Inspection Reports for
Rogers Health and Rehabilitation Center
1149 W. New Hope Rd, Rogers, AR, 72758
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
10 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
92% worse than Arkansas average
Arkansas average: 5.2 deficiencies/yearDeficiencies per year
24
18
12
6
0
Occupancy
Latest occupancy rate
61% occupied
Based on a December 2023 inspection.
This facility has shown a decline in demand based on occupancy rates.
Occupancy rate over time
Inspection Report
Routine
Deficiencies: 3
Date: Jan 24, 2025
Visit Reason
The inspection was conducted to assess compliance with safety and health regulations in the nursing home, including accident prevention and food safety standards.
Findings
The facility was found deficient in ensuring mechanical lift safety procedures were followed, specifically locking rear casters during resident lifts, which could cause tipping hazards. Additionally, the kitchen environment had multiple maintenance issues such as damaged tiles, exposed wiring, and rust, and dietary staff failed to follow proper handwashing protocols before handling clean equipment.
Deficiencies (3)
Failure to ensure rear casters on mechanical lift remained unlocked during lifting a resident, risking injury or tipping.
Kitchen walls, tiles, air vents, and door frames were not maintained in good repair and sanitary condition.
Dietary staff failed to wash hands before handling clean equipment during meal service.
Report Facts
Ice cream cups: 20
Chipped kitchen floor areas: 3
Missing floor tiles: 10
Loose tiles: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #4 | CNA | Named in mechanical lift safety deficiency |
| Director of Nursing | DON | Interviewed about mechanical lift procedures and provided user manual |
| Dietary Aide #1 | DA | Observed and interviewed for improper handwashing and food handling |
| Dietary Aide #2 | DA | Observed and interviewed for improper handwashing and food handling |
| Dietary Manager | Interviewed regarding food safety and handwashing policies |
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 5
Date: Dec 1, 2023
Visit Reason
The inspection was conducted due to complaints regarding failure to follow physician's orders for medication and enteral nutrition administration, insufficient nursing staff to meet resident needs, uncertified nurse aides working beyond allowed timeframes, and lack of a designated infection preventionist.
Complaint Details
The complaint investigation substantiated issues with medication administration timing, failure to follow physician's orders for enteral feeding, insufficient nursing staff impacting resident care and call light response times, nurse aides working beyond allowed certification timeframes, and lack of a designated infection preventionist with proper certification.
Findings
The facility failed to follow physician's orders for elevating the head of bed during medication and enteral feeding for Resident #32 and failed to administer medications within the recommended time frame for Residents #29 and #37. The facility also lacked sufficient qualified nursing staff to meet resident needs timely, had nurse aides working beyond the allowed 120 days without certification, and failed to maintain a designated infection preventionist with proper certification.
Deficiencies (5)
Failure to ensure physician's orders were followed when administering medication and enteral nutrition for Resident #32, including not elevating the head of bed to 30-45 degrees.
Failure to administer medications within the recommended time frame for Residents #29 and #37.
Failure to provide enough nursing staff every day to meet the needs of every resident; delays in responding to call lights and resident care.
Failure to ensure nurse aides who have worked more than 4 months are certified; nurse aides working beyond 120 days without certification.
Failure to maintain a designated infection preventionist responsible for the infection prevention and control program; lack of certification and unclear role.
Report Facts
Residents affected: 58
Hours worked: 1411.75
Medication administration time window: 1
Nurse aide allowed work period before certification: 120
Facility census: 58
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #3 | Licensed Practical Nurse | Named in medication administration timing deficiency |
| Licensed Practical Nurse #2 | Licensed Practical Nurse | Named in failure to elevate head of bed during enteral feeding |
| Licensed Practical Nurse #1 | Licensed Practical Nurse | Provided statements about proper positioning for enteral feeding |
| Director of Nursing | Director of Nursing | Acknowledged failure to follow physician's orders and discussed staffing and nurse aide certification |
| Administrator | Administrator | Acknowledged failure to follow physician's orders and discussed staffing and infection preventionist role |
| Nurse Aide #3 | Nurse Aide | Worked over 120 days without certification |
| Licensed Practical Nurse #5 | Licensed Practical Nurse | Identified as infection control nurse without certification |
Inspection Report
Annual Inspection
Deficiencies: 13
Date: Dec 1, 2023
Visit Reason
The inspection was an annual recertification and complaint survey conducted to assess compliance with regulatory requirements for nursing home care.
Findings
The facility was found deficient in multiple areas including failure to maintain advance directives in resident records, privacy breaches, environmental maintenance issues, inadequate personal care such as fingernail hygiene, medication administration errors, insufficient nursing staff, lack of certified nurse aides, infection control program deficiencies, and failure to ensure call lights were accessible to residents.
Deficiencies (13)
Failure to maintain Advance Directive documents readily retrievable for 4 of 18 sampled residents.
Failure to protect privacy of residents by leaving medication cart laptop unlocked and exposing PHI, and failure to provide privacy during medication administration.
Failure to maintain 3 rooms free of damage; peeling sheetrock and holes in walls.
Failure to ensure fingernails were maintained to promote good hygiene for 1 of 15 sampled residents.
Failure to follow physician's orders for medication and enteral nutrition administration for residents with PEG tubes and medication timing errors.
Failure to ensure oxygen was administered at the ordered flow rate for 1 of 9 sampled residents.
Failure to ensure sufficient qualified nursing staff were available at all times to meet resident needs in a timely manner.
Failure to ensure nurse aides became certified within 4 months of training.
Failure to ensure facility was free of significant medication errors; insulin administered despite order to hold if blood sugar below 150.
Failure to develop and implement effective QAPI plans to prevent repeated deficiencies with nail care and call light availability.
Failure to ensure laundry room was free from standing water and trash.
Failure to maintain a designated Infection Preventionist responsible for the infection prevention and control program.
Failure to ensure call light was kept within reach for 1 of 21 sampled residents.
Report Facts
Residents sampled for Advance Directive review: 18
Rooms inspected for damage: 12
Residents sampled for fingernail hygiene: 15
Residents with PEG tubes sampled for medication administration: 2
Residents sampled for oxygen administration: 9
Total residents affected by staffing shortages: 58
Days nurse aide worked without certification: 141
Insulin doses administered incorrectly: 54
QAPI monitoring frequency: 1
Standing water depth: 0.75
Rooms with peeling sheetrock: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #2 | Licensed Practical Nurse | Named in privacy breach and medication administration findings |
| LPN #3 | Licensed Practical Nurse | Named in medication administration and call light accessibility findings |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding multiple findings including advance directives, medication administration, staffing, infection control |
| Administrator | Facility Administrator | Interviewed regarding staffing, QAPI, infection control, and environmental issues |
| NA #3 | Nurse Aide | Worked over 120 days without certification |
| LPN #5 | Licensed Practical Nurse | Identified as infection control nurse without certification |
| Certified Nursing Assistant (CNA) #2 | Certified Nursing Assistant | Interviewed regarding call light accessibility |
Inspection Report
Complaint Investigation
Deficiencies: 3
Date: Sep 25, 2023
Visit Reason
The inspection was conducted following a complaint investigation related to the failure to implement individualized care plans and prevent resident accidents, including a fall incident involving Resident #2.
Complaint Details
The complaint investigation was substantiated based on interviews and record reviews showing failure to follow care plans and prevent falls, specifically involving Resident #2 who fell out of bed on 08/03/2023 due to lack of required assistance.
Findings
The facility failed to implement the individualized care plan for Resident #2, resulting in a fall when the resident rolled off the bed without the required two-person assistance. Additionally, the facility failed to maintain a sanitary environment, with issues such as black substances on vents and ceiling damage noted.
Deficiencies (3)
Failed to implement the individualized plan of care for Resident #2 requiring two staff for bed mobility.
Failed to prevent a resident from falling out of bed during a bed bath due to inadequate supervision and assistance.
Failed to provide a sanitary environment by not cleaning black substances, replacing ceiling tiles, and cleaning air vents.
Report Facts
Residents affected: 1
Residents affected: 4
Date of fall incident: Aug 3, 2023
Date of care plan: May 31, 2022
Date of in-service training: Aug 21, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant (CNA) #1 | Interviewed regarding failure to assist Resident #2 during bed mobility | |
| Administrator | Presented in-service training records related to care plan implementation | |
| Licensed Practical Nurse (LPN) #1 | Interviewed regarding facility maintenance issues and ceiling damage | |
| Licensed Practical Nurse (LPN) #2 | Interviewed regarding facility maintenance issues |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Apr 17, 2023
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to provide transportation to physician-ordered follow-up appointments for Resident #1 after hospital discharge.
Complaint Details
The complaint investigation found that Resident #1 was not transported to follow-up physician appointments scheduled after hospital discharge. The facility staff, including Social Service Directors, Assistant Director of Nursing, and Administrator, confirmed no appointments were scheduled or transportation provided. The complaint was substantiated with findings of noncompliance.
Findings
The facility failed to ensure Resident #1 was transported to scheduled follow-up physician appointments on 01/09/23 and 01/18/23, as no appointments were scheduled on the transportation calendar and staff interviews confirmed the resident was not transported. The facility policy requires arranging transportation for medically necessary visits, but this was not followed.
Deficiencies (1)
Failure to provide transportation to physician-ordered follow-up appointments for Resident #1.
Report Facts
Residents affected: 1
Follow-up appointment dates: Scheduled for 01/09/23 and 01/18/23 but not transported
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Social Service Director | Interviewed regarding scheduling and transportation of Resident #1's appointments | |
| Assistant Director of Nursing | Interviewed regarding responsibility for setting follow-up appointments | |
| Administrator | Interviewed regarding reasons for missed appointments and staff expectations |
Inspection Report
Routine
Census: 73
Deficiencies: 5
Date: Sep 2, 2022
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, assessment accuracy, hygiene, food safety, and staffing qualifications at Rogers Health and Rehabilitation Center.
Findings
The facility was found deficient in ensuring call lights were within residents' reach, accurate Minimum Data Set (MDS) assessments, proper hygiene and bathing assistance, food storage and sanitation practices, infection control during meal service, and employment of a qualified social worker. Deficiencies were generally of minimal harm but affected multiple residents.
Deficiencies (5)
Failed to ensure call light was kept within residents' reach for 1 of 12 sampled residents.
Failed to ensure Minimum Data Set (MDS) assessments were completed accurately for 2 of 2 sampled residents.
Failed to ensure fingernails were maintained and bathing was provided as scheduled for dependent residents.
Failed to ensure foods stored in freezer, refrigerator, and dry storage were covered, sealed, and dated; ice machine was clean; leftover food used properly; and proper hand hygiene during meal service.
Failed to employ a qualified full-time social worker with a bachelor's degree in a facility with more than 120 beds.
Report Facts
Residents affected: 73
Sampled residents for call light deficiency: 12
Sampled residents for MDS assessment deficiency: 2
Sampled residents for hygiene and bathing deficiency: 16
Sampled residents for bathing deficiency: 10
Food items with missing dates: 15
Leftover food item date: 3
Residents affected by food safety deficiencies: 68
Beds in facility: 120
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrator #1 | Administrator | Provided information on facility policies and social worker staffing |
| Director of Nursing | Director of Nursing (DON) | Interviewed about importance of call lights and bathing frequency |
| Certified Nursing Assistant #1 | CNA | Interviewed about call light placement and meal service monitoring |
| Certified Nursing Assistant #2 | CNA | Observed failing hand hygiene during meal service |
| Licensed Practical Nurse #1 | LPN | Interviewed about call light placement |
| Licensed Practical Nurse #2 | LPN | Interviewed about responsibility for infection control during meal service |
| Dietary Manager | Dietary Manager (DM) | Interviewed about food storage, ice machine sanitation, and meal service |
| Assistant Director of Nursing | ADON | Interviewed about bathing frequency and infection control monitoring |
| Social Service Director | Social Service Director (SSD) | Lacks required bachelor's degree and license |
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