Cypress Glen Retirement Community

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: 09/15/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

** Details Last Reported on: 9/15/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-08-22	2002-09-19	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2002-08-22	2002-09-19	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-08-22	2002-09-19	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-08-22	2002-09-19	Environmental Deficiencies	Get rid of garbage properly.	Widespread	Minimal harm or potential for actual harm

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