Countryside Manor

Total Number of Beds: 60	Percent of Occupied Beds: 95%
Total Number of Residents: 57	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 08/06/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.74

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.25

Number of CNA Hours per Nursing Home Resident per Day: 3.13

Number of Staff Hours per Nursing Home Resident per Day: 4.12

Nursing Home Resident Information**:

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: 10%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 4%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 18%
Percent of Residents Who are More Depressed or Anxious: 20%
Percent of Residents Who Were Physically Restrained: 32%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 2%
Percent of Residents With a Urinary Tract Infection: 4%
** Details Last Reported on: 8/6/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-09-06	2001-10-25	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2001-09-06	2001-10-25	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
2001-09-06	2001-10-25	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
2001-09-06	2001-10-25	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2002-07-03	2002-07-25	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
2003-08-06	2003-09-05	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Pattern	Potential for minimal harm

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