Following are some of the deficiencies found during inspections of this nursing home on 11/6/08, 2/1/08, 9/8/07 and 5/9/07. These Reports and others (3/23/07 - 50 pages; 4/28/06 – 65 pages and 7/19/05 – 15 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.
Inspection on 11/6/08 (8 pages) 1. SANITARY CONDITIONS: . . .the facility failed to ensure the ice machine was free of debris, employees washed their hands between handling dirty equipment and food items and that the kitchen was free of flies. . . On 11/3/08 at 11:31 a.m., the following observations made were: a. The ice scoop holder hanging on the right side of the machine had black matter in the bottom. The ice scoop was resting directly on the substance . . . c. Dietary Employee #1 had gloves on both hands, she picked up slices of bread and placed them on the plates to be served to the residents at the lunch meal. The employee removed the gloves on her hands, went to the dish room, lifted up the trash can lid and threw away the gloves. Without washing her hands, she picked up the saucers with the chocolate cake in them from the rack to be served to the residents at the lunch meal with her fingers on the cake. d. There were two flies on the wall above the food preparation area where the mixer was located. e. There were three flies on the chain attached to the glass board above the steam table where diet order slips were hung. f. There was a fly crawling on a slice of bread in a pan that contained slices of bread to be served to the residents at the lunch meal that was located on the shelf above the steam table. The fly was pointed out to the Dietary Employee #2 . . . g. There was a fly on the leg of a table located in front of the steam table where plate covers were kept. h. There was a fly on the wall by the door leading to the kitchen. i. There was a fly on the vent hood. j. There was a fly on the ceiling above the coffee maker. k. There was a fly on the steam table bar. There was a fly on the cake in a plate on the rack to be served to a resident at the lunch meal. l. Dietary Employee #1 took two pans of chocolate cake to the 300 Hall. She walked back in the kitchen, without washing her hands, and started picking up plates with chocolate cakes in them with her fingers on the cake while placing them on a tray to be served to the residents . . . 2. On 11/3/08 at 4:45 p.m., there was a fly crawling on the flour tortilla in a pan located on the shelf above the steam table to be served to the residents at the supper meal. Pages 5-8.
Inspection on 2/1/08 (65 pages) 1. UNNECESSARY DRUGS: . . . the facility failed to ensure dose reductions were attempted on Residents #2, #3, #7, #8 and #10 that received anti-psychotic medications. . . Page 32.
2. INFECTION CONTROL: . . . the facility . . . failed to ensure their infection control program tracked / trended infectious processes from one month to the next . . . by not maintaining a complete infection control log. . . The Infection Control Logs from July 2007 through December 2007 documented the resident’s name, onset date, site, antibiotic and date resolved. 96 of 107 entries did not identify if a culture was obtained, 106 of 107 did not identify if the resident was isolated, 107 of 107 did not identify an organism, 107 of 107 did not identify if the infection was nosocomial [i.e. contracted in the nursing home]. . . and the January 2008 Infection Control Log could not be provided. Pages 53, 55-56. 3. INFECTION CONTROL – LINENS: . . .the facility failed to ensure soiled linens were handled in a manner to prevent the potential spread of infection for . . . Resident #9. Page 58.
Inspection on 9/8/07 (13 pages) 1. ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure urine and feces were removed from all areas of the resident’s skin during incontinent care for Residents #1, #2, #3, #4, #5, #6 and #7. Page 1.
2. PRESSURE SORES: . . the facility failed to ensure resident’s skin was kept clean and dry and residents were repositioned every two hours to prevent the development of pressure sores or to promote the healing of pressure sores for . . . Residents #1, #2, #3, #6 and #7. . . Resident #1 . . . was incontinent of bowel and bladder. The Care Plan updated 6/20/07 documented “. . . toileted q 2 hr’s (hours) and PRN (as needed) by staff.” The Weekly Skin Report dated 9/7/07 documented, “ . . In-House Stage 2 . . L buttock 0.3 x 0.3 . . . treatment Santyl . . date identified: 8-10-07.” On 9/7/07 at 10:00 a.m., the resident was in a wheelchair. . . without being toileted, until 2:30 p.m. when . . . CNA #1 assisted the resident from the wheelchair to the bed. The incontinent brief was saturated with urine and time written on the brief was 10:00 a.m. . . Incontinent care was provided. The perineal area, inner thighs and buttocks were not cleansed. Pages 5-6.
Inspection on 5/9/07 (17 pages) 1. ACTIVITIES OF DAILY LIVING: . . .Resident #9 . . . was incontinent of bowel and bladder . . . The Care Plan reviewed on 3/7/07 documented, “Problem: At risk for skin breakdown . . Approaches: . . .Cleanse perineal area with soap and water following each urination. Cleanse perineal area with soap and water following each bowel movement. . . “ On 5/9/07 at 10:43 a.m., CNA #3 provided incontinent care following an episode of bowel and bladder incontinence. CNA #3 cleaned the perineal area, including the urinary meatus, using wet washcloths that had no cleansing agent. CNA #3 ran out of wet washcloths and used one periwipe on the scrotal area only. CNA #3 was asked what was on the washcloths that was used for cleansing during incontinent care. CNA #3 stated, “Just water.” . . . On 5/9/07 at 1:50 p.m., the Assistant Director of Nursing ADON was asked what is the procedure for cleaning a resident who had been incontinent of bowel. The ADON stated, “. . . Can use either soap and water or wipes.” Pages 4-5.
