Gibson Community Hospital Annex

Total Number of Beds: 42	Percent of Occupied Beds: 88%
Total Number of Residents: 37	Located Within a Hospital: Yes
Type of Ownership: Non profit - Other	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: 03/13/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.95

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.32

Number of CNA Hours per Nursing Home Resident per Day: 2.13

Number of Staff Hours per Nursing Home Resident per Day: 3.4

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 7%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 10%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 3%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 5%
Percent of Residents Who are More Depressed or Anxious: 11%
Percent of Residents Who Were Physically Restrained: 5%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 10%
Percent of Residents With a Urinary Tract Infection: 16%
** Details Last Reported on: 3/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-04-19	2001-04-19	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
2001-04-19	2001-05-17	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-05-07	2002-06-05	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
2002-05-07	2002-06-07	Quality Care Deficiencies	Give each resident a special diet to help when there is a nutritional problem.	Pattern	Minimal harm or potential for actual harm
2002-05-07	2002-06-07	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
2003-03-13	0000-00-00	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
2003-03-13	2003-03-24	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Widespread	Potential for minimal harm

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