Good Samaritan Hospital

Total Number of Beds: 28	Percent of Occupied Beds: 86%
Total Number of Residents: 24	Located Within a Hospital: No
Type of Ownership: For profit - Individual	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: 09/18/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 25%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 81%
Percent of Short-Stay Residents With Delirium: 5%
** Details Last Reported on: 9/18/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-08-24	2001-10-05	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Potential for minimal harm
2001-08-24	2001-10-05	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.	Pattern	Potential for minimal harm
2001-08-24	2001-10-05	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Pattern	Potential for minimal harm
2001-08-24	2001-10-05	Resident Assessment Deficiencies	Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing.	Pattern	Potential for minimal harm
2001-08-24	2001-10-05	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	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.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Environmental Deficiencies	Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection.	Pattern	Potential for minimal harm
2002-10-07	2002-11-01	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2003-09-18	2003-10-20	Resident Rights Deficiencies	Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.	Isolated	Minimal harm or potential for actual harm
2003-09-18	2003-10-20	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Pattern	Potential for minimal harm
2003-09-18	2003-10-20	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Pattern	Potential for minimal harm
2003-09-18	2003-10-20	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm

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