Health Care Center at The Forum

Total Number of Beds: 48	Percent of Occupied Beds: 90%
Total Number of Residents: 43	Located Within a Hospital: No
Type of Ownership: Non profit - Other	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 02/28/2003

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**:

Percent of Residents Who Have Moderate to Severe Pain: 0%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 3%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 9%
Percent of Residents Who are More Depressed or Anxious: 21%
Percent of Residents Who Were Physically Restrained: 8%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 73%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 0%
Percent of Residents With a Urinary Tract Infection: 3%
** Details Last Reported on: 2/28/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-09-12	2000-11-03	Resident Rights Deficiencies	Try to resolve each resident's complaints quickly.	Widespread	Potential for minimal harm
2000-09-12	2000-11-03	Mistreatment Deficiencies	Protect residents from mistreatment, neglect, and/or theft of personal property.	Pattern	Potential for minimal harm
2000-09-12	2000-11-03	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
2000-09-12	2000-11-03	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Pattern	Potential for minimal harm
2000-09-12	2000-11-03	Resident Assessment Deficiencies	Keep assessments completed in the preceding 15 months in the resident's active record.	Pattern	Potential for minimal harm
2000-09-12	2000-11-03	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Pattern	Potential for minimal harm
2000-09-12	2000-11-03	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2000-09-12	2000-11-03	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Potential for minimal harm
2000-09-12	2000-11-03	Environmental Deficiencies	Provide at least one room to use as a dining room and for activities, that is a good size, with good lighting, airflow and furniture.	Pattern	Potential for minimal harm
2002-01-03	2002-05-03	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Pattern	Potential for minimal harm
2002-01-03	2002-05-03	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Pattern	Potential for minimal harm
2002-01-03	2002-05-03	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	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.	Isolated	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	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
2002-01-03	2002-05-03	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	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
2002-01-03	2002-05-03	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Pattern	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	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
2002-01-03	2002-05-03	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.	Pattern	Potential for minimal harm
2002-01-03	2002-05-03	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Pattern	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	Pharmacy Service Deficiencies	Use the services of a licensed pharmacist.	Isolated	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	Environmental Deficiencies	Provide enough emergency electricity.	Pattern	Minimal harm or potential for actual harm
2002-01-03	2002-05-03	Environmental Deficiencies	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Pattern	Minimal harm or potential for actual harm
2003-02-28	2003-04-27	Resident Assessment Deficiencies	Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing.	Isolated	Minimal harm or potential for actual harm
2003-02-28	2003-04-27	Resident Assessment Deficiencies	Make sure that doctors visit residents regularly, as required.	Isolated	Minimal harm or potential for actual harm
2003-02-28	2003-04-27	Environmental Deficiencies	Provide enough emergency electricity.	Pattern	Minimal harm or potential for actual harm
2003-02-28	2003-04-27	Administration Deficiencies	Choose a doctor to be the medical director.	Isolated	Minimal harm or potential for actual harm
2003-02-28	2003-04-27	Administration Deficiencies	Keep accurate and appropriate medical records.	Widespread	Potential for minimal harm
2003-02-28	2003-04-27	Administration Deficiencies	Have a detailed, written plan for disasters and emergencies.	Isolated	Minimal harm or potential for actual harm

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