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 - Individual
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 62
Perc of occupied beds 54
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints28
Number of Fines5
Total Amount of Fines$42177
Total Number of Penalties0
Total Number of Penalties5
Ratings Summary: NORTH CHURCH NURSING & REHAB
Overall rating 1
1
Nursing Home Staffing Not available.
Registered Nurses only Not available.
Health Inspections 1
1
Quality Measures 4
4
Nursing Home Staffing Info: NORTH CHURCH NURSING & REHAB
National AverageIllinois AverageNORTH CHURCH NURSING & REHAB
Overall staff rating NA NA Not available.
Registered Nurses only rating NANA Not available.
Total Number of Residents NA NA 62
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 3.78 hours Not available hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.53 hours Not available hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.92 hours Not available hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.61 hours Not available hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.24 hours Not available hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.1 hours Not available hours
Health Survey: NORTH CHURCH NURSING & REHAB
Heath Survey Summary on 2013-11-26
Total Number of Health Deficiencies 8
Scope and Severity of most Severe Health Deficiency Isolated/Actual harm
Heath Survey Summary on 2012-10-12
Total Number of Health Deficiencies 13
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Heath Survey Summary on 2011-11-04
Total Number of Health Deficiencies 9
Scope and Severity of most Severe Health Deficiency Isolated/Actual harm
Health Survey Details: NORTH CHURCH NURSING & REHAB
Inspection Results: 11/26/2013
Corrected Deficiency Scope and Severity
11/26/2013 Protect each resident from mistreatment, neglect and misappropriation of personal property. Isolated/Actual harm
11/26/2013 Provide housekeeping and maintenance services. Pattern/Minimal harm or potential for actual harm
11/26/2013 Ensure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion. Isolated/Minimal harm or potential for actual harm
11/26/2013 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Actual harm
12/13/2013 Give each resident enough fluids to keep them healthy and prevent dehydration. Isolated/Minimal harm or potential for actual harm
12/13/2013 Provide food in a way that meets a resident's needs. Pattern/Potential for minimal harm
12/13/2013 Store, cook, and serve food in a safe and clean way. Widespread /Minimal harm or potential for actual harm
12/13/2013 Make sure that a working call system is available in each resident's room or bathroom and bathing area. Pattern/Minimal harm or potential for actual harm
Inspection Results: 10/12/2012
Corrected Deficiency Scope and Severity
11/16/2012 Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. Pattern/Minimal harm or potential for actual harm
11/16/2012 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Widespread /Minimal harm or potential for actual harm
11/16/2012 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Pattern/Minimal harm or potential for actual harm
11/16/2012 Make sure that a working call system is available in each resident's room or bathroom and bathing area. Widespread /Minimal harm or potential for actual harm
11/16/2012 Store, cook, and serve food in a safe and clean way. Widespread /Minimal harm or potential for actual harm
11/16/2012 Offer other nutritional food to each resident who will not eat the food served. Pattern/Minimal harm or potential for actual harm
11/16/2012 Provide a safe, clean, comfortable and home-like environment; and allow residents to use personal belongings to the extent possible. Pattern/Minimal harm or potential for actual harm
11/16/2012 Make 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. Widespread /Minimal harm or potential for actual harm
11/16/2012 Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. Isolated/Minimal harm or potential for actual harm
11/16/2012 Give each resident enough fluids to keep them healthy and prevent dehydration. Isolated/Minimal harm or potential for actual harm
11/16/2012 Ensure residents maintain acceptable nutritional status. Isolated/Minimal harm or potential for actual harm
11/16/2012 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated/Minimal harm or potential for actual harm
11/16/2012 Ensure 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. Isolated/Minimal harm or potential for actual harm
Inspection Results: 11/04/2011
Corrected Deficiency Scope and Severity
11/07/2011 Develop 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. Widespread/Potential for minimal harm
11/18/2011 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated/Minimal harm or potential for actual harm
11/18/2011 Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated/Actual harm
12/13/2011 Give 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. Isolated/Minimal harm or potential for actual harm
11/18/2011 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Actual harm
11/18/2011 Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. Isolated/Minimal harm or potential for actual harm
11/18/2011 Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. Pattern/Minimal harm or potential for actual harm
11/18/2011 Have a program that investigates, controls and keeps infection from spreading. Isolated/Minimal harm or potential for actual harm
11/18/2011 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated/Minimal harm or potential for actual harm

Fire Safety Survey: NORTH CHURCH NURSING & REHAB
Fire Safety Survey Summary on 2013-12-03
Total Number of Fire SafetyDeficiencies 9
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2012-10-16
Total Number of Fire SafetyDeficiencies 2
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-12-09
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey: NORTH CHURCH NURSING & REHAB
Fire Safety Survey Results: 12/03/2013
Corrected Deficiency Severity
12/04/2013 Corridor and hallway doors that block smoke. Pattern/Minimal harm or potential for actual harm
12/04/2013 Walls that prevent smoke from passing through and would resist fire for at least one hour. Widespread /Minimal harm or potential for actual harm
12/04/2013 Properly installed electrical wiring and equipment. Isolated/Minimal harm or potential for actual harm
12/04/2013 Exits that are free from obstructions and can be used at all times. Pattern/Minimal harm or potential for actual harm
12/04/2013 Properly protected cooking facilities. Isolated/Minimal harm or potential for actual harm
12/04/2013 Smoke barrier doors that can resist smoke for at least 20 minutes. Pattern/Minimal harm or potential for actual harm
12/04/2013 Record of quarterly fire drills for each shift under varying conditions. Widespread/Potential for minimal harm
12/04/2013 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Isolated/Minimal harm or potential for actual harm
12/10/2013 Automatic sprinkler systems that have been maintained in working order. Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Results: 10/16/2012
Corrected Deficiency Severity
10/22/2012 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Pattern/Minimal harm or potential for actual harm
10/22/2012 Exits that are accessible at all times. Pattern/Minimal harm or potential for actual harm

Resident Complaints: NORTH CHURCH NURSING & REHAB
Date Complaint Substantiated: 01/10/2014
CorrectedCategoryDeficiencySeverity
01/31/2014Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. D
Date Complaint Substantiated: 07/05/2013
CorrectedCategoryDeficiencySeverity
07/16/2013Give or get specialized rehabilitative services per the patient's assessment or plan of care. D
07/16/2013Provide necessary care and services to maintain or improve the highest well being of each resident . D
07/16/2013Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. F
Date Complaint Substantiated: 03/18/2013
CorrectedCategoryDeficiencySeverity
04/05/2013Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. E
Date Complaint Substantiated: 09/11/2012
CorrectedCategoryDeficiencySeverity
11/16/2012Ensure residents maintain acceptable nutritional status. G
09/21/2012Try to resolve each resident's complaints quickly. D
09/21/2012Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. D
Date Complaint Substantiated: 03/13/2012
CorrectedCategoryDeficiencySeverity
03/13/2012Ensure that residents are safe from serious medication errors. G
03/15/2012Provide necessary care and services to maintain or improve the highest well being of each resident . G
03/13/2012Use a registered nurse at least 8 hours a day, 7 days a week. F
Date Complaint Substantiated: 01/23/2012
CorrectedCategoryDeficiencySeverity
01/30/2012Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. D
Date Complaint Substantiated: 01/03/2012
CorrectedCategoryDeficiencySeverity
01/13/2012Keep all essential equipment working safely. D
01/13/2012Reasonably accommodate the needs and preferences of each resident. D
Date Complaint Substantiated: 10/07/2011
CorrectedCategoryDeficiencySeverity
10/08/2011Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. G
10/08/2011Ensure each resident receives an accurate assessment by a qualified health professional. D
10/08/2011Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D
Date Complaint Substantiated: 08/31/2011
CorrectedCategoryDeficiencySeverity
09/01/2011Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. G
09/01/2011Conduct initial and periodic assessments of each resident's functional capacity. D
09/01/2011Ensure that residents are safe from serious medication errors. D
Date Complaint Substantiated: 05/05/2011
CorrectedCategoryDeficiencySeverity
05/06/2011Give 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
05/06/2011Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. D

Quality Measures: NORTH CHURCH NURSING & REHAB
Quality Measures National Average Illinois Average NORTH CHURCH NURSING & REHAB
Overall quality rating NA NA 4
4
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 16.8% 14.6%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 6.8% 13.4%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 6.6% 4.0%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 7.6% 9.2%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 36.2% 21.9%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 3.7% 2.7%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 6.0% 8.7%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 11.4% 42.6%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 1.4% 0.0%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 3.2% 1.6%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 91.5% 80.2%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 93.4% 92.4%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 24.6% 64.8%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 16.9% 28.1%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.2% 0.7%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 80.4% 93.5%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 80.0% 97.9%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 2.5% 0.0%

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