Four Corners Good Samaritan Village

Total Number of Beds: 88	Percent of Occupied Beds: 89%
Total Number of Residents: 78	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: 08/15/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.81

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.35

Number of CNA Hours per Nursing Home Resident per Day: 2.88

Number of Staff Hours per Nursing Home Resident per Day: 4.04

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 0%
Percent of Short-Stay Residents With Pressure Sores: 13%
Percent of High-Risk Residents Who Have Pressure Sores: 13%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 25%
Percent of Residents Who Have Moderate to Severe Pain: 14%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 12%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 21%
Percent of Residents Who are More Depressed or Anxious: 23%
Percent of Short-Stay Residents With Delirium: 4%
Percent of Residents Who Were Physically Restrained: 0%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 43%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 6%
Percent of Residents With a Urinary Tract Infection: 10%
** Details Last Reported on: 8/15/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-03-22	2001-05-08	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
2001-03-22	2001-05-08	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-14	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
2003-08-15	2003-09-15	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-15	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
2003-08-15	2003-09-25	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
2003-08-15	2003-09-15	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.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-15	Quality Care Deficiencies	Prevent a loss in range of motion among residents who entered the nursing home with a full range of motion.	Isolated	Actual harm
2003-08-15	2003-09-15	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.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-15	Pharmacy Service Deficiencies	Make sure that residents who have not taken antipsychotic drugs are not given these drugs, unless they are used to treat a problem that is diagnosed and noted in the medical record.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-11	Resident Assessment Deficiencies	Make sure that doctors visit residents regularly, as required.	Isolated	Minimal harm or potential for actual harm
2003-08-15	2003-09-15	Administration Deficiencies	1) Review the work of each nurse aide every year; or 2) give regular training for the nurse aides.	Pattern	Minimal harm or potential for actual harm

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