Avera Bormann Manor

Total Number of Beds: 47	Percent of Occupied Beds: 98%
Total Number of Residents: 46	Located Within a Hospital: Yes
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: 09/10/2003

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: 0.14

Number of CNA Hours per Nursing Home Resident per Day: 2.76

Number of Staff Hours per Nursing Home Resident per Day: 3.7

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 3%
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: 12%
Percent of Residents Who are More Depressed or Anxious: 9%
Percent of Residents Who Were Physically Restrained: 10%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 56%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 5%
Percent of Residents With a Urinary Tract Infection: 10%
** Details Last Reported on: 9/10/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-08-08	2001-09-13	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Isolated	Minimal harm or potential for actual harm
2001-08-08	2001-09-13	Quality Care Deficiencies	Make sure that each residents' abilities to take care of themselves does not lessen, unless a change cannot be avoided.	Isolated	Minimal harm or potential for actual harm
2001-08-08	2001-09-13	Pharmacy Service Deficiencies	1) Make sure that residents who take drugs are not given too many doses or for too long; 2) make sure that the use of drugs is carefully watched; or 3) stop or change drugs that cause unwanted effects.	Isolated	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Pattern	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Pattern	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Pattern	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-10-30	2002-12-26	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2003-09-10	2003-11-07	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.	Widespread	Potential for minimal harm
2003-09-10	2003-11-07	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-09-10	2003-11-07	Pharmacy Service Deficiencies	1) Make sure that residents who take drugs are not given too many doses or for too long; 2) make sure that the use of drugs is carefully watched; or 3) stop or change drugs that cause unwanted effects.	Isolated	Minimal harm or potential for actual harm
2003-09-10	2003-11-07	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm
2003-09-10	2003-11-07	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm

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