Following are some of the deficiencies found during inspections of this nursing home on the following dates: 12/4/08, 2/15/08 and 4/27/07.  These reports and others (1/24/07 – 23 pages; 3/8/07 – 7 pages; and 3/27/07 – 15 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.

Inspection on 12/4/08 (19 pages)
1.  QUALITY OF CARE: . . . the facility failed to ensure indwelling urinary catheter tubing was secured to decrease the potential for trauma to the urinary meatus for Residents #4. . . On 12/3/08 at 9:00 a.m., CNA#6 and CNA #7 pulled the sheet down and exposed the resident's catheter and tubing. The resident's catheter tubing was not secured and there was blood tinged urine coming out of the catheter, into the drainage tube.   Pages 1-2.

2.  PRESSURE SORES: . . . the facility failed to ensure contaminated dressing supplies were not used to perform dressing changes for Resident #5.  Pages 2-3.

3.  URINARY INCONTINENCE: . . . the facility failed to ensure front to back cleansing motions were used during incontinent care to decrease the potential for urinary tract infections for Resident #2. . . a. On 12/3/08 at 9:10 a.m. . . The CNA spread and cleansed the mid labia area back-to-front 3 times, cleansing from mid labia toward and over the urinary meatus.  b. On 12/3/08 at 9:30 a.m., CNA #3 was asked, “How were you trained [to do incontinent care], in what direction should you cleanse?" CNA #3 stated, up in the front... I cleaned up (back to front) in the front..." When asked, "What can happen when you cleanse that way (back to front)?" the CNA stated, "Infections."  Pages 6-7.

4.  NASO-GASTRIC TUBES: . . . the facility failed to ensure the head of the bed was elevated while an enteral feeding solution was infusing to decrease the potential for aspiration for Resident #6 who had a Percutaneous Endogastrostomy (PEG) tube. . . . a. On 12/2/08 at 8:35 a.m. . . .  the head of the resident's bed was flat and the feeding pump was infusing the feeding at 80 cubic centimeters (cc) per hour. . . 2. The Policy and Procedure for Gastric Tube Feeding via Continuous Pump documented. . . Step 4. Always keep resident receiving continuous feedings in semi-Fowler's or higher position with head of bed (HOB) elevated 30 degrees..."  Pages 8-9.

Inspection on 2/15/08(43 pages)
1.  ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure urine/feces were cleansed from all areas of the residents' skin during incontinent care or toileting for Residents #1, #3, #6 and #9. . . The facility failed to ensure residents who were provided with incontinent care were not placed back onto wet mattresses or sheets for Resident #6. . . Pages 7-8.

2.  PRESSURE SORES: . . .  the facility failed to ensure a mattress and bed linens were clean and dry to promote healing of existing pressure ulcers and prevent the development of new pressure ulcers and failed to ensure clean technique was followed during pressure ulcer treatments for Resident #5. . .  Pages 12-13.

3.   URINARY INCONTINENCE: . . . the facility failed to ensure Certified Nursing Assistants' incontinent care technique did not increase the risk of Urinary Tract Infections (UTI's) for Residents #3, #6 and #18 . . . as evidenced by failure to remove contaminated gloves prior to providing incontinent care, failure to use a clean washcloth or change to a clean area of the washcloth between cleansing the anal and perineal areas and failure to utilize a front-to-back cleansing motion.  Page 17.

4.   SPECIAL NEEDS: . . . the facility failed to ensure intravenous (IV) fluids were infused continuously as ordered by the physician . . . for Resident #1.  The facility also failed to ensure licensed nursing staff remained with the residents during updraft treatments to ensure correct administration . . . for Residents #2 and #19. Pages 28-29.

5.  PREVENTING SPREAD OF INFECTION:  The facility must require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice. . . the facility failed to ensure staff washed their hands or changed gloves between handling soiled items and providing direct care to Residents #6, #10 and #18. . . Page 37.

6.  LABORATORY SERVICES:   The facility must provide or obtain laboratory services to meet the needs of its residents. . .  the facility failed to ensure laboratory services were provided as ordered by the physician for Residents #3, #5 and #6. . .   Page 41.

Inspection on 4/27/07 (8 pages)
1.  ACTIVITIES OF DAILY LIVING: . . . The facility also failed to ensure incontinent care was provided completed for Residents #3, 5 and 8. . . Resident #8 . . . a. On 4/25/07 at 11:07 incontinent care was provided by CNA #3 and 4. The resident was lying on a wet incontinent pad and the bottom sheet was also wet. Incontinent care was provided to the buttocks and rectal area, the soiled incontinent pad was removed, the resident was left on the wet sheet, turned, and incontinent care continued on the front. The CNA's  failed to wash the Mons pubis and did not separate the labia. The resident's left foot which had a dressing covering a pressure sore was also lying on the part of the sheet wet with urine.   Resident #3. . . a. On 4/25/07 at 10:35 a.m., CNA’s #5 and 6 provided incontinent care for the resident. The CNA failed to separate the labia and did not wash the buttocks.  Resident #5 . . . a. On 4/25/07 at 10:53 a.m. CNA's #5 and 6 provided incontinent care for the resident. The CNA failed to separate and cleanse the labia. Pages 2-5.

2.  PRESSURE SORES: . . . the facility must ensure that. . . a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. . . the facility failed to ensure pressure relieving devices were used and/or heels were off loaded to prevent pressure for Resident #8 . . . with pressure sores.  Page 5.