Joplin Gardens

In the surveyor’s words

From the most serious findings on record at Joplin Gardens, in the surveyor’s own words.

• Actual harm, isolatedF689Mar 17, 2026

  Based on record review and interviews, the facility failed to ensure all residents were kept free from possible accident hazards when staff failed to follow the care plan regarding the use of a mechanical lift for a transfer resulting in one resident (Resident #1) suffering a fracture to the upper arm. A sample of six residents was reviewed for transfer safety. The facility census was 76.On 02/17/26, the Administrator and Director of Nursing (DON) were notified of the Past Non-Compliance that occurred on 02/16/26, at 10:30 A.M., which resulted in injury to Resident #1. On 02/17/26, the Administrator completed a root cause analysis and investigation into the incident and educated employees involved. […]

• No harm, potential for more than minimal, widespreadF727Dec 12, 2025

  Based on interview and record review, the facility failed to provide the services of a registered nurse (RN) for at least eight consecutive hours per day seven days per week. The facility census was 79.Review showed the facility did not provide a policy related to nursing schedules.1. Review of the Monthly Work Schedule, dated August 2025, showed no RN scheduled to work.Review of the Monthly Work Schedule, dated September 2025, showed no RN scheduled to work.Review of the facility provided time sheets showed no RN clocked in or out on 09/13/25, 09/20/25, 09/21/25, and 09/28/25. Review of the facility provided time sheets showed on 09/14/25 an RN clocked in at 7:00 A.M. and clocked out at 11:00 A.M. […]

• No harm, potential for more than minimal, widespreadF812Aug 23, 2024

  Based on observation and interview, the facility failed to maintain ceiling vents to ensure condensation and/or peeling paint did not drop from the vent onto the food preparation area. This had the potential to affect all 65 residents of the facility who received their meals from the facility kitchen. 1. During the initial tour of the kitchen on 08/20/24, at 9:00 A.M., with the Dietary Manager (DM), three ceiling vents were observed to have rust, dust, and peeling paint on and around the vents. One vent, located in front of the freezer, was observed to be falling from the ceiling. Another vent, located above the edge of the food preparation table, had condensation dripping from the edges of the vent, landing in front of the food preparation table. […]

• No harm, potential for more than minimal, patternF561Jan 23, 2026

  This citation is uncorrected. For prior example please see Event ID 1D8649-H1, exit date 12/12/25.1.Please refer to event 1D8649-H2, exit date 01/23/26, for details. Complaint #2718425

• No harm, potential for more than minimal, patternF561Dec 12, 2025

  Based on observation, interview, and record review, the facility failed to promote and facilitate the right of self-determination for every resident when staff failed to honor reasonable shower preferences for four residents (Resident #1, #2, #3, #4, #5, #6) . The facility census was 79.Based on observation, interview, and record review, the facility failed to promote and facilitate the right of self-determination for every resident when staff failed to honor reasonable shower preferences for six residents (Resident #1, #2, #3, #4, #5, and #6) . The facility census was 79. Review showed the facility did not provide a shower policy. 1. […]