Example Record

	Profile Information
	Name: JOHN PUBLIC NURSING HOMES
	Address: 123 MAIN STREET
	DOVER, DE 19901- 4721
	Phone Number: 302-456-7890
	Fax Number 302-789-0123
	Last Update: 03-12-2002
	Country: UNITED STATES
	Owner Information
	Owner Name: JOHN PUBLIC
	Owner Type: Profit Corporation
	Facility Information
	Type of Facility: SNF/NF Distinct Part
	Located in a hospital: FALSE
	Chain: TRUE
	Organized Groups: NONE
	Beds in Facility: 78
	Beds Certified for Medicare: 54
	Number of Residents: 46
	Total Medicare Residents: 0
	Total Medicaid Residents: 43
	Percent of Occupied Beds: 85%
	Staffing Information
	Nurse Aide Hours: 3.80
	Licensed Practical or Vocational Nurse Hours: 0.85
	Registered Nurse Hours: 1.05
	Licensing Information
	Federal Type: 123456
	Summary Information (This section will be in chart form on the actual Detail Report.)
	Survey Date: 10-29-1997
	Survey Type: ROUTINE INSPECTION
	Fire Code Compliance FALSE
	Number of Health Threat Violations: 8
	Number of Life Threat Violations: 4
	Survey Information (This section will be in chart form on the actual Detail Report.)
	Survey Date: 04-10-2000
	Chart Type: Bedfast all or most of time
	Chart Score: 35
	Deficiency Information: (This section will be in chart form on the actual Detail Report.)
	Survey Date: 10-29-1997
	Survey Type: INVESTIGATION RESULTING FROM A COMPLAINT
	Deficiency Type: HEALTH
	Deficiency Description: Store, cook, and give out food in a safe and clean way.
	Scope of Deficiency: Widespread Minimal Harm
	Deficiency Status: Plan of Correction

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