Blackhawk Life Care Center

Total Number of Beds: 60	Percent of Occupied Beds: 75%
Total Number of Residents: 45	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 02/06/2004

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.43

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.6

Number of CNA Hours per Nursing Home Resident per Day: 2.33

Number of Staff Hours per Nursing Home Resident per Day: 3.36

Nursing Home Resident Information**:

** Details Last Reported on: 2/6/2004

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-12-13	2003-01-15	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Isolated	Minimal harm or potential for actual harm
2002-12-13	2003-01-15	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Pattern	Minimal harm or potential for actual harm
2002-12-13	2003-01-15	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2002-12-13	2003-01-15	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Potential for minimal harm
2004-02-06	2004-03-08	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2004-02-06	2004-03-08	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2004-02-06	2004-03-08	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm

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