Five Counties Nursing Home

Total Number of Beds: 44	Percent of Occupied Beds: 98%
Total Number of Residents: 43	Located Within a Hospital: Yes
Type of Ownership: Non 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: 08/21/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.93

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.42

Number of CNA Hours per Nursing Home Resident per Day: 2.31

Number of Staff Hours per Nursing Home Resident per Day: 3.66

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 6%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 7%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 15%
Percent of Residents Who are More Depressed or Anxious: 15%
Percent of Residents Who Were Physically Restrained: 5%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 0%
Percent of Residents With a Urinary Tract Infection: 5%
** Details Last Reported on: 8/21/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-08-29	2001-10-16	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2001-08-29	2001-10-16	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Widespread	Minimal harm or potential for actual harm
2002-09-25	2002-11-21	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Widespread	Potential for minimal harm
2002-09-25	2002-12-20	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2002-09-25	2002-11-21	Administration Deficiencies	Hire a qualified activities director.	Widespread	Potential for minimal harm
2002-09-25	2002-11-21	Environmental Deficiencies	Keep sound levels comfortable.	Pattern	Potential for minimal harm
2002-09-25	2002-12-20	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2002-09-25	2002-11-21	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Widespread	Minimal harm or potential for actual harm
2002-09-25	2002-11-21	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	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
2003-08-21	2003-10-10	Quality Care Deficiencies	Make sure that a resident does not become withdrawn, angry or depressed if these problems did not exist before.	Isolated	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2003-08-21	2003-10-10	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Pattern	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm
2003-08-21	2003-10-10	Administration Deficiencies	Hold committee meetings every 3 months to review and ensure quality in the nursing home.	Widespread	Minimal harm or potential for actual harm

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