Kings Mountain Hospital Skilled Nursing Facility

Total Number of Beds: 10	Percent of Occupied Beds: 70%
Total Number of Residents: 7	Located Within a Hospital: Yes
Type of Ownership: Government - State	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: 08/22/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 1.49

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.88

Number of CNA Hours per Nursing Home Resident per Day: 3.21

Number of Staff Hours per Nursing Home Resident per Day: 6.58

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 5%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 71%
Percent of Short-Stay Residents With Delirium: 3%
** Details Last Reported on: 8/22/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-08-08	2001-09-05	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Potential for minimal harm
2001-08-08	2001-09-05	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Isolated	Minimal harm or potential for actual harm
2002-07-30	2002-08-15	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
2002-07-30	2002-08-15	Pharmacy Service Deficiencies	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Minimal harm or potential for actual harm
2002-07-30	2002-08-15	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Pattern	Minimal harm or potential for actual harm
2002-07-30	2002-08-15	Environmental Deficiencies	Keep all essential equipment working safely.	Isolated	Minimal harm or potential for actual harm

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