Bolivar Medical Center Skilled Nursing Facility

Total Number of Beds: 24	Percent of Occupied Beds: 25%
Total Number of Residents: 6	Located Within a Hospital: Yes
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: None	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 07/15/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 5.9

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.38

Number of CNA Hours per Nursing Home Resident per Day: 4

Number of Staff Hours per Nursing Home Resident per Day: 10.28

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 16%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 28%
Percent of Short-Stay Residents With Delirium: 14%
** Details Last Reported on: 7/15/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-08-31	2001-10-15	Quality Care Deficiencies	Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary.	Pattern	Minimal harm or potential for actual harm
2001-08-31	2001-10-15	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2002-06-13	2002-07-30	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Pattern	Potential for minimal harm
2002-06-13	2002-07-30	Resident Rights Deficiencies	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Resident Rights Deficiencies	Make sure each resident has the right to choose activities, schedules and health care according to his or her interests, assessment, and plan of care.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Widespread	Potential for minimal harm
2002-06-13	2002-07-30	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	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
2002-06-13	2002-07-30	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Widespread	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Quality Care Deficiencies	Have enough nurses to care for every resident in a way that maximizes the resident's well being.	Widespread	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Isolated	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	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	Potential for minimal harm
2002-06-13	2002-07-30	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm
2002-06-13	2002-09-10	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Widespread	Minimal harm or potential for actual harm
2002-06-13	2002-07-30	Administration Deficiencies	Be administered in a way that leads to the highest possible level of well being for each resident.	Widespread	Minimal harm or potential for actual harm
2003-07-15	0000-00-00	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm

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