Derby Green Nursing Home

Total Number of Beds: 23	Percent of Occupied Beds: 91%
Total Number of Residents: 21	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: 10/29/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.79

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.63

Number of CNA Hours per Nursing Home Resident per Day: 2.24

Number of Staff Hours per Nursing Home Resident per Day: 3.66

Nursing Home Resident Information**:

** Details Last Reported on: 10/29/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-08-07	2002-11-05	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2003-10-29	2003-12-19	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm

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