Grace Skilled Nursing And Therapy Jenks

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide.

Based on record review and interview, the facility failed to ensure a resident's damaged personal property was replaced for 1 (#66) of 1 resident sampled who was reviewed for personal property.The administrator identified #107 residents resided in the facility. Findings: A quarterly assessment, dated 07/16/25, showed Resident #66 had a BIMS of 14 which indicated the resident's cognition was intact and diagnosis which included stroke. Review of the grievance log showed no grievance for Resident #66 regarding their television. On 09/02/25 at 9:49 a.m., Resident #66 stated after a power outage at the facility, their television would not come on. They stated he screen would stay black and they only had sound. Resident #66 stated

the facility took their television and loaned them one of theirs to use, but did not replace their television.

They stated the administrator told them the facility would not replace their television. On 09/02/25 at 10:41 a.m., the administrator stated they were not aware of an issue with the television for Resident #66. They stated if a power outage had fried their television the family would have to replace it because the facility did not replace personal property. The administrator stated it was in their admission agreement.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Grace Skilled Nursing and Therapy Jenks

711 North 5th Street Jenks, OK 74037

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

noted to the forehead. The note showed abrasions were noted to both knees with the fall mat in place. The note showed neurological checks were initiated, and Resident #48 had complained of generalized pain. The note showed an order was received to send Resident #48 to the hospital for evaluation and treatment. A care plan, revised 08/12/25, showed interventions for falls to include ensure a baby doll was in bed with Resident #48, assist with toileting at night, concave mattress while in bed, educate to not remove oxygen, fall mat at bedside, sign in room to ask for help, keep call light in reach, keep bed in lowest position, and nonskid footwear before transfers. On 09/02/25 at 11:09 a.m., CNA #1 stated the interventions for Resident #48 were a fall mat and to keep the bed low. On 09/03/25 at 2:03 p.m., CNA #4 stated interventions in place for Resident #48 were a fall mat and low bed. They stated they did not know why the fall mat was not there.

On 09/03/25 at 2:20 p.m., the DON stated they provided in-service and education to the staff and observed to ensure the interventions were in place. On 09/03/25 at 5:29 p.m., LPN #4 stated Resident #48 was observed partially on the fall mat when they fell. They stated the event was so rushed they were trying to remember. LPN #4 stated they were not sure if Resident #48 hit their head on the nightstand, bed side table, or a clothes hamper that was close to them. They stated they did not see blood on anything, so they were not sure, but were sure Resident #48 had the fall mat because they used it anytime Resident #48 was

in bed.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Grace Skilled Nursing and Therapy Jenks

711 North 5th Street Jenks, OK 74037

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Based on observation, record review, and interview, the facility failed to ensure sufficient staff to meet the needs of 1 (#110) of 1 sampled resident who was reviewed for sufficient staffing.The administrator identified 107 residents resided in the facility. Findings: On 08/26/25 at 2:10 p.m., Resident #110 was observed to be calling out for help to the bathroom. CNA #2 came down the hall to get the dirty linen cart and did not check on Resident #110. Resident #110 continued to call out for help to the bathroom. A quarterly assessment, dated 06/05/25, showed Resident #110 had a BIMS of 06 which indicated severe cognitive impairment. The assessment showed Resident #110 required supervision for sitting to standing and partial to moderate assistance with toilet hygiene. On 08/26/25 at 2:15 p.m., LPN #3 stated CNA #2 monitored the hall for residents who required assistance. LPN #3 was informed staff were not on the hall to monitor, and Resident #110 was yelling out for help to the bathroom. LPN #3 went down the hall and entered the room of Resident #110. On 09/03/25 at 5:26 p.m., CNA #6 stated they should get to call lights

in a minimum of five minutes. They stated they did not feel there was enough staff to answer call lights that fast.On 09/03/25 at 5:27 p.m., CNA #2 stated they had five minutes to answer a call light, and they did not have enough staff to answer them that fast.On 09/03/25 at 5:29 p.m., CNA #7 stated they had five minutes to answer call lights, and they did not have enough staff to answer them that fast.

Event ID:

Facility ID:

If continuation sheet