Following are some of the deficiencies found during inspections of this nursing home on 9/11/08, 6/20/08 and 11/2/07. These reports and another on 12/21/07 – 2 pages can be found at www.arknursinghomeinspectiondeficiencies.com.
Inspection on 9/11/08 (7 pages) 1. UNNECESSARY DRUGS: . . . the facility failed to ensure tapering of Zantac was attempted for . . . Resident #4. . . Page 1.
Inspection on 6/20/08 (11 pages) 1. STAFF TREATMENT OF RESIDENTS: . . . the facility failed to ensure a thorough investigation was conducted regarding an allegation of abuse for . . . Resident #2. . . The facility failed to ensure staff immediately reported another staff for taking residents’ food and local law enforcement was notified for Resident #6 who had an allegation of misappropriation of property. Page 2.
Inspection on 11/2/07 (210 pages) 1. NOTIFICATION OF CHANGES: . . . the facility failed to [ensure] the physician was consulted after deterioration of a pressure ulcer for Resident #4 . . . Page 1.
2. PHYSICAL RESTRAINTS: . . .the facility failed to ensure residents had medical symptoms and/or diagnosis to justify the use of a restraint and least restricted devices was attempted for Residents #5 and #7 . . . Page 10.
3. STAFF TREATMENT OF RESIDENTS: . . .The facility failed to implement policies and procedures for identification / investigation of injuries of unknown origin for . . . Residents #1 and #9. Page 20.
4. COMPREHENSIVE ASSESSMENTS: . . .the facility failed to conduct comprehensive assessments to ensure appropriate nutritional parameters for . . . Resident #9 . . . who had pressure sores and to ensure adequate pain management for Resident #13 . . .with identified pain. This failed practice resulted in a pattern of harm for Resident #9, who had an extended history of edema and weight gain without determination of his true protein needs to aid in healing of an unstagable pressure sore and actual harm for Resident #13, who had a large stage II pressure sore and possible deterioration in the wound due to skin allergies to tape / adhesives with exhibited acute pain during wound treatments with adhesive products. Pages 34-35.
5. PRESSURE SORES: . . the facility failed to ensure provision of services to prevent pressure ulcer development and infections and to promote healing of existing pressure ulcers by failure to document accurate pressure ulcer assessments at least on a weekly basis, provide pressure relief devices for the bed, chairs, as ordered for feet / heels and/or off-loading of heels while in bed, encouragement to consume protein supplements provided with meals, complete nutritional assessments to determine true protein needs in the presence of Edema, conduct pressure ulcer treatments as ordered, reposition and cleanse of incontinent urine / feces in a timely manner, consult with a physician after deterioration in a pressure ulcer and in the presence of possible allergic skin reactions, plan appropriate interventions to promote healing of pressure ulcers and/or conduct pressure ulcer treatments with use of aseptic techniques and acceptable standards of nursing practice for infection control for . . . Residents #1, #4, #8, #9 and #13 . . . who were at risk for development and/or had actual pressure sores. Page 60.
6. URINARY INCONTINENCE: . . . the facility failed to ensure that the labia was separated and cleansed during incontinent care to prevent the potential of urinary tract infection for . .Resident #8 . . . that incontinent care was not performed for an extended period of time for Resident #1 . . . that was incontinent of bladder and/or bowel, that an indwelling urinary catheter was not inserted without medical necessary for Resident #2 and that appropriate catheter care was performed for Resident #13 . . . Page 91.
7. MEDICATION ERRORS: . .The facility must ensure that it is free of medication error rates of five percent or greater . . . The medication error rate was 13.04%. Page 117.
8. INFECTION CONTROL: . . . the facility failed to ensure staff provided wound care in a manner to prevent contamination of supplies and direct care nursing staff changed gloves after they were contaminated for Residents 1, 4, 9 & 13. Page 142.
9. PREVENTING SPREAD OF INFECTION: . . the facility failed to ensure procedures were followed to prevent cross-contamination, including hand washing and/or changing gloves after providing personal care and performing other tasks for Resident #11. . .that [was] on contact isolation. Resident #11. . . a. The Laboratory Request form dated 9/05/07 and reported on 9/06/07 for Clostridium Difficile (C-diff) results were positive for A Toxin and/or B. The resident was moved to a private room and placed on contact isolation. c. On 10/31/07 at 11:43 a.m. CNAs #3 and #9 gowned and gloved and entered the resident’s room. . . The resident was positioned on the right side and CNA #3 washed the resident’s left buttock. CNA #3 did not remove her gloves but used the same contaminated gloves to pull the resident’s pants up some. The resident was then turned to the other side and CNA #9 washed the other side of his buttock. . . CNA #3 picked up the resident’s heel pads and threw them onto the air conditioning unit in the window. With the same contaminated glove she touched the wheelchair, slide board, plastic cup with his hearing aids, closet door and the resident’s clean cloth. CNA #9 removed a clean washcloth from the closet and gave it to the resident to wash his face. After the resident was transferred from the bed to chair CNA #9 made the bed. CNA #3 or CNA #9 did not change gloves after potential contact with contaminated materials. d. On 10/31/07 at 11:51 a.m., CNA #9 was asked, “When should you have changed your gloves?” CNA #9 stated, “After we cleaned his butt, we should have.” Pages 155-156.
