Following are some of the deficiencies found during inspections of this nursing home on 1/14/09, 7/7/08, 2/8/08, 10/12/07, 3/30/07 and 5/26/06. These and one dated 3/19/08 - 3 pp, can be found at www.arknursinghomeinspectiondeficiencies.com
Inspection on 1/14/09 (18 pages) 1. QUALITY OF CARE: . . . the facility failed to ensure the labia was separated and cleaned during Foley catheter care to prevent the potential for urinary tract infections (UTI) for Resident #10 . . . A Physician Order dated 12/11/08 documented, “Routine Foley cath care, cleanse q (every) shift with soap & (and) water.” b. The Resident Care Plan dated 12/16/08 documented, “Potential for urinary tract infection due to presence of indwelling catheter with poor kidney function. h/o (history of) urinary retention and UTI . . . Use proper hygiene practices.” c. A Physician telephone order dated 12/29/08 documented, “Levaquin 500 mg (milligrams) 1 po (by mouth) qd (every day) x (times) 3 days for UTI.” d. A hospital History and Physical /Medical Consultation dated 12/30/08 documented, “67 year old female admitted with hematuria, UTI.” e. A Physician Order dated 1/5/09 documented, “Admit to . . [facility] . . DX (diagnosis) UTI… Cipro 500 mg BID (twice daily) x 7 days /UTI ([1] po).” On 12/11/08 Resident #10 had an indwelling catheter and a UTI in the last 30 days. . . f. On 1/12/09 at 9:45 a.m., . . . CNA #1 . . . cleansed the catheter from the point that it was visible on the outside of the labia but did not separate the labia to begin cleansing at the catheter insertion area. Pages 1-2.
Inspection on 7/7/08 (2 pages) 1. LABORATORY SERVICES:… the facility failed to ensure laboratory tests . . . were conducted in a timely manner for [a] resident who received Coumadin therapy and had physician’s orders for monitoring Prothombin Time and International Normalized Ratio’s. Page 1.
Inspection on 2/8/08 (28 pages) 1. QUALITY OF CARE:… the facility failed to ensure necessary care and services to prevent potential urinary tract infections and to restore bladder function were provided to Resident #11 . . . with [an] indwelling urinary catheter in use. . . as evidenced by failure to remove the indwelling catheter when there was no longer a medical justification for its use. . . Resident #11 was admitted to the facility on 12/19/07 . . . The initial Minimum Data Set (MDS) dated 12/26/07 documented the resident . . . had . . . an indwelling catheter. d. On 2/5/08 at 9:00 a.m., the resident was asked why he had a urinary catheter. He pointed to his right knee. When asked if he still had a pressure sore on his coccyx, the resident stated, “No, the only sore I have is on my leg from a brace rubbing it.” e. On 2/7/08 at 1:00 p.m., Licensed Practical Nurse (LPN) #2 was asked if the resident still had a pressure sore to his coccyx. The LPN stated, “No, the only treatment he gets now is on his leg.” When asked if she [LPN] was aware of why the resident still had a urinary catheter in place, the LPN stated, “No, he was admitted with it is all I know.” Pages 5-7.
2. SANITARY CONDITIONS – FOOD PREP & SERVICE: . . . the facility . . . failed to ensure the ice scoop holder was free of debris and failed to ensure Dietary Employees washed their hands between dirty and clean tasks. Pages 19-20.
Inspection on 10/12/07 (28 pages) 1. QUALITY OF CARE: . . . the facility failed to ensure that therapeutic levels of anticoagulation therapy were monitored for Resident #1. . . This failed practice resulted in immediate jeopardy for Resident #1 when her Coumadin levels exceeded therapeutic levels resulting in hospitalization for acute blood loss. . . i. The Nurse’s Notes dated 9/25/07 documented: 1) 9:26 a.m.: “Res (resident) noted to have vaginal & (and) nose bleeding medium amt (amount) bright red, pressure applied to nose approx (approximately) 5 min (minutes) 0 (zero) nose bleeding noted. . . MD (Medical Doctor) notified, awaiting further orders. Cont (continue) to observe.” k. The Nurse’s Notes dated 9/25/07 documented: . . . 2) 5:05 p.m.: “Res c/o SOB and ‘something isn’t right, don’t leave me by myself’ . . . Blood noted to nose. Bloody sore approx 2cm (centimeter) to inside (R) [right hip]. . . (hospital) called to page on call MD. Awaiting (doctor) call.” 5:10 p.m. and 5:35 p.m.: “Attempted to call on call doctor.” 5:50 p.m.: “Resident transferred to hospital per family request.” . . . The hospital . . . “Assessment: 1. Coagulapathy related to Coumadin. 2. Acute blood loss anemia both vaginal and nasal.” . . . On 10/11/07 at 8:35 a.m. the daughter of Resident #1 . . . stated, “They called (facility) to say she (Resident #1) was bleeding from her nose and vagina. They sent her to the ER and the doctor said she was bleeding internally but didn’t know from where. She was put on a ventilator on the next day. Dr. (Physician) said he had ordered lab to check her Coumadin at the facility and that they had forgotten it.” . . . The physician stated, “ . . . I did one lab, got the results and ordered another lab . . . and that one wasn’t done as ordered. The next call I got (9/25/07) was that she was bleeding from her nose and vaginally. She had pulmonary hemorrhage as well and was intubated at the hospital. If not for this bleeding, she would have been OK.” Pages 1-6.
Inspection on 3/30/07 (10 pages) 1. ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure the urethral area, scrotum and inner thighs were not cleaned during incontinent care for . . . Resident #5 . . . Pages 2-3.
Inspection 5/26/06 (29 pages) 1. ACTIVITIES OF DAILY LIVING: . . . the facility failed to ensure personal hygiene was provided for Resident #1, #2, #4, #6, #8 and #9 who were incontinent and required assistance with Activities of Daily Living. Page 10.
