Following are some of the deficiencies found during inspections of this nursing home on 2/27/09, 10/8/08, 4/18/08, 7/12/07 (1), 7/12/07 (2), and 5/18/07.  These Reports and others (6/6/08 – 3 pp, 9/8/06 – 9 pp, 7/14/06 – 31 pp, 2/1/06 – 10 pp and 9/16/05 – 51 pp) can be found at www.arknursinghomeinspectiondeficiencies.com.

Inspection on 2/27/09  (13 pages)
1.  NASO-GASTRIC TUBE: ...the facility must ensure that a resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and service... 1. Resident #7... had problems with swallowing, weight loss, had a feeding tube... a. A Nutrition Progress Note dated 10/14/08 documented, “Wt [weight] 8/08 184, 9/08 185, 10/08 180, current 158# [pounds].  The resident had a 22 pound weight loss.  This represents a 22# loss [times] 1 week.   Assistant Director of Nursing reports diet was changed from reg [regular] to Mech Soft LCS [Mechanical Soft Low Concentrated Sweets] on 10/6/08 and that Res [Resident] had ‘lots of edema.’”... d. 12/31/08 ... 150 pounds ... e. 1/21/09 144 pounds ...Pages 2-4.

Inspection on 10/8/08  (12 pages)
1.  NOTIFICATION OF CHANGES: ...the facility failed to ensure the physician was consulted about lab work that was not completed for Resident #2 who had orders for laboratory tests.  Page 2.

Inspection on 4/18/08  (53 pages)
1.  QUALITY OF CARE: ...the facility failed to ensure that the bowel elimination pattern was monitored and interventions implemented in a timely manner to prevent a fecal impaction for Resident #6... c. The Elimination Sheet for the month of March 2008 did not document a BM [bowel movement] on either shift for 6 consecutive days, 3/18-23/08.  d. The resident was admitted to the hospital on 3/24/08 with a fecal impaction.  Pages 12-13.

2.  PRESSURE SORES: ... the facility... failed to follow physician orders for wound care and failed to notify the physician when a decubitus ulcer had deteriorated from a stage II to a stage III pressure ulcer for Resident #5... f. On 4/10/08 at 3:45 p.m... .The Treatment Nurse was then asked, since the left ankle pressure ulcer had not shown improvement, had the wound been assessed for a change in the current treatment, the Treatment Nurse stated, “No.” Pages 18-23.

3.  MEDICATION ERRORS:... the facility must ensure that it is free of medication error rates of five percent or greater... The medication error rate was 10.63%...  Pages 39-40.

4.  SANITARY CONDITIONS – FOOD PREP & SERVICE:  . . the facility failed to ensure that employees washed their hands to prevent cross contamination after handling contaminated items. Page 46.

5.  LABORATORY SERVICES: ... The facility must provide or obtain laboratory services to meet the needs of its residents.  1. Resident #11 ... a. A Physician Order dated 3/12/08 documented, “STAT labs.  Stool for C-Diff.”  2. Resident #9 ... a. A Physician Order dated 3/20/08 documented, “1 C-Diff of stool ...”  3. On 4/10/08 at 6:50 p.m. the Director of Nursing was asked if the C-Diff lab test were done for Residents #9 and #11.  The DON stated, “No.” Pages 52-53.

Inspection on 7/12/07 (1)  (3 pages)
1.  ACCIDENTS: ...the facility failed to ensure supervision was provided during a shower ... Client #1 ... This failed practice resulted in ... actual harm to Resident #1 who sustained a fracture to the right leg.  Page 1

Inspection on 7/12/07 (2)  (9 pages)
1.  QUALITY OF CARE: ... Resident #5: ... a. On 7/10/07 at 8:45 a.m., CNA #3 provided a bed bath... The CNA wiped up and down the vagina 2 times without changing to a clean area of the feces smeared cloth and did not cleanse the Foley catheter tubing or around the meatus.  Pages 2-4.

Inspection on 5/18/07  (40 pages)
1.  NOTIFICATION OF CHANGES: ... the facility failed to ensure the physician was consulted about the deterioration in a wound in a timely manner for Resident #10.  Page 2

2.  DIGNITY: ... the facility failed to ensure dignity was maintained by requiring incontinent briefs to be worn and not offering a toileting program for Resident #12 who was continent of bowel and bladder. Page 6.

3.  INFECTION CONTROL: ... the facility failed to ensure scissors were disinfected between wound treatment procedures... 3. On 5/15/07 at 3:35 p.m., the surveyor asked the treatment nurse when she had cleaned the scissors.  The treatment nurse stated, “I do treatments for the house, starting on the 4th floor.  I haven’t cleaned the scissors from floor to floor or resident to resident.”  Pages 37-39.