Following are some of the deficiencies found during inspections of this nursing home on 9/12/08.  This report and another (10/31/08 – 8 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.

Inspection on 9/12/08 (208 pages)
1.  STAFF TREATMENT OF RESIDENTS: . . . the facility failed to ensure . . . the reporting and investigation of a bruise of unknown origin for Resident #2.  Page 8.

2.  HOUSEKEEPING/MAINTENANCE: . . . the facility failed to ensure food was not left in the floor for an extended period of time for Resident #18 . . . the environment was free of strong urine odors, missing and broken window blinds were replaced, paint was not peeling on walls, the laundry entrance and ice machine were free of mold . . . 1. On 9/8/08 at 1:30 p.m. and 5:45 p.m. and on 9/9/08 at 7:35 a.m. and 8:53 a.m., Resident Room #15 had a strong, stale urine-like odor. . . Resident #18:. . . b. On 9/11/08 at 9:49 a.m., the resident was sitting in a chair next to the door in her room.  There were large food particles and bread crumbs from the breakfast meal [that had been served at 7:30 a.m.] on the floor surrounding the resident’s feet.  There were two brown soft-formed balls of bowel movement on the floor between the resident’s feet and the bedside commode, next to the resident’s chair.  There were 4 flies in the room on the floor.  Pages 21-23.

3.  COMPREHENSIVE CARE PLAN:. . . the facility failed to ensure plans of care were developed or implemented to ensure appropriate care was provided for Residents #2, #3, #4, #6, #7 and #15. . . This failed practice resulted in actual harm to Resident #6 who had a diagnosis of seizure disorder and developed a pressure sore that deteriorated to a stage IV. . . Pages 25-26.

4.  QUALITY OF CARE: . . .the facility failed to ensure treatment was promptly obtained for a urinary tract infection for Resident #8. . .  Page 43.

5.  ACTIVITIES OF DAILY LIVING: . . .the facility failed to ensure all soiled areas were cleansed completely and back to front wiping motions were used during incontinent care for Residents #1, #2, #3, #4, #5, #16 and #18 . . . and all areas of the body were cleansed during bathing for Resident #2, #3 and #8 . . .Resident #4. . . On 9/9/08 at 2:20 p.m., CNA #10 and CNA #11 provided incontinent care for the resident, after she had been incontinent of bowel and bladder.  CNA #10 did not clean the labial area.  The CNAs had a clean adult brief on the resident, at which time CNA #10 was asked by the surveyor to please wipe the labial area.  When the CNA  wiped down the area, the wash cloth had feces on it when brought out to fold.  Resident #2: . . . b.  On 9/9/08 at 8:55 a.m., CNA #7 and CNA #8 provided personal care and bathed the resident.  The CNAs did not cleanse and rinse the resident’s arms, hands, fingers, breast, abdomen, legs, feet, toes, right buttock or back.  CNA #7 did not separate the labial folds to cleanse the inner labia and urinary meatus.  Resident #18: . . . On 9/11/08 at 3:50 p.m., there was yellow liquid on the floor in front of the resident and a urine odor in the room.  The resident’s left shoe was wet.  CNA #9 removed the resident’s dress, then stood the resident from the chair next to the door.  With a disposable wipe, the CNA then wiped the resident’s right groin front to back, folded the wipe and wiped the left groin, folded the wipe again and then wiped down the center of the outer labia.  The resident continued to stand while the CNA changed gloves; the CNA then wiped the resident’s rectum and folded the cloth and wiped again across the rectum.  The buttocks were not cleaned and the labial folds not separated and cleansed.  The resident remained in a standing position throughout the peri care.  No brief was placed on the resident.  Resident #1: . . . On 9/8/08 at 2:10 p.m., the resident was observed receiving incontinent care, provided by CNA #3.  The resident’s mons pubis was not washed nor was the labia separated and washed.  The rectal area was not washed.  Resident #3: . . . a. On 9/9/08 at 10:30 a.m. the resident was observed receiving a bed bath, provided by CNA #2, with CNA #6 assisting . . . While washing the frontal areas there was feces on the washcloth.  When the resident was turned, there was a moderate amount of stool.  CNA #5 was ready to put the resident’s clean brief on, but was then asked by the surveyor if she could wipe the groin areas again, she did and the resident still had feces on the cloth from these areas. . . Resident #8. . . On 9/9/08 at 9:00 a.m., the resident was observed receiving a bed bath given by CNA #2 with CNA #6 assisting.  The resident’s back and the back of the resident’s thighs were not washed during the bath.  Pages 44-52.

6.  PRESSURE SORES: . . the facility failed to ensure pressure relief devices were provided as ordered by the physician, a nutritional assessment addressed the presence of skin breakdown and interventions were developed based on that assessment and implemented to decrease the potential for further breakdown and promote healing for Resident #6, skin breakdown was promptly reported and treatment obtained to promote healing for Resident #15, turning and repositioning was implemented timely to prevent the reoccurrence of pressure sores for Resident  #3 . . .  This failed practice resulted in actual harm for Resident #6 who experienced a decline in the condition of the pressure ulcer . . .. Page 53.

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 18%. . . Pages 86-87.

8.  INFECTION CONTROL: . . . the facility failed to ensure that sanitary precautions were followed in the use of the fasting blood sugar glucometer to prevent the spread of infection and/or cross contamination for Residents #3 and #4. . . staff changed gloves before touching or handling other objects when providing incontinent care for Residents #4, #6 and #16. . . Page 115.