Villages of Jackson Creek

In the surveyor’s words

From the most serious findings on record at Villages of Jackson Creek, in the surveyor’s own words.

• Immediate jeopardy, isolatedF698Oct 31, 2024

  Based on interview, and record review, the facility failed to ensure one sampled resident (Resident #1) who required dialysis three times a week, received physician ordered dialysis services on 10/22/24 and 10/24/24. On 10/26/24, the resident was sent to dialysis and dialysis staff noticed a significant change in condition and sent the resident to the hospital. The resident was admitted to the hospital on 10/26/24 for weight gain, abdominal pain, acute encephalitis (a neurological condition), end stage renal disease, hyponatremia (low sodium), hyperkalemia (elevated potassium), and his/her hemoglobin was low- requiring an immediate blood transfusion before the resident could receive dialysis. The facility census was 91 residents. […]

• Actual harm, isolatedF689Jun 14, 2023

  Based on observation, interview and record review, the facility failed to safely provide a two person assist sit-to-stand lift (is a device that assists a patient to rise from the seated position but does not support the patient's entire body weight, a sling is attached to the lift) transfer by Agency Certified Nursing Assistant (CNA) A, for one sampled resident (Resident #1) that resulted in a major injury of deep tissue laceration (deep cut or tear in the skin or flesh) to his/her right lower leg, out of four sampled residents. The failure has the potential to affect the safety of residents who require assistance with transfers. The facility census was 101 residents. On 6/14/23, the Administrator was notified of the past noncompliance which occurred on 6/3/23. […]

• No harm, potential for more than minimal, widespreadF812Dec 5, 2025

  Based on observation, interview and record review, the facility failed to maintain the walk in cooler ceiling, fans, and floors; failed to maintain the cleanliness of the floors under the cooking equipment area; failed to maintain the cleanliness of the knife holder by the dish machine area; failed to sanitize the counter surface after a thermometer was placed on it after it fell on the floor; failed to ensure utensils were washed and sanitized; and a facility staff member working in the kitchen failed to wash their hands providing a risk of cross contamination between objects and food. Facility census was 108 residents. […]

• No harm, potential for more than minimal, widespreadF812May 7, 2024

  Based on observation and interview, the facility failed to remove grime from the top of the garbage disposal (a device, installed under a kitchen sink between the sink's drain and the trap used to shred food waste into pieces small enough--less than 2 mm -- in diameter, to pass through plumbing); to remove a buildup of grime and debris including drinking cups from under the ice machine; to remove debris from around the nozzles of the juice machine; to ensure that Dietary Aide's (DA) A's hair was fully covered; to place a label to identify an unknown substance that was in a bottle on the shelf above the stove; to label a white powdery substance in a container in a dry goods' storage to identify that item; and to maintain the milk at 400 Hall kitchenette at a temperature of 41 F (degrees… […]

• No harm, potential for more than minimal, widespreadF812Aug 10, 2022

  Based on observation, interview, and record review, the facility failed to keep the kitchen, Dry Storage room, and walk-in refrigerator and walk-in freezer floors clean and free from pests; to safeguard against foreign material possibly getting into food and/or beverages; to keep trash and garbage receptacles lidded; to properly document food temperatures to ensure they were suitably cooked to lessen the chance of bacterial contamination; to maintain plastic cutting boards and utensils in good condition to avoid food safety hazards; and to separate damaged foodstuff. These deficient practices potentially affected all residents, visitors, volunteers, or staff who ate food from the kitchen. The facility's census was 98 residents with a licensed capacity for 120 residents. 1. […]