Inspection Reports for
Katherines Place at Wedington
4405 West Persimmon Street, Fayetteville, AR, 72704
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
5.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
12% worse than Arkansas average
Arkansas average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
94 residents
Based on a May 2023 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Occupancy over time
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Apr 18, 2025
Visit Reason
The inspection was conducted due to an allegation of verbal abuse reported by Resident #5 during a bed bath on 04/08/2025.
Complaint Details
The complaint involved an allegation of verbal abuse by a CNA toward Resident #5 during a bed bath on 04/08/2025. The allegation was reported to the Administrator in Training on the same day but was not reported to the State Licensing Agency as required. Investigations by the DON and Administrator found no verbal abuse occurred. The resident's statements changed from 'big back' to 'fat ass' during the investigation. The complaint was ultimately not substantiated as abuse.
Findings
The facility failed to report the alleged verbal abuse incident to the State Licensing Agency within the required timeframe. After investigation, including interviews with staff and the resident, the Director of Nursing concluded there was no verbal abuse as the staff were conversing about family members and not the resident. The allegation was initially reported late and the resident's description of the incident changed over time.
Deficiencies (1)
Failure to timely report suspected abuse to the State Licensing Agency.
Report Facts
Residents reviewed for abuse: 5
Assessment Reference Date: Apr 13, 2025
Brief Interview of Mental Status (BIMS) score: 14
Date of incident: Apr 8, 2025
Date of interviews: Apr 17, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nursing Assistant | Named in verbal abuse allegation and investigation |
| CNA #2 | Certified Nursing Assistant | Witness and involved in investigation of verbal abuse allegation |
| Director of Nursing | Director of Nursing (DON) | Conducted follow-up investigation and concluded no verbal abuse |
| Administrator | Administrator | Oversaw reporting and investigation of abuse allegation |
| Administrator in Training | Administrator in Training (AIT) | Received initial report of abuse allegation and participated in investigation |
Inspection Report
Routine
Deficiencies: 10
Date: May 16, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, medication management, infection control, and facility operations at Katherine's Place at Wedington.
Findings
The facility was found deficient in multiple areas including failure to notify residents or representatives of bed hold after hospital transfers, incomplete care plans for high-risk medications and oxygen use, failure to revise care plans timely, improper wound care practices, failure to follow physician orders for wound care and oxygen equipment maintenance, inadequate medication regimen reviews, improper food handling and meal service practices, and lapses in infection prevention and control including hand hygiene during wound care.
Deficiencies (10)
Failed to ensure bed hold notification was sent to resident or representative following hospital transfer.
Failed to initiate care plan interventions for oxygen usage and high-risk medications for 3 residents.
Failed to revise resident care plans to reflect current physician orders for 3 residents.
Failed to follow physician's orders for wound care during dressing changes for 2 residents.
Failed to ensure physician's orders were followed for changing oxygen tubing and humidifier bottle for 1 resident.
Failed to ensure monthly medication regimen review was completed for 1 resident.
Failed to serve meals at safe temperatures and maintain palatability for residents receiving meal trays.
Failed to ensure pureed food items were blended to a smooth, lump-free consistency for residents on pureed diets.
Failed to ensure dietary staff washed hands and changed gloves before handling food items, risking cross contamination.
Failed to perform proper hand hygiene before and during wound care to maintain aseptic technique and prevent cross contamination for 2 residents.
Report Facts
Residents affected: 1
Residents affected: 3
Residents affected: 2
Residents affected: 1
Residents affected: 1
Residents affected: 9
Residents affected: 103
Residents affected: 104
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #2 | LPN | Named in wound care and hand hygiene deficiencies |
| Licensed Practical Nurse #3 | LPN | Confirmed medication care plan deficiencies |
| Registered Nurse #1 | RN | Observed oxygen care deficiencies |
| Director of Nursing | DON | Interviewed regarding multiple care plan, medication, and infection control deficiencies |
| Business Office Manager | BOM | Confirmed bed hold notification deficiency |
| Dietary Employee #1 | Dietary Staff | Observed preparing pureed food with improper consistency |
| Dietary Employee #2 | Dietary Staff | Observed handling food without proper hand hygiene |
| Dietary Employee #3 | Dietary Staff | Observed handling food without proper hand hygiene |
| Dietary Employee #4 | Dietary Staff | Observed handling food without proper hand hygiene |
Inspection Report
Routine
Census: 94
Deficiencies: 9
Date: May 18, 2023
Visit Reason
The inspection was a routine survey conducted to assess compliance with regulatory requirements for nursing home care, including resident rights, care plans, hygiene, infection control, food safety, and staff vaccination status.
Findings
The facility was found deficient in multiple areas including call light accessibility, confidentiality breaches during shift change, residents' personal property accessibility, care plan implementation, personal hygiene and grooming, food safety and sanitation, infection prevention practices, COVID-19 staff vaccination compliance, and pest control in the kitchen.
Deficiencies (9)
Failed to ensure call lights were within reach for residents to call for assistance.
Failed to maintain confidentiality of residents' personal and medical information during shift change.
Failed to allow residents to have personal property within reach to create a homelike environment.
Failed to ensure care plans were implemented and accessible to staff responsible for interventions.
Failed to ensure residents' fingernails were cleaned and trimmed and shaving/beard trimming services were regularly provided.
Failed to ensure food items were dated, kitchen appliances were clean, and staff washed hands properly to prevent cross contamination.
Failed to properly store and label residents' toothbrushes to prevent infection.
Failed to ensure all staff were fully vaccinated against COVID-19 and failed to submit vaccination data timely.
Failed to maintain a pest control program that effectively prevented pests in the kitchen.
Report Facts
Residents affected by call light deficiency: 77
Residents affected by confidentiality breach: 16
Residents affected by personal property accessibility issue: 94
Residents affected by care plan implementation deficiency: 1
Residents affected by hygiene and grooming deficiencies: 90
Residents affected by shaving and beard trimming deficiencies: 39
Total census: 94
Staff partially vaccinated: 3
Staff worked without full vaccination: 2
Residents tested positive for COVID-19 since 09/15/22: 18
Staff tested positive for COVID-19 since 09/15/22: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #1 | Assisted with call light placement for Resident #145 | |
| Certified Nursing Assistant #9 | Discussed personal property policy and shaving/nail care process | |
| Certified Nursing Assistant #8 | Discussed toothbrush storage and labeling | |
| Certified Nursing Assistant #2 | Described meal tray verification process | |
| Dietary Consultant | Described dietary staff meal tray verification | |
| Director of Nursing | DON | Provided information on call light policy, care plans, and resident care |
| Administrator | Provided grievance logs, policies, and COVID-19 vaccination information | |
| Licensed Practical Nurse #1 | LPN | Commented on toothbrush storage |
| Licensed Practical Nurse #2 | LPN | Described fingernail condition and care for Resident #346 |
| Assistant Director of Nursing | ADON | Provided matrix of residents affected and timesheets for staff vaccination |
| Dietary Supervisor | Provided food safety policy and observed kitchen conditions |
Inspection Report
Annual Inspection
Census: 87
Deficiencies: 3
Date: Jan 7, 2022
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident safety, medication management, and food safety in the nursing home.
Findings
The facility was found deficient in conducting timely and accurate elopement risk assessments for a resident at risk of wandering, storing employee food in medication refrigerators, maintaining medication carts free of expired medications, and ensuring proper food storage and sanitation in the kitchen and freezer areas. These deficiencies posed minimal harm or potential for actual harm to residents.
Deficiencies (3)
Failed to ensure elopement risk assessments were conducted and documented at least quarterly and as needed for a resident at risk for elopement.
Failed to ensure employee food and drink were not stored in medication refrigerators and expired medications were removed from medication carts.
Failed to ensure food items stored in the kitchen and freezer were sealed or covered, expired food items were promptly removed or discarded, and kitchen equipment and ice scoop holders were maintained in clean condition.
Report Facts
Elopement risk score: 9
Elopement risk score: 7
Expired medication: 1
Expired medication: 1
Resident census: 87
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #3 | Licensed Practical Nurse | Provided statement regarding resident's exit-seeking behavior |
| Assistant Director of Nursing | Assistant Director of Nursing | Signed elopement risk assessment and interviewed about assessment completion |
| Licensed Practical Nurse #4 | Licensed Practical Nurse | Checked medication cart containing expired medications |
| Dietary Supervisor | Interviewed regarding food storage, cleaning practices, and expired food items | |
| Dietary Employee #1 | Observed handling of leftover food items in kitchen |
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