Center at Arrowhead, LLC

In the surveyor’s words

From the most serious findings on record at Center at Arrowhead, LLC, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF880May 2, 2025

  Based on observation, staff interviews and facility policy, the facility failed to maintain infection prevention and control when delivering meal trays, providing foley catheter care for one of one sampled resident's (#9), and failing to consistently implement tracking and trending of their infection prevent and control program. The deficient practice could result in transmission of infection within the facility. -Regarding delivering of meal trays: Observations were conducted on April 30, 2025 of a Certified Nursing Assistant (CNA/staff #200) delivering in-room lunch meal trays to four residents on enhanced barrier precautions (EBP). […]

• No harm, potential for more than minimal, patternF881May 2, 2025

  Based on record review, staff interviews, policy review and Center for Disease Control (CDC) guidelines, the facility failed to consistently implement tracking and trending of their antibiotic stewardship program. The facility census was 79 residents. This deficient practice could result in improper antibiotic use and adverse outcomes to residents. Findings include: On May 1, 2025 at 11:35 AM, an interview was conducted with the Assistant Director of Nursing (ADON/staff #54) and the Regional Clinical Director (RCD/staff #205). The ADON and the RCD explained that the ADON was in the process of completing her training as the Infection Preventionist (IP). […]

• No harm, potential for more than minimal, patternF658Jun 14, 2022

  Based on clinical records, family and staff interviews, and facility policies and procedures, the facility failed to perform Quality Control (QC) for one resident's (#1) blood glucose monitor. The deficient practice could result in inaccurate blood glucose results. Findings include: Resident #1 was admitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . A care plan initiated on May 18, 2022 for fluctuating blood glucose levels included a goal that the resident would have no complications related to hypo/[CONDITION(S)]. […]

• No harm, potential for more than minimal, patternF607Jul 23, 2021

  Based on resident, family and staff interviews, clinical record review, facility documentation, and policy and procedures, the facility failed to implement their policy regarding reporting allegations of abuse for two of two sampled residents (#19 and #309); conducting a thorough investigation for an allegation of abuse for one of two sampled residents (#19); and providing training on abuse, neglect, exploitation and misappropriation of property for one staff (#170). The deficient practice can result in an allegation of abuse not being reported and investigated on; and staff not being educated regarding, neglect, exploitation and misappropriation of resident property. Findings include: -Resident #19 was admitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, patternF684Jul 23, 2021

  Based on observation, resident and staff interviews, clinical record review, and facility policies review, the facility failed to ensure one sampled resident's (#58) [CONDITION(S)] to the right lower extremity with pain was acted upon timely. The deficient practice could result in negative resident outcomes. Findings include: Resident #58 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of the nurse admission note dated July 4, 2021 at 6:00 pm revealed the resident was admitted via stretcher for [CONDITION(S)] and was alert and oriented x 4 (person, place, time, and situation). The note included the there were therapy orders for physical therapy (PT) and occupational therapy (OT). A physician order [MEDICAL RECORD OR PHYSICIAN ORDER] . […]