Hickory Creek at Madison

Total Number of Beds: 36	Percent of Occupied Beds: 72%
Total Number of Residents: 26	Located Within a Hospital: No
Type of Ownership: Non 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: 04/14/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.8

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.56

Number of CNA Hours per Nursing Home Resident per Day: 1.62

Number of Staff Hours per Nursing Home Resident per Day: 2.98

Nursing Home Resident Information**:

** Details Last Reported on: 4/14/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-03-20	2001-03-21	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
2001-03-20	2001-04-18	Administration Deficiencies	Hire a qualified activities director.	Pattern	Minimal harm or potential for actual harm
2001-03-20	2001-04-05	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Minimal harm or potential for actual harm
2001-03-20	2001-04-06	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	Minimal harm or potential for actual harm
2001-03-20	2001-04-18	Environmental Deficiencies	Keep all essential equipment working safely.	Widespread	Minimal harm or potential for actual harm
2001-03-20	2001-04-18	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
2002-06-11	2002-07-24	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
2002-06-11	2002-07-24	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Minimal harm or potential for actual harm
2002-06-11	2002-07-24	Quality Care Deficiencies	Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.	Isolated	Minimal harm or potential for actual harm
2002-06-11	2002-07-24	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2002-06-11	2002-07-24	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
2002-06-11	2002-07-24	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
2003-04-14	2003-05-01	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
2003-04-14	2003-05-01	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-04-14	2003-05-06	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2003-04-14	2003-04-30	Environmental Deficiencies	Provide bedrooms that don't allow residents to see each other when privacy is needed.	Pattern	Minimal harm or potential for actual harm
2003-04-14	2003-05-01	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
2003-04-14	2003-04-30	Environmental Deficiencies	Put firmly secured handrails on each side of hallways.	Isolated	Minimal harm or potential for actual harm

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