Good Sam. Village - Perkins Pav.

Total Number of Beds: 204	Percent of Occupied Beds: 97%
Total Number of Residents: 198	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 03/06/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.52

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.56

Number of CNA Hours per Nursing Home Resident per Day: 2.21

Number of Staff Hours per Nursing Home Resident per Day: 3.29

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 6%
Percent of Short-Stay Residents With Pressure Sores: 28%
Percent of High-Risk Residents Who Have Pressure Sores: 8%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 54%
Percent of Residents Who Have Moderate to Severe Pain: 20%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 16%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 1%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 15%
Percent of Residents Who are More Depressed or Anxious: 15%
Percent of Short-Stay Residents With Delirium: 1%
Percent of Residents Who Were Physically Restrained: 4%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 40%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 9%
Percent of Residents With a Urinary Tract Infection: 7%
** Details Last Reported on: 3/6/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-01-14	2002-03-15	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2002-01-14	2002-03-15	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Isolated	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2003-03-06	2003-04-21	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm

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