Following are some of the deficiencies found during inspections of this nursing home on 8/13/08, 11/2/07, 1/19/07 and 12/3/06.  These reports and others (9/25/08 – 5 pages, 5/20/08 – 3 pages, 1/19/07-2 – 7 pages 5/23/06 – 6 pages, 1/12/06 – 12 pages and 8/26/05 – 2 pages) can be found at www.arknursinghomeinspectiondeficiencies.com.

Inspection on 8/13/08 (24 pages)
1.  QUALITY OF CARE:  Based on observation, record review and interview, the facility failed to ensure an indwelling Foley catheter had a diagnosis to validate the use of the catheter . . . This failed practice affected Resident #6. . . Page 4

2. URINARY INCONTINENCE: . . . Resident #4 had a diagnosis of Recurrent Urinary Tract infections.  The Significant Change Minimum Data Set dated 5/14/08 documented the resident was . . . incontinent of bowel and bladder, and required extensive assistance with . . . toilet use and personal hygiene.  a. On 8/9/08 at 3:30 p.m., CNA #1 provided incontinent care after being incontinent of bowel and bladder.  The CNA used a peri wipe to cleanse the groin areas and wiped from back to front, cleansed the head of the penis in a circular direction and across the urinary meatus without replacing or turning the peri wipe.  CNA #1 did not cleanse the entire buttocks area.  b. On 8/9/08 at 3:45 p.m. CNA #1 . . . stated, “I didn’t clean the entire buttocks and I wiped the wrong direction.”  c. On 8/10/08, a review of the resident’s chart revealed the resident had 13 urinary tract infections from 1/4/08 through 8/5/08.  Pages 7-8.
 
3.  NUTRITION: . .  the facility failed to ensure . . . a resident with severe tremors received assistance to consume adequate nutritional intake for Resident #4 . . . who experienced a significant, unplanned weight loss.  Page 10.

Inspection on 11/2/07  (23 pages)
1.  PRESSURE SORES: . . the facility failed to ensure that incontinent care was provided in a timely manner and the skin was cleansed of urine/feces to prevent the potential for skin breakdown for Residents #2 and #7. Page 6.

2.  SANITARY CONDITIONS – FOOD PREP & SERVICE: . . .  the facility failed to ensure the ice machines were free of debris to prevent cross contamination and dietary staff washed their hands between dirty and clean tasks . . . the a. ice machine located in the kitchen . . . had slimy reddish matter on the panel where ice shoots down to the collector bucket.  b. The ice machine, located in the dining room . . . had reddish matter inside the spout where ice shoots down.  Pages 14-15.

Inspection on 1/19/07  (7 pages)
1.  COMPREHENSIVE CARE PLAN:. . . the facility failed to ensure that Lantiseptic cream was applied to the buttocks after an incontinent episode for Resident #5 who had a physician order to apply Lantiseptic cream to the buttocks after an incontinent episode.  Page 2.  

Inspection on 12/3/06  (186 pages)
1. STAFF TREATMENT OF RESIDENTS: . . . the facility failed ensure allegations of physical, verbal, and/or mental abuse were reported to Office of Long Term Care and other State agencies . . ., were thoroughly investigated, and residents were protected from further incidents for Residents #2, #5 and #19 who had allegations of abuse.  Page 13.
 
2.  QUALITY OF CARE: . . .  the facility failed to ensure the areas of the wash cloth was changed after each stroke during catheter care in order to decrease the risk of infection for Resident #1.  Page 54.
 
3.  PRESSURE SORES: . . the facility failed to ensure the pressure sore dressing was wrapped in such a manner to prevent swelling of the foot and positioning devices were used between bony prominences for Resident #1 . . . who had multiple pressure ulcers.  Page 61.

4.   NASO-GASTRIC TUBES:. . . the facility failed to ensure the head of the bed was maintained at 45 degrees for Resident #22 . . . who had a feeding tube.  The facility failed to ensure the feeding tube was flushed before administration of medications for Residents #2 and #19 . . . The facility failed to ensure a continuous feeding was not stopped for Resident #19 . . . The facility failed to ensure the feeding tube tubing was capped when disconnected from the feeding tube for Residents #1 and #8 . . . The facility failed to ensure feeding
pumps were turned off by trained staff for Resident #1.  Page 69.
 
5.  ACCIDENTS: . . .  the facility failed to ensure 2 persons were used when transferring Resident #19 . . This . . . resulted in actual harm to Resident #19 who had a left hip fracture . . .  Page 80.
 
6.  NUTRITION: . . the facility failed to ensure nutritional interventions . . . for Resident #3 who experienced a significant weight loss.  Page 83.

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 21.56%. . .  Pages 92-93.

8.  SANITARY CONDITIONS – FOOD PREP & SERVICE: . . . the facility failed to ensure food stored in the refrigerator and freezer area were covered or sealed to prevent the potential for cross contamination and freezer burn; employees washed hands between changing gloves, handling dirty tray cards and clean dishes; the ice machine was free of debris. . .  Pages 112-113.

9. FREQUENCY OF PHYSICIANS VISITS:  the facility failed to ensure the physician visited residents at least every 60 days. . .  Page 119.

10.  PHARMACY SERVICES – SERVICE CONSULTATION: . . .  the facility failed to employ a licensed pharmacist for consultation services. . . Page 131.

11.   PHYSICAL ENVIRONMENT – PEST CONTROL: . . . the facility failed to ensure that there were no flies in the facility.  Page 154.