Laurel Grove Hospital D/P Skilled Nursing Facility

Total Number of Beds: 11	Percent of Occupied Beds: 55%
Total Number of Residents: 6	Located Within a Hospital: Yes
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: 07/09/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

** Details Last Reported on: 7/9/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-05-04	2001-07-01	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Pattern	Potential for minimal harm
2001-05-04	2001-07-02	Nutrition and Dietary Deficiencies	Hire enough skilled workers to carry out dietary service.	Pattern	Potential for minimal harm
2001-05-04	2001-06-15	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Pattern	Minimal harm or potential for actual harm
2001-05-04	2001-05-05	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2001-05-04	2001-05-05	Environmental Deficiencies	Get rid of garbage properly.	Pattern	Minimal harm or potential for actual harm
2001-05-04	2001-06-12	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm
2001-05-04	2001-06-30	Environmental Deficiencies	Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection.	Pattern	Potential for minimal harm
2001-05-04	2001-05-05	Environmental Deficiencies	Keep all essential equipment working safely.	Pattern	Minimal harm or potential for actual harm
2002-06-14	2002-07-29	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Pattern	Potential for minimal harm
2002-06-14	2002-07-29	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2003-07-09	2003-08-20	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

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