Nancy Ann Nursing Home, Inc.

Total Number of Beds: 20	Percent of Occupied Beds: 95%
Total Number of Residents: 19	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 06/13/2002

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 1.31

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0

Number of CNA Hours per Nursing Home Resident per Day: 1.99

Number of Staff Hours per Nursing Home Resident per Day: 3.3

Nursing Home Resident Information**:

** Details Last Reported on: 6/13/2002

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-04-21	2000-06-27	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Widespread	Potential for minimal harm
2000-04-21	2000-06-27	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
2000-04-21	2000-04-21	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2000-04-21	2000-06-27	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
2000-04-21	2000-06-27	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Widespread	Minimal harm or potential for actual harm
2000-04-21	2000-06-27	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Widespread	Potential for minimal harm
2001-06-07	2001-07-13	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Minimal harm or potential for actual harm
2001-06-07	2001-07-13	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Minimal harm or potential for actual harm
2001-06-07	2001-07-13	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
2001-06-07	2001-07-13	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
2001-06-07	2001-07-13	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Widespread	Potential for minimal harm
2002-06-13	0000-00-00	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Widespread	Potential for minimal harm

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