Clover Rest Home

Total Number of Beds: 30	Percent of Occupied Beds: 93%
Total Number of Residents: 28	Located Within a Hospital: No
Type of Ownership: For 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: 08/14/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.52

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.49

Number of CNA Hours per Nursing Home Resident per Day: 2.33

Number of Staff Hours per Nursing Home Resident per Day: 3.34

Nursing Home Resident Information**:

** Details Last Reported on: 8/14/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-06-06	2001-08-15	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2001-06-06	0000-00-00	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Pattern	Potential for minimal harm
2002-07-03	2002-09-20	Resident Rights Deficiencies	Provide proof that all residents' personal money which is deposited with the nursing home, is secure.	Pattern	Potential for minimal harm
2002-07-03	2002-09-20	Mistreatment Deficiencies	1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.	Isolated	Minimal harm or potential for actual harm
2002-07-03	2002-07-03	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Immediate jeopardy to resident health or safety
2002-07-03	2002-07-03	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Immediate jeopardy to resident health or safety
2002-07-03	2002-09-20	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-07-03	2002-09-20	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Pattern	Potential for minimal harm
2002-07-03	2002-07-03	Administration Deficiencies	Be administered in a way that leads to the highest possible level of well being for each resident.	Isolated	Immediate jeopardy to resident health or safety
2002-07-03	2002-09-20	Administration Deficiencies	Hire nurse aides who have completed required training and shown that they are skilled.	Pattern	Potential for minimal harm
2003-08-14	2003-10-03	Resident Assessment Deficiencies	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Widespread	Potential for minimal harm
2003-08-14	2003-10-03	Environmental Deficiencies	Be designed, built, equipped, or well kept to protect the health and safety of residents, workers, and the public.	Pattern	Minimal harm or potential for actual harm
2003-08-14	0000-00-00	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Pattern	Potential for minimal harm

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