Ellsworth Good Sam Rt Village

Total Number of Beds: 64	Percent of Occupied Beds: 86%
Total Number of Residents: 55	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	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: 08/07/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.59

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.37

Number of CNA Hours per Nursing Home Resident per Day: 1.81

Number of Staff Hours per Nursing Home Resident per Day: 2.77

Nursing Home Resident Information**:

Percent of High-Risk Residents Who Have Pressure Sores: 10%
Percent of Residents Who Have Moderate to Severe Pain: 23%
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: 22%
Percent of Residents Who are More Depressed or Anxious: 20%
Percent of Residents Who Were Physically Restrained: 4%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 40%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 2%
Percent of Residents With a Urinary Tract Infection: 8%
** Details Last Reported on: 8/7/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-09-13	2001-10-05	Quality Care Deficiencies	Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion.	Isolated	Minimal harm or potential for actual harm
2001-09-13	2001-10-05	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Minimal harm or potential for actual harm
2002-08-22	2002-08-30	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2002-08-22	2002-08-30	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2003-08-07	2003-08-22	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
2003-08-07	2003-08-22	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-08-07	2003-08-22	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Actual harm

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