Good Samaritan Hospital Ltc

Total Number of Beds: 22	Percent of Occupied Beds: 73%
Total Number of Residents: 16	Located Within a Hospital: Yes
Type of Ownership: Non profit - Church related	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: None	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 11/20/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 3.39

Number of LPN/LVN Hours per Nursing Home Resident per Day: 2.05

Number of CNA Hours per Nursing Home Resident per Day: 3.69

Number of Staff Hours per Nursing Home Resident per Day: 9.13

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 33%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 75%
Percent of Short-Stay Residents With Delirium: 22%
** Details Last Reported on: 11/20/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-09-27	2001-11-01	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2001-09-27	2001-11-01	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-11-20	2004-01-08	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm

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