Leipsic Retirement Village

Total Number of Beds: 18	Percent of Occupied Beds: 83%
Total Number of Residents: 15	Located Within a Hospital: No
Type of Ownership: Non profit - Church related	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: 11/18/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 1.44

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.22

Number of CNA Hours per Nursing Home Resident per Day: 2.67

Number of Staff Hours per Nursing Home Resident per Day: 5.33

Nursing Home Resident Information**:

** Details Last Reported on: 11/18/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-11-21	2002-12-19	Mistreatment Deficiencies	1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.	Isolated	Minimal harm or potential for actual harm
2002-11-21	2002-12-19	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Isolated	Minimal harm or potential for actual harm

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