General Information: NORTH CHURCH NURSING & REHAB
Nursing home name NORTH CHURCH NURSING & REHAB
Address1021 NORTH CHURCH STREET
JACKSONVILLE, IL 62650
Phone number (217) 245-4174
Located within a hospital No
Type of ownership For profit - Corporation
Owner operates multiple homesYes
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils RESIDENT
Certified number of beds 113
Total number of residents 78
Perc of occupied beds 69
Sprinkler status Yes
Last health survey date 10/12/2012
Fire survey date: 10/16/2012
Ratings Summary: NORTH CHURCH NURSING & REHAB
Overall rating 2
2
Nursing Home Staffing 1
1
Registered Nurses only 1
1
Health Inspections 1
1
Quality Measures 5
5
Nursing Home Staffing Info: NORTH CHURCH NURSING & REHAB
National AverageNORTH CHURCH NURSING & REHAB
Overall staff rating Not Available. 1
1
Registered Nurses only rating Not Available 1
1
Total Number of Residents 88.1 78.00
Total Number of Licensed Nurse Staff Hours per Resident per Day 29.8 hours .97 hours
Registered Nurses Hours per Residents per Day 29.0 hours .22 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 29.0 hours .75 hours
Certified Nursing Assistants Hours per Residents per Day 29.0 hours .22 hours
Health Inpections: NORTH CHURCH NURSING & REHAB
Inspection Results: 10/12/2012
CorrectedCategoryDeficiencySeverity
11/16/2012Environmental DeficienciesMake sure there is a pest control program to prevent/deal with mice, insects, or other pests. F
11/16/2012Environmental DeficienciesMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. E
11/16/2012Environmental DeficienciesMake sure that a working call system is available in each resident's room or bathroom and bathing area. F
11/16/2012Nutrition and Dietary DeficienciesStore, cook, and serve food in a safe and clean way. F
11/16/2012Nutrition and Dietary DeficienciesOffer other nutritional food to each resident who will not eat the food served. E
11/16/2012Nutrition and Dietary DeficienciesPrepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. E
11/16/2012Nutrition and Dietary DeficienciesMake sure menus meet the resident's nutritional needs and that there is a prepared menu by which nutritious meals have been planned for the resident and followed. F
11/16/2012Pharmacy Service DeficienciesKeep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. D
11/16/2012Quality Care DeficienciesGive each resident enough fluids to keep them healthy and prevent dehydration. D
11/16/2012Quality Care DeficienciesEnsure residents maintain acceptable nutritional status. D
11/16/2012Quality Care DeficienciesEnsure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. D
11/16/2012Environmental DeficienciesProvide a safe, clean, comfortable and home-like environment; and allow residents to use personal belongings to the extent possible. E
11/16/2012Quality Care DeficienciesGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. D
Inspection Results: 11/04/2011
CorrectedCategoryDeficiencySeverity
11/18/2011Administration DeficienciesKeep accurate, complete and organized clinical records on each resident that meet professional standards. D
11/18/2011Environmental DeficienciesHave a program that investigates, controls and keeps infection from spreading. D
11/18/2011Nutrition and Dietary DeficienciesPrepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. E
11/18/2011Pharmacy Service DeficienciesKeep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. D
11/18/2011Environmental DeficienciesEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. G
11/07/2011Mistreatment DeficienciesDevelop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. C
11/18/2011Quality Care DeficienciesProvide necessary care and services to maintain or improve the highest well being of each resident. G
11/18/2011Resident Assessment DeficienciesDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D
12/13/2011Quality Care DeficienciesGive proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible. D
Inspection Results: 12/17/2010
CorrectedCategoryDeficiencySeverity
12/27/2010Nutrition and Dietary DeficienciesPrepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. D
12/27/2010Quality Care DeficienciesUse a registered nurse at least 8 hours a day, 7 days a week. C

Fire Safety Inpections: NORTH CHURCH NURSING & REHAB
Inspection Results: 10/16/2012
CorrectedCategoryDeficiencySeverity
10/22/2012Exits and Egress DeficienciesExits that are accessible at all times. E
10/22/2012Hazardous Area DeficienciesSpecial areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. E
Inspection Results: 01/19/2011
CorrectedCategoryDeficiencySeverity
01/27/2011Electrical DeficienciesWeekly inspections and monthly testing of generators. F
01/27/2011Electrical DeficienciesProperly installed electrical wiring and equipment. E
01/27/2011Automatic Sprinkler Systems DeficienciesAutomatic sprinkler systems that have been maintained in working order. F
02/03/2011Automatic Sprinkler Systems DeficienciesAn approved automatic sprinkler system connected to the fire alarm system. E
01/25/2011Hazardous Area DeficienciesSpecial areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. E

Resident Complaints: NORTH CHURCH NURSING & REHAB
Date Complaint Substantiated: 03/18/2013
CorrectedCategoryDeficiencySeverity
04/05/2013Environmental DeficienciesMake sure that the nursing home area is safe E
Date Complaint Substantiated: 09/11/2012
CorrectedCategoryDeficiencySeverity
09/21/2012Quality Care DeficienciesEnsure residents maintain acceptable nutritional status. G
09/21/2012Environmental DeficienciesEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. D
09/21/2012Resident Rights DeficienciesTry to resolve each resident's complaints quickly. D
Date Complaint Substantiated: 03/13/2012
CorrectedCategoryDeficiencySeverity
03/13/2012Quality Care DeficienciesUse a registered nurse at least 8 hours a day F
03/13/2012Pharmacy Service DeficienciesEnsure that residents are safe from serious medication errors. G
03/15/2012Quality Care DeficienciesProvide necessary care and services to maintain or improve the highest well being of each resident. G
Date Complaint Substantiated: 01/23/2012
CorrectedCategoryDeficiencySeverity
01/30/2012Quality Care DeficienciesGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. D
Date Complaint Substantiated: 01/03/2012
CorrectedCategoryDeficiencySeverity
01/13/2012Environmental DeficienciesKeep all essential equipment working safely. D
01/13/2012Resident Rights DeficienciesReasonably accommodate the needs and preferences of each resident. D
Date Complaint Substantiated: 10/07/2011
CorrectedCategoryDeficiencySeverity
10/08/2011Environmental DeficienciesEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. G
10/08/2011Resident Assessment DeficienciesDevelop a complete care plan that meets all the resident's needs D
10/08/2011Resident Assessment DeficienciesEnsure each resident receives an accurate assessment by a qualified health professional. D
Date Complaint Substantiated: 08/31/2011
CorrectedCategoryDeficiencySeverity
09/01/2011Resident Assessment DeficienciesConduct initial and periodic assessments of each resident's functional capacity. D
09/01/2011Quality Care DeficienciesGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. G
09/01/2011Pharmacy Service DeficienciesEnsure that residents are safe from serious medication errors. D
Date Complaint Substantiated: 05/05/2011
CorrectedCategoryDeficiencySeverity
05/06/2011Resident Rights DeficienciesImmediately tell the resident D
05/06/2011Quality Care DeficienciesGive proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia D
Date Complaint Substantiated: 04/06/2011
CorrectedCategoryDeficiencySeverity
04/07/2011Environmental DeficienciesMake sure there is a pest control program to prevent/deal with mice F
Date Complaint Substantiated: 03/04/2011
CorrectedCategoryDeficiencySeverity
03/11/2011Quality Care DeficienciesProvide care by qualified persons according to each resident's written plan of care. E
Date Complaint Substantiated: 01/08/2010
CorrectedCategoryDeficiencySeverity
01/08/2010Environmental DeficienciesHave a program that investigates F

Quality Measures: NORTH CHURCH NURSING & REHAB
Quality MeasuresNational AverageNORTH CHURCH NURSING & REHAB
Overall quality rating Not Available 5
5
Long-Stay Residents
Percent of long-stay residents who were physically restrained. 11% 0%
Percent of long-stay residents assessed and given, appropriately, the seasonal influenza vaccine. 97% 87.900000000000006%
Percent of long-stay residents who lose too much weight. 16% 6.0999999999999996%
Percent of long-stay residents who received an antipsychotic medication. 31% 66.700000000000003%
Percent of long-stay residents assessed and given, appropriately, the pneumococcal vaccine. 99% 91.299999999999997%
Percent of long-stay residents whose need for help with daily activities has increased. 27% 6%
Percent of long-stay residents who self-report moderate to severe pain. 22% 12.199999999999999%
Percent of long-stay low-risk residents who lose control of their bowels or bladder 62% 35.299999999999997%
Percent of long-stay residents who have/had a catheter inserted and left in their bladder. 13% 1.3999999999999999%
Percent of long-stay high-risk residents with pressure ulcers. 19% 3.7000000000000002%
Percent of long-stay residents who have depressive symptoms. 16% 10.699999999999999%
Percent of long-stay residents experiencing one or more falls with major injury. 12% 1.3%
Percent of long-stay residents with a urinary tract infection. 16% 10%
Short-Stay Residents
Percent of short-stay residents who self-report moderate to severe pain. 36% 37.899999999999999%
Percent of short-stay residents with Pressure ulcers that are new or worsened. 11% 0%
Percent of short-stay residents assessed and given, appropriately, the pneumococcal vaccine. 87% 95.599999999999994%
Percent of short-stay residents who newly received an antipsychotic medication. 27% 2.7999999999999998%
Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine. 92% 86%
Severity Codes Explanation. Note: The higher the letter, the higher the severity.
AIsolated /Potential for minimal harm
BPattern /Potential for minimal harm
CWidespread /Potential for minimal harm
DIsolated /Minimal harm or potential for actual harm
EPattern /Minimal harm or potential for actual harm
FWidespread /Minimal harm or potential for actual harm
GIsolated /Actual harm
HPattern /Actual harm
IWidespread /Actual harm
JIsolated /Immediate jeopardy to resident health or safety
KPattern /Immediate jeopardy to resident health or safety
LWidespread /Immediate jeopardy to resident health or safety

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