Inspection Reports for
Arbor Lake Health & Rehab, LLC

1365 Gatewood Drive, Auburn, AL, 36830

Back to Facility Profile

Deficiencies (last 3 years)

Deficiencies (over 3 years) 3 deficiencies/year

Deficiencies are regulatory findings recorded during state inspections.

17% better than Alabama average
Alabama average: 3.6 deficiencies/year

Deficiencies per year

8 6 4 2 0
2019
2022
2023

Inspection Report

Routine
Census: 74 Deficiencies: 5 Date: Aug 9, 2023

Visit Reason
Routine inspection conducted to assess compliance with regulatory standards related to resident rights, safety, dietary services, medication destruction, food safety, and facility cleanliness.

Findings
The facility was found deficient in multiple areas including use of disposable Styrofoam cups instead of reusable coffee mugs, unclean showers with mold and mildew, incomplete signatures on medication destruction sheets, improper portion sizes in meals, and multiple food safety and sanitation violations in the kitchen and storage areas. These deficiencies had the potential to affect many residents.

Deficiencies (5)
Use of disposable Styrofoam cups for serving coffee instead of reusable insulated coffee mugs.
Shower in resident's room had orange/yellow and brown discoloring, mold and mildew on shower curtain and surfaces.
Non-Controlled Medication Destruction Sheets lacked the two required signatures for two of eight months reviewed.
Facility failed to provide proper portion sizes of oatmeal (served 4 oz instead of 6 oz) and Country Fried Steak (served less than 3 oz) as per menu.
Kitchen and storage room floors were dirty; kitchen equipment had residue and grease build-up; food safety logs were incomplete or inaccurate; food and paper products were improperly stored on the floor; leftover foods were not labeled with correct Use-By dates; drawers were rusted and greasy; serving carts were dirty with food particles and debris.
Report Facts
Residents affected: 74 Insulated coffee mugs found: 19 Medication destruction sheets reviewed: 8 Portion size oatmeal: 6 Portion size oatmeal served: 4 Portion size Country Fried Steak: 3 Portion size Country Fried Steak observed: 2.25 Portions per box: 71 Dishwashing machine chlorine concentration: 50 Boxes of Canola oil: 2 Foam cups box: 1 Blue insulated mugs: 19

Employees mentioned
NameTitleContext
Assistant Director of NursingInterviewed regarding coffee cup usage and medication destruction sheet signatures.
Dietary ManagerInterviewed regarding coffee cup usage, meal portion sizes, food safety, and kitchen cleanliness.
Registered DietitianInterviewed regarding meal portion sizes and dining experience.
Certified Nursing Assistant (CNA)/Supply ClerkObserved serving coffee in Styrofoam cups and interviewed about coffee cup availability.
Maintenance DirectorInterviewed regarding mold in resident shower.
Housekeeping SupervisorInterviewed regarding shower cleanliness and mold/mildew observations.
PM Dietary AideObserved washing dishes and recording dishwashing machine data.
AM CookObserved meal preparation and interviewed about serving sizes and cleaning duties.
PM CookObserved meal portion sizes and food packaging.
District Manager for contract food serviceObserved meal portion sizes and advised on protein serving requirements.

Inspection Report

Annual Inspection
Deficiencies: 0 Date: Apr 29, 2022

Visit Reason
Annual inspection survey conducted to assess compliance with health and safety regulations at Arbor Lake Health and Rehab.

Findings
No health deficiencies were found during the inspection.

Inspection Report

Routine
Deficiencies: 4 Date: Jul 25, 2019

Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to discharge procedures and infection prevention and control practices at Arbor Lake Health and Rehab.

Findings
The facility failed to ensure a discharge summary was completed for one resident discharged on 05/02/2019. Additionally, infection control deficiencies were identified including improper glove use by nursing staff during medication and tube feeding administration, bare hand contact with resident food by a CNA, and failure to wash hands between glove changes during pericare.

Deficiencies (4)
Failure to ensure a discharge summary was completed for Resident Identifier #84 at time of discharge.
Medication nurse moved floor mat with gloves on then administered tube feeding and medications without changing gloves, risking contamination.
Certified Nursing Assistant touched resident's bun with bare hands while serving meal, risking cross contamination.
Certified Nursing Assistant did not wash hands between glove changes during pericare, risking contamination.
Report Facts
Residents Affected: 1 Residents Affected: 1 Residents Affected: 1 Residents Affected: 1

Employees mentioned
NameTitleContext
Director of NursingInterviewed regarding discharge summary for Resident Identifier #84
Licensed Practical NurseObserved and interviewed regarding improper glove use during medication and tube feeding for Resident Identifier #7
Certified Nursing AssistantObserved and interviewed regarding bare hand contact with resident food and pericare hand hygiene for Resident Identifier #60
Registered Nurse, Infection Control NurseInterviewed regarding infection control practices and glove use

Viewing

Loading inspection reports...