Inspection Reports for John H. Johnson Senior Apartments

1213 NW 122nd St, Oklahoma City, OK 73114, OK, 73114

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Inspection Report Complaint Investigation Census: 111 Deficiencies: 2 May 13, 2025
Visit Reason
A State Licensure survey with complaint investigations was conducted at John H Johnson Care Suites on May 13, 2025, to investigate multiple allegations including medication administration errors, failure to complete assessments by qualified staff, resident dignity concerns, falsification of medical records, failure to assess and intervene timely for changes in condition, pest control issues, and failure to provide personal clothing to a resident.
Findings
The investigation found multiple deficiencies including unclean kitchen floors, failure to maintain required staffing ratios as per resident lease agreements, and other care and service deficiencies. The facility was cited for these deficiencies and required to submit a plan of correction. A follow-up revisit on July 3, 2025, confirmed all deficiencies were corrected as of June 27, 2025.
Complaint Details
Multiple complaints were investigated including medication administration errors, failure to complete assessments, resident dignity and grievance issues, falsification of medical records, failure to assess and intervene timely for changes in condition, pest control problems, and failure to return personal clothing to a resident. The investigations were conducted through observations, interviews, and record reviews.
Severity Breakdown
SS=D: 1 SS=E: 1
Deficiencies (2)
DescriptionSeverity
The kitchen floors were not clean and free of debris, with buildup observed around stove legs and corners.SS=D
Failed to maintain an on-site care staff ratio for 3 sampled residents as specified in the resident lease agreement.SS=E
Report Facts
Facility Census: 111 Staffing ratio required: 1 Staffing ratio required: 1 Staff assigned: 3 Staff assigned: 7 Invoice amount: 711.2
Employees Mentioned
NameTitleContext
Lisa CalvinEnforcement Analyst IISigned enforcement letters and communications regarding the survey and plan of correction
Kimberly CardenasAdministratorNamed as facility administrator in relation to the inspection and plan of correction
Notice Capacity: 120 Deficiencies: 0 Feb 13, 2025
Visit Reason
This document serves as a renewal application and notification of the facility's renewed license to operate an assisted living center.
Findings
The document confirms the issuance of a renewal license for the John H Johnson Care Suites assisted living center, valid from 05/21/2025 to 05/21/2028.
Report Facts
Maximum licensed beds: 120
Employees Mentioned
NameTitleContext
Lisa HaleAdministrative Programs ManagerSigned the renewal notification letter
Keith ReedCommissioner of HealthSigned the license certificate
Inspection Report Complaint Investigation Census: 95 Deficiencies: 3 Apr 19, 2024
Visit Reason
A complaint investigation was conducted at John H Johnson Care Suites based on multiple allegations including failure to provide refunds timely, inadequate assistance with activities of daily living, ineffective pest control, improper food service, medication administration issues, discrimination, abuse, and failure to report incidents timely.
Findings
The investigation found multiple deficiencies including failure to ensure dietary staff wore hair restraints, failure to follow physician medication orders, failure to submit timely reportable incidents to the State Department, and failure to report allegations of abuse within required timeframes. The facility was found to have deficiencies representing potential for more than minimal harm but no actual harm was identified.
Complaint Details
The complaint investigation included allegations of failure to provide refunds within 30 days of discharge, failure to provide assistance with activities of daily living and housekeeping, failure to implement effective pest control, failure to serve food according to resident preferences, failure to administer medications according to physician orders, failure to prevent discrimination, failure to prevent abuse, failure to maintain accurate records, and failure to report abuse allegations timely to the Oklahoma State Department of Health and other authorities.
Severity Breakdown
Level E: 1 Level D: 2
Deficiencies (3)
DescriptionSeverity
Dietary staff failed to utilize hair restraints while in the kitchen.Level E
Failure to ensure physician orders were followed for one resident.Level D
Failure to submit reportable incidents to the State Department within one business day for two residents.Level D
Report Facts
Facility Census: 95 Sample size: 11 Deficiency counts: 3
Inspection Report Complaint Investigation Census: 107 Deficiencies: 4 Nov 9, 2023
Visit Reason
A complaint survey was conducted due to allegations that the facility failed to implement effective systems for medication ordering and administration, failed to ensure palatable food was served, failed to provide laundry services as contracted, and failed to have an effective pest control program.
Findings
The investigation found deficiencies related to medication administration, food service, laundry services, and pest control. Specifically, one resident's medications were not held per physician's orders in a timely manner. The facility was found to have deficiencies representing potential for more than minimal harm but no actual harm was identified.
Complaint Details
The complaint investigation was based on allegations of failure to implement effective medication ordering and administration systems, failure to serve palatable food, failure to provide contracted laundry services, and failure to maintain an effective pest control program. The investigation included observations, interviews, and record reviews. The deficiencies cited represented potential for more than minimal harm but no actual harm was identified.
Severity Breakdown
SS=D: 1
Deficiencies (4)
DescriptionSeverity
Facility failed to hold medications per physician's orders for one resident.SS=D
Facility failed to ensure palatable food was served according to the menu and/or with options available.
Facility failed to ensure laundry services were provided according to the contract.
Facility failed to have and/or implement an effective pest control program.
Report Facts
Residents: 107 Deficiency count: 4
Employees Mentioned
NameTitleContext
Lisa CalvinEnforcement Analyst IISigned enforcement and revisit letters related to the complaint investigation.
Tempal KillmanAdministrative Assistant IISigned acceptance letter of plan of correction.
Inspection Report Renewal Census: 100 Deficiencies: 3 Jun 8, 2023
Visit Reason
A relicensure survey was conducted from June 1 through June 8, 2023, to assess compliance with state licensure requirements for the assisted living center.
Findings
The survey identified deficiencies including failure to date and label food items properly, incomplete comprehensive assessments lacking required personal interviews and signatures, and inadequate nurse supervision of residents self-administering medications or treatments. The facility lacked a self-administration policy and failed to conduct required assessments and care planning for residents self-administering medications.
Severity Breakdown
SS=D: 1 SS=E: 2
Deficiencies (3)
DescriptionSeverity
Failed to date and label food items according to company policy and Chapter 257.SS=D
Failed to ensure each comprehensive assessment included a personal interview between the resident or resident's representative for three of ten sampled residents.SS=E
Failed to provide adequate nurse supervision of residents self-administering medications or treatments for three of five sampled residents.SS=E
Report Facts
Deficiencies cited: 3 Resident census: 100
Employees Mentioned
NameTitleContext
Kimberly CardenasAdministratorNamed as facility administrator in the survey report.
Lisa CalvinEnforcement AnalystSigned enforcement and correspondence letters related to the survey.
Kimberly WoodExecutive DirectorResponded to plan of correction rejection and submitted amended plan.
Inspection Report Complaint Investigation Deficiencies: 1 Feb 28, 2023
Visit Reason
A complaint investigation was conducted at John H Johnson Care Suites on February 27-28, 2023, based on multiple complaints alleging deficiencies in care and facility operations.
Findings
The investigation found no substantiated deficient practices related to the specific allegations, but cited deficiencies representing potential for more than minimal harm, including failure to report two hospital incidents for one resident. The facility submitted an acceptable plan of correction and a revisit confirmed all deficiencies were corrected by March 30, 2023.
Complaint Details
Multiple allegations were investigated including failure to serve meals at preferred temperatures, failure to answer call lights timely, failure to administer pain medications as ordered, misappropriation of resident property, failure to assist with assistive equipment, failure to provide palatable and sufficient food, and physical environment concerns. All allegations were found unsubstantiated.
Severity Breakdown
SS=D: 1
Deficiencies (1)
DescriptionSeverity
Failed to report to the Department two incidents for one resident who required hospital treatment.SS=D
Report Facts
Complaint investigation dates: 2 Plan of correction completion date: Mar 30, 2023 Revisit date: May 24, 2023
Employees Mentioned
NameTitleContext
Franklin CalvinHealth Facility Surveyor IIINamed as surveyor who conducted complaint investigation and signed reports
Melissa SwaimRNNamed as surveyor who signed one of the complaint investigation reports
Katie StagnerEnforcement AnalystSigned enforcement related correspondence
Tempal KillmanAdministrative Assistant IISigned letter accepting plan of correction
Lisa CalvinEnforcement AnalystSigned letter confirming deficiencies corrected after revisit
Teri EllisAdministratorNamed as administrator who signed plan of correction
Inspection Report Renewal Capacity: 120 Deficiencies: 0 Oct 31, 2022
Visit Reason
This document is a license renewal issued to John H. Johnson ALF, LP for the assisted living center John H Johnson Care Suites, certifying the facility to conduct and maintain an assisted living center.
Findings
The license renewal certifies the facility's compliance with Oklahoma statutes and state board of health regulations, allowing operation until May 20, 2025.
Report Facts
Maximum licensed beds: 120
Inspection Report Complaint Investigation Census: 91 Deficiencies: 1 Feb 9, 2022
Visit Reason
Complaint investigation conducted due to multiple allegations including medication administration, resident rights, medical care, abuse, and property misappropriation.
Findings
The investigation found no substantiated deficient practices for allegations related to medication administration, resident rights, abuse, and property misappropriation. However, a deficiency was substantiated related to failure to ensure accurate and complete assessments, monitoring, and timely implementation of interventions for a resident with a change in condition, resulting in a citation (C1505).
Complaint Details
The complaint investigation included allegations that the center failed to ensure medications were properly administered, residents had the right to choose their physician, residents received adequate medical care, care and services were provided as contracted, and the center provided an abuse-free environment. All allegations were unsubstantiated except for a deficiency unrelated to the complaint.
Severity Breakdown
H: 1
Deficiencies (1)
DescriptionSeverity
Failure to ensure accurate and complete assessments, monitor and implement interventions timely for one resident who demonstrated a change in condition.H
Report Facts
Residents present: 91 Deficiency completion date: Jun 20, 2022
Employees Mentioned
NameTitleContext
Lisa CalvinEnforcement AnalystSigned enforcement letters and correspondence related to the complaint investigation.
Melissa SwaimRNSigned investigative reports and determination summaries.
LPN #1Licensed Practical NurseInterviewed regarding incomplete orders and lack of documentation related to resident care.
Teri EllisAdministratorSigned the plan of correction dated 4/27/2022.
Inspection Report Renewal Capacity: 120 Deficiencies: 0 May 4, 2021
Visit Reason
This document is a renewal license issued to John H. Johnson ALF, LP for the operation of an Assisted Living Center.
Findings
The license certifies that the facility is authorized to conduct and maintain an Assisted Living Center with a maximum capacity of 120 beds, effective from 2021-05-21 to 2022-05-20.
Report Facts
Maximum licensed beds: 120
Inspection Report Routine Census: 49 Deficiencies: 0 Aug 31, 2020
Visit Reason
The visit was conducted as a COVID-19 Special Focus Infection Control Survey to determine if the facility was in compliance with implementing proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
No deficiencies were cited during the COVID-19 Special Focus Survey conducted on August 31, 2020.
Report Facts
Total residents: 49
Inspection Report Renewal Capacity: 120 Deficiencies: 0 Jun 17, 2020
Visit Reason
This document is a renewal license issued to John H. Johnson ALF, LP to conduct and maintain an Assisted Living Center.
Findings
The license certifies that the facility meets the requirements to operate as an Assisted Living Center with a maximum capacity of 120 beds. The license is effective from 2020-05-21 to 2021-05-20.
Report Facts
Maximum licensed beds: 120
Inspection Report Original Licensing Capacity: 120 Deficiencies: 0 Nov 22, 2019
Visit Reason
The document is an initial license approval and issuance for John H. Johnson ALF, LP, a new assisted living center with 120 beds, located in Oklahoma City, OK.
Findings
The application for the initial license was approved, and all required documents for the resident contract were accepted by the Oklahoma State Department of Health.
Report Facts
Maximum licensed beds: 120
Employees Mentioned
NameTitleContext
Espaniola BowenAdministrative Program ManagerNamed as contact for licensing questions and signatory on the letter transmitting the initial license

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