Fayetteville – Fayetteville Health And Rehabilitation Center
Following are some of the deficiencies found during inspections of this nursing home on 1/30/09, 5/16/08, 2/6/08 and 12/14/07. These reports and others (8/3/07 – 24 pp, 3/16/07 – 9 pp, 1/19/07 – 59 pp, 8/17/06 – 2 pp, 7/7/06 – 70 pages, 2/16/06 – 22 pages and 8/5/05 – 2 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.
Inspection on 1/30/09 (15 pages) 1. ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure . . . the inner thighs and buttocks were cleaned during incontinent care for Resident #6. On 1/30/09, at 8:40 a.m., CNA #9 provided incontinent care. The resident’s incontinent brief had blue lines indicating the incontinent brief was wet with urine. The CNA disposed of wipe, then turned the resident onto the left side, and removed the saturated incontinent brief. The CNA used one wipe and washed the rectal area, but did not wash the inner thighs or either buttocks. Pages 1-3.
Inspection on 5/16/08 (57 pages) 1. PRESSURE SORES. The facility. . . failed to ensure a physician-ordered protein supplement was obtained and administered to promote healing of a Stage IV pressure ulcer for . . . Resident #6. The facility failed to ensure turning / repositioning were provided at least every 2 hours in accordance with the Plan of Care or accepted standards of nursing practice to prevent potential pressure ulcer development for Residents #4 and #14. Pages 12-13.
2. URINARY INCONTINENCE: . . .the facility failed to ensure the perineal area was cleansed of feces after an incontinent bowel movement to decrease the risk of Urinary Tract Infections for Resident #5… a. The Care Plan dated 3/10/06 documented: “Frequently incontinent of urine and occasional bowel incontinence r/t [related to] DX [diagnosis] of Dementia, routine Lasix, use, and impaired mobility . . . utilizes brief – staff to toilet resident Q [every] 2 hours and PRN [as needed] providing pericare when toileting and after each incontinent episode.” b. A Laboratory Report dated 10/16/07 documented results of a Urinalysis with Culture as, “heavy Group B Beta Strep > [greater than] 1,000,000.” c. A Laboratory Report dated 10/19/07 documented results of a Urinalysis with Culture as, “heavy Streptococcus Agalactiae > 1,000,000.” d. A Laboratory Report dated 12/23/07 documented results of a Urinalysis with Culture as, “heavy Streptococcus Agalactiae > 1,000,000.” …On 5/12/08 at 2:15 p.m., the resident was incontinent of soft brown stool that ran out of the incontinent brief and onto the bed linens. CNA #1 turned the resident to her right side and, without cleansing her left buttock / hip, inner thighs, perineum, supra-pubic area or groin area, applied Lantiseptic barrier cream and placed a clean brief on the resident. As CNA #1 and CNA #2 were preparing to tape the brief into place, they were asked if incontinent care was completed. Both CNAs nodded their heads. CNA #1 was asked by the Surveyor to pull back the brief, get a clean peri-wipe and wipe the resident’s perineal area and show the wipe to the Surveyor. CNA #1 complied with this request and the peri-wipe was soiled with a significant amount of soft feces upon wiping the perineal area. The mid to front area of the clean brief was also soiled with fecal material. Four additional peri-wipes were needed to remove the feces from the resident’s perineal area. Pages 19-21.
3. DIETARY SERVICES – SUFFICIENT STAFF:… the facility failed to ensure sufficient qualified dietary staff was available to prepare and serve palatable meals at the correct temperature and facilitate the utilization of sanitary techniques . . . On 5/12/08 at 1:35 p.m. during the initial kitchen observation, kitchen equipment was dirty. From 5/12/08 through 5/14/08, multiple observations were made of failed practices in the kitchen area due to insufficient staff. Dirty kitchen equipment, including dishes with dried food particles on them were used during meal preparation and service. Molded bread dated as far back as January 2008 was stored in the storage room because no one had time to discard it according to the Dietary Staff. Improper hand washing was observed multiple times. On 5/12/08 during the dinner meal and 5/13/08 during the lunch meal, food was not prepared in sufficient quantities to feed all residents. Page 36-37. 4. INFECTION CONTROL: . . .the facility failed to ensure staff followed Contact Isolation Precautions in order to prevent the potential spread of Clostridium difficile (C-diff) from Resident #5. Page 52.
Inspection on 2/6/08 (14 pages) 1. QUALITY OF CARE: . . .the facility failed to ensure wound care was provided for Resident #1, wound care was provided in a manner to reduce the risk for infections for Residents #1, #2 and #3 and assessments of wounds were documented for Resident #3. Page 1.
Inspection on 12/14/07 (7 pages) 1. ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure incontinent care was provided following an episode of urinary incontinence for Resident #3 . . . On 12/12/07 at 5:26 a.m. . . . CNA #1 and #2 removed the resident’s brief which was wet with urine. The linens on the bed were also wet at the level of the resident’s buttock area. The CNA’s placed a new brief on the resident without providing incontinent care. On 12/12/07 at 5:48 a.m., CNA #1 was asked what was wrong with the peri-care that had been provided to the resident. The CNA stated, “Didn’t clean resident up at all. Just slipped my mind.” On 12/12/07 at 5:50 a.m., CNA #2 was asked what was wrong with the peri-care that had been provided to the resident. The CNA stated, “Didn’t do it. Didn’t clean him.” The policy entitled “Perineal Care” documented, “. . . Residents who are incontinent of urine or feces should receive perineal care as needed . . .” Pages 1-2.
