Masonic and Eastern Star Home

Total Number of Beds: 15	Percent of Occupied Beds: 27%
Total Number of Residents: 4	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	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: 11/13/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 9.79

Number of LPN/LVN Hours per Nursing Home Resident per Day: 2

Number of CNA Hours per Nursing Home Resident per Day: 7.5

Number of Staff Hours per Nursing Home Resident per Day: 19.29

Nursing Home Resident Information**:

** Details Last Reported on: 11/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-12-18	2002-01-15	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
2003-11-13	2004-01-30	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm

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