The Forum at Memorial Woods

Total Number of Beds: 25	Percent of Occupied Beds: 76%
Total Number of Residents: 19	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 05/23/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 1.29

Number of LPN/LVN Hours per Nursing Home Resident per Day: 3.21

Number of CNA Hours per Nursing Home Resident per Day: 6.91

Number of Staff Hours per Nursing Home Resident per Day: 11.41

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 17%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 19%
Percent of Short-Stay Residents With Delirium: 1%
** Details Last Reported on: 5/23/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-04-11	0000-00-00	Mistreatment Deficiencies	1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.	Isolated	Minimal harm or potential for actual harm
2001-04-11	0000-00-00	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2001-04-11	0000-00-00	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
2002-04-18	2002-07-11	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
2003-05-23	2003-06-19	Resident Rights Deficiencies	Honor all of the resident's rights as a resident of the nursing home and as a citizen or resident of the United States.	Pattern	Minimal harm or potential for actual harm
2003-05-23	2003-06-22	Resident Rights Deficiencies	Have a private telephone available for use.	Pattern	Potential for minimal harm
2003-05-23	2003-06-27	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
2003-05-23	2003-06-27	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Actual harm
2003-05-23	2003-06-27	Pharmacy Service Deficiencies	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Actual harm
2003-05-23	2003-06-27	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm

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