Excell Health Care Center

Based on observation and interview, the facility failed to prepare food in accordance with professional standards of food service safety when the Facility [NAME] (COOK) used a cleaning cloth instead of a potholder to remove an item from the oven. This failure had the potential to result in cross-contamination, resulting in the potential for food-borne illness for 83 out of 90 residents who receive food from the kitchen. Findings: During an observation on 11/19/24 at 10:33 a.m. in the kitchen, the Facility [NAME] (COOK) removed a tray of chicken from the oven using a pot holder on her left hand and a red cloth to cover her right hand. The red cloth was observed to come into contact with liquid on the tray. During an interview on 11/19/24 at 10:40 a.m., COOK stated she used the red cloth and the pot holder to remove the chicken from the oven. COOK stated the chicken was heavy and required two hands. During an interview on 11/19/24 at 10:42 a.m., with the Dietary Services Manager (DSM), DSM stated the red cloth should be used for cleaning and pot holders should be used for food.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to ensure to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for three of five sample selected residents (Resident 84, 48 and 43) when: 1. The facility's staff left the disconnected feeding tube uncapped and exposed to the air on the pole (pole was holding feeding liquid bags and water) and then staff touched the feeding bag and put the cap on the tip of tube with bare hand (no gloves). 2. The facility's staff did not change the gloves between clean and dirty supplies during the wound care for 48. 3. The facility's staff touched the equipment and belonging with bare hand (no gloves) for Resident 43. Residents 84, 48 and 43 were on EBP care (Enhanced Barrier Precautions is an approach to the use of personal protective equipment (PPE) to reduce transmission of Multi-Resistant Organisms (MDROs) between residents in skilled nursing facilities). Findings: A review of Resident 43's admission Record indicated, Resident 43…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record review, the facility failed to ensure medications were stored and labeled appropriately when: 1. two insulin (a medication to maintain blood sugar in diabetics) pens (an insulin dispensing device with replaceable needles) and a vial of insulin were found without an open or expiration date in a drawer in Medication Cart (Med Cart) 3; 2. six loose pills were found in two drawers in Med Cart 3; 3. two expired glucagon (a medication to raise blood sugar) auto-injectors (a device that automatically injects medication) were found in a drawer in Med Cart 3, 4. a bottle of fluticasone propionate solution 50 mcg/act (nasal spray used to relieve nasal symptoms, such as stuffy nose, itching and sneezing) was stored on Resident 30's nightstand. These failures had the potential for administration of expired medications to residents and administration of medications to the wrong resident. Findings: 1.During a concurrent inspection of Med Cart 3 and interview on 12/20/22, at 10:08 a.m., with Licensed Vocational Nurse (LVN) 2, two insulin pens and one…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to store and serve food in a sanitary manner when food items stored in the snack refrigerator were unlabeled and food items served during lunch did not have their temperatures checked before being served. These deficient practices had the potential to cause food borne illness that can affect all residents. The facility census was 99 and 95 residents were served food from the kitchen. Findings: During a concurrent observation and interview on 12/19/22 at 9:10 a.m. of the kitchen with Dietary Manager (DM) 1, three food items stored in the snack refrigerator were not labeled. DM 1 confirmed the three food items stored in the snack refrigerator were not labeled. DM 1 stated food items stored in the snack refrigerator should all have a label to identify what food items are stored in the container. During an observation and interview on 12/20/22 at 12:30 a.m. with [NAME] 1 during lunch service, two servings of rice, one serving of carrots and one serving of hot dog were served. [NAME] 1 stated the two servings of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record review, the facility failed to ensure a medication error rate below five percent for two of nine sampled residents (Resident 23 and 32) when: 1. Resident 32 was administered sennosides (medication to induce bowel movement) 8.6 milligram (mg, a unit of weight measurement) instead of docusate (medication to induce bowel movement) 200 mg as prescribed by physician's order; and 2. Resident 23 did not receive vitamin d3 (a vitamin needed for various body function) 25 mcg (microgram, a unit of measurement) as prescribed. This failure resulted in two medication errors out of 30 opportunities during observation of medication administration which resulted in the facility having a medication error rate of 6.67% and resulted in residents not receiving the correct medication or receiving the medication as prescribed. Findings: 1. During a concurrent medication pass observation and interview on 12/19/22, at 9:40 a.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 administered to Resident 32, two tablets of sennosides 8.6 mg. LVN 1 stated the two…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to ensure competency skills checks for three of five licensed nursing staff were completed. This failure had the potential for care to be provided by licensed nurses in an unsafe and incompetent manner. Findings: During an interview on 12/4/19, at 12:04 p.m., with the Director of Nursing (DON), DON acknowledged her role as the nursing supervisor included conducting competency skills checks for all licensed nurses. During an interview on 12/4/19, at 12:33 p.m., with Registered Nurse 1 (RN 1), RN 1 stated DON had never done a competency skills checklist with her. During a review of employee personnel files, the files indicated RN 1 was hired on 10/24/11, LVN 1 was hired on 8/21/17, and LVN 4 was re-hired on 10/3/18. No competency skills checklists for RN 1, LVN 1, and LVN 4 could be found in their employee personnel files. During a concurrent interview and record review on 12/4/19, at 12:49 p.m., with DON, DON could not show current and previous years' competency skills checklists for three licensed nurses.

Based on observation, interview, and record review, the facility failed to ensure the medication error rate was less than five percent (5%) when, during a medication pass observation, three medication errors out of 32 opportunities resulted in a 9.3% error rate because: 1. Licensed Vocational Nurse 2 (LVN 2) did not follow the manufacturer's specifications when administering a potassium chloride tablet without food to Resident 32. 2. Licensed Vocational Nurse 3 (LVN 3) incorrectly crushed and administered an enteric-coated aspirin to Resident 83 and also administered a potassium chloride tablet without food to Resident 83. These failures had the potential to result in undesired health outcomes for Residents 32 and 83, such as stomach irritation, gastric ulcer, and gastric bleeding. Findings: 1. During a medication pass observation on 12/4/19 at 9 a.m., LVN 2 prepared and administered 13 medications to Resident 32, including potassium chloride (Klor-con). During a review of the Order Summary Report for Resident 32, the physician's order, dated 9/2/14, stated, Klor-con M20 ER [ER,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to provide personal hygiene assistance (combing hair, brushing, teeth, shaving, washing, and drying the face and hands) to one of 18 sampled residents (Resident 36) when Resident 36's facial hair was not shaved. This failure resulted in Resident 36, a female, having overgrown facial hair resembling a mustache and beard. Findings: During a review of Resident 36's Minimum Data Set (MDS, an assessment tool used to guide care) dated 10/2/19, indicated Resident 36 had a Brief Interview for Mental Status (BIMS, a tool used to assess mental function) score of 03, indicating Resident 36 was severely cognitive impaired. The MDS also indicated Resident 36 needed extensive assistance of one person with her Activities of Daily Living (ADLs). During a concurrent observation and interview on 12/2/19 at 12:20 p.m., with Resident 36 and the Director of Staff Development (DSD), in the main dining room, Resident 36 was observed to have overgrown facial hair (beard and mustache). Resident 36 stated, I don't like it but no one does…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to follow the physician's order for oxygen administration for one of 18 sampled residents (Resident 29), when Resident 29's oxygen flow rate was not at the specific ordered rate. This failure had the potential to result in life threatening adverse effects for Resident 29, who had a medical history of Chronic Obstructive Pulmonary Disease (COPD, a term used to describe progressive lung diseases including emphysema, chronic bronchitis, and non-reversible asthma) due to oxygen toxicity. Findings: During a review of Resident 29's face sheet dated 12/4/19, the face sheet showed Resident 29 was admitted with multiple diagnoses, including COPD and lung cancer. During a review of the Brief Interview for Mental Status (BIMS, a tool used to assess mental function) in Resident 29's Annual Minimum Data Set (MDS, an assessment tool used to guide care), dated 6/25/19, Resident 29's BIMS score was 15, meaning Resident 29 was cognitively intact. The MDS…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure safe storage of medications when a bottle of Timolol Maleate eye drops (a medication used to lower pressure in the eyes) was stored in the medication refrigerator instead of at room temperature, as per the manufacturer's specifications. This failure had the potential for the effectiveness of the medication to be reduced and residents receiving the medication to not receive the full therapeutic benefit of the drug. Findings: During a concurrent observation and interview on 12/3/19, at 8 a.m., with Registered Nurse 1 (RN 1), in Medication Storage room [ROOM NUMBER], a bottle of Timolol Maleate eye drops was seen in the medication refrigerator and the refrigerator's temperature was 40 degrees Fahrenheit. The medication instructions printed on the Timolol Maleate box indicated Store at 25 degrees Celsius (77 degrees Fahrenheit). RN 1 stated, I don't know why this is here but it should not be stored in the refrigerator. We missed it. RN…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure their infection control and prevention program was followed for two of 18 sampled residents when: 1. Licensed Vocational Nurse 1 (LVN 1) did not wash his hands between glove changes and after providing wound care to Resident 10. 2. The urinary drainage bag for Resident 58 was on the floor. These failures had the potential to spread infection to Resident 10 and Resident 58. Findings: 1. During a wound dressing change observation on 12/2/19 at 9:45 a.m. with LVN 1, LVN 1 donned gloves, removed the soiled dressing, removed the gloves, put a new pair of gloves on without washing his hands, cleansed the wound, applied an ordered medical treatment to the wound, and covered the wound wearing the same pair of gloves. LVN 1 gathered the soiled dressing materials, discarded them, then removed his gloves. LVN 1 used hand sanitizer, and then exited Resident 10's room without washing his hands During an interview on 12/2/19 at 9:55 a.m. with…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.