North Okaloosa Medical Center

Total Number of Beds: 10	Percent of Occupied Beds: 50%
Total Number of Residents: 5	Located Within a Hospital: Yes
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: None	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 08/06/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

** Details Last Reported on: 8/6/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-11-14	2001-11-15	Resident Rights Deficiencies	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
2002-09-18	2002-10-04	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2003-08-06	2003-09-18	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2003-08-06	2003-09-18	Resident Assessment Deficiencies	Assess the resident when the resident enters the nursing home, in a timely manner.	Pattern	Minimal harm or potential for actual harm
2003-08-06	2003-09-18	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm

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