Crystal Lake Good Sam Center

Total Number of Beds: 93	Percent of Occupied Beds: 88%
Total Number of Residents: 82	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 11/13/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.6

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.93

Number of CNA Hours per Nursing Home Resident per Day: 2.39

Number of Staff Hours per Nursing Home Resident per Day: 3.92

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 3%
Percent of Short-Stay Residents With Pressure Sores: 9%
Percent of High-Risk Residents Who Have Pressure Sores: 6%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 48%
Percent of Residents Who Have Moderate to Severe Pain: 17%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 13%
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: 28%
Percent of Residents Who are More Depressed or Anxious: 23%
Percent of Short-Stay Residents With Delirium: 5%
Percent of Residents Who Were Physically Restrained: 9%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 40%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 5%
Percent of Residents With a Urinary Tract Infection: 3%
** Details Last Reported on: 11/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-10-18	2002-12-12	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Isolated	Minimal harm or potential for actual harm
2002-10-18	2002-12-12	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
2002-10-18	2002-12-12	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Pattern	Minimal harm or potential for actual harm
2002-10-18	2002-12-12	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
2003-05-01	2003-06-23	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
2003-05-01	2003-06-23	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2003-05-01	2003-06-23	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
2003-05-01	2003-06-23	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Isolated	Minimal harm or potential for actual harm
2003-11-13	2004-01-14	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm

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