RIC         1  1                                        C RIC CODE FOR SURVEY FACILITY ID RECORD

FILEYR      2  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      4  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                               1,236             LOW-HIGH BASEID Count

D_FACID    12  6                                        C FACILITY ID

NHSTAT     18  2  NHSTFMT                               N NURSING HOME STAT FL

                                   4                   -9 NOT ASCERTAINED
                                   1                   -7 REFUSED
                                  13                    0 NOT MET--NH
                               1,023                    1 MEETS-NO PAR PROBS
                                 115                    2 MEETS-MR
                                  25                    3 MEETS-MENTALLY ILL
                                   0                    4 MEETS-DEAF OR BLIND
                                  10                    5 MEETS-PHYS HANDI
                                   1                    6 MEETS-UNWED MOMS,ETC.
                                   3                    7 MEETS-SOME OTH GROUP
                                  13                    8 MEETS-NO PART GROUP
                                  28                    9 UNABLE TO DETERMINE

FACOWNED   20  2  OWNFMT                      FA31      N DESCRIPTION OF OWNERSHIP OF FACILITY

                                   2                   -9 NOT ASCERTAINED
                                 785                    1 FOR PROFIT
                                 294                    2 PRIV NON PROFIT
                                  54                    3 CITY/COUNTY GOVT
                                  87                    4 STATE GOVT
                                  14                    5 VETERANS ADMIN
                                   0                   91 OT FED AG (SPEC)

FACDISC    22  2  FACFMT                      RH21      N FACILITY DESCRIPTION

                                   1                   -9 NOT ASCERTAINED
                                  17                    1 HOSPITAL
                                 916                    2 NURSING HOME
                                  24                    3 RETIREMENT HOME
                                  56                    4 DOMI/PER CARE FAC
                                  38                    5 MENTAL HLTH FACLITY
                                  86                    6 INST FOR MR/DEV DISA
                                   1                    7 MENTAL HLTH CNTR
                                  17                    8 LIFE CARE/CONT CARE
                                  43                    9 ASSISTED LIVING FAC
                                   5                   10 REHAB FACILITY
                                  32                   91 OTHER PLACE (SPEC)

FACDIOS    24  2  FACDFMT                     RH21      N FACILITY DESCRIPTION--OTHER SPECIFIED

                               1,204                    . INAPPLICABLE
                                   3                    1 ADULT HOSTEL
                                   8                    2 ADULT FOSTER CARE
                                   2                    3 HOSPICE
                                   8                    4 RESIDENTIAL CARE
                                   1                    5 EXTENDED CARE FACILITY
                                   2                    6 INDEPENDENT LIVING
                                   1                    7 GROUP HOME--MENTAL ILL
                                   2                    8 SHELTER CARE
                                   1                    9 FAMILY CARE/FOSTER
                                   1                   10 NH/PERSONAL CARE FAC
                                   2                   11 NH/REHAB FACILITY
                                   0                   12 ASSISTED LIVING
                                   0                   14 PSYCHIATRIC HOSPITAL
                                   0                   15 ACLF
                                   0                   19 RESIDENTIAL CARE
                                   0                   20 GROUP HOME
                                   0                   21 PEDIATRIC LTC FACILITY
                                   0                   22 NH/ASSISTED LIVING
                                   0                   23 MENTAL HLTH/MR/DEV DIS
                                   1                   24 NURSING HM/ASSISTED
                                   0                   25 NH/RETIREMENT HME/DD
                                   0                   26 NH/RETIREMENT HOME
                                   0                   27 DOMICILIARY/ASSISTED
                                   0                   28 NH/PERSONAL CARE FAC
                                   0                   29 RESIDENTIAL HEALTH CARE
                                   0                   30 FAMILY CARE
                                   0                   31 NH/LIFE CARE FACILITY
                                   0                   32 NH/MEDICAL CENTER
                                   0                   33 ON LOK

                  Note: Applies only if FACDIOS=91.

FACLONGT   26  2  MOSTFMT                     FA8       N DOES FACILITY PROVIDE LONG TERM CARE?

                                  13                    . INAPPLICABLE
                               1,212                    1 YES
                                  11                    2 NO

FACLTBED   28  3  BEDFMT                                N NUMBER OF LONG TERM BEDS ONLY

                                  11                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                               1,060                1-990 NUMBER OF BEDS
                                 154                  993 3 OR MORE BEDS
                                   0                  996 # BEDS > 990

FACTOBED   31  3  BEDFAFMT                    FA19      N TOTAL NUMBER OF BEDS IN FACILITY

                                  19                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,205                0-995 NUMBER OF BEDS
                                   7                  996 # BEDS > 995

PROVLEVL   34  2  MOSTFMT                               N DOES FACILITY PROVIDE DIFF CARE LEVELS?

                                  16                   -9 NOT ASCERTAINED
                                 716                    1 YES
                                 504                    2 NO

LEVLSKIL   36  2  MOSTFMT                               N DOES FACILITY PROVIDE SKILLED CARE?

                                 520                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 558                    1 YES
                                 156                    2 NO

LEVLINTR   38  2  MOSTFMT                               N DOES FACILITY PROVIDE INTERMEDIATE CARE?

                                 520                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 537                    1 YES
                                 177                    2 NO

LEVLOTH1   40  2  MOSTFMT                               N DOES FACILITY PROV OTHER LVL OF CARE 1?

                                 520                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 310                    1 YES
                                 404                    2 NO

                  Note: Applies only if PROVLEVL = 1

LEVLOTS1   42  2  LEVLOTFT                              N OTHER LEVEL OF CARE 1 - SPECIFY

                                 935                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   6                    1 LIGHT
                                  15                    2 HEAVY
                                  15                    3 CUSTODIAL
                                  11                    4 ALZHEIMERS
                                  14                    5 MINIMUM
                                   4                    6 MODERATE
                                   0                    7 MAXIMUM
                                   3                    8 SPECIALIZED CARE
                                   0                    9 INTENSIVE
                                   0                   10 HEAVY INTENSIVE CARE
                                   4                   11 EXTENSIVE CARE
                                   2                   12 RETARDED
                                   1                   13 RETARDED/EXTRA CARE
                                   0                   14 PERSONAL CARE/TOTAL
                                   4                   15 BEHAVIORAL
                                   0                   16 DEVELOPMENTALLY DISABLED
                                   0                   17 MENTALLY ILL & HOMELESS
                                   1                   18 COMPLEX CARE ISNF
                                   0                   19 CLOSELY MONITORED
                                   1                   20 ADL ASSISTANCE
                                   5                   21 PROFOUND MENTAL RETARDATION
                                   1                   22 MILD MENTAL RETARDATION
                                   0                   23 SEVERE MENTAL RETARDATION
                                   0                   24 SPECIALIZED DEMENTIA
                                   0                   34 RESPITE
                                   1                   38 PSYCHIATRIC REHAB
                                   1                   46 LONG TERM PSYCHIATRIC
                                   1                   47 DEPENDENT
                                   1                   56 OUTPATIENT
                                   4                   57 INDEPENDENT LIVING
                                   1                   61 RETIREMENT
                                 147                   95 NOT SPECIFIC
                                  57                   96 STATE SPECIFIC

LEVLOTH2   44  2  MOSTFMT                               N DOES FACILITY PROV OTHER LVL OF CARE 2?

                                 520                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  42                    1 YES
                                 672                    2 NO

                  Note: Applies only if PROVLEVL = 1

LEVLOTS2   46  2  LEVLOTFT                              N OTHER LEVEL OF CARE 2 - SPECIFY

                               1,199                    . INAPPLICABLE
                                   2                    1 LIGHT
                                   4                    2 HEAVY
                                   0                    3 CUSTODIAL
                                   3                    4 ALZHEIMERS
                                   1                    5 MINIMUM
                                   6                    6 MODERATE
                                   2                    7 MAXIMUM
                                   0                    8 SPECIALIZED CARE
                                   0                    9 INTENSIVE
                                   0                   10 HEAVY INTENSIVE CARE
                                   0                   11 EXTENSIVE CARE
                                   0                   12 RETARDED
                                   0                   13 RETARDED/EXTRA CARE
                                   0                   14 PERSONAL CARE/TOTAL
                                   4                   15 BEHAVIORAL
                                   0                   16 DEVELOPMENTALLY DISABLED
                                   0                   17 MENTALLY ILL & HOMELESS
                                   0                   18 COMPLEX CARE ISNF
                                   1                   19 CLOSELY MONITORED
                                   0                   20 ADL ASSISTANCE
                                   0                   21 PROFOUND MENTAL RETARDATION
                                   0                   22 MILD MENTAL RETARDATION
                                   0                   23 SEVERE MENTAL RETARDATION
                                   0                   24 SPECIALIZED DEMENTIA
                                   1                   34 RESPITE
                                   0                   38 PSYCHIATRIC REHAB
                                   0                   46 LONG TERM PSYCHIATRIC
                                   0                   47 DEPENDENT
                                   0                   56 OUTPATIENT
                                   2                   57 INDEPENDENT LIVING
                                   0                   61 RETIREMENT
                                  11                   95 NOT SPECIFIC
                                   0                   96 STATE SPECIFIC

LEVLOTH3   48  2  MOSTFMT                               N DOES FACILITY PROV OTHER LVL OF CARE 3?

                                 520                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  13                    1 YES
                                 701                    2 NO

                  Note: Applies only if PROVLEVL = 1

LEVLOTS3   50  2  LEVLOTFT                              N OTHER LEVEL OF CARE 3 - SPECIFY

                               1,225                    . INAPPLICABLE
                                   1                    1 LIGHT
                                   3                    2 HEAVY
                                   0                    3 CUSTODIAL
                                   0                    4 ALZHEIMERS
                                   1                    5 MINIMUM
                                   1                    6 MODERATE
                                   1                    7 MAXIMUM
                                   0                    8 SPECIALIZED CARE
                                   0                    9 INTENSIVE
                                   0                   10 HEAVY INTENSIVE CARE
                                   0                   11 EXTENSIVE CARE
                                   0                   12 RETARDED
                                   0                   13 RETARDED/EXTRA CARE
                                   0                   14 PERSONAL CARE/TOTAL
                                   0                   15 BEHAVIORAL
                                   0                   16 DEVELOPMENTALLY DISABLED
                                   0                   17 MENTALLY ILL & HOMELESS
                                   1                   18 COMPLEX CARE ISNF
                                   0                   19 CLOSELY MONITORED
                                   0                   20 ADL ASSISTANCE
                                   0                   21 PROFOUND MENTAL RETARDATION
                                   0                   22 MILD MENTAL RETARDATION
                                   0                   23 SEVERE MENTAL RETARDATION
                                   0                   24 SPECIALIZED DEMENTIA
                                   0                   34 RESPITE
                                   0                   38 PSYCHIATRIC REHAB
                                   0                   46 LONG TERM PSYCHIATRIC
                                   0                   47 DEPENDENT
                                   0                   56 OUTPATIENT
                                   0                   57 INDEPENDENT LIVING
                                   0                   61 RETIREMENT
                                   3                   95 NOT SPECIFIC
                                   0                   96 STATE SPECIFIC

SNFBEDN    52  3  SNFBEFMT                    FA43+45   N NUMBER OF SNF BEDS--MEDICARE

                                 602                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   0                    0 NO BEDS OF TYPE
                                 629                1-997 NUMBER OF BEDS

                  Note: This count includes beds that are dual-certified for Medicare & Medicaid

MCDSNFN    55  3  SNFBEFMT                    FA43+44   N NUMBER OF SNF BEDS--MEDICAID

                                 521                    . INAPPLICABLE
                                   7                   -8 DONT KNOW
                                   0                    0 NO BEDS OF TYPE
                                 708                1-997 NUMBER OF BEDS

                  Note: This count includes beds that are dual-certified for Medicare & Medicaid

MCDICFN    58  3  SNFBEFMT                              N NUMBER OF ICF BEDS ONLY

                                 779                    . INAPPLICABLE
                                  16                   -9 NOT ASCERTAINED
                                   7                   -8 DONT KNOW
                                  53                    0 NO BEDS OF TYPE
                                 381                1-997 NUMBER OF BEDS

                  Note: Applies only if facility has no beds certified by Medicare or Medicaid

MCDICFMR   61  3  SNFBEFMT                    FA45b     N NUMBER OF ICF-MR BEDS ONLY

                                 779                    . INAPPLICABLE
                                  21                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                 333                    0 NO BEDS OF TYPE
                                  98                1-997 NUMBER OF BEDS

CERTBEDS   64  3  SNFBEFMT                    FA46      N NUMBER OF UNCERTIFIED BEDS

                               1,082                    . INAPPLICABLE
                                   1                   -8 DONT KNOW
                                   0                    0 NO BEDS OF TYPE
                                 153                1-997 NUMBER OF BEDS

                  Note: Derived -- sum of MNORBED, OLTCBED, and NLTCBEDS

PRIMDEAF   67  2  MOSTFMT                               N FACIL PRIM SERVE--DEAF

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  28                    1 YES
                               1,173                    2 NO

PRIMBLND   69  2  MOSTFMT                               N FACIL PRIM SERVE--BLIND

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  31                    1 YES
                               1,170                    2 NO

PRIMUWED   71  2  MOSTFMT                               N FACIL PRIM SERVE--UNWED MOMS

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                   0                    1 YES
                               1,201                    2 NO

PRIMABUS   73  2  MOSTFMT                               N FACIL PRIM SERVE-ALCOHOL/DRUG ABUSERS

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  14                    1 YES
                               1,187                    2 NO

PRIMORPH   75  2  MOSTFMT                               N FACIL PRIM SERVE-ORPHANS/DEPEND

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                   2                    1 YES
                               1,199                    2 NO

PRIMMDEF   77  2  MOSTFMT                               N FACIL PRIM SERVE-MENTALLY ILL & DEAF

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  10                    1 YES
                               1,191                    2 NO

PRIMMENT   79  2  MOSTFMT                               N FACIL PRIM SERVE-MENTALLY ILL ONLY

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  44                    1 YES
                               1,157                    2 NO

PRIMMEDD   81  2  MOSTFMT                               N FACIL PRIM SERVE-MENT RET/DEV DIS

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                 126                    1 YES
                               1,075                    2 NO

PRIMMIMR   83  2  MOSTFMT                               N FACIL PRIM SERVE-MENT RET & MENT ILL

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  52                    1 YES
                               1,149                    2 NO

PRIMGERI   85  2  MOSTFMT                               N FACIL PRIM SERVE-GERIATRIC

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                 954                    1 YES
                                 247                    2 NO

PRIMNEUR   87  2  MOSTFMT                               N FACIL PRIM SERVE-NEURO OR PHYS HANDI

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  66                    1 YES
                               1,135                    2 NO

PRIMOTHR   89  2  MOSTFMT                               N FACIL PRIM SERVE-SOME OTHER GRP

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  21                    1 YES
                               1,180                    2 NO

PRIMOS     91  2  LVL1FMT                               N FACIL PRIM SERVE-SOME OTHER GRP-OS

                               1,215                    . INAPPLICABLE
                                   3                   -9 NOT ASCERTAINED
                                   5                    1 ALZHEIMERS
                                   3                    2 TER ILL PAT
                                   3                    3 VETERANS
                                   2                    4 REHABILITATION
                                   1                    5 CHRISTIAN SCIENCE
                                   1                    6 HOSPICE
                                   0                    7 CONVICTS
                                   3                    8 ADOLESCENT MEN ILL
                                   0                    9 MALES >18 AMBULATORY
                                   0                   11 AIDS
                                   0                   12 EMOTIONALLY DISTURB
                                   0                   13 MENTAL ILL/PHYSICAL
                                   0                   14 VENTILATOR DEPEND
                                   0                   15 MENTAL ILL/HOMELESS
                                   0                   16 ADULT FOSTER CARE

PRIMGRP    93  2  MOSTFMT                               N FACIL PRIM SERVE-NO PRIMARY GRP

                                  33                   -9 NOT ASCERTAINED
                                   2                   -7 REFUSED
                                  80                    1 YES
                               1,121                    2 NO

ROOMCARE   95  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE NURSE/MEDICAL CARE?

                                 191                    . INAPPLICABLE
                                  37                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 913                    1 YES
                                  87                    2 NO

SUPRVMED   97  2  MOSTFMT                     FA22c     N DOES FACIL SUPERVISE SELF-ADMIN MEDS?

                                 191                    . INAPPLICABLE
                                  37                   -9 NOT ASCERTAINED
                                   8                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 715                    1 YES
                                 283                    2 NO

FHLPBATH   99  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/BATHING?

                                 191                    . INAPPLICABLE
                                  38                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 972                    1 YES
                                  28                    2 NO

FHLPDRES  101  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/DRESSING?

                                 191                    . INAPPLICABLE
                                  37                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 973                    1 YES
                                  28                    2 NO

FHLPSHOP  103  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/SHOPPING?

                                 191                    . INAPPLICABLE
                                  36                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 984                    1 YES
                                  18                    2 NO

FHLPWALK  105  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/WALKING?

                                 191                    . INAPPLICABLE
                                  36                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 959                    1 YES
                                  43                    2 NO

FHLPEAT   107  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/EATING?

                                 191                    . INAPPLICABLE
                                  36                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 952                    1 YES
                                  50                    2 NO

FHLPCOMM  109  2  MOSTFMT                     FA22c     N DOES FACIL PROVIDE HELP W/COMMUNCATION?

                                 191                    . INAPPLICABLE
                                  37                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 968                    1 YES
                                  33                    2 NO

FHLPNURS  111  2  MOSTFMT                     FA22a     N DOES FACIL PROVIDE 24HR NURSING CARE?

                                 191                    . INAPPLICABLE
                                  16                   -9 NOT ASCERTAINED
                               1,010                    1 YES
                                  19                    2 NO

SPIDCNT   113  2  SPFMT                                 N NUMBER OF SPS IN FACILITY

                                 190                    . INAPPLICABLE
                                   4                   -9 NOT ASCERTAINED
                                 730                    1 ONE SAMPLE PERSON
                                 190                    2 TWO SAMPLE PEOPLE
                                  81                    3 THREE SAMPLE PEOPLE
                                  18                    4 FOUR SAMPLE PEOPLE
                                  14                    5 FIVE SAMPLE PEOPLE
                                   0                    6 SIX SAMPLE PEOPLE
                                   4                    7 SEVEN SAMPLE PEOPLE
                                   5                    8 EIGHT SAMPLE PEOPLE
                                   0                    9 NINE SAMPLE PEOPLE
                                   0                   10 TEN SAMPLE PEOPLE

                  Note: Determined from administrative records.

NORATE    115  2  NORTFMT                               N REASON FOR NO RATES

                               1,226                    . INAPPLICABLE
                                   7                    1 VA
                                   2                    2 STATE FUNDED
                                   1                    3 CAPITATED

