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NATIONAL NURSING HOME WATCH LIST

GOLDEN MOMENTS SENIOR CARE CTR: Actual Harm and/or Immediate Jeopardy

1021 NORTH CHURCH STREET

JACKSONVILLE IL

TELEPHONE: 2172454174

TYPE OF OWNERSHIP: For profit - Corporation

NUMBER OF BEDS / PERCENT OCCUPIED: 113 / 53

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Based on the annual and complaint survey data reported by CMS as of 06/25/08 , this home is listed because in at least one area they caused actual harm to a patient and/or subjected the patients to immediate jeopardy. More recent reports/corrections may be available. Check with the nursing home administrator. Actual harm is indicated by a score of G, H, I, while J, K, L indicate immediate jeopardy. The color coding scheme is below:
RATING DEFINITION
actual harm and/or immediate jeopardy: score= G,H,I,J,K,L
potential for more than minimal harm: score= D, E, F
potential for minimal harm: score= A, B, C
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NOTE: THIS HOME ALSO FOUND TO HAVE CAUSED ACTUAL HARM OR PLACED
PATIENTS IN IMMEDIATE JEOPARDY ON AT LEAST: 2 ADDITIONAL SURVEY(S)
RESULTS LISTED BASED ON MOST RECENT ANNUAL SURVEY DATED: 11/09/2007
RATING VIOLATION SCOPE/SEVERITY CODE
Store, cook, and give out food in a safe and clean way. B
Provide activities to meet the needs of each resident. D
Keep safe, clean and homelike surroundings. B
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. D
Give each resident a special diet to help when there is a nutritional problem. E
Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. G
Provide social services for related medical problems to help each resident achieve the highest possible quality of life. D

COMPLAINT SURVEY RESULTS: SUBSTANTIATED

DATERATINGCOMPLAINT VIOLATION CONFIRMEDSCOPE/SEVERITY CODE
06/03/2005 Make a complete assessment that covers all questions for areas that are listed in official regulations. F
06/03/2005 Give or get dental care for each resident. F
06/03/2005 Keep accurate and appropriate medical records. D
07/05/2005 Follow all laws and professional standards. C
08/04/2005 Give each resident care and services to get or keep the highest quality of life possible. D
08/24/2005 Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transf D
08/24/2005 1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. D
02/22/2006 Provide services to meet the needs and preferences of each resident. B
04/11/2006 Provide activities to meet the needs of each resident. B
05/05/2006 Give professional services that meet a professional standard of quality. D
05/05/2006 Give each resident care and services to get or keep the highest quality of life possible. D
05/05/2006 Follow all laws and professional standards. C
01/04/2007 Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. D
02/01/2007 Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. D
07/23/2007 Provide needed housekeeping and maintenance. E
07/23/2007 Provide clean bed and bath linens that are in good condition. C
07/23/2007 Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. E
07/23/2007 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. G
07/23/2007 Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. D
07/23/2007 Make sure that the nursing home area is free of dangers that cause accidents. D
07/23/2007 Offer other nutritional food to each resident who will not eat the food served. E
07/23/2007 Store, cook, and give out food in a safe and clean way. E
07/23/2007 Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection. C
07/23/2007 Make sure there is a program to prevent/deal with mice, insects, or other pests. E
10/16/2007 Give each resident care and services to get or keep the highest quality of life possible. D
10/16/2007 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. G
10/16/2007 Make sure that the nursing home area is free of dangers that cause accidents. G
01/10/2008 Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transf D
01/10/2008 Give each resident care and services to get or keep the highest quality of life possible. G
01/10/2008 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. D
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