Following are some of the deficiencies found during inspections of this nursing home on 1/15/09 and 4/4/08. These reports and others (1/3/08– 12 pp; 11/08/07– 5 pp; 9/13/07– 4 pp; 4/5/07– 8 pp; 3/2/07– 18 pp; 4/7/06– 22 pp) can be found at www.arknursinghomeinspectiondeficiencies.com.
Inspection on 1/15/09 (3 pages) 1. ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure incontinent care was provided. . . b. On 1/13/08 at 8:45 a.m. the resident was taken to her room to change her soiled clothing. CNAs #2 and #3 used a Stand Up Lift to raise the resident to a standing position. CNA #2 pulled the resident’s pants down and removed the resident’s incontinent brief. The brief was yellow with urine. The CNA disposed of the incontinent brief. . . and then put a clean incontinent brief on the resident. The CNAs did not provide incontinent care. Pages 1-2
2. URINARY INCONTINENCE: . . .The facility failed to ensure a back to front motion was not used during incontinent care and a clean area of the cloth was used during each wipe to prevent the potential for a urinary tract infection for Resident #10 who was incontinent. . . On 1/13/09 at 3:54 p.m., the resident was incontinent of bowel and bladder. CNA #1 cleansed the resident’s rectal area with a wet facecloth and no rinse per-wash and then turned the resident onto her back. CNA #1 cleansed the resident’s vaginal area by making repeated swipes with the facecloth from the rectal area to the vaginal area introducing feces that was on the facecloth into the vaginal area. Pages 2-3.
Inspection on 4/4/08 (32 pages) 1. QUALITY OF CARE: . . .The facility failed to ensure the correct size urinary catheter was inserted in accordance with the physician order for Resident #14. . . The failed practice resulted in immediate jeopardy, which caused . . . serious harm to . . . Resident #14, who sustained a urethral perforation which resulted in a scrotal abscess and surgical removal of the testicles. . . Pages 3-4.
2. QUALITY OF CARE: . . .The facility failed to ensure indwelling urinary catheters were secured to prevent potential dislodgement of the catheter or trauma to the urinary meatus during a transfer for Resident #11. . . The facility also failed to ensure the urinary catheter and perineal area were cleansed after incontinent bowel movements to prevent potential urinary tract infections for Residents #6 and #11. . . The facility failed to ensure urinary catheter drainage tubing was positioned off of the floor during wheelchair locomotion to prevent contamination and to minimize the potential for dislodgement of the tubing for Resident #12. . . Resident #11 . . .was incontinent of bowel and had an indwelling catheter. . . b. On 4/1/08 at 10:10 a.m., the resident was in bed. She had been incontinent of a large amount of liquid feces which had pooled underneath her on the incontinent pad. The feces covered the resident’s anterior perineal area, the proximal half of the catheter and the upper inner thighs. CNA #1 performed incontinent care and cleansed only the anal area and buttocks. The anterior perineal area and the catheter were not cleansed. CNA #1 unfastened the leg strap that secured the catheter to the resident’s thigh prior to transferring the resident to a shower chair. During the transfer, the catheter bag was lying on the floor and CNA #1 stepped on the bag and tubing causing the catheter to be pulled taut. The resident slid herself to the edge of the shower chair. RN #1 stated, “You’re fixing to fall out” and assisted the CNAs to reposition the resident back to the seat of the shower chair. The proximal half of the catheter was between the resident’s right thigh and the shower chair seat. The resident was taken to the shower room. CNA #1 performed the resident’s shower but did not reposition the catheter from under the resident’s thigh and did not perform catheter care or spread the labia and wash the anterior perineal area during the shower. . . Pages 15-17.
3. QUALITY OF CARE: . . . Resident #6 had . . . an indwelling catheter and required extensive assistance with personal hygiene. On 4/1/08 at 10:39 a.m. the resident was in bed on her back. . . The resident’s incontinent brief was removed from the front perineal area then pushed toward the buttocks. With a wet washcloth and perineal wash, CNA #4 cleansed the pubic area and underneath the resident’s abdominal folds. With the same washcloth, the CNA wiped down both sides of the groin area. The resident was then positioned onto her right side. The incontinent brief, which was soiled feces, was pushed under the resident’s right buttock and leg area by CNA #3. CNA #3 then used a wet washcloth to cleanse the left buttock and anal area. The resident was positioned on her left side and the soiled brief was removed. Without cleansing the left buttock, the perineal area or the catheter, the CNAs applied a clean brief to the resident. … Pages 17-18.
4. QUALITY OF CARE: . . .Resident #12 . . . was incontinent of bowel, had an indwelling catheter . . .On 4/2/08 at 11:01 a.m., the resident was sitting in a wheelchair with an indwelling catheter in place. The catheter drainage bag . . . tubing was resting on the floor. The resident propelled the wheelchair down the 600 Hall, past the nurses’ station, then down the 500 Hall to the therapy room. The resident passed several staff members, but no attempt was made to adjust the catheter tubing, which was dragging on the floor. On 4/2/08 at 11:33 a.m., the resident was sitting in wheelchair receiving therapy. The catheter tubing remained on the floor. On 4/2/08 at 12:00 p.m., the resident propelled the wheelchair from the therapy room to the main dining room. The catheter tubing was looped and dragging on the floor. On 4/2/08 at 1:28 p.m., the resident propelled the wheelchair out of the dining room and down the 600 Hall with the catheter tubing dragging on the floor. On 4/4/08 at 9:15 a.m., the resident was sitting in a wheelchair in his room. The catheter tubing was touching the floor. Page 16, 19-20.
