Kingsbury Memorial Manor

Total Number of Beds: 44	Percent of Occupied Beds: 95%
Total Number of Residents: 42	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 and Medicaid
* Details Last Reported on: 08/27/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.69

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.04

Number of CNA Hours per Nursing Home Resident per Day: 2.41

Number of Staff Hours per Nursing Home Resident per Day: 3.14

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 28%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 6%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 23%
Percent of Residents Who are More Depressed or Anxious: 13%
Percent of Residents Who Were Physically Restrained: 16%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 3%
Percent of Residents With a Urinary Tract Infection: 16%
** Details Last Reported on: 8/27/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-09-26	2001-11-20	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2001-09-26	2001-11-20	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Isolated	Minimal harm or potential for actual harm
2001-09-26	2001-11-20	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm
2002-10-09	2003-01-02	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Isolated	Minimal harm or potential for actual harm
2002-10-09	2003-01-02	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2002-10-09	2003-01-02	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
2002-10-09	2003-01-02	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2003-08-27	2003-10-21	Resident Rights Deficiencies	Send and promptly deliver unopened mail to residents.	Widespread	Potential for minimal harm
2003-08-27	2003-10-21	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Isolated	Minimal harm or potential for actual harm
2003-08-27	2003-10-21	Resident Assessment Deficiencies	Do an assessment of the resident every year.	Isolated	Minimal harm or potential for actual harm
2003-08-27	2003-10-21	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.	Widespread	Potential for minimal harm
2003-08-27	2003-10-21	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Actual harm
2003-08-27	2003-10-21	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-08-27	2003-10-21	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Actual harm
2003-08-27	2003-10-21	Resident Assessment Deficiencies	Keep assessments completed in the preceding 15 months in the resident's active record.	Pattern	Potential for minimal harm
2003-08-27	2003-10-21	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm

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