Deficiencies (last 3 years)
Deficiencies (over 3 years)
5.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
2% worse than Arkansas average
Arkansas average: 5.2 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Jan 9, 2025
Visit Reason
The inspection was conducted due to complaints and incidents involving resident safety, including burns from hot liquids, unsafe transfers, and failure to follow care plans regarding choking hazards.
Complaint Details
The complaint investigation substantiated immediate jeopardy related to failure to follow care plans and safety protocols, including burns from hot liquids and unsafe transfers. The immediate jeopardy was removed after the facility implemented a removal plan including staff in-service, signage, and monitoring.
Findings
The facility failed to follow care plans and safety protocols resulting in immediate jeopardy to resident health, including a resident burned by hot coffee heated in a microwave, unsafe mechanical lift transfers causing falls, failure to use gait belts during transfers, and failure to follow no-straw orders for a resident with swallowing difficulties. The immediate jeopardy was removed after corrective actions were implemented.
Deficiencies (4)
Failure to monitor temperature of hot liquids resulting in burns to Resident #60.
Failure to safely transfer residents #62 and #81 using mechanical lifts, resulting in falls.
Failure to use gait belt properly for safe transfer of Resident #148, resulting in a fall.
Failure to follow care plan intervention of no straws for Resident #300, posing choking hazard.
Report Facts
Staff in-service signatories: 46
Staff interviews: 20
Fall injuries: 3
MDS BIMS score: 9
MDS BIMS score: 11
MDS BIMS score: 7
MDS BIMS score: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nursing Assistant | Heated coffee in microwave for Resident #60 causing burns. |
| CNA #5 | Certified Nursing Assistant | Failed to secure lift sling loops causing Resident #62 to fall; failed to use gait belt during transfer of Resident #148 causing fall. |
| Administrator | Notified of immediate jeopardy, initiated removal plan and staff in-service. | |
| Registered Nurse Consultant | RN Consultant | Notified of immediate jeopardy. |
| CNA #2 | Certified Nursing Assistant | Confirmed failure to follow no straw order for Resident #300. |
| CNA #3 | Certified Nursing Assistant | Confirmed importance of no straw order for Resident #300. |
| Assistant Dietary Manager | ADM | Confirmed dietary staff responsible for providing straws; CNAs distribute straws. |
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Jan 9, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, care plan implementation, and food safety in the facility.
Findings
The facility was found deficient in accurately assessing a resident's dental status, implementing resident care plans related to visual devices and dysphagia precautions, and maintaining proper food safety and hand hygiene practices in the kitchen.
Deficiencies (3)
Failed to accurately assess a resident's dental status for one resident.
Failed to implement care plans ensuring visual devices were utilized and no straws were given to residents with dysphagia.
Failed to ensure food items were labeled with received dates, stored properly, and hand hygiene was performed during food preparation and serving.
Report Facts
Residents affected: 1
Residents affected: 2
Meals observed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #4 | LTC MDS Coordinator | Named in relation to dental status assessment deficiency |
| Certified Nursing Assistant #2 | CNA | Confirmed non-compliance with care plan for Resident #300 |
| Certified Nursing Assistant #3 | CNA | Confirmed non-compliance with care plan for Resident #300 |
| Assistant Dietary Manager | ADM | Named in relation to food safety and hand hygiene deficiencies |
| Dietary Aide #7 | Dietary Aide | Named in relation to hand hygiene deficiencies |
| Dietary Aide #8 | Dietary Aide | Named in relation to hand hygiene deficiencies |
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Dec 1, 2023
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident safety, environment, medication management, and dietary preferences at Apple Creek Health and Rehab, LLC.
Findings
The facility was found deficient in multiple areas including failure to maintain resident wheelchairs and bed linens in good condition, inadequate storage of hazardous hygiene products, presence of expired medications in storage and medication carts, and failure to consistently provide resident dietary preferences such as fluids. Several staff interviews confirmed lack of policies and inconsistent practices.
Deficiencies (5)
Failure to ensure resident's wheelchair was in good useable condition for Resident #74.
Failure to ensure bed linen was maintained and in good condition for Resident #45.
Failure to ensure the resident's environment was free of accident hazards due to unsecured potentially hazardous hygiene products for Residents #49 and #82.
Failure to ensure expired medications were removed from Medication Storage room and Medication Cart for the 100 and 200 Halls.
Failure to ensure resident dietary preferences were consistently made available to promote good fluid intake for Resident #3.
Report Facts
Medication expiration date: 2023
Medication tablets: 6
Denture tablets: 8
Juice amount: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #1 | CNA | Mentioned in relation to dietary preference deficiency for Resident #3 |
| Certified Nursing Assistant #2 | CNA | Mentioned in relation to wheelchair maintenance reporting |
| Certified Nursing Assistant #3 | CNA | Mentioned in relation to wheelchair condition and hazardous items storage |
| Licensed Practical Nurse #1 | LPN | Mentioned in relation to dietary preference deficiency for Resident #3 |
| Licensed Practical Nurse #2 | LPN | Mentioned in relation to medication storage and sheet changing |
| Licensed Practical Nurse #3 | LPN | Mentioned in relation to medication storage |
| Director of Nursing | DON | Mentioned in relation to wheelchair maintenance, hazardous items storage, and medication disposal |
| Administrator | Administrator | Mentioned in relation to facility policies and dietary preferences |
| Dietary Manager #1 | DM | Mentioned in relation to dietary preference deficiency for Resident #3 |
| Maintenance Supervisor | MS | Mentioned in relation to wheelchair maintenance reporting |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jul 6, 2023
Visit Reason
The inspection was conducted due to a complaint regarding failure to ensure two staff members were present when transferring a resident who requires two-person assistance, which resulted in a resident injury.
Complaint Details
The complaint investigation found that Resident #1 was transferred by one staff member instead of two as required, causing a skin tear injury. The CNA admitted to transferring the resident alone and was suspended. The incident was reported to the Administrator, Director of Nursing, provider, family, and police.
Findings
The facility failed to ensure two staff members assisted Resident #1 during transfers as required by the care plan, resulting in a skin tear injury requiring sutures. Multiple staff and the Director of Nursing confirmed the resident requires two-person assistance with a gait belt for transfers. The CNA involved was suspended and corrective actions including staff training and audits were implemented.
Deficiencies (1)
Failure to ensure two staff members were present when transferring a resident requiring two-person assistance, resulting in injury.
Report Facts
Residents affected: 3
Date of injury incident: Jul 1, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant (CNA) #1 | Certified Nursing Assistant | Involved in transferring resident alone causing injury |
| Medical Technician #1 | Medical Technician | Interviewed regarding transfer requirements |
| Licensed Practical Nurse (LPN) #1 | Licensed Practical Nurse | Interviewed regarding transfer requirements and assessments |
| Licensed Practical Nurse (LPN) #2 | Licensed Practical Nurse | Interviewed regarding transfer requirements |
| Director of Nursing | Director of Nursing | Interviewed regarding transfer requirements and facility policy |
| Administrator | Administrator | Interviewed and involved in incident notification and corrective actions |
Inspection Report
Routine
Census: 74
Deficiencies: 3
Date: Aug 25, 2022
Visit Reason
The inspection was conducted to evaluate the facility's compliance with food preparation, storage, and safety standards to ensure resident safety and proper nutrition.
Findings
The facility failed to ensure pureed food items were blended to a smooth, lump-free consistency, failed to maintain proper food storage and sanitation practices including expired and uncovered food items, and did not maintain hot food items at safe temperatures, posing potential risks of choking, foodborne illness, and contamination to residents.
Deficiencies (3)
Pureed food items were not blended to a smooth, lump-free consistency for residents requiring pureed diets.
Food items stored in the refrigerator were not covered or sealed, expired food items were not promptly removed, leftover food items were improperly used, and the ice machine was not maintained in a clean and sanitary condition.
Hot food items on the steam table were not maintained at or above 135 degrees Fahrenheit, with temperatures recorded as low as 94 degrees Fahrenheit.
Report Facts
Residents affected: 2
Residents affected: 73
Census: 74
Temperature: 118
Temperature: 123
Temperature: 94
Count: 11
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Employee #1 | Observed preparing pureed food and responding about leftover food usage | |
| Dietary Employee #2 | Observed preparing pureed food and responding about reheating food items | |
| Dietary Employee #3 | Described consistency of pureed chicken spaghetti and bread | |
| Certified Nursing Assistant #1 | Described consistency of pureed food items served | |
| Certified Nursing Assistant #2 | Described consistency of pureed food items served | |
| Dietary Supervisor | Provided information on diet list and leftover food usage, cleaned ice machine panel |
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