Country Manor Nursing Home

Total Number of Beds: 30	Percent of Occupied Beds: 90%
Total Number of Residents: 27	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: 06/18/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.84

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.46

Number of CNA Hours per Nursing Home Resident per Day: 3.35

Number of Staff Hours per Nursing Home Resident per Day: 4.65

Nursing Home Resident Information**:

** Details Last Reported on: 6/18/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-05-02	2001-06-14	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Isolated	Minimal harm or potential for actual harm
2001-05-02	2001-06-01	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
2001-05-02	2001-06-01	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2001-05-02	2001-06-04	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
2001-05-02	2001-06-13	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Immediate jeopardy to resident health or safety
2002-03-07	2002-04-05	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Pattern	Potential for minimal harm
2002-03-07	2002-04-05	Resident Rights Deficiencies	Provide enough notice before discharging or transferring a resident.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-12	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Potential for minimal harm
2002-03-07	2002-04-12	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
2002-03-07	2002-03-22	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-03-07	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Resident Assessment Deficiencies	Provide a final summary of the resident's health status and a summary of the resident's stay, when the resident is ready to leave the nursing home.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	Resident Assessment Deficiencies	Develop a plan with the resident and family for the resident's care after leaving the nursing home.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-17	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
2002-03-07	2002-03-22	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
2002-03-07	2002-03-22	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-12	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2002-03-07	2002-04-12	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2002-03-07	2002-04-19	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
2002-03-07	2002-04-11	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2003-06-18	0000-00-00	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Widespread	Potential for minimal harm
2003-06-18	0000-00-00	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	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
2003-06-18	0000-00-00	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	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
2003-06-18	0000-00-00	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
2003-06-18	0000-00-00	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
2003-06-18	0000-00-00	Nutrition and Dietary Deficiencies	Offer other nutritional food to each resident who will not eat the food served.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Pharmacy Service Deficiencies	Act when the pharmacist reports something unusual.	Pattern	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Environmental Deficiencies	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Isolated	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Administration Deficiencies	Follow all laws and professional standards.	Widespread	Potential for minimal harm
2003-06-18	0000-00-00	Administration Deficiencies	Keep complete, dated lab records in the resident's file.	Pattern	Minimal harm or potential for actual harm
2003-06-18	0000-00-00	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm

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