Inspection Reports for
Stella Manor Nursing and Rehabilitation Center
400 North Vancouver Avenue, Russellville, AR, 72801
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
54% worse than Arkansas average
Arkansas average: 5.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Deficiencies: 1
Date: Nov 7, 2024
Visit Reason
The inspection was conducted to evaluate the facility's compliance with pharmaceutical service requirements, specifically ensuring that expired over-the-counter and prescribed as needed (PRN) medications were removed from medication storage areas and carts.
Findings
The facility failed to remove expired medications from medication rooms and medication carts, including expired Vitamin B-6 and several PRN medications for multiple residents. Interviews confirmed that some expired medications were missed and that staff in-service training had begun to address the issue.
Deficiencies (1)
Failure to ensure expired over-the-counter and prescribed as needed medications were removed from medication storage rooms and medication carts.
Report Facts
Expired Vitamin B-6 bottles: 3
Expired PRN medication cards: 6
Expired Cyclobenzaprine tablets: 30
Expired Benzonatate capsules: 29
Expired Clonidine Hydrochloride tablets: 24
Expired Tizanidine tablets: 23
Expired Ondansetron tablets: 29
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN | Stated expired medications would be turned in to the Director of Nursing | |
| Director of Nursing (DON) | Confirmed Vitamin B-6 should have been removed and that staff in-service had started regarding checking expiration dates |
Inspection Report
Deficiencies: 1
Date: Nov 7, 2024
Visit Reason
The inspection was conducted to evaluate the facility's compliance with pharmaceutical service requirements, specifically ensuring that expired over-the-counter and prescribed as needed (PRN) medications were removed from medication storage areas and carts.
Findings
The facility failed to ensure removal of expired medications from medication rooms and carts, with multiple expired medications found during the inspection. The Director of Nursing confirmed missed expired Vitamin B-6 medications and stated that staff in-service training had begun to address expiration date checks.
Deficiencies (1)
Failure to remove expired over-the-counter and prescribed as needed medications from medication storage rooms and medication carts.
Report Facts
Expired Vitamin B-6 bottles: 3
Expired medication cards: 6
Expired Cyclobenzaprine tablets: 30
Expired Benzonatate capsules: 29
Expired Clonidine Hydrochloride tablets: 24
Expired Tizanidine tablets: 23
Expired Ondansetron tablets: 29
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) | Interviewed regarding expired medications being turned in to Director of Nursing | |
| Director of Nursing (DON) | Interviewed confirming missed expired Vitamin B-6 and staff in-service training |
Inspection Report
Annual Inspection
Deficiencies: 6
Date: Oct 12, 2023
Visit Reason
The inspection was conducted as an annual survey to assess compliance with regulatory requirements related to medication management, food service, infection control, and overall resident care at Stella Manor Nursing and Rehabilitation Center.
Findings
The facility was found deficient in multiple areas including failure to justify continued use of PRN psychotropic medications beyond 14 days without physician evaluation, improper storage of controlled medications, failure to prepare and serve meals according to planned menus and nutritional needs, inadequate food consistency for pureed diets, unsanitary food handling practices, and failure to maintain a sanitary environment during meal service.
Deficiencies (6)
Failure to ensure PRN psychotropic medications were not continued past 14 days without justification and physician evaluation for 3 residents.
Failure to store controlled medications securely in locked compartments in 3 medication rooms.
Failure to ensure meals were prepared and served according to planned menus and nutritional needs for residents.
Failure to ensure pureed food items were blended to a smooth, lump-free consistency for residents on pureed diets.
Failure to maintain clean and sanitary conditions in the kitchen including expired food items, unclean ice scoop holder, and improper hand hygiene by dietary staff.
Failure to maintain a sanitary environment during lunchtime on the secure unit, including staff stepping inside food carts.
Report Facts
Residents reviewed for unnecessary medication: 6
Residents failed to meet medication criteria: 3
Medication rooms inspected for controlled medication storage: 3
Meals observed: 2
Residents affected by unsanitary environment: 15
Expired food items found: 9
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Confirmed lack of justification and physician evaluation for continued PRN medication use; confirmed controlled medications not stored properly |
| Dietary Employee #1 | Dietary Employee | Observed serving meals not according to menu and poor food consistency; improper hand hygiene |
| Dietary Employee #2 | Dietary Employee | Observed serving meals not according to menu and poor food consistency; improper hand hygiene |
| Dietary Employee #3 | Dietary Employee | Observed improper hand hygiene and food handling |
| Registered Nurse #1 | Registered Nurse (RN) | Identified medications during medication room tour |
| Licensed Practical Nurse #1 | Licensed Practical Nurse (LPN) | Identified medications and admitted to unlocked medication container |
| Licensed Practical Nurse #2 | Licensed Practical Nurse (LPN) | Identified medications during medication room tour |
| Dietary Supervisor | Dietary Supervisor | Provided explanations regarding meal preparation and food safety |
| Administrator | Facility Administrator | Stated facility had no policy on medication storage |
| CNA #3 | Certified Nursing Assistant | Observed stepping inside food cart during meal service |
| CNA #4 | Certified Nursing Assistant | Interviewed about proper procedures for accessing items on food carts |
Inspection Report
Routine
Deficiencies: 6
Date: Oct 12, 2023
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to medication management, food service, infection control, and overall resident care at Stella Manor Nursing and Rehabilitation Center.
Findings
The facility was found deficient in multiple areas including failure to justify continued use of PRN psychotropic medications beyond 14 days without physician evaluation, improper storage of controlled medications, failure to prepare and serve meals according to prescribed menus and consistency standards, unsanitary food handling practices, and inadequate infection prevention practices on the secure unit.
Deficiencies (6)
Failure to ensure PRN psychotropic medications were not continued past 14 days without justification and physician evaluation for 3 of 6 sampled residents.
Failure to store controlled medications securely in locked compartments in 3 medication rooms.
Failure to prepare and serve meals according to the planned written quantified recipe and menus for 2 meals observed.
Failure to ensure pureed food items were blended to a smooth, lump-free consistency for 2 meals observed.
Failure to maintain clean and sanitary conditions in the kitchen including expired food items, unclean ice scoop holder, and improper hand hygiene by dietary staff.
Failure to maintain a sanitary environment during lunchtime on the secure unit, including staff stepping inside food carts.
Report Facts
Residents reviewed for unnecessary medication: 6
Residents affected by medication deficiency: 3
Medication rooms inspected for secure storage: 3
Meals observed: 2
Residents affected by infection control deficiency: 15
Expired dairy cartons found: 4
Expired carrot cake mix boxes found: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing (DON) | Confirmed no justification or physician evaluation for continued PRN medication use; confirmed controlled medications not stored securely |
| RN #1 | Registered Nurse | Identified controlled medications in North/Northeast Medication Room |
| LPN #1 | Licensed Practical Nurse | Opened unlocked metal container with controlled medications in East Medication Room |
| LPN #2 | Licensed Practical Nurse | Identified controlled medications in [NAME] Medication Room refrigerator |
| Dietary Employee #1 | Dietary Employee | Observed improper food preparation and poor hand hygiene |
| Dietary Employee #2 | Dietary Employee | Observed improper food preparation and poor hand hygiene |
| Dietary Employee #3 | Dietary Employee | Observed improper food handling without hand washing or glove changes |
| Dietary Supervisor | Dietary Supervisor | Provided explanations regarding food preparation and ice scoop cleaning |
| CNA #3 | Certified Nursing Assistant | Observed stepping inside food cart on secure unit |
| CNA #4 | Certified Nursing Assistant | Interviewed about proper handling of items on food carts |
| Administrator | Facility Administrator | Stated facility had no policy on medication storage |
Inspection Report
Annual Inspection
Census: 80
Deficiencies: 5
Date: Jul 14, 2022
Visit Reason
The inspection was conducted as a routine annual survey to assess compliance with federal and state regulations regarding resident care, food service, and facility operations.
Findings
The facility was found deficient in multiple areas including failure to provide accessible survey results to residents, improper meal preparation and serving inconsistent with planned menus, poor food quality and appearance, inadequate food consistency for pureed diets, and unsafe food storage and handling practices. Several food safety and sanitation violations were observed, including expired and improperly stored food items and inadequate hand hygiene among dietary staff.
Deficiencies (5)
Failed to ensure the surveys and plans of correction for the past 3 years were readily accessible to residents and visitors.
Failed to ensure meals were prepared and served according to the planned written menu to meet nutritional needs for residents on pureed diets.
Failed to ensure food was prepared by methods that maintained appearance to encourage adequate nutritional intake.
Failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize risk of choking.
Failed to procure food from approved sources and store, prepare, distribute and serve food in accordance with professional standards, including expired food items, uncovered and undated food, and poor sanitation of equipment and food storage areas.
Report Facts
Residents affected: 10
Residents affected: 45
Residents affected: 79
Total census: 80
Number of servings: 6
Number of servings: 10
Number of residents: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Employee #1 | Involved in meal preparation and serving deficiencies including improper portion sizes and food consistency | |
| Dietary Employee #2 | Observed with improper glove use and hand hygiene violations during food preparation | |
| Dietary Supervisor | Provided information on dietary practices, food storage, and food appearance during inspection | |
| Human Resource Manager | Commented on food appearance during meal tray loading | |
| DON | Director of Nursing | Discussed responsibility for updating survey results binder |
Inspection Report
Routine
Census: 80
Deficiencies: 5
Date: Jul 14, 2022
Visit Reason
The inspection was a routine survey to assess compliance with federal and state regulations regarding nursing home operations, including resident access to survey results, nutritional services, food safety, and sanitation.
Findings
The facility was found deficient in multiple areas including failure to provide residents easy access to survey results, improper meal preparation and serving inconsistent with planned menus, poor food quality and appearance, inadequate food consistency for pureed diets, and multiple food safety and sanitation violations such as expired foods, improper food storage, and poor hand hygiene among dietary staff.
Deficiencies (5)
Failed to ensure surveys and plans of correction for the past 3 years were readily accessible to residents and visitors.
Failed to ensure meals were prepared and served according to the planned written menu for residents on pureed diets.
Failed to ensure food was prepared by methods that maintained appearance to encourage adequate nutritional intake.
Failed to ensure pureed food items were blended to a smooth, lump free consistency for residents requiring pureed diets.
Failed to procure food from approved sources and store, prepare, distribute, and serve food in accordance with professional standards, including expired foods, uncovered and undated food items, and poor hand hygiene.
Report Facts
Residents affected: 10
Residents affected: 45
Residents affected: 79
Total census: 80
Number of servings: 6
Number of residents: 10
Number of cereal boxes: 9
Number of muffins: 22
Number of muffins: 24
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