C.A. Mues Memorial Good Sam. Center

Total Number of Beds: 30	Percent of Occupied Beds: 87%
Total Number of Residents: 26	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 05/29/2003

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: 0.44

Number of CNA Hours per Nursing Home Resident per Day: 2.29

Number of Staff Hours per Nursing Home Resident per Day: 3.68

Nursing Home Resident Information**:

** Details Last Reported on: 5/29/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-03-28	2001-05-17	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Pattern	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	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
2001-03-28	2001-05-17	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Pattern	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Quality Care Deficiencies	Make sure that each resident gets help to keep vision and hearing.	Isolated	Actual harm
2001-03-28	2001-05-17	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2001-03-28	2001-05-17	Quality Care Deficiencies	Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Nutrition and Dietary Deficiencies	Offer other nutritional food to each resident who will not eat the food served.	Isolated	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Nutrition and Dietary Deficiencies	1) Provide 3 meals daily at regular times; or 2) serve breakfast within 14 hours after dinner; or 3) offer a snack at bedtime each day.	Pattern	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Widespread	Minimal harm or potential for actual harm
2001-03-28	2001-05-17	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
2002-05-22	0000-00-00	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Widespread	Potential for minimal harm

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