Northern Surry Skilled Nursing Facility

Total Number of Beds: 33	Percent of Occupied Beds: 88%
Total Number of Residents: 29	Located Within a Hospital: Yes
Type of Ownership: Government - Hospital district	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Family	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 04/22/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.73

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.67

Number of CNA Hours per Nursing Home Resident per Day: 2.66

Number of Staff Hours per Nursing Home Resident per Day: 4.06

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 10%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 59%
Percent of Short-Stay Residents With Delirium: 2%
** Details Last Reported on: 4/22/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-07-03	2001-07-25	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Widespread	Potential for minimal harm

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