Following are some of the deficiencies found during inspections of this nursing home on 6/14/08, 2/29/08, 8/10/07, 6/8/07, 12/14/06 and 10/20/06.  These reports and others (8/28/08 10 pp; 12/14/06 – 4 pp; 9/15/06 – 3 pages and 6/16/06 – 39 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.
 
Inspection on 6/14/08 (18 pages)
1.  QUALITY OF CARE: ...the facility failed to ensure the urethral meatus and catheter tubing were cleansed during catheter care for Resident #3... had diagnosis of… Chronic Pressure Ulcer. The Quarterly Minimum Data Set dated 6/6/08 documented. . . totally dependent on staff for personal hygiene and had an indwelling catheter. On 6/11/08 at 8:45 a.m., CNA #1 provided perineal care to the resident. The CNA wiped down the center of the labia, but failed to separate the labia and clean around the catheter insertion site and did not cleanse the catheter tubing from the insertion site downward. Pages 8-9.

Inspection on 2/29/08 (26 pages)
1.  HOUSEKEEPING /MAINTENANCE:. . . the facility failed to ensure the shower chairs, shower stalls, the floor and wall tiles in shower rooms and the multi-resident use equipment was clean and whirlpool tubs were clean and free of litter... 1. On 2/28/08 at 5:40 p.m., the following observations were made on the 200 Hall Shower: a. The 2 shower chairs in the first stall on the left side of the room had brownish-green material on the seats of the chairs. The shower chair in the second (middle) stall had a dark greenish substance smeared on the seat and the left arm. b. The whirlpool tub contained clothes hangers, empty petroleum jelly tubes, 2 bottles of roll-on antiperspirant, a dirty wooden orange stick, a dirty hair brush, dirty wheelchair accessories, a bottle of prescription shampoo labeled, "ketoconazole" dated 12/29/06, and dust and dirt in the bottom of the tub.... Pages 5-6.
 
2.  ACTIVITIES OF DAILY LIVING: ...the facility failed to ensure the groin and labia area were cleaned to during incontinent care for Resident #3... who was dependent on staff of incontinent care.  Pages 10-11.

3.  URINARY INCONTINENCE: …the facility failed to ensure a clean area of the cloth was used to clean the groin and vaginal area during incontinent care to prevent the potential for urinary tract infections for Resident #1.  Pages 11-12.

4.  PREVENTING SPREAD OF INFECTION: …the facility failed to ensure employees washed their hands after providing colostomy care and incontinent care and before performing other tasks for Residents #1 and 3.  Page 23.

Inspection on 8/10/07 (6 pages)
1.  ACTIVITIES OF DAILY LIVING: …the facility failed to ensure the perineal area was cleansed of feces during incontinent care for Residents #11 and #12.... Page 1.

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 10.53 %... Page 2-3.

3.  SANITARY CONDITIONS – FOOD PREP & SERVICE: …the facility failed to ensure… employees washed their hands before handling food, clean dishes, utensils and properly sanitized tray covers to prevent cross contamination.  Page 4.

Inspection on 6/8/07 (87 pages)
1.  ACCIDENTS: …the facility failed to ensure . . . staff was competent in using specific types of mechanical lifts, and that staff was transferring residents according to assessed/care planned needs. . . for Residents #1, #3, #5, #6, and #7... This failed practice... resulted in actual harm for Resident #6 who sustained a fracture during a transfer.  Resident #6 had diagnoses of Osteoporosis, Osteoarthrosis… d. The Plan of Care documented the following:... (3) Problem, identified on 3/21/07 and last reviewed on 4/7/07: "Fall risk - [Resident #6] is at risk for falls... limited physical mobility, and receives medications that may increase the risk of falls." Interventions were "assist R (resident) with transfers as needed x 1-2 staff mechanical lift." ...the Nurse's Notes, dated 5/18/07 at 2:21 p.m., documented "Resident is assisted up to wheel chair for lunch. During meal Resident C/O (complained of) right knee hurting. LPN checked knee noted it to be swollen discolored, warm to touch.  Resident denies knee being bumped. Triage for [Physician #1] made aware new order for stat right knee x-ray. . . Lortab given at 1305 (1:05 p.m.). Little relief at 1410 (2:10 p.m.). [Daughter] made aware of condition and of new orders. . . 1430 (2:30 p.m.) Results are called as Acute impacted proximal tibial shaft fracture...” f. The CNAs involved in the incident did not use a mechanical lift as resident was assessed and care planned to need...Pages 12-17.

Inspection on 12/14/06 (7 pages)
1.  ACCIDENTS: ...the facility failed to ensure that staff was trained and knowledgeable in the use of the facility van restraint system in order to prevent accidents and injury for Resident #2 who required facility transportation for medical appointments. This failed practice resulted in... actual harm for Resident #2 who was injured while being transported in the facility van... Pages 1-2.

Inspection on 10/20/06 (38 pages)
1.  NOTIFICATION OF CHANGES: ...the facility failed to ensure that [a] Physician [was] consulted for Resident #1... who experienced a change in condition.  This failed practice resulted in harm to Resident #4... On 10/12/06 at 12:00 p.m. the RN Consultant and the DON were interviewed.... When asked if it appropriate for nurses NOT to contact a physician for 15 days when a resident is crying and in pain that is not relieved by Darvocet, the RN Consultant stated, "No. . . and I have already discussed it with all the nurses yesterday. I told them (nurses) I can't believe that you let that lady holler in pain for 15 days and didn't call the Doctor to get her something else for pain."  Pages 1-2 and 9-10.