Following are some of the deficiencies found during inspections of this nursing home on 9/25/08, 12/12/07, 9/6/07 and 8/11/06. These reports and others (1/22/09 – 3 pages; 4/9/08 – 7 pages; and 1/12/07 – 20 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.
Inspection on 9/25/08 (32 pages) 1. ACTIVITIES OF DAILY LIVING: A resident who is unable to carry out activities of daily living receives the necessary services to maintain . . . personal. . . hygiene.. . The facility failed to ensure staff completely cleaned all areas during incontinent care for Resident #12. . . Resident #12 had diagnoses of. . . Symptoms involving Urinary System Continuous Leakage, Chronic Urinary Tract Infections (UTI), Suprapubic Foley Catheter and Pressure Ulcers. The Admission MDS dated 7/27/08 documented the resident was. . . totally dependent on staff for toilet use, and had an indwelling catheter. . . b. On 9/22/08 at 6:30 p.m. Licensed Practical Nurse (LPN) #5 entered the resident's room. She lifted the covers and the resident had had a large liquid stool and it was between her legs and down below the pad and on her gown. Part of the stool had started to dry along her thighs approximately 3 inches in length by 1/4 inch. The LPN put the covers back over the resident and went to get help. At 6:35 p.m. LPN#5 returned with CNA#2 to do incontinent care. The resident was repositioned on her back. CNA #2 sprayed the peri wash on the perineal area. LPN #2 wiped down the front of the perineal area one time. The thighs were then sprayed and wiped and then the resident was turned to the left side again. The sheet and mattress had stool on them. The mattress was wiped and the sheet was changed. The buttocks and right side was sprayed and then wiped, changing a different area of towel past each wipe. The resident was positioned onto her back and a new gown was placed on her. The surveyor then asked if they were through with incontinent care. They both stated, "Yes". The LPN and CNA were asked to perform the incontinent care again on the groin area and inner and outer labia showing the surveyor the towel past each wipe. The left groin was sprayed and wiped and the towel had a medium amount of brown stool on it as did the right groin and whole peri area past each wipe. Pages 9, 11-12.
2. PRESSURE SORES: . . . the facility failed to ensure turning and repositioning was completed at least every two hours for Resident #12. . . c. On 9/22/08 at 3:10 p.m., 5:00 p.m. and 5:45 p.m., the resident was in bed laying on her left side. . . d. On 9/22/08 at 6:25 p.m., CNA #2 was asked about positioning and incontinent care. The CNA was asked "Are you the CNA for this hall?" She stated, "Yes". The CNA was asked "How often do you do incontinent care and reposition the residents?" She stated, "Every two hours. The CNA was asked "When did you reposition this resident?" She stated, "At 4 p.m." The surveyor stated that the resident was on her left side at 3 p.m. and was still on her left side. The CNA was asked "So did you reposition her?" CNA#2 just looked at the surveyor and did not answer. Pages 13-15. 3. URINARY INCONTINENCE: . . . the facility must ensure. . . a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections. . . the facility failed to ensure the labia was separated and cleaned for Resident #8 and incontinent care was completed for Resident #1. . . Resident #8 . . . required extensive assistance for personal hygiene and was totally dependent on staff for bathing. . . b. On 9/23/08 at 9:15 a.m., the resident had a large incontinent bowel movement and CNA #1 provided incontinent care to the resident's peri and rectal area with no rinse peri-wash and a face cloth. After CNA #1 finished the incontinent care and was about to put an incontinent brief on the resident this surveyor asked CNA #1 to again wash the resident's peri area especially the labia. When CNA #1 cleansed the peri area, separating the labia it was noted there was feces on the face cloth after the labia was separated and cleansed. . . Resident #1. . . was . . . dependent on staff for toileting and personal hygiene, and incontinent of bowel and bladder. On 9/22/08 at 5:15 p.m., CNA #4 removed the resident's incontinent brief. The incontinent brief had liquid feces in it. The CNA placed a clean incontinent brief on the resident. The CNA stated, "Its just water." The CNA did not cleanse any of the resident's perineum or buttocks. Pages 15-17.
4. MEDICATION ERRORS: The facility must ensure that it is free of medication error rates of five percent or greater. . . The medication error rate was 13.33 % . . Pages 18-19.
Inspection on 12/12/07 (11 pages) 1. SANITARY CONDITIONS – FOOD PREP & SERVICE: . . the facility failed to ensure the ice machine was maintained in clean and sanitary condition . . . On 12/10/07 at 2:10 p.m., the ice machine had a thick slimy, black and pink mucus- like substance that extended the entire length of the plastic panel border inside the ice machine. Pages 10-11.
Inspection on 9/6/07 (5 pages) 1. PRESSURE SORES: . . . the facility failed to ensure that the Physician was consulted, treatment orders obtained and treatment started in a timely manner for . . . Resident #1 . . . who had pressure sores. This deficient practice resulted in actual harm for Resident #1 who had a delay in treatment of 12 days resulting in an infection and a left above the knee amputation. . . Page 1.
Inspection on 8/11/06 (7 pages) 1. ACCIDENTS: . . .the facility failed to ensure staff had keys available to lock the shower room on the Alzheimer's Unit and that a cognitively impaired, wandering resident with an unsteady gait was monitored. This failed practice resulted. . . in harm . . . for Resident #5 who experienced. . . fall causing fractures and a scalp laceration . . . a. Ambulance here and transported resident per 2 attendants via stretcher at 1:50 p.m. . . Pages 2-4
