Judson Park Health Center

In the surveyor’s words

From the most serious findings on record at Judson Park Health Center, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Jan 12, 2023

  Based on observation, interview, and record review the facility failed to ensure food was stored, prepared, and served in a sanitary manner and in accordance with professional standards of food safety. The failure to ensure food was stored appropriately, the dishwasher reached the required temperature necessary to sanitize dishes, ensure the clean area of the dishwashing area was free of food debris, hand hygiene was performed as required, and food preparation surfaces were free of contaminants left residents at risk of food contamination and food-borne illness. Findings included . Food Storage During initial rounds of the facility's main kitchen on 01/04/2023 at 9:00 AM open containers of dried parsley, poppy seeds and rice were observed in the dried food storage area. […]

• No harm, potential for more than minimal, widespreadF880Jan 12, 2023

  Based on observation, interview, and record review the facility failed to implement, monitor, and maintain their infection control practices providing a safe and sanitary environment to help prevent the transmission of communicable disease. The failure to ensure staff performed hand hygiene when required, implemented correct Transmission Based Precautions (TBP) for a contagious infection for 1 of 2 residents (Resident 280) reviewed for TBP, ensured staff received education and proper fit testing for N95 respirators, used standard infection control practices during medication pass (Resident 14 and 288) placed residents, staff, and visitors at risk for development of contagious communicable infections and disease. Findings included . […]

• No harm, potential for more than minimal, widespreadF886Jan 12, 2023

  Based on observation, interview, and record review the facility failed to ensure their COVID-19 (a highly transmissible infectious virus that causes respiratory illness and in severe cases can cause difficulty breathing, pneumonia, hospitalization , and even death) staff testing procedures were conducted in a manner consistent with current standards of practice for COVID-19 testing, followed proper infection control guidance for safe testing, and was performed according to the Named brand COVID-19 Point-of-Care manufacturers recommendations to ensure accurate test results. […]

• No harm, potential for more than minimal, patternF578Aug 28, 2025

  Based on interview and record review the facility failed to obtain and/or renew guardianship papers, and/or failed to provide assistance in the formulation of an Advanced Directive (AD - a document describing a resident's wishes for care if they became incapacitated) for 6 of 20 residents (Residents 5, 49, 9, 1, 2 & 54) reviewed for guardianship/advance directives. This failure left residents at risk for losing the right to have their preferences and choices honored during emergent and end-of-life care.Findings included .<Facility Policy>According to the facility's revised September 2022 Advanced Directives policy, the resident had the right to formulate an advanced directive (AD) and advance directives were honored in accordance with state law and facility policy. […]

• No harm, potential for more than minimal, patternF628Aug 28, 2025

  Based on interview and record review, the facility failed to ensure a system by which residents received required written notices at the time of transfer and/or discharge, or as soon as practicable for 3 (Residents 5, 10 & 82), offer a bed hold for 2 (Resident 10 & 82), notify the office of the Long Term Care Ombudsman (LTCO) for 1 (Resident 12), and provide discharge planning for 2 (Residents 1 & 43) of 7 residents reviewed for hospitalizations and discharges. These failures placed residents at risk of being uninformed about their discharge rights, the cost of holding the resident's bed while hospitalized , and a decreased quality of life.Findings included .<Facility Policy>The facility's October 2016, Supplement to Health Facility admission Agreement showed residents who were being… […]