Above average — CMS composite of the measures below.
The next survey window likely opens around January 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Jnh-jaquith Inn during CMS and state inspections, most recent first.
MDS death assessments were not transmitted within the required timeframe for two residents who died in the facility. One resident had dementia and schizophrenia, and the other had major depressive disorder and type 2 DM. RN stated the assessments had been completed but did not transmit properly, and the MDS history did not show timely submission.
Improper Storage of Controlled Substances: Surveyors observed a medication refrigerator in the med storage room without an external lock, and an unlocked open-top box inside contained seven vials of Lorazepam, a Schedule IV controlled substance. An LPN confirmed the refrigerator had no lock and that the only secured barrier was the med room door, while the DON confirmed the medication was protected by only one locked barrier instead of two.
Improper Hair Restraint in Kitchen: The facility failed to ensure proper hair restraint practices in the kitchen when a COU was observed working without a hair cover or beard covering while performing daily tasks. The facility policy required hair restraints to cover all hair, including beards, and the COU stated he should wear both a hair net and beard net when handling food. The Administrator stated kitchen staff should wear head and beard coverings when preparing food.
The facility failed to accurately submit PBJ staffing data, causing licensed nursing hours to be underreported for one reporting period. Surveyors found no lapses in licensed nurse coverage on the staffing schedules, but the PBJ report still triggered for insufficient 24-hour nursing coverage. Interviews showed the DON worked overtime in direct care, and the discrepancy involved the MDS nurse, who also worked floor shifts but was coded in a way that did not count her direct care hours in PBJ.
An LPN failed to change gloves between touching a feeding pump and accessing a resident’s PEG tube, then touched the resident’s sink with the same soiled gloves during medication administration. In a separate event, a CNA used bare hands to handle and serve a resident’s food and passed out meal trays to other residents without hand hygiene between residents. The DON identified both actions as infection control concerns.
Three residents with severe cognitive and physical impairments were found living in a room with significant dust, debris, stains, and unclean surfaces, including walls, floors, and furniture. Facility leadership and environmental services staff confirmed that proper cleaning had not occurred, and that belongings from a previous occupant remained at the time of a new admission. The deficiency was identified through direct observation, interviews, and record review.
MDS Death Assessments Not Transmitted Timely
Penalty
Summary
The facility failed to ensure Minimum Data Set (MDS) assessments were completed and transmitted within required timeframes for two residents who died in the facility. Record review showed that Resident #10 expired in the facility at 7:40 AM and had diagnoses including dementia without behavioral disturbance and schizophrenia, but the Death in Facility assessment was not transmitted within 14 days of the resident’s death. The MDS tracking/assessment history did not show a transmission date within the required timeframe. Resident #44 also expired in the facility at 10:10 AM, with diagnoses including major depressive disorder, single episode, unspecified, and type 2 diabetes mellitus. Nurse notes documented that the physician pronounced the resident deceased, but the Death in Facility assessment was not completed and transmitted within 14 days of death. During interview, RN #1 stated the death in facility assessments for both residents were not transmitted within the required 14-day timeframe and said she had completed them, but they must not have transmitted properly; she was unable to provide more up-to-date documentation showing timely submission.
Improper Storage of Controlled Substances
Penalty
Summary
The facility failed to properly store controlled medications in accordance with its policy and accepted storage requirements. The facility policy for Management of Controlled Substances/Medications, effective September 2025, stated that controlled substances/medications must be stored under two locks. On 02/04/2026 at 2:41 PM, surveyors observed a medication refrigerator in the medication storage room that did not have an external locking mechanism. Inside the refrigerator was an unlocked, open-top box containing seven vials of Lorazepam 2 mg/1 mL, a Schedule IV controlled substance classified as a benzodiazepine sedative. During interview, an LPN confirmed that the refrigerator had no lock and stated that the only lock present was on the medication room door. The LPN also stated that controlled substances should be secured in a locked box to prevent unauthorized access and noted that the refrigerator had been replaced within the past six months and maintenance had not installed a lock. The DON later confirmed that controlled substances are required to be secured behind two locked barriers and stated that, in this instance, the Lorazepam was secured behind only one locked door, the medication room entrance.
Improper Hair Restraint in Kitchen
Penalty
Summary
The facility failed to ensure staff followed proper hair restraint practices while working in the kitchen. During observation on 2/2/26 at 9:45 AM, the State Agency observed the Coordinator of Unit working in the facility kitchen without a hair cover or beard covering while performing daily tasks. The facility policy, Food Services Personal Hygiene Habits, effective August 2025, states that hair restraints that cover all hair, including beards, will always be worn while in the pantry. During an interview immediately after the observation, the Coordinator of Unit stated that he should wear both a hair net and a beard net because they are hygienic and help ensure he remains sanitary when handling food. On 2/3/26, the Administrator stated that all kitchen staff should wear head and beard coverings when preparing food in the kitchen because it ensures cleanliness and is sanitary.
Inaccurate PBJ Staffing Submission
Penalty
Summary
The facility failed to accurately submit direct care staffing information to the CMS Payroll Based Journal (PBJ) system for the third quarter of 2025, resulting in inaccurate staffing data for one of four reporting periods reviewed. Surveyors found that the facility triggered for insufficient 24-hour nursing coverage in the PBJ report, even though a review of licensed nurse staffing schedules and staffing grids for July through September 2025 showed no lapses in licensed nurse coverage. The discrepancy involved how licensed nursing hours were coded and reported as direct care nursing hours. During interviews, the DON stated she worked frequent overtime providing direct resident care because of staffing shortages and limited agency coverage, but she was unsure whether her time was accurately transferred on timecards for PBJ reporting when she worked as a staff nurse rather than in her administrative role. The HR Director, who was responsible for PBJ submissions, stated the issue involved the MDS nurse, who began working additional shifts as a floor nurse beginning on 08/09/25 while also performing administrative duties. She explained that licensed nurses are typically coded as 7 for PBJ, while the MDS nurse was coded as 6, which does not count toward licensed nursing hours. The MDS nurse confirmed she worked multiple weekend and weekday shifts as a floor nurse during this period but was unsure how her time was coded in the payroll system. The Administrator confirmed the facility identified a discrepancy in how the MDS nurse's time was transferred from the timekeeping system to the PBJ report, resulting in her direct care nursing hours not being reflected accurately.
Infection Control Failures During PEG Medication Administration and Meal Assistance
Penalty
Summary
The facility failed to follow infection prevention and control practices during medication administration via PEG tube for Resident #3. On 02/04/26 at 12:17 PM, an LPN was observed administering Haloperidol 5 mg via the resident’s PEG tube while wearing the same gloves used to touch the feeding pump, then later walked to the resident’s sink and turned on the water without removing the gloves. The facility policy on Hand Hygiene stated that all employees will use proper hand hygiene techniques to prevent the spread of infectious diseases. During interview, the LPN stated she should have changed gloves between touching the feeding pump and accessing the PEG tube and should have removed the gloves before touching the sink. The DON stated the LPN should have changed gloves before accessing the PEG tube and should not have touched the sink with soiled gloves due to the risk of spreading infection to surfaces and residents. Resident #3 had diagnoses including schizoaffective disorder. The facility also failed to ensure appropriate hand hygiene and barriers when handling resident food for Resident #16. On 02/02/2026 at 12:54 PM, a CNA was observed using bare hands to apply condiments to a hamburger bun, mash the hamburger together, cut the hamburger, pick up pieces of food, and hand them directly to the resident. The CNA also passed out additional meal trays to other residents without performing hand hygiene between residents. During interview, the CNA stated she believed it was acceptable to touch food with bare hands if she had sanitized her hands beforehand and said she had been told not to use gloves when touching food. The DON stated the CNA should have worn gloves or used utensils when handling resident food and should not have used bare hands. Resident #16 had diagnoses including neurocognitive disorder with behavioral disturbance and blindness, with diet orders for finger foods and allowance for hamburgers at lunch, and the MDS showed a BIMS score of 3 indicating severe cognitive impairment.
Failure to Maintain Clean and Comfortable Resident Environment
Penalty
Summary
The facility failed to provide a clean and comfortable environment for three residents, as evidenced by multiple observations of uncleanliness and lack of proper housekeeping. During a visit, a complainant observed spots and streaks resembling blood and saliva on the wall next to a resident's bed, dirty floors, and a broken bed. Subsequent inspection by facility leadership revealed numerous brown spots and streaks on the door frame, sticky and discolored hallway handrails, visible dust and debris beneath the sink, and a streaked mirror. The paper towel holder was dusty and stained, and the floor behind the door and at the end of a resident's bed was covered with lint, dust, scraps of paper, and various colored streaks. Additional findings included dust-covered junction boxes, dusty bedframes, debris under beds, maroon streaks on a structural encasement, dusty baseboards, and call light boxes with visible dust. Some areas, such as the room's general clutter and odor, were found to be acceptable, and all beds were functional at the time of inspection. Interviews with facility staff confirmed the lack of adequate cleaning. The Administrator-in-Training acknowledged being notified by a resident's family about the room's condition, including unclean walls and floors and the presence of belongings from a previous resident at the time of admission. She admitted that thorough cleaning had not occurred prior to the new admission and that she did not personally inspect the room after instructing staff to remove the previous resident's belongings. The facility Administrator stated that rooms should be deep cleaned when a resident leaves and before a new admission, with daily cleaning ongoing, and that a contracted housekeeping service was used, with oversight by administration and nursing leadership. The Environmental Services Department Supervisor confirmed that the accumulated dust, debris, and streaking observed in the residents' room were unacceptable and indicated that the areas had not been recently cleaned. The residents involved had significant cognitive and physical impairments, including severe neurocognitive disorder, anoxic brain injury, and spastic cerebral palsy, with all three having severely impaired cognition or communication abilities. The failure to maintain a clean and comfortable environment was directly observed and corroborated by staff interviews and record reviews.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Whitfield
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Jnh-jefferson Inn | 0 mi | ★★★★★ | 8 | 0 |
| Jnh-madison Inn | 0 mi | ★★★★★ | 2 | 0 |
| Wisteria Gardens | 3.5 mi | ★★★★★ | 3 | 0 |
| Brandon Community Care Center | 4.1 mi | ★★★★★ | 2 | 0 |
| Brandon Court | 4.3 mi | ★★★★★ | 1 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.