Lake Forest Good Samaritan Village

Total Number of Beds: 60	Percent of Occupied Beds: 93%
Total Number of Residents: 56	Located Within a Hospital: No
Type of Ownership: Non 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: 09/06/2002

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.85

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.58

Number of CNA Hours per Nursing Home Resident per Day: 2.17

Number of Staff Hours per Nursing Home Resident per Day: 3.6

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 3%
Percent of Short-Stay Residents With Pressure Sores: 22%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 21%
Percent of Residents Who Have Moderate to Severe Pain: 8%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 2%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 10%
Percent of Residents Who are More Depressed or Anxious: 8%
Percent of Short-Stay Residents With Delirium: 7%
Percent of Residents Who Were Physically Restrained: 8%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 9%
Percent of Residents With a Urinary Tract Infection: 6%
** Details Last Reported on: 9/6/2002

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-07-14	2000-07-27	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.	Pattern	Minimal harm or potential for actual harm
2000-07-14	2000-08-16	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	Actual harm
2000-07-14	2000-08-18	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Actual harm
2000-07-14	2000-08-14	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2000-07-14	2000-08-17	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
2000-07-14	2000-08-11	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Potential for minimal harm
2000-07-14	2000-08-11	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
2000-07-14	2000-08-04	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Pattern	Minimal harm or potential for actual harm
2001-08-11	2001-11-12	Mistreatment Deficiencies	Protect residents from mistreatment, neglect, and/or theft of personal property.	Isolated	Actual harm
2001-08-11	2001-11-12	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
2001-08-11	2001-08-30	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
2001-08-11	0000-00-00	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Widespread	Immediate jeopardy to resident health or safety
2001-08-11	2001-09-24	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm
2001-08-11	2001-08-23	Administration Deficiencies	Make sure that nurse aides show they have the skills to be able to care for residents.	Pattern	Potential for minimal harm

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