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2003-04-02	2003-05-21	Administration Deficiencies	Give or get lab tests to meet the needs of residents.	Isolated	Minimal harm or potential for actual harm

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