Arkansas Health Center

Based observation, interview, and record review, the facility failed to ensure foods stored in the freezer, refrigerator and dry storage area were covered, sealed, and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen; expired food items were promptly removed/discarded on or before the expiration or use by date to prevent the growth of bacteria; ensure cold dairy products were maintained at 41 degrees Fahrenheit or below to prevent the growth of bacteria; dietary staff washed their hands before handling clean equipment or food items to prevent the potential for cross contamination for residents who received meals from 1 of 1 kitchen. These failed practices had the potential to affect 155 residents who received meals from 1 of 1 kitchen (Total Census:157). The findings are: 1. On 02/28/24 at 09:25 AM, two opened boxes of cobbler dough sheets were on a shelf in the walk-in refrigerator. Neither box was covered or sealed. 2. On 02/28/24 at 09:29 AM, an opened gallon of soy sauce was on a shelf in the kitchen. The manufacturer…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure privacy was maintained for 1 (Resident #11) of 7 sampled residents who resided on Pine [NAME] and utilized the bathroom on their hallway; a lunch tray or substitute was served sequentially for 1 (Resident #128) of 17 sampled residents who received a meal tray on the Cedar Unit and failed to ensure Certified Nursing Assistants (CNA) were seated when providing assistance with eating for 5 (Residents #67, #150, #128, #61, and #52) of 10 sampled residents who resided on the Cedar Unit. The findings are: 1. Resident #11 had diagnoses of Epilepsy and Epileptic Syndromes with Complex Partial Seizures, Major Depressive Disorder, Anxiety Disorder, Altered Mental Status, unspecified, and Constipation. The resident received a score of 10 (8-12 indicates moderate cognitive impairment) on the Brief Interview for Mental Status (BIMS). a. On 02/26/24 at 12:40 PM, Resident #11 was observed sitting on the toilet when CNA #9 went in to assist Resident #11 with pulling up the resident's pants and putting on a new brief.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review the facility failed to ensure resident clothing was clean and maintained in a respectable manner to promote dignity and self-confidence for 1 (Resident #87) sampled resident who were dependent on staff for care, and failed to ensure residents fingernails were trimmed and cleaned to promote good hygiene for 1 (Resident #93) sampled resident who were dependent on staff for nail care. This had the potential to affect 33 residents who were dependent on staff for care The findings are: 1. Resident #87 had a diagnosis of Hemiplegia, unspecified affecting right dominant side. The Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 9-19-2023 documented a Brief Interview Mental Status (BIMS) score of 10 (8-12 indicates moderate cognitive impairment). a. On 2/26/24 at 7:26 PM, Resident #87 was wearing a t-shirt that had spots of spilled food that were white and dry. b. On 2/27/24 at 11:33 AM, Resident #87 was wearing a lightweight jacket that had spilled food on the front of it, dried on, white in color. c. On 2/28/24 at…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure smoking assessment interventions were followed for 1 (Resident #149) sampled resident. The findings are: Resident #149 had a diagnosis of Chronic obstructive pulmonary disease, unspecified. A Significant Change Minimum Data Set [MDS] with an Assessment Reference Date [ARD] of 1-9-2024 documented a Brief Interview for Mental Status (BIMS) score of 11 (8-12 indicates moderate cognitive impairment). On 02/28/24 at 09:48 AM, Resident #149 was observed outside smoking and was not wearing a smoking apron. The Care Plan with a review dated of 2/6/2024 documented Resident is at risk for injury to self and others related to smoking-must wear smoking apron and be directly supervised at ALL times . Resident must wear smoking apron and be directly supervised at ALL times . Enforce smoking restrictions. On 02/28/24 at 09:56 AM, the Surveyor asked Certified Nursing Assistant (CNA) #7, does the resident (Resident #149) require a smoking apron. CNA #7 stated, I do not know, I will have to check . On 02/28/24 at 01:33…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure and maintain their Schedule II-V medications in a permanently affixed compartment. The findings are: 1. On 2/29/2024 at 9:30 AM, on the Aspen East/West Halls the Surveyor observed the narcotic box, locked in the refrigerator, behind the locked medication room door. The narcotic box was locked, but not permanently affixed to the refrigerator that it was stored in. 2. On 2/29/24 at 2:03 PM, on the Elm Unit, Licensed Practical Nurse (LPN) #3 unlocked the refrigerator in the medication storage room and put the narcotic box on the counter. There were 7 vials of Ativan (a controlled substance) in the medication lock box. The narcotic box was not permanently affixed to the refrigerator. a. On 2/29/24 at 2:18 PM, on the [NAME] Unit, LPN #4 unlocked the refrigerator and walked out of the medication storage room with the box. LPN #4 stated, The nurse is on break, and I got to go find the key. The narcotic box was not permanently affixed to the refrigerator. b. On 2/29/24 at 2:49 PM, Registered Nurse (RN) #1…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interview, and record review, the facility failed to ensure handrolls were applied to 1 (Resident #8) of 2 sampled residents who had an order for hand rolls. The findings are: 1. Resident #8 had a diagnosis of Primary generalized (osteo)arthritis. A significant Change Minimum Data Set (MDS) with Assessment Reference Date of 1/26/24 documented functional limitations to upper and lower extremities. A Staff Interview for Mental Status (SAMS) documented the resident was moderately cognitively impaired. A Care Plan with review date of 2/5/24 documented, .Bilateral Hand Rolls at all times as resident will Tolerate/Allow with the Exception of During Bathing Times . On 02/29/24 at 10:58 AM, Resident #8 was in the sitting room with no hand rolls in the resident's hands. On 2/29/24 at 11:00 AM, the Surveyor asked Registered Nurse (RN) #1 if Resident #8 was supposed to have hand rolls in place. RN #1 stated, Sometimes [the resident] will allow them and sometimes [the resident] will refuse. Also, [the resident] will open his/her hands up and let them fall out. The…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review and interview, the facility failed to ensure foods stored in a dry storage area was covered to minimize the potential for cross contamination for residents who received meals from 1 of 1 kitchen; expired snacks were promptly removed/ discarded on or before the expiration or use by date to prevent the growth of bacteria; dietary staff washed their hands between dirty and clean tasks and before handling clean equipment or food items to prevent potential for cross contamination. These failed practices had the potential to affect 174 residents who received meals from the kitchen (total census: 184) as documented on a list provided by the Registered Dietitian. The findings are: 1.The following items were observed uncovered or expired: a. On 11/14/22 at 10:08 AM, An opened box was on a cart in the kitchen. The box was not covered. b. On 11/15/22 at 10:12 AM, A box that contained 15 bags of assorted chips in a cabinet on [named unit] had an expiration date of 9/2022. 2. The following observations were made in the kitchen: a. On 11/14/22 at 10:19 AM,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to complete a Significant Change in Status Minimum Data Set (MDS) within 14 days of determining a decline in Activities of Daily Living (ADLs) for 1 (Resident #180) of 8 (R #10, R #17, R #20, R #46, R #54, R #123, R #152, and R #180) sampled residents. This failed practice had the potential to affect all 65 residents that reside on [named] Unit as documented on the [named] Unit Resident Census which was provided by Licensed Practical Nurse (LPN) #2 on 11/14/22 at 10:05 AM. The findings are: Resident #180 had a diagnosis of Bipolar and Vascular Dementia. The Quarterly MDS with an Assessment Reference Date (ARD) of 10/19/22 documented Resident #180 scored a 6 on a Brief Interview for Mental Status (BIMS) (0-6 Indicates Severely Cognitively Impaired) and required total dependence with toileting and eating and extensive assistance with transfers and bed mobility. 1. Chart review on 11/16/22, showed the most current Significant Change in Status MDS was dated 11/16/22. 2. On 11/16/22 review of the October 2019 Resident Assessment…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to ensure resident's fingernails were cleaned and trimmed to promote good personal hygiene and grooming for 1 resident (R #3) of 6 (R #3, R #16, R #20, R #48, R #104, and R #158) sampled residents on the unit who were dependent for nail care. The findings are: 1.Resident #3 had diagnoses of Cerebral Palsy, Non-Alzheimer's Dementia and Parkinson's Disease. An Annual MDS (Minimum Data Set) with ARD (Assessment Reference Date) of 09/08/2022 documented a BIMS (Brief Interview for Mental Status) of 10 (8-12 indicates moderately impaired), total assistance of two people required for bathing and extensive assistance of one person required for personal hygiene. a. On 11/14/22 at 10:28 AM, Resident #3 was sitting up in a wheelchair in the day room. She had her hands hanging down on both sides of the chair. The fingernails on each hand were greater than ¼ inch past her fingertips. The nails on her 3rd [third] and 4th [fourth] finger of her right hand and the thumb and 3rd finger of her left hand were jagged and rough. b. On…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on Observation, Interview and Record review the facility failed to ensure that 1 resident (Resident #17) was repositioned, range of motion preformed, and incontinent care provided while up in wheelchair. This failed practice had the potential to affect 4 (R #17, R #25, R #26, and R #36) residents that resided on the (named East and West) Units who were totally dependent on staff for ADL's (Activities of Daily Living) as indicated on a list provided by the Director of Nursing (DON) on 11/17/22 at 8:58 AM. The findings are: 1. Resident # 17 had diagnoses of Profound intellectual Disabilities, generalized Idiopathic Epilepsy and Epileptic Syndromes, not Intractable, without status Epilepticus, Unspecified mental disorder due to known physiological condition. The Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 10/12/22 showed the resident scored a 00 (00 indicated a severe cognitive deficit) on the Brief Interview of Mental Status (BIMS), the resident was totally dependent for toileting and eating and required extensive assistance for transfers and bed mobility.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview the facility failed to ensure indwelling catheter drainage bags were kept below the level of the bladder to prevent potential infection risk and secured to prevent pulling and potential for meatal injury for one resident (Resident #61) of three sample residents (Resident #51, #61, #71) reviewed. This failed practice had the potential to affect three residents who had catheters according to a list provided by the Director of Nursing (DON) on 11/17/22 at 8:10 AM. The findings are: 1. Resident #61 was admitted to the facility on [DATE] with Diagnoses of Urinary Retention, Schizoaffective Disorder Bipolar Type, and Personal History of Urinary Tract Infections. A Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 08/03/22 documented the resident was moderately impaired in cognitive skills for daily decision making per a Staff Assessment for Mental Status (SAMS). a. On 11/14/22 at 10:37 AM, Resident #61 was lying in bed with eyes closed, the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.