Good Samaritan Hospital

Total Number of Beds: 23	Percent of Occupied Beds: 100%
Total Number of Residents: 23	Located Within a Hospital: Yes
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: None	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 07/11/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 2.83

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.04

Number of CNA Hours per Nursing Home Resident per Day: 3.25

Number of Staff Hours per Nursing Home Resident per Day: 7.12

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 7%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 3%
Percent of Short-Stay Residents With Delirium: 2%
** Details Last Reported on: 7/11/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-06-26	2002-08-12	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.	Isolated	Minimal harm or potential for actual harm
2002-06-26	2002-08-12	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
2002-06-26	2002-08-05	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
2002-06-26	2002-10-25	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
2002-06-26	2002-07-01	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-06-26	2002-07-18	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2002-06-26	2002-08-12	Environmental Deficiencies	Keep a resident apart from the others if the resident has an infection that can spread.	Pattern	Minimal harm or potential for actual harm
2003-07-11	2003-07-17	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm

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