Grace Brethren Village

Total Number of Beds: 4	Percent of Occupied Beds: 75%
Total Number of Residents: 3	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	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: 12/05/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.57

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.62

Number of CNA Hours per Nursing Home Resident per Day: 2.58

Number of Staff Hours per Nursing Home Resident per Day: 3.77

Nursing Home Resident Information**:

** Details Last Reported on: 12/5/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2003-12-05	2004-01-23	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Pattern	Potential for minimal harm
2003-12-05	2004-01-23	Resident Rights Deficiencies	Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.	Isolated	Minimal harm or potential for actual harm
2003-12-05	2004-01-23	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
2003-12-05	2004-01-23	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2003-12-05	0000-00-00	Environmental Deficiencies	Have enough backup water supply for important areas of the nursing home.	Widespread	Potential for minimal harm
2003-12-05	0000-00-00	Administration Deficiencies	Follow all laws and professional standards.	Widespread	Potential for minimal harm
2003-12-05	0000-00-00	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm

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