Devils Lake Good Samaritan Center

Total Number of Beds: 84	Percent of Occupied Beds: 86%
Total Number of Residents: 72	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 11/06/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.51

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.5

Number of CNA Hours per Nursing Home Resident per Day: 4.07

Number of Staff Hours per Nursing Home Resident per Day: 5.08

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 0%
Percent of High-Risk Residents Who Have Pressure Sores: 8%
Percent of Residents Who Have Moderate to Severe Pain: 11%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 27%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 19%
Percent of Residents Who are More Depressed or Anxious: 16%
Percent of Residents Who Were Physically Restrained: 4%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 45%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 6%
Percent of Residents With a Urinary Tract Infection: 7%
** Details Last Reported on: 11/6/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-11-27	2002-01-22	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2001-11-27	2002-01-11	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	Potential for minimal harm
2001-11-27	2002-01-11	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.	Pattern	Potential for minimal harm
2001-11-27	2002-01-22	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
2001-11-27	2002-01-22	Resident Assessment Deficiencies	Make sure that doctors visit residents regularly, as required.	Isolated	Minimal harm or potential for actual harm
2002-11-20	2002-12-19	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2003-11-06	2003-12-11	Resident Rights Deficiencies	Listen to the resident or family groups or act on their complaints or suggestions.	Pattern	Minimal harm or potential for actual harm
2003-11-06	2003-12-11	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.	Widespread	Potential for minimal harm
2003-11-06	2003-12-11	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-11-06	2003-12-11	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
2003-11-06	2003-12-11	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
2003-11-06	2003-12-11	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2003-11-06	2003-12-11	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Widespread	Potential for minimal harm
2003-11-06	2003-12-11	Environmental Deficiencies	Put firmly secured handrails on each side of hallways.	Widespread	Potential for minimal harm

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