Following are some of the deficiencies found during inspections of this nursing home on 1/08/09, 4/11/08 and 2/18/08.  These reports and others (7/3/08 - 4 pp, 5/29/08 - 2 pp, 11/5/07 – 10 pp, 8/14/07 – 13 pp, 6/1/07 – 38 pp, 4/13/07 – 54 pp, 5/11/06 – 35 pp and 8/16/05 – 2 pp) can be found at www.arknursinghomeinspectiondeficiencies.com

Inspection on 1/08/09 (17 pages)
1. NOTIFICATION OF CHANGES: . . . the facility failed to ensure the physician was immediately consulted regarding a large abrasion to the lower extremity for Resident #7 with a history of venous ulcers. . . This resulted in actual harm to Resident #7 who had deterioration and additional venous ulcers noted . . . Pages 1-2.

Inspection on 4/11/08 (14 pages)
1. QUALITY OF CARE: . . .the facility failed to ensure the urinary catheter was secured during incontinent care to prevent potential trauma to the urinary meatus for Resident #2.  Pages 3-4.

2.  NASO-GASTRIC TUBES . . . the facility failed to ensure infection control procedures were followed during administration of flushes and medications for Residents #2 and #3 who had feeding tubes.  Pages 4-5.

Inspection on 2/18/08 (206 pages)
1.  ABUSE:  The facility failed . . . to ensure a thorough investigation was completed after an allegation of sexual abuse for Resident #11. . .  The failed practices resulted in immediate jeopardy which caused . . . serious harm, injury . . . for Resident #11 who suffered psychological / emotional harm after CNA #3, who allegedly sexually abused the resident, was permitted to return to work which caused fear / anxiety for the resident to the extent that she changed her sleeping habits and fashioned a weapon in order to protect herself from that male CNA.  Pages 9-10.

2. DIGNITY:. . . the facility failed to ensure dignity was maintained by not removing urine odors after an incontinent episode and prior to serving a meal for Resident #7.  Page 54.

3.  COMPREHENSIVE CARE PLANS:. . . the facility failed to ensure . . . care plans were revised to reflect actual pressure ulcers for Residents #2 and #8 who had actual pressure ulcers . . . failed to ensure daily fluid needs were accessed and monitored for Residents #2, #7 and #10 who were at risk for dehydration and failed to ensure a care plan was developed for use of a feeding tube for Resident #6 . . .  These failed practices resulted in actual harm for Residents #2 and #7 who required hospitalizations to treat dehydration and Resident #8 who developed an unidentified unstageable pressure ulcer.  Pages 81-82.

4. ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure . . . removal of dried feces with cleansing agent to prevent the potential for skin irritation for Resident #1. . . Resident #1 . . . required total assistance for toilet use, hygiene and bathing . . . On 2/12/08 at 1:33 p.m., CNA #5 and #4 provided incontinent care for the resident.  The resident had a healing stage IV at the coccyx (at stage II depth) and a new stage II on the right hip.  There was dried feces stuck on both lower buttocks of the resident.  CNA #5 was asked if the resident was incontinent of feces, she stated, “No,” and then was asked if feces was dried to the resident’s skin and she stated, “It looks like it.”  CNA #5 had to rub hard against the resident’s buttocks to remove the dried feces from a previous incontinent episode of bowel. CNA #4 was asked what was on the wipes used to cleanse the resident and she stated, “water.”  When asked if anything else was used other than water, she stated, “No.”  Pages 98-100.

5.  PRESSURE SORES: . . the facility failed to ensure an unstageable pressure sore was identified, pressure relieving devices were provided to prevent the development of other pressure sores and to promote healing and appropriate treatments were implemented for Resident #8 and pressure relieving devices were in place, skin was cleansed of urine, and turning and repositioning was implemented for Resident #7 who had pressure sores or was at risk for developing pressure sores.  These failed practices resulted in actual harm for Resident #8, who had an unidentified and untreated pressure ulcer and contraindicated treatments utilized for other pressure sores. . .  Pages 100-1001.

6.  SPECIAL NEEDS: . . .the facility failed to ensure oxygen concentrator filters were clean, nasal cannulas covered when not in use and oxygen administered with equipment as intended for Residents #15 and #18. . . The facility failed to ensure monitoring was conducted by licensed nursing staff during administration of updraft treatments for Resident #2.  Pages 140-141.

7.  MEDICATION ERRORS: . .The facility must ensure that it is free of medication error rates of five percent or greater. . . The medication error rate was 37.5%.  Pages 150-151.

8.  INFECTION CONTROL: . . .the facility failed to ensure the infection control program identified areas where infections occurred for trending and investigative purposes and the manufacturer’s instructions were followed for disinfecting bathtubs.
The facility could not demonstrate effective policies and procedures designed to prevent the spread of infection through policies for Standard Precautions and the use of gloves.  The findings are:  Pages 172-173.

9.  INFECTION CONTROL – LINENS:. . . the facility failed to ensure staff washed their hands after handling dirty linen and before handling clean linen, laundry was processed in a manner as to prevent the spread of infection and there was no separation between dirty and clean areas to prevent potential cross contamination.  Page 174.

10. RESIDENT ROOMS:… Bedrooms must measure at least 80 square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms…the facility failed to ensure multiple resident rooms provided at least 80 square feet of living space for each resident…On 2/15/08 at 2:40p.m. the Administrator stated, “The size of the rooms hasn’t changed. I don’t want to give up any rooms.” Page 175.