St Margaret Hall Inc

Total Number of Beds: 99	Percent of Occupied Beds: 93%
Total Number of Residents: 92	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	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: 11/15/2002

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.78

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.12

Number of CNA Hours per Nursing Home Resident per Day: 3.12

Number of Staff Hours per Nursing Home Resident per Day: 5.02

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 0%
Percent of Short-Stay Residents With Pressure Sores: 31%
Percent of High-Risk Residents Who Have Pressure Sores: 22%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 46%
Percent of Residents Who Have Moderate to Severe Pain: 28%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 16%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 7%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 19%
Percent of Residents Who are More Depressed or Anxious: 15%
Percent of Short-Stay Residents With Delirium: 3%
Percent of Residents Who Were Physically Restrained: 18%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 54%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 6%
Percent of Residents With a Urinary Tract Infection: 13%
** Details Last Reported on: 11/15/2002

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-12-05	2001-01-23	Resident Rights Deficiencies	Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Mistreatment Deficiencies	Protect each resident from all abuse, physical punishment, and being separated from others.	Isolated	Actual harm
2000-12-05	2001-01-23	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	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
2000-12-05	2001-01-23	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
2000-12-05	2001-01-23	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Quality Care Deficiencies	Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	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
2000-12-05	2001-01-23	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2000-12-05	2001-01-23	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Actual harm
2000-12-05	2001-01-23	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Pattern	Actual harm
2000-12-05	2001-01-23	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
2000-12-05	2001-01-23	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-02-15	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Administration Deficiencies	Be administered in a way that leads to the highest possible level of well being for each resident.	Pattern	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Administration Deficiencies	Make sure that nurse aides show they have the skills to be able to care for residents.	Isolated	Minimal harm or potential for actual harm
2000-12-05	2001-01-23	Administration Deficiencies	Choose a doctor to be the medical director.	Pattern	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Isolated	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	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
2001-09-14	2001-10-31	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2001-09-14	2001-10-31	Environmental Deficiencies	Have enough backup water supply for important areas of the nursing home.	Widespread	Potential for minimal harm

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