01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-05 | 13 | 2025-12-05 | 8 |
| Cycle 2 | 2024-05-07 | 19 | 2024-05-07 | 12 |
| Cycle 3 | 2022-08-10 | 7 | 2022-08-10 | 8 |
CMS CCN 2658202026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Villages Of Jackson Creek
3980 South Jackson Drive · Independence, MO 64057 · Jackson County
Certified beds120CMS provider file
Recent citation rows67current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
67 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 13 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-01-22 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Past Non-Compliance · complaint2025-12-05 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREE0015Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0584Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0692Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0804Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0849Severity E · pattern; potential for more than minimal harm
Administration Deficiencies
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · HEALTHF0921Severity E · pattern; potential for more than minimal harm
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0271Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Have exits that are accessible at all times.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0361Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that waiting areas, nurse’s stations, gift shops, and cooking facilities, open to the corridor are properly protected.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0374Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0781Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have restrictions on the use of portable space heaters.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0919Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the use of electrical equipment.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-12-05 · FIREK0923Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2026-01-122025-04-10 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2025-05-29 · complaint2025-04-10 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-05-29 · complaint2025-04-10 · HEALTHF0698Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2025-05-29 · complaint03 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2024-10-31 | Fine | $29,186 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- BLUEBIRD MASTER TENANT LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 08/02/2023
- PACS GROUP, INC.Organization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 08/02/2023
- PACS HOLDINGS, LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 08/02/2023
- PROVIDENCE GROUP INCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 08/02/2023
- MURRAY, JASONIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 08/02/2023
- MURRAY, JASONIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2024
- JERGENSEN, JOSHUAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- MITCHELL, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2024
- BUSHMAN, MATTHEWIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/25/2025
- ENRIQUEZ, SOLIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2024
- JERGENSEN, JOSHUAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2024
- LACHANCE, HARRISIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2024
- MARTIN, DOMINIQUEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/27/2024
- MITCHELL, JOHNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2024
- 3980 SOUTH JACKSON DRIVE LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2024
- PACS GROUP, INC.Organization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2024
- PACS HOLDINGS, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2024
- PROVIDENCE ADMINISTRATIVE CONSULTING SERVICES INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2024
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.36per resident day
RN hours0.21per resident day
Weekend nurse hours2.97per resident day
Staff turnover55.2%CMS reported field
06 / LOCAL RECORDS
Open the Independence ledger →Other published facilities nearby
Abode Health And Wellness Center118 beds · CMS overall 1/5135 citation rowsCarmel Hills Wellness & Rehabilitation194 beds · CMS overall 1/5103 citation rowsIndependence Manor Care Center99 beds · CMS overall 3/554 citation rowsMaywood Terrace Living Center89 beds · CMS overall 1/5108 citation rowsMonterey Park Rehabilitation & Health Care Center122 beds · CMS overall 3/551 citation rowsRehabilitation Center Of Independence, The130 beds · CMS overall 2/584 citation rowsRosewood Rehab And Healthcare Center300 beds · CMS overall 2/595 citation rowsSunterra Springs Independence38 beds · CMS overall 5/532 citation rows