Dominican Hospital D/P Skilled Nursing Facility

Total Number of Beds: 37	Percent of Occupied Beds: 70%
Total Number of Residents: 26	Located Within a Hospital: Yes
Type of Ownership: Non profit - Corporation	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: 01/08/2004

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**:

Percent of Short-Stay Residents With Pressure Sores: 25%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 58%
Percent of Short-Stay Residents With Delirium: 3%
** Details Last Reported on: 1/8/2004

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-02-20	2002-04-14	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-02-20	2002-04-14	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2003-03-13	0000-00-00	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Pattern	Potential for minimal harm
2003-03-13	0000-00-00	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Potential for minimal harm
2003-03-13	0000-00-00	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Pattern	Potential for minimal harm
2003-03-13	0000-00-00	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2004-01-08	2004-01-31	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2004-01-08	2004-01-31	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm

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