Country Side Estates

Total Number of Beds: 48	Percent of Occupied Beds: 60%
Total Number of Residents: 29	Located Within a Hospital: No
Type of Ownership: For 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: 11/21/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.27

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.82

Number of CNA Hours per Nursing Home Resident per Day: 1.28

Number of Staff Hours per Nursing Home Resident per Day: 2.37

Nursing Home Resident Information**:

** Details Last Reported on: 11/21/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-10-11	2001-10-11	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
2001-10-11	2001-10-11	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Minimal harm or potential for actual harm
2001-10-11	2001-10-11	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Minimal harm or potential for actual harm
2001-10-11	2001-10-11	Quality Care Deficiencies	Use a registered nurse at least 8 hours a day, 7 days a week.	Isolated	Minimal harm or potential for actual harm
2002-09-19	2002-10-17	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Pattern	Minimal harm or potential for actual harm
2003-11-21	2003-12-29	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
2003-11-21	2004-01-20	Resident Assessment Deficiencies	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Pattern	Potential for minimal harm
2003-11-21	2004-01-20	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2003-11-21	2004-01-20	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Isolated	Minimal harm or potential for actual harm
2003-11-21	2004-01-20	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-11-21	2004-01-20	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
2003-11-21	2003-12-29	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Isolated	Minimal harm or potential for actual harm
2003-11-21	2003-12-18	Environmental Deficiencies	Put firmly secured handrails on each side of hallways.	Pattern	Minimal harm or potential for actual harm
2003-11-21	2004-01-20	Administration Deficiencies	Follow all laws and professional standards.	Pattern	Minimal harm or potential for actual harm

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