Carolina Village Health Care Center

Total Number of Beds: 40	Percent of Occupied Beds: 90%
Total Number of Residents: 36	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare Only
* Details Last Reported on: 01/22/2004

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.33

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.79

Number of CNA Hours per Nursing Home Resident per Day: 2.38

Number of Staff Hours per Nursing Home Resident per Day: 3.5

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 17%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 10%
Percent of Residents Who are More Depressed or Anxious: 7%
Percent of Short-Stay Residents With Delirium: 3%
** Details Last Reported on: 1/22/2004

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-03-14	2002-04-14	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Widespread	Potential for minimal harm
2002-03-14	2002-04-14	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
2002-03-14	2002-04-08	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2002-03-14	2002-04-08	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Minimal harm or potential for actual harm
2003-02-20	0000-00-00	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.	Pattern	Potential for minimal harm
2003-02-20	2003-03-20	Mistreatment Deficiencies	1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.	Isolated	Minimal harm or potential for actual harm
2003-02-20	0000-00-00	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	Potential for minimal harm
2003-02-20	0000-00-00	Resident Assessment Deficiencies	Keep assessments completed in the preceding 15 months in the resident's active record.	Pattern	Potential for minimal harm
2003-02-20	2003-05-07	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2003-02-20	2003-03-20	Quality Care Deficiencies	Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.	Isolated	Minimal harm or potential for actual harm
2003-02-20	2003-03-20	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
2003-02-20	2003-05-07	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2003-02-20	2003-03-20	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm
2003-02-20	2003-05-07	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
2003-02-20	2003-03-20	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Minimal harm or potential for actual harm
2004-01-22	2004-02-10	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Pattern	Potential for minimal harm
2004-01-22	2004-02-22	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
2004-01-22	2004-02-22	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.