Following are some of the deficiencies found during inspections of this nursing home on 6/20/08, 4/18/08 and 2/06/08. These Reports and others (1/24/08 - 4 pp, 5/24/07 - 43 pp, 3/14/07 – 4 pp, 1/31/07 - 5 pp, 8/17/06 – 6 pp, 6/16/06 – 15 pp, 3/09/06 – 18 pp) can be found at www.arknursinghomeinspectiondeficiencies.com
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Inspection on 6/20/08 (11 pages)
1. STAFF TREATMENT OF RESIDENTS: . . . the facility failed to ensure allegations of misappropriation of a resident property was investigated for Residents #1 and #2. . . and an allegation of neglect with provision of incontinent care was investigated for Resident #5. Page 2 and 4-5.

Inspection on 4/18/08 (40 pages)
1. HOUSEKEEPING/MAINTENANCE: …the facility failed to ensure that the facility was maintained in a sanitary and orderly manner as evidenced by feces observed on the floor in the shower room on the Minor Lodge wing and in the drain hole and shower curtain on D hall... Pages 10 - 11.

2. MEDICATION ERRORS: …The facility must ensure that it is free of medication error rates of five percent or greater. . . The medication error rate was 10.87% . . . Pages 24-25.

3. SANITARY CONDITIONS – FOOD PREP & SERVICE: . . . the facility failed. . . to ensure the ice machine was free of debris. . .1. On 4/17/08 at 11:22 a.m., the following observations were made in the facility’s kitchen: a. The ice machine located in the kitchen had thick accumulation of black substance on the inside back panel hanging down. The inside front panel had accumulations of grayish, brownish and greenish slimy substance with water condensation dripping on the ice... 3. On 4/18/08 at 4:00 p.m., the ice machine by the soda vending machine towards the E-hall where water condensation was dripping down on the ice had an accumulation of slimy blackish and brownish substance on it. Pages 27-29.

4. PHARMACY SERVICES: . . . the facility failed to ensure that all products and medications available for administration were in date according to the manufacturers dated . . . 1. On 4/18/08 . . . the medication rooms and medication carts were reviewed with the following findings: a. B hall medication room: 7 24-gauge IV catheter needles expired 2005, 5 24-gauge IV catheter needles expired 2006, 1 24-gauge IV catheter needle expired 2001, 1 24-gauge IV catheter needle expired 2000, 6 24-gauge IV catheter needles expired 2007, 3 24-gauge IV catheter needles expired 01/2008, 1 24-gauge IV catheter needle expired 03/2008, 2 22-gauge IV catheter needles expired 2001, 2 22-gauge IV catheter needles expired 2004, 1 22-gauge IV catheter needle expired 2005, 3 22-gauge IV catheter needles expired 2006, 2 22-gauge IV catheter needles expired 03/2008, 1 20-gauge IV catheter needle expired 1997, 2 20-gauge IV catheter needles expired 2004, 2 20-gauge IV
catheter needles expired 2006, 4 20-gauge IV catheter needles expired 04/2007, 3 20-gauge IV catheter needles expired 02/2008, 2 20-gauge IV catheter needles expired 01/2008, 47 Fibracol Plus Dressing expired 04/2007 and 28 Carra Smart Foam dressing expired 08/2007. Pages 29-30.

Inspection on 2/06/08 (6 pages)
1. ACCIDENTS AND SUPERVISION: . . . the facility failed to ensure interventions were developed and implemented to prevent repeated falls and skin tears for . . . Resident #5. 1. During a skin audit conducted on 2/6/08 at 10:48 a.m., the resident had injuries to the lower extremities including a bruise to the lateral right upper leg measuring 3.5 cm by 1.4 cm, a skin tear to the lower right leg (anterior surface) measuring 4.3 cm, bruising to the right foot (anterior surface) measuring 5.8 cm by 8.2 cm and a skin tear to the posterior left upper calf measuring 5.8 cm by 6 cm with a surrounding hematoma measuring 13.2 cm by 7.4 cm. . . m. During a skin audit conducted on 2/6/08 at 10:48 a.m., the resident had injuries to the right upper extremity including: skin tear measuring 4.5 cm surrounded by a hematoma measuring 5 cm by 5.8 cm to the posterior aspect of the right arm; dark purple bruising from the middle of the forearm posteriorly, encircling the mid-right upper arm too the wrist, three pale blue circular hematomas measuring 0.2 cm, 0.2 cm and 0.5 cm on the anterior upper right arm, a hematoma to the right upper anterior arm measuring by 1.5 cm by 0.8 cm, a scabbed skin tear measuring 5.5 cm x 1.4 cm to the right upper arm, a skin tear to the outer right antecubital space measuring 3.2 cm by 2.0 cm, a skin tear to the anterior right forearm measuring 6 cm x 2.2 cm, a purple hematoma to the right forearm measuring 7.1 cm by 5.5 cm, light purple bruising to the top surface of the right hand, a dark purple bruise measuring 4.2 cm by 2.5 cm to the middle finger of the right hand. . . o. On 2/5/08 at 3:00 p.m., the Director of Nursing stated, “I cannot show you interventions for skin tears or falls.”  On 2/6/08 at 10:48 a.m. and 12:07 p.m., the resident was in bed with no personal protective sleeving or padding on her side rails. Pages 1, 4-6.