Jefferson Memorial Hospital, D/P

Total Number of Beds: 10	Percent of Occupied Beds: 50%
Total Number of Residents: 5	Located Within a Hospital: Yes
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: None	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 11/13/2003

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**:

** Details Last Reported on: 11/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-11-26	2002-12-23	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Widespread	Potential for minimal harm
2002-11-26	2002-12-16	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm
2002-11-26	2003-01-22	Environmental Deficiencies	Have a program to keep infection from spreading.	Widespread	Potential for minimal harm
2002-11-26	2002-11-27	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
2003-11-13	2003-12-12	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Widespread	Potential for minimal harm
2003-11-13	2003-12-17	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
2003-11-13	2003-12-12	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Widespread	Potential for minimal harm
2003-11-13	2003-12-12	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm

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