Covenant Village Care Center

Total Number of Beds: 60	Percent of Occupied Beds: 65%
Total Number of Residents: 39	Located Within a Hospital: No
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: 05/29/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.91

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.95

Number of CNA Hours per Nursing Home Resident per Day: 1.08

Number of Staff Hours per Nursing Home Resident per Day: 2.94

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 26%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 33%
Percent of Residents Who are More Depressed or Anxious: 7%
Percent of Short-Stay Residents With Delirium: 0%
** Details Last Reported on: 5/29/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-05-17	2001-07-05	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
2001-05-17	2001-07-05	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Pattern	Minimal harm or potential for actual harm
2001-05-17	2001-07-05	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Widespread	Potential for minimal harm
2001-05-17	2001-07-05	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	Minimal harm or potential for actual harm
2001-05-17	2001-07-05	Nutrition and Dietary Deficiencies	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
2001-05-17	2001-07-05	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm
2002-06-13	2002-08-01	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
2002-06-13	2002-08-01	Nutrition and Dietary Deficiencies	Make sure that the attending doctor orders special diets.	Pattern	Minimal harm or potential for actual harm
2002-06-13	2002-08-01	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-06-13	2002-08-01	Environmental Deficiencies	Get rid of garbage properly.	Widespread	Minimal harm or potential for actual harm
2002-06-13	2002-08-01	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Minimal harm or potential for actual harm

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