St Croix Valley Good Samaritan Center

Total Number of Beds: 91	Percent of Occupied Beds: 90%
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: 11/12/2003

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**:

Percent of Low-Risk Residents Who Have Pressure Sores: 3%
Percent of Short-Stay Residents With Pressure Sores: 31%
Percent of High-Risk Residents Who Have Pressure Sores: 26%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 37%
Percent of Residents Who Have Moderate to Severe Pain: 7%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 22%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 3%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 29%
Percent of Residents Who are More Depressed or Anxious: 24%
Percent of Short-Stay Residents With Delirium: 2%
Percent of Residents Who Were Physically Restrained: 3%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 43%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 8%
Percent of Residents With a Urinary Tract Infection: 7%
** Details Last Reported on: 11/12/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-09-20	2001-10-20	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2001-09-20	2001-10-20	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2001-09-20	2001-10-20	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
2001-09-20	2001-10-20	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Isolated	Minimal harm or potential for actual harm
2001-09-20	2001-10-20	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm
2001-09-20	2001-10-20	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Widespread	Potential for minimal harm
2003-11-12	2003-11-13	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm

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