Hot Springs Health & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Hot Springs Health & Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF684Dec 7, 2023

  Based on interview and record review, the facility failed to properly identify, document, and implement physicians' orders and appropriate interventions to treat the resident's conditions in a timely manner. This included a skin condition on the entire buttocks of a resident, which was found to be related to sepsis and UTI due to incontinence, and required IV antibiotics and catheter placement during hospitalization for 1 (#32) of 15 sampled residents. Findings include: During an interview on 12/5/23 at 8:12 a.m., NF1 stated they had concerns for resident #32 from a hospital stay with high blood sugar and burns on her buttocks from sitting in soiled briefs and then discharged AMA to another facility and passed away. […]

• Actual harm, isolatedF760Dec 7, 2023

  Based on interview and record review, the facility failed to provide scheduled medication, as ordered by the physician, to 1 (#26) of 15 sampled residents. This deficient practice resulted in undue physical symptoms for the resident. Findings include: During an interview on 12/4/23 at 1:18 p.m., resident #26 stated, They (the facility) ran out of my nausea medication on Sunday, and I didn't get any until Friday. I went through such withdrawals; I was so sick and all they said was it was on order day after day. […]

• No harm, potential for more than minimal, widespreadF657Dec 19, 2024

  Based on observation, interview, and record review, the facility failed to update and maintain current individualized care plans, to include when a change to the resident's care occurred, for activity preferences, or ensure staff were aware of how to use/find the individualized comprehensive care plans for use, for 6 (#s 1, 3, 6, 10, 20, and 22) of 19 sampled residents. Findings include: 1. During an interview on 12/17/24 at 2:56 p.m., staff member B said she had been at the facility for [AGE] years, and resident #1's behaviors and care had not changed. Staff member B said all resident care plans were accurate for the residents. Record Review of resident #1's comprehensive care plan showed an admitted [DATE]. […]

• No harm, potential for more than minimal, widespreadF812Dec 19, 2024

  Based on observation, interview, and record review, the facility failed to ensure staff followed safe food handling practices and ensure staff used proper hair and beard coverings while meals were prepared and served, which may affect any resident receiving meals or meal services from the staff or kitchen. Findings include: During an observation on 12/17/24 at 12:03 p.m., staff member N had a goatee, which was not covered with a beard net, while N was cooking at the stove. Staff member F was working in the kitchen during meal service, installing new equipment, with no hairnet and beard net. Staff member F had long hair, and a long, full beard. During an observation and interview on 12/17/24 at 12:18 p.m., staff member N was plating resident lunch trays without a beard cover in place. […]

• No harm, potential for more than minimal, widespreadF837Dec 19, 2024

  Based on interview and record review, the facility governing body failed to ensure the facility implemented and operationalized policies and procedures related to Advance Directives, PASARR Screenings, Care Plans, and Accidents/Hazards. This failure increased the risk of any resident in the facility being negatively affected due to the lack policies and procedures. Surveyors identified deficient practices for resident #s (6, 20, 30, and 32.) of 19 residents sampled, and for these specific residents, the facility did not have policies or procedures for the facility or staff to utilize. […]