Below average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at The Springs Of Pine Bluff during CMS and state inspections, most recent first.
Surveyors found deficiencies in kitchen sanitation and food handling, including unclean air vents, grease and debris accumulation, uncovered food items, and a dirty ice machine. Dietary staff failed to follow proper hand hygiene, handling food and equipment with contaminated hands or gloves, and using inappropriate utensils. These issues were confirmed by staff interviews and were not in accordance with facility policies.
Two residents did not receive required personal hygiene care: one with diabetes and severe cognitive impairment had excessively long, dirty fingernails due to inconsistent nail care by staff, and another did not receive scheduled baths or showers after admission, with staff unable to explain the missed care. Facility records and staff interviews confirmed these lapses in following established care policies.
A resident with severe cognitive impairment and under hospice care had a DNR order in place, but the care plan was not updated to reflect this change and continued to list the resident as a full code. The MDS Coordinator did not document or conduct recent care plan meetings with the resident's representative, and there was no explanation in the record for the lack of participation or updates.
A resident with severe cognitive impairment and diabetes, who had a documented goal to lose weight, was prescribed an antidepressant for abnormal weight loss despite consistently expressing a desire to lose weight. The resident was not informed about the medication's purpose, and staff interviews revealed confusion about the rationale for the prescription and lack of awareness of the resident's wishes, contrary to facility policy requiring medication use to align with individual values and goals.
A resident with dementia and malnutrition developed scabs and bruises on the left arm that were observed by surveyors but not documented or treated by staff, despite facility protocols requiring skin inspections and reporting. Nursing and CNA staff interviews confirmed that new skin issues should be reported and documented, but this was not done, and no treatment orders were initiated for the arm injuries.
Three residents with severe cognitive impairment or complex medical histories did not have proper documentation regarding the administration or refusal of pneumococcal vaccines. In each case, records lacked either the date of refusal, verification of vaccine administration, or evidence that education on risks and benefits was provided to the resident or their representative, contrary to facility policy.
Staff did not consistently follow infection control protocols, including proper hand hygiene, use of PPE, and disinfection of shared equipment for two residents on Enhanced Barrier Precautions. A CNA provided care without gloves or hand hygiene, and an LPN failed to clean a glucometer according to manufacturer guidelines. Staff interviews revealed inconsistent knowledge and application of EBP and infection control policies.
Deficiencies in Kitchen Sanitation and Food Handling Practices
Penalty
Summary
Surveyors identified multiple deficiencies in the facility's food service operations, including unsanitary conditions and improper food handling practices. Observations revealed that the kitchen air vents were not adequately cleaned, showing water condensation, rust, and gray stains. The area below the deep fryer was found to have accumulated grease and food debris, and the kitchen floor had chips, debris, dirt, rust, and stains, with some floor tiles needing replacement. Food items in the freezer, such as dinner rolls and fish breading, were not properly covered or sealed, exposing them to potential contamination. The ice machine, used for resident beverages and water pitchers, had visible brown and black residue inside, indicating it was not maintained in a clean and sanitary condition as required by facility policy. Additionally, dietary staff failed to follow proper hand hygiene protocols before handling clean equipment or food items. Staff were observed contaminating their hands and gloves after touching dirty objects and then proceeding to handle food without washing their hands. One staff member used a contaminated tissue to dry her hands after washing, then handled food without re-washing. Another staff member used an empty bread bag instead of tongs to push bread into a blender for pureed diets. These actions were confirmed by staff interviews, and facility policies reviewed indicated that food should be stored covered and hands should be washed frequently, especially before food preparation and when changing tasks.
Failure to Provide Scheduled Nail Care and Bathing
Penalty
Summary
The facility failed to provide adequate nail care for a resident with diabetes and severe cognitive impairment. Observations over several days revealed that the resident's fingernails were excessively long and had a dark, brown substance underneath, which staff described as appearing to be feces and dirt. Interviews with CNAs and an LPN confirmed that nail care was inconsistently provided, with no clear schedule or documentation for weekly nail care by licensed staff, despite the resident's care plan indicating a need for regular nail checks and cleaning. The resident's records did not show any refusal of care, and there was no order for weekly nail care in the electronic Medication Administration Record or treatment record. Additionally, the facility failed to ensure that another resident received scheduled baths or showers after admission. The resident reported not having had a bath since admission, and review of the ADL/bath record confirmed that no showers were documented as given according to the resident's scheduled days. Staff interviews revealed confusion about the resident's shower schedule and documentation, with CNAs indicating that new admissions should receive showers promptly but unable to explain why this resident had not received one as scheduled. The DON and Administrator both acknowledged that the resident should have received a bath or shower earlier, but this did not occur. Both deficiencies were observed through direct observation, interviews with staff and residents, and review of facility records and policies. The facility's own policies required regular nail care and scheduled bathing to promote hygiene and comfort, but these were not followed for the residents involved.
Failure to Update Care Plan and Involve Resident Representative in Care Planning
Penalty
Summary
The facility failed to ensure that a resident and their representative were included in care planning meetings and did not update the resident's care plan to reflect a change in code status to Do Not Resuscitate (DNR) after the resident was admitted to hospice care. The resident, who had diagnoses including type 2 diabetes mellitus, paranoid schizophrenia, and Alzheimer's disease, was severely cognitively impaired and unable to make decisions. Despite a DNR order being present in the resident's medical record, the care plan continued to indicate that the resident was a full code and directed staff to initiate CPR if necessary. Interviews with facility staff revealed that the MDS Coordinator was responsible for updating care plans and conducting care plan meetings, but the resident's care plan was not revised to reflect the DNR status. The MDS Coordinator also did not have documentation of recent care plan meetings with the resident's family, and the resident's name was missing from the care plan meeting schedule. The family member confirmed that no care plan meeting had occurred since several months prior, and there was no documentation explaining the lack of participation or attempts to include the resident or representative in the care planning process.
Unnecessary Antidepressant Prescribed Despite Resident's Stated Weight Loss Goal
Penalty
Summary
A resident with type 2 diabetes mellitus and severe cognitive impairment was admitted to the facility and expressed a desire to lose weight, setting a goal of 145 lbs. The resident's care plan and weekly weight notes consistently documented this weight loss goal and the resident's motivation to lose weight for personal reasons. Despite this, an order was placed for an antidepressant to be administered daily, with the stated reason being abnormal weight loss. The resident's weight records showed a decrease from 155 lbs to 148 lbs, aligning with their stated goal, and later an increase to 153 lbs. The resident was not informed that the antidepressant was prescribed to address weight loss and continued to express a desire to lose more weight. Interviews with facility staff revealed a lack of awareness and communication regarding the resident's weight loss intentions. The DON confirmed the resident's goal and acknowledged that the antidepressant was started after weight loss was observed, but could not confirm if it was recommended by the dietician or the MD. The MD stated the antidepressant was for depression but could not recall if the resident had a depression diagnosis or if a gradual dose reduction had been considered. The administrator was unaware of the resident's weight loss goal. Facility policy required medication use to be consistent with the individual's condition, prognosis, values, wishes, and responses to treatment, but this was not followed in this case.
Failure to Document and Treat Non-Pressure Skin Issues
Penalty
Summary
A deficiency occurred when a resident with dementia and moderate protein calorie malnutrition developed scabs and bruises on the left arm, which were observed by a surveyor over several days. The resident was unable to provide a clear explanation for the injuries due to severely impaired cognition. Despite multiple observations of the skin issues, there was no documentation in the resident's progress notes or treatment records regarding the bruising, scabs, or redness on the left arm. The only documented skin issue was related to a left lower leg wound, for which there was an active treatment order. The facility's care plan directed staff to inspect the resident's skin weekly and as needed, and to report any changes such as redness, open areas, scratches, cuts, or bruises to the nurse. However, skin checks and ADL task documentation did not reflect the presence of new skin issues on the left arm, and no treatment orders were initiated for these injuries. Interviews with nursing staff and CNAs confirmed that their protocol was to notify the nurse and document any new skin issues, but this process was not followed in this case. Additionally, the facility's policy required daily skin inspections during personal care and ADLs, with evaluation, reporting, and documentation of any changes. Despite this, the observed skin issues on the resident's left arm were neither documented nor addressed according to facility policy. The DON was unable to provide a specific policy on skin issues when requested, further highlighting a gap in adherence to established procedures.
Failure to Document and Administer Required Pneumococcal Vaccinations
Penalty
Summary
The facility failed to ensure that required pneumococcal vaccinations were properly administered and documented for three out of five sampled residents reviewed for immunizations. For one resident with severe cognitive impairment, the responsible party had consented to the vaccine, but when the resident refused, there was no documentation of the refusal date, nor evidence that the responsible party or the resident received education on the risks and benefits of refusal. Another resident, also with severe cognitive impairment, had a documented refusal of the vaccine, but the record did not specify if education was provided to the resident or their representative. For a third resident with multiple diagnoses including diabetes, schizophrenia, and Alzheimer's disease, the record indicated an order for the vaccine but lacked documentation verifying administration or refusal. Interviews with the Assistant Director of Nursing (ADON) revealed that while refusals were typically noted, there was a lack of consistent documentation regarding the date of refusal and whether education was provided to residents or their responsible parties. The facility's policy required that all residents be assessed for vaccine eligibility and offered the vaccine within 30 days of admission, with refusals and related education to be documented in the medical record. However, the records reviewed did not consistently meet these documentation requirements, leading to the identified deficiency.
Failure to Follow Infection Control Protocols and Enhanced Barrier Precautions
Penalty
Summary
Staff failed to adhere to proper infection prevention and control practices for two residents who were on Enhanced Barrier Precautions (EBP). In one instance, a certified nursing assistant (CNA) entered a resident's room, donned a gown but did not wear gloves while applying lotion, repositioning the resident, and handling both clean and dirty linens. The CNA did not perform hand hygiene during care and only sanitized hands after leaving the room. The required hand sanitizer was not accessible in the resident's room, and the CNA was unsure about EBP training, although she acknowledged prior handwashing in-service. For another resident with diabetes on EBP, a licensed practical nurse (LPN) did not perform hand hygiene before donning PPE and entering the room to perform a fingerstick blood sugar check. After the procedure, the LPN washed hands but then handled the used glucometer, placing it on the medication cart before cleaning it. The LPN cleaned the glucometer with an alcohol prep pad, despite the manufacturer's instructions specifying the use of a germicidal cleaning wipe, not alcohol. Staff interviews revealed inconsistent knowledge and practices regarding EBP and proper disinfection of shared equipment. Facility policy reviews confirmed that EBP requires gloves and gowns for high-contact care and that hand hygiene supplies should be present in each room. The facility's own procedures and the glucometer manufacturer's guidelines were not followed, as staff used unapproved cleaning agents and did not consistently perform hand hygiene or use PPE as required. Staff interviews indicated gaps in training and understanding of EBP protocols and infection control standards.
What surveyors are citing around you — mapped
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Illustrative
What surveyors actually found near you
We read the 6 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Pine Bluff
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Trinity Village Medical Center | 0.3 mi | ★★★★★ | 0 | 0 |
| Pine Bluff Transitional Care | 0.5 mi | ★★★★★ | 6 | 0 |
| The Blossoms At White Hall Rehab & Nursing Center | 9.3 mi | ★★★★★ | 0 | 0 |
| The Green House Cottages Of Southern Hills | 17.2 mi | ★★★★★ | 0 | 0 |
| The Blossoms At Star City Rehab & Nursing Center | 18 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.