Beaver Dam Health Care Manor

Total Number of Beds: 58	Percent of Occupied Beds: 88%
Total Number of Residents: 51	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	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: 02/13/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.46

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.94

Number of CNA Hours per Nursing Home Resident per Day: 3.42

Number of Staff Hours per Nursing Home Resident per Day: 4.82

Nursing Home Resident Information**:

Percent of High-Risk Residents Who Have Pressure Sores: 14%
Percent of Residents Who Have Moderate to Severe Pain: 3%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 14%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 26%
Percent of Residents Who are More Depressed or Anxious: 8%
Percent of Residents Who Were Physically Restrained: 14%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 5%
Percent of Residents With a Urinary Tract Infection: 18%
** Details Last Reported on: 2/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-01-10	2001-02-09	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2001-01-10	2001-02-02	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
2002-04-17	2002-05-30	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Widespread	Potential for minimal harm
2002-04-17	2002-04-30	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2002-04-17	2002-04-30	Quality Care Deficiencies	Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.	Isolated	Minimal harm or potential for actual harm
2003-02-13	2003-03-28	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	Minimal harm or potential for actual harm
2003-02-13	2003-03-28	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Minimal harm or potential for actual harm
2003-02-13	2003-03-28	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
2003-02-13	2003-03-28	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2003-02-13	2003-03-28	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm

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