Cottage Grove Place - The Club

Total Number of Beds: 16	Percent of Occupied Beds: 94%
Total Number of Residents: 15	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 03/21/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 1.86

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.18

Number of CNA Hours per Nursing Home Resident per Day: 3.17

Number of Staff Hours per Nursing Home Resident per Day: 6.21

Nursing Home Resident Information**:

** Details Last Reported on: 3/21/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-04-11	2001-05-04	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
2001-04-11	2001-05-04	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Isolated	Minimal harm or potential for actual harm
2001-04-11	2001-05-04	Quality Care Deficiencies	Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion.	Pattern	Minimal harm or potential for actual harm
2001-04-11	2001-05-04	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2001-04-11	2001-05-04	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
2001-04-11	2001-05-04	Nutrition and Dietary Deficiencies	Make sure that the attending doctor orders special diets.	Widespread	Minimal harm or potential for actual harm
2001-04-11	2001-05-04	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Isolated	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Widespread	Minimal harm or potential for actual harm
2002-03-22	2002-04-30	Administration Deficiencies	Follow all laws and professional standards.	Pattern	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Pattern	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Nutrition and Dietary Deficiencies	1) Provide 3 meals daily at regular times; or 2) serve breakfast within 14 hours after dinner; or 3) offer a snack at bedtime each day.	Widespread	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Resident Assessment Deficiencies	Make sure that all needed doctor visits are made personally by a doctor, as required.	Isolated	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Pharmacy Service Deficiencies	At least once a month, have a licensed pharmacist check the drugs that each resident takes.	Widespread	Potential for minimal harm
2003-03-21	2003-04-22	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Widespread	Minimal harm or potential for actual harm
2003-03-21	2003-04-22	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm

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