South Park East

In the surveyor’s words

From the most serious findings on record at South Park East, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Sep 10, 2025

  On 09/09/25, an IJ situation was determined to exist related to the facility's failure to provide protection from sexual abuse/inappropriate touching from two residents towards three residents sampled for abuse.On 09/09/25 at 11:19 a.m., the Oklahoma State Department of Health was notified and verified the existence of an IJ situation.On 09/09/25 at 11:54 a.m., the administrator and ADON were notified of the IJ situation and the IJ template was provided.On 09/10/25 at 11:53 a.m., an acceptable plan of removal was approved by the Oklahoma State Department of Health. […]

• Actual harm, patternF686Sep 2, 2021

  Based on record review and staff interviews, it was determined the facility failed to ensure a resident's skin was assessed and monitored and an avoidable stage-3 pressure ulcer did not develop for one (#82) of one sampled resident reviewed for pressure ulcers. The resident developed a stage 3 pressure ulcer that was present on admission to the emergency room . The facility census was 30. The Resident Census and Conditions of Residents report, dated 08/31/21, documented no residents had pressure ulcers. […]

• Actual harm, patternF692Sep 2, 2021

  Based on record review and interview, it was determined the facility failed to ensure physician ordered weekly weights were obtained for one (#82) of three sampled residents reviewed for weight loss. This resulted in the resident sustaining a 23.7 (13%) weight loss that was identified when she was sent to the emergency room . The facility census was 30. Findings: The facility's weight policy, revised March 2011, documented, .provide a baseline and an ongoing record of the resident's body weight as an indicator of the nutritional status and medical condition .note and record the resident's weight .All assessment data obtained during the procedure .Report significant weight loss/weight gain to the nurse supervisor . Resident #82 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, widespreadF803May 8, 2026

  Based on observation, record review, and interview, the facility failed to follow menus and provide bread for 1 of 1 meal observation. The dietary manager identified 38 residents in the facility received nutrition from the kitchen. Findings:On 05/04/26 at 12:00 p.m., cook #1 was observed serving the noon meal. [NAME] #1 was observed serving 38 out of 38 trays without any bread or bread sticks. On 05/04/26, the facility menu for the noon meal showed residents were to have the following items served: Ravioli, Italian blend vegetables, bread sticks, and desert. On 05/04/26 at 12:35 p.m., the dietary manager stated no bread had been served, but the cook was supposed to provide plain bread because the stove and oven was not working. […]

• No harm, potential for more than minimal, widespreadF880May 8, 2026

  Based on record review and interview, the facility failed to have a water management program to prevent the growth and detection of Legionella. The DON identified 38 residents resided in the facility. Findings:A facility policy titled Legionella Surveillance and Detection, revised July 2017, read in part, Our facility is committed to the prevention, detection and control of water borne contaminants, including Legionella. A facility policy titled Legionella Water Management Program, revised July 2017, read in part, The purpose of the water management program are to identify areas in water system where Legionella bacteria can grow and spread and to reduce the risk of Legionnaire's disease.The water management program includes the following elements . […]