Samantha R Wilson Senior Citiz

Total Number of Beds: 120	Percent of Occupied Beds: 96%
Total Number of Residents: 115	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 and Medicaid
* Details Last Reported on: 11/20/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.37

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.03

Number of CNA Hours per Nursing Home Resident per Day: 2.63

Number of Staff Hours per Nursing Home Resident per Day: 4.03

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 3%
Percent of Short-Stay Residents With Pressure Sores: 10%
Percent of High-Risk Residents Who Have Pressure Sores: 13%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 31%
Percent of Residents Who Have Moderate to Severe Pain: 5%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 27%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 1%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 25%
Percent of Residents Who are More Depressed or Anxious: 9%
Percent of Short-Stay Residents With Delirium: 0%
Percent of Residents Who Were Physically Restrained: 0%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 32%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 10%
Percent of Residents With a Urinary Tract Infection: 17%
** Details Last Reported on: 11/20/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-02-14	2002-03-18	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
2002-02-14	2002-03-18	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Isolated	Minimal harm or potential for actual harm
2002-02-14	2002-03-18	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Isolated	Minimal harm or potential for actual harm
2002-02-14	2002-03-18	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.	Pattern	Minimal harm or potential for actual harm
2002-02-14	2002-03-18	Environmental Deficiencies	Have a program to keep infection from spreading.	Widespread	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Resident Rights Deficiencies	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Resident Rights Deficiencies	Give enough notice to the resident before changing the resident's room or roommate.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	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
2003-01-31	2003-03-06	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Quality Care Deficiencies	Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Quality Care Deficiencies	Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Quality Care Deficiencies	Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.	Isolated	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	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
2003-01-31	2003-03-06	Nutrition and Dietary Deficiencies	1) Provide 3 meals daily at regular times; or 2) serve breakfast within 14 hours after dinner; or 3) offer a snack at bedtime each day.	Widespread	Potential for minimal harm
2003-01-31	2003-03-06	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Widespread	Minimal harm or potential for actual harm
2003-01-31	2003-03-06	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
2003-11-20	2003-12-22	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
2003-11-20	2003-12-22	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-11-20	2003-12-22	Quality Care Deficiencies	Give or get dental care for each resident.	Isolated	Minimal harm or potential for actual harm
2003-11-20	2003-12-22	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Widespread	Potential for minimal harm

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