Northern Pines Good Sam Center

Total Number of Beds: 48	Percent of Occupied Beds: 90%
Total Number of Residents: 43	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 04/25/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.85

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.48

Number of CNA Hours per Nursing Home Resident per Day: 1.62

Number of Staff Hours per Nursing Home Resident per Day: 2.95

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 26%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 8%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 2%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 15%
Percent of Residents Who are More Depressed or Anxious: 24%
Percent of Residents Who Were Physically Restrained: 5%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 9%
Percent of Residents With a Urinary Tract Infection: 10%
** Details Last Reported on: 4/25/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-11-03	2000-12-22	Resident Rights Deficiencies	Try to resolve each resident's complaints quickly.	Pattern	Minimal harm or potential for actual harm
2000-11-03	2000-12-22	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
2000-11-03	2000-12-22	Mistreatment Deficiencies	Protect each resident from all abuse, physical punishment, and being separated from others.	Isolated	Actual harm
2000-11-03	2000-12-22	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
2000-11-03	2000-12-22	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Pattern	Minimal harm or potential for actual harm
2000-11-03	2000-12-22	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Actual harm
2000-11-03	2000-12-22	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
2000-11-03	2000-12-22	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2000-11-03	2000-12-22	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Pattern	Potential for minimal harm
2002-02-01	2002-03-05	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Minimal harm or potential for actual harm
2002-02-01	2002-03-05	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2002-02-01	2002-03-05	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-18	Resident Rights Deficiencies	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
2003-04-25	2003-06-18	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-18	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

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