Following are some of the deficiencies found during inspections of this nursing home on 1/13/09, 10/13/08, 7/18/08, 3/14/08 and 10/18/07. These reports and others (7/23/07 – 5 pages; 7/5/07 – 2 pages; 6/5/07 – 20 pages; 4/6/07 – 37 pages; 1/9/07 – 17 pages; 12/8/06 - 6 pages; 5/25/06 – 98 pages; and 1/6/06 – 2 pages) can be found at www.arknursinghomeinspectiondeficiencies.com .
Inspection on 1/13/09 (39 pages) 1. QUALITY OF CARE: . . . the facility failed to ensure the indwelling urinary catheter insertion site was thoroughly cleansed to decrease the potential for infection for Resident #1. . . On 1/6/09 at 9:55 a.m., CNA #11 provided catheter care for the resident, following an incontinent episode of loose yellowish-tan stool. Upon completion of the incontinent care, the CNA was asked to remove the resident's disposable brief and re-cleanse the area of the urinary meatus. The CNA used an adult wipe to cleanse the resident's urinary meatus and was then asked to describe the used adult wipe; the CNA stated, "There is a yellowish-tan discoloration on the adult wipe [from the urinary meatus] on it." Pages 8-9.
2. ACTIVITIES OF DAILY LIVING: …the facility failed to ensure all soiled areas were cleansed during incontinent care for Resident #3… Resident #3: …On 1/6/09 at 2:45 p.m., during incontinent care for liquid feces, CNA #1 did not cleanse the resident's mons pubis or separate the labia for cleansing. Pages 10-11.
3. PRESSURE SORES: . . . the facility failed to ensure repositioning was provided timely for Resident #10. . . The resident care plan dated 11/27/08 documented ". . . Assist and encourage frequent position changes." . . . The resident sat up in the wheelchair. . . under constant observation by the surveyor from 8:30 a.m. until 1:43 p.m., approximately 5 hours and 13 minutes, without being repositioned. Pages 12-14.
4. URINARY INCONTINENCE: . . . the facility failed to ensure all front to back cleansing motions were used during incontinent care to decrease the potential for urinary tract infections for Resident #3. . . On 1/6/09 at 2:45 p.m., during Incontinent care for liquid feces, CNA #2 wiped visible feces down the groin areas and across the vaginal areas 2 times. Pages 15-16.
5. MEDICATION ERRORS: The facility must ensure that it is free of medication error rates of five percent or greater. . . The medication error rate was 10.20% . . . Pages 28-29.
Inspection on 10/13/08 (15 pages) 1. STAFF TREATMENT OF RESIDENTS: . . . the facility failed to ensure an investigation was completed and reported to the Office of Long Term Care and other State agencies …for an injury of unknown origin. . . Pages 1-2.
2. COMPREHENSIVE CARE PLANS: …the facility failed to ensure a wound treatment was performed as ordered for Resident #4 who had a physician order for treatment to a skin tear. Page 7.
Inspection on 7/18/08 (28 pages) 1. STAFF TREATMENT OF RESIDENTS: . . . the facility failed to ensure allegation of neglect was reported to OLTC and local law enforcement in accordance with State law for Residents #1 through #13. . . who did not receive medications per Physician Orders. Pages 1-2.
Inspection on 3/14/08 (81 pages) 1. QUALITY OF CARE: . . . the facility failed to ensure soap or other cleansing agent was used for foley catheter care, all areas of the perineum were cleansed and the catheter tubing was cleansed for Residents #15 and #21. . . Resident #21. . . On 3/13/08 at 11:00 a.m., CNA #9 and #8 provided care for the resident. CNA #8 pulled the covers back. . . The labia had a thick purulent appearing substance visible around the foley extending down the entire fold of the pubic area. CNA #8 handed CNA #9 a bundle of wet wash cloths and CNA #9 washed the resident with the wash cloths. CNA #9 washed the left side of the labia. A brown substance was seen on the wash cloth. CNA #9 was asked, "What is that?" CNA #9 stated, "BM (bowel movement)." CNA #9 turned the wash cloth and washed the left side of the labia. CNA #9 spread the labia… CNA #8 handed a new wash cloth to CNA #9. The vaginal and inner labia area was washed front to back, turning the cloth after each wipe. . . CNA #9 was asked, "Was there any kind of cleansing agent on the wash cloths?" CNA #8 stated, "No, only water." . . . On 3/13/08 at 4:20 p.m., the Director of Nursing. . . "Is it appropriate to clean residents with catheters with wash cloths wet with water only?" The DON stated, "No, especially if they have a catheter." Pages 20-22.
2. ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure all areas of the perineum were cleansed when incontinent care was provided for Resident #7. . . On 3/11/08 at 12:35 p.m., the resident was lying in bed on top of the bed spread on a pad and was covered with a sheet. CNA #12 and #13 provided care for the resident. . . Both CNA's removed the soiled bed pad and placed a clean incontinent brief on the resident. The front of the perineal area and the buttocks were not cleansed. The labia was not separated to cleanse the urinary meatus. . . Pages 24-26.
3. PRESSURE SORES: . . . the facility failed to ensure a Stage II decubitus was identified and treated, and failed to implement measures to prevent the development of pressure ulcers for Resident #21. Page 33.
4. NUTRITION: . . . the facility failed to ensure interventions were implemented for a significant weight loss for Resident #3. . . Pages 55-58.
Inspection on 10/18/07 (20 pages) 1. QUALITY OF CARE . . . the facility failed to ensure residents on anticoagulation therapy received test to monitor therapeutic blood levels and recognized and implemented timely interventions when bleeding occurred for Resident # 7 . . . The Immediate Jeopardy was removed by the facility and the scope and severity reduced to a "G" when Resident #7 was transferred to the hospital for treatment on 10/11/07 and a plan of corrective action was initiated. Page 1.
