Countryside Place

Total Number of Beds: 49	Percent of Occupied Beds: 94%
Total Number of Residents: 46	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 04/23/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.68

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.71

Number of CNA Hours per Nursing Home Resident per Day: 2.23

Number of Staff Hours per Nursing Home Resident per Day: 3.62

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 1%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 14%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 4%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 21%
Percent of Residents Who are More Depressed or Anxious: 11%
Percent of Residents Who Were Physically Restrained: 2%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 15%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 7%
Percent of Residents With a Urinary Tract Infection: 4%
** Details Last Reported on: 4/23/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-06-01	2001-06-30	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Pattern	Potential for minimal harm
2001-06-01	2001-06-30	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
2001-06-01	2001-06-30	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
2001-06-01	2001-06-30	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Potential for minimal harm
2001-06-01	2001-06-30	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-06-30	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-06-30	Administration Deficiencies	Keep clinical information safe, so that it will not be lost, destroyed or used by the wrong person.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Resident Rights Deficiencies	Let the resident refuse treatment or refuse to take part in an experiment.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Pattern	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Resident Assessment Deficiencies	Keep assessments completed in the preceding 15 months in the resident's active record.	Isolated	Minimal harm or potential for actual harm
2002-05-03	2002-06-01	Environmental Deficiencies	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Pattern	Immediate jeopardy to resident health or safety
2002-05-03	2002-06-01	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm

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