Jan Frances Care Center

In the surveyor’s words

From the most serious findings on record at Jan Frances Care Center, in the surveyor’s own words.

• Immediate jeopardy, widespreadF727Sep 19, 2022

  On [DATE], an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to designate a registered nurse to serve as DON on a full-time basis and ensure a registered nurse served in the facility for at least eight consecutive hours a day, seven days a week to assess residents and provide oversight for facility staff. Res #152 admitted to the facility from the hospital on [DATE] for skilled nursing services. Res #152's medical records did not document an admission assessment, skilled services progress notes, ADL documentation, meal or fluid intake, completed Medication Administration Record, [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• Immediate jeopardy, patternF600Aug 1, 2025

  On 07/28/25 at 4:01 p.m., the Oklahoma State Department of Health was notified and verified the existence of an immediate jeopardy situation related to the facility's failure to provide supervision and interventions to prevent resident-to-resident abuse. Resident #1 and Resident #2 became involved in an altercation over cigarettes on 07/19/25. Resident #1 hit Resident #2 with a wet floor sign, causing a fracture to Resident #2's left arm. The facility did not implement interventions to prevent another incident. On 07/27/25, Resident #1 and Resident #4 were involved in an altercation over cigarettes which resulted in the residents slapping each other. No interventions or additional supervision were implemented to prevent another resident-to-resident altercation. […]

• Immediate jeopardy, patternF760Sep 19, 2022

  On [DATE], an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure ensure residents were free of significant medication errors. Res #152 admitted to the facility on [DATE] for skilled nursing services with orders including [MEDICATION(S)] (a medication that raises blood pressure) 10 mg three times daily. Medication administration records documented Res #152 did not receive this medication at any time during his admission. Res #152 expired in the facility four days after admission. During the course of the investigation, five additional residents (#3, 14, 34, 40, and #56) were found to have significant medication errors. […]

• Immediate jeopardy, patternF686Sep 12, 2022

  On 09/09/22, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure the residents received necessary treatment and services for pressure ulcers. There were no routine skin assessments, pressure ulcer assessments, and routine physician ordered treatments being conducted for Res #5 and #9. This resulted in Res #5 being admitted to the hospital with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . On 09/09/22 at 1:02 p.m., the Oklahoma State Department of Health was notified and verified the existence of the IJ situation. On 09/09/22 at 1:10 p.m., the regional director and the corporate RN were notified of the IJ situation. On 09/09/22 at 4:36 p.m., an acceptable plan of removal was submitted to the Oklahoma State Department of Health. […]

• Immediate jeopardy, isolatedF600Sep 19, 2022

  On [DATE], an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure residents were free from neglect. Res #152 admitted to the facility from the hospital on [DATE] for skilled nursing services. Res #152's medical records did not document an admission assessment, skilled services progress notes, ADL documentation, meal or fluid intake, completed Medication Administration Record, [MEDICAL RECORD OR PHYSICIAN ORDER] . Res #152 expired in the facility four days after admission. On [DATE] at 1:13 p.m., the Oklahoma State Department of Health was notified and verified the existence of the IJ situation. On [DATE] at 1:19 p.m., the administrator was notified of the IJ situation related to neglect for Res #152. […]