Following are some of the deficiencies found during inspections of this nursing home on 7/16/08, 5/9/08, 8/3/07, 7/27/06 and 8/18/05.  These reports and others (11/28/07 – 7 pages and 12/08/06 – 3 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.

Inspection on 7/16/08  (16 pages)  
1.  COMPREHENSIVE ASSESSMENTS: . . .  the facility failed to ensure neurological assessments were consistently completed for Residents #1, #2, and #6. . . who experienced falls with or without head injury. . . Resident #2: . . The Unusual Occurrence Report dated 7/1/08 at 9:05 a.m. . . documented, "...Type of Occurrence: Found on floor... Type of Injury: Hematoma/bruise... PERLA [pupils equal, round, reactive to light and accommodation]: [Zero]..." The section of the form designated, "Describe exactly what was observed" was not completed.  Vital signs were documented, but there was no documentation the resident's neurological status was assessed at this time, other than the assessment of the resident's pupils. . . The Unusual Occurrence Report dated 7/1/08 at 1:15 p.m. documented: "Type of  Occurrence: Found on floor... R was found lying face down on the floor. . . no documentation of an assessment of the resident's neurological status other than the assessment of the resident's pupil size and reaction. . . The Unusual Occurrence Report dated 7/2/08 at 9:00 a.m. documented, "Type of Occurrence: Found on floor... found lying on his back . . . no documentation of a neurological assessment other than the assessment of the resident's pupils. . . The Unusual Occurrence Report dated 7/3/08 at 10:00 p.m. documented, "...Type of Occurrence: Found on floor... lying on back on floor at side of bed ..." . . . there was no documented neurological assessment other than the assessment of the resident's pupils… The Unusual Occurrence Report dated 7/9/08 at 10:30 a.m. documented, "Type of  Occurrence: Fall... was being transported in facility van . . . res was tipped over in wheelchair..." . . . no documentation of a neurological assessment other than the assessment of the resident's pupils.. . The Unusual Occurrence Report dated 7/11/08 at 6:30 p.m. documented, "...Type of Occurrence: Found on floor... " . . . there was no documentation of a neurological assessment after this fall . . .  Resident #6:. . . b. The Unusual Occurrence Report dated 5/5/08. . . ”. . . Type of Occurrence: Bumped. . . during trip to dialysis res. bumped head on side. . . [no] . . .  neuro checks." . . . Resident #1: . . .The Unusual Occurrence Report dated 3/27/08 at 2:45 p.m. documented, "...Type of Occurrence: Fall... Type of Injury: Hematoma...Describe exactly what happened: ...observed res [resident] on floor in her room next to the bed ... Able to move all extremities. Hematoma R [right] side of head [with] small amount of blood ... Sent to ER [Emergency Room] for eval [evaluation]..." Pages 2-8.

2.  ACCIDENTS AND SUPERVISION: . . .the facility failed to ensure wheelchair tie-downs and passenger restraint systems in the facility van were applied in accordance with the manufacturer's instructions to prevent accidents/injuries for Residents #2 and #6. . . The failed practice resulted in Immediate Jeopardy, which caused or could have caused serious harm, injury or death to Residents #2 and #6 who experienced falls in the facility van due to incorrectly applied tie-downs and passenger restraints.. .  Pages 9-10.  

Inspection on 5/9/08 (35 pages)              
1. NOTIFICATION OF CHANGES: . . .the facility failed to ensure the physician was consulted regarding pressure ulcers, ostomy care and pain management for Resident #3 . . . Pages 1-2.

2.  QUALITY OF CARE: . . . the facility failed to assess pain and provide pain management for Resident #3 who exhibited signs of pain. . . Pages 8-9.

3.  ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure that all soiled areas of skin were cleansed and free of feces during incontinent care for Resident #5 . . . Pages 13-14.

4.  PRESSURE SORES: . . the facility failed to assess, monitor, obtain physician orders for treatment and failed to provide a protein calorie supplement to promote healing of identified pressure ulcers as recommended by the Registered Dietitian for Resident #3 . . . The facility also failed to conduct treatments as ordered for Resident #8. . . Page 15.

5.  MEDICATION ERRORS:. . . the facility failed to ensure that the medication error rate was less than 5%.  . . The medication error rate was 13.043%.  Pages 26-27.  

Inspection on 8/3/07  (17 pages)
1. ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure the labia was spread for cleansing and the buttocks were cleansed during incontinent care for Residents #1, #5 and #8 and failed to ensure the mons pubis, groins and vaginal area were cleansed during incontinent care for Resident #1. . . Page 3 

Inspection on 7/27/06  (35 pages)
1.  QUALITY OF CARE: . . .the facility failed to ensure urinary catheter care was provided in a manner to prevent potential Urinary Tract Infections (UTI's) for Resident #8 . . . Page 9.

2.  ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure incontinent care was provided for Resident # 6 who was incontinent of urine.  Page 11.  

Inspection on 8/18/05  (18 pages)
1. PRESSURE SORES: . . the facility failed to conduct weekly skin audits for residents who were high at risk for pressure sores per the facility policy, failed to ensure treatment was obtained for the pressure sores . . .  Page 6.

2. MEDICATION ERRORS: . . the facility failed to ensure the medication error rate was less than 5%. . . The medication error rate was 10.52%. . Page 9.