John Paul II Nursing Home

In the surveyor’s words

From the most serious findings on record at John Paul II Nursing Home, in the surveyor’s own words.

• Immediate jeopardy, patternF689Feb 5, 2021

  Based on interview and record review, the facility failed to provide adequate supervision and assistance devices to prevent accidents for 2 of 12 residents (Residents #26 and #9) reviewed for accidents in that: 1. Resident #26 fell fifteen times in a seven month period and sustained a laceration and a fracture. 2. Resident #9 fell four times in a six month period and sustained a laceration and a head injury. This failure resulted in an identification of an Immediate Jeopardy (IJ) situation on 02/02/2021. […]

• No harm, potential for more than minimal, patternF730Jun 30, 2023

  Based on interview and record review, the facility failed to conduct a performance review at least once every 12 months and provide regular in-service education based on the outcome of these reviews for 6 of 6 CNA's, NA's or RA's (RA F, NA G, NA H, NA I, NA J, NA K) reviewed for performance reviews, in that: The facility failed to conduct performance reviews at least every 12 months for RA F, NA G, NA H, NA I, NA J, NA K. This failure could result in residents not receiving the necessary care and services due to nurse aides not receiving training based on their performance review outcome. […]

• No harm, potential for more than minimal, patternF812Jun 30, 2023

  Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen (Main Kitchen), in that: The facility failed to ensure an opened items in the reach in refrigerators were dated or discarded correctly This deficient practice could place residents who ate food from the kitchen at risk for foodborne illness. The findings included: During an observation, in the dry storage area, on 06/27/2023 at 11:59 a.m., revealed a box container of Idaho potatoes with a received date of 06.23.2023, but no opened date. During an observation, in the walk-in refrigerator, on 06/27/2023 at 12:04 p.m., revealed one 32 oz. […]

• No harm, potential for more than minimal, patternF944Jun 30, 2023

  Based on interviews and record reviews, the facility failed to ensure Quality Assurance and Performance Improvement (QAPI) training that outlines and informs staff of the elements and goals of the facility's QAPI program for 10 of 16 employees (RA F, NA G, NA H, NA I, NA J, NA K, LVN L, RN M, LVN N, LVN O) reviewed for training, in that: The facility failed to ensure RA F, NA G, NA H, NA I, NA J, NA K, LVN L, RN M, LVN N, LVN O completed QAPI training within the last year. These failures could affect residents and place them at risk of poor care or victimization due to lack of staff training. Findings included: a. Record review of Staff Roster, dated 06/30/2023, revealed RA F was hired on 09/15/2014. […]

• No harm, potential for more than minimal, patternF949Jun 30, 2023

  Based on interview and record review, the facility failed to provide mandatory effective behavioral health training for 16 of 16 employees (RA F, NA G, NA H, NA I, NA J, NA K, LVN L, RN M, LVN N, LVN O, MR, DM, AD, DON, MDS Coordinator and SW)reviewed for training, in that: The facility failed to ensure RA F, NA G, NA H, NA I, NA J, NA K, LVN L, RN M, LVN N, LVN O, MR, DM, AD, DON, MDS Coordinator and SW completed behavioral health training within the previous year. This failure could place residents at risk of not attaining or maintaining their highest practicable physical, mental, and psychosocial well-being due to lack of staff training. The findings included: a. Record review of Staff Roster, dated 06/30/2023, revealed RA F was hired on 09/15/2014. […]