Excel Care at Dover

Inspectors wroteComplaint #2800328 Based on interviews, record review, and review of pertinent documents, it was determined that the facility failed to ensure staff did not neglect to carry out a physician's order to send a resident (Resident #1) immediately to the hospital, who had low blood pressure and a change in condition. The resident was sent later that day to the hospital by the physician and the resident expired at the hospital the same day. This deficient practice was identified for 1 of 3 residents reviewed for neglect (Resident #1). [...]

Inspectors wroteBased on interview, record review, and review of pertinent documents, it was determined that the facility failed to report an allegation of neglect to the New Jersey Department of Health (NJDOH). This deficient practice was identified for 1 of 3 residents reviewed for neglect (Resident #1), and was evidenced by the following:On [DATE] at 9:00 AM, the surveyor was informed by the Assistant Director of Nursing (ADON #1), that ADON #2 did not carry out a physician's order (PO) to send Resident #1 to the hospital on [DATE], for low blood pressure and a change in condition. ADON #1 continued that Resident #1's Medical Doctor (MD #1) came into the facility later that day, and MD #1 was upset that Resident #1 was still at the facility. ADON #1 stated that MD #1 immediately sent Resident #1 to the hospital, who expired there that day. [...]

Inspectors wroteBased on interview, record review, and review of pertinent documents, it was determined that the facility failed to thoroughly investigate an unexpected death of a resident who was transferred to the emergency room and expired the same day to rule out neglect. This deficient practice was identified for 1 of 3 residents reviewed for neglect (Resident #1), and was evidenced by the following:On [DATE] at 9:00 AM, the surveyor was informed by ADON #1, that ADON #2 did not carry out a physician's order (PO) to send Resident #1 to the hospital immediately on [DATE], for low blood pressure and the resident expired in the hospital that day. ADON #1 continued that ADON #2 was made aware by nursing of the resident's low blood pressure (BP), and ADON #2 called MD #1, who ordered the resident to be sent to the ER immediately. [...]

Inspectors wroteBased on observation, interview, record review, and review of other pertinent facility documents, it was determined that the facility failed to: a) ensure adequate supervision was provided to a resident to prevent falls, b) follow the facility accident policy to investigate falls, and c) initiate and implement appropriate care plan interventions to prevent accidents. This deficient practice occurred for two (2) of two (2) residents reviewed (Resident # 89 and #109) for falls with major injury who were identified as being at high risk for falls, sustained multiple falls including falls that required transfer to the emergency room (ER) for evaluation and treatment. The deficient practice was evidenced by the following: A review of the facility's Reporting Accidents and Incidents Policy dated [DATE], provided by the [NAME] President of Risk Management (VPoRM), indicated: [...]

Inspectors wroteBased on observation, interview, record review and review of pertinent facility documents, it was determined that the facility failed to ensure that a resident was free from alleged abuse. This deficient practice occurred for one (1) of four (4) residents reviewed for abuse (Resident #6) and was evidenced by the following: Refer to 610 F On 5/21/24 at 11:04 AM, Resident #6 stated the following: On 5/06/24 a phlebotomist and a Certified Nursing Assistant (CNA) held both of the residents arms down against the residents will to obtain blood work that the resident did not agree to. As a result the resident sustained bruises to both forearms. Resident #6 then stated that he/she was frustrated and she reported the incident to the facility (RN on duty) on the next day 5/07/24. [...]

Inspectors wroteComplaint #NJ171307 Based on interview, record review and review of pertinent documents, it was determined that the facility failed to develop comprehensive policies and consistently implement procedures to prevent and investigate abuse by failing to ensure: a) a system was in place to pre-screen contracted staff timely and provide training on the current facility abuse policies, b) all residents who may have been abused were identified and a documented system was in place to rule out abuse, c) all involved persons, including potential witnesses, were identified, and a documented interview was completed per facility policy, and d) a system was in place to ensure a complete and thorough investigation occurred and was documented. This deficient practice occurred for two (2) of two (2) residents (Resident #42 and #85) who alleged sexual abuse by a contracted certified nurse aide. [...]

Inspectors wrote2. On 5/24/24 at 10:29 AM, the surveyor interviewed the Occupational Therapist (OT). The OT stated [he/she] recalled an incident that happened on the second floor of the facility in the activity room/dining area. The OT stated the resident was seated in their wheelchair and the Director of Activities (DA) forcibly pulled the resident away from the table. The OT said it was on camera and the resident filed a complaint. The OT stated that was the last time [he/she] had seen the DA. On 5/28/24 at 11:29 AM, the surveyor observed Resident #35 in their room watching television and socializing with her peer. Resident #35 was noted to be in their wheelchair and greeted the surveyor at the door and motioned for the surveyor to come in. The resident stated he/she had been at the facility for eight years. [...]

Inspectors wroteComplaint # NJ162913 Based on observation, interview, and record review, it was determined that the facility failed to a.) ensure there was no delay in addressing laboratory (lab) values in a timely manner for two (2) of two (2) residents (Resident #6 and #109), b.) notify the physician of the the change in condition generated by a [health alert system] for three (3) of three (3) residents (Residents #6, #109, and #330), c.) monitor the skin, specifically the arm of Resident #109, who had a known behavior of scratching, and d.) provide wound care in accordance with professional standards of practice. This deficient practice was evidenced by the following: Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the state of New Jersey states: [...]

Inspectors wroteComplaint #s NJ157563, NJ158377, NJ159018, NJ162913, NJ169759, and NJ173245 Based on observation, interview, record review and review of pertinent documentation, it was determined that the facility failed to provide sufficient nursing staff to ensure residents' were provided with care to achieve their highest practical wellbeing by failing to a.) provide adequate staff to ensure effective supervision and documentation for residents with multiple falls (Resident #89 and #109) for two (2) of four (4) residents reviewed for falls, and b.) maintain the required minimum direct care staff-to-resident ratios as mandated by the state of New Jersey. This deficient practice was evidenced by the following: Refer to F689H 1.) On 5/21/24 at 9:53 AM, Surveyor #1 (S#1) observed Resident #89 in the unit day room in a wheelchair (w/c) eating breakfast. [...]

Inspectors wroteBased on observation, interview, review of medical records, and other facility provided documents, it was determined that the facility administration failed to ensure policies, procedures, and effective systems were implemented to maintain each resident's highest practicable physical, mental, and psychosocial well-being by failing to ensure a.) resident was free from the alleged abuse, b.) a thorough investigation was completed for all alleged abuse and frequent falls with history of falls and fractures, c.) the physician was notified of the change in condition and the results of the blood work in a timely manner, and d.) staffing levels were adequate to meet resident needs. This failure had the potential to affect all 148 residents who currently live in the facility. This deficient practice was evidenced by the following: Refer to: [...]

Inspectors wroteComplaint #NJ171307 #NJ164582 Based on observations, interviews, review of medical records, and other pertinent facility documentation, it was determined that the facility failed to report as required to the New Jersey Department of Health (NJDOH) within two hours: a) an allegation of sexual abuse that occurred for two residents by a staff member, b.) an injury of unknown origin, and c.) an allegation of abuse. This deficient practice occurred for four (4) of six (6) residents reviewed for abuse (Residents #35, #42, #85, and #104) and was evidenced by the following: Refer to 610F 1. Surveyor#1 (S#1) reviewed a Reportable Event Record (RER) confirmation sheet that indicated the RER was submitted to the NJDOH by the facility Director of Nursing (DON) on 02/09/24 at 12:34 PM (one day after the incidents were reported). The RER revealed: Today's date: 02/08/24 Date of Event: [...]

Inspectors wroteBased on observation, interview, record review and review of other facility provided documents, it was determined that the facility failed to provide pharmaceutical services in accordance with professional standards to ensure, a.) expired supplies were identified and removed from active inventory, b.) maintain a system of medication (med) records that enabled to account the disposition and the prompt identification of potential drug diversion of controlled dangerous substance (narcotics meds, with high potential for abuse and are tracked with detail) within the narcotic box of a med cart, and c.) demonstrate periodic reconciliation of controlled dangerous substances stored within the electronic back-up machine (EBM) was maintained. [...]

Inspectors wroteREPEAT DEFICIENCY Based on observation, interview, record review, and review of other pertinent documents, it was determined that the facility failed to ensure that all medications (meds) were administered without error of 5% or more. During the med observation conducted on 5/24/24, the two (2) surveyors observed five (5) nurses administer meds to six (6) residents. There were 30 opportunities, and three errors were observed which resulted in a med error rate of 10%. This deficient practice was identified for two (2) of six (6) residents (Residents #31 and #88), which was administered by two (2) of five (5) nurses. This deficient practice was evidenced by the following: According to the manufacturer's specifications for Omeprazole included Administration Instructions to take before meals. 1. [...]

Inspectors wroteBased on observation, interview, and review of medical records, it was determined that the facility failed to promptly, within three (3) days, refer Resident #88 for dental services to replace the lost dentures which persisted for nine months, and resulted in a diet texture change to ground due to difficulty chewing. This deficient practice was identified for one (1) of six (6) residents observed during medication (med) administration (Resident #88), and was evidenced by the following: On 5/24/24 at 8:59 AM, the surveyors observed the Registered Nurse (RN) crush the meds, which she poured into a med cup that contained apple sauce, in preparation for administration to Resident #88 that included Metoprolol Succinate ER (extended release, medication for blood pressure) 50 mg (milligrams). At that time, the RN stated the resident had special instructions for med administration of crush meds. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to follow appropriate hand hygiene practices during medication (med) administration and dining observation. This deficient practice was identified for two (2) of six (6) staff (one Licensed Practical Nurse and Certified Nursing Aide #1) during med administration, and for two (2) of four (4) staff (CNA#2 and Hospitality Aide) during dining observations according to facility's policy, practice, and Centers for Disease Control and Prevention (CDC) guidelines. This deficient practice was evidenced by the following: According to the CDC Clinical Safety: Hand Hygiene for Healthcare Workers dated 02/27/24, included, Healthcare personnel should use an alcohol-based hand rub (ABHR) or wash with soap and water for the following clinical indications: [...]

Inspectors wroteComplaint # NJ157563 Based on observation, interview, and review of facility documentation, it was determined the facility failed to maintain a comfortable and homelike environment for resident rooms on one (1) of six (6) nursing units of the facility observed (2nd floor Unit). The evidence of this deficient practice includes: On 5/23/24 at 10:28 AM, during the initial tour of the 2nd floor Unit, the surveyor observed the following: room [ROOM NUMBER] and room [ROOM NUMBER]- Noticeable odor of wet carpet and urine in room room [ROOM NUMBER]-carpets in room visibly frayed room [ROOM NUMBER]-carpets in room were visibly frayed and stained. room [ROOM NUMBER]- large black stain observed between door and window bed. On 5/28/24 at 12:28 PM, the surveyor observed the following on the 2nd Floor Unit: room [ROOM NUMBER] and room [ROOM NUMBER]-odor of wet carpet and urine remained. [...]

Inspectors wroteBased on observation, interview, and document review, it was determined that the facility failed to ensure the facility policy was followed and a comprehensive person centered care plan was revised to include target behaviors and non-pharmacological interventions for a resident who was administered antipsychotic medications. This deficient practice occurred for one (1) of five (5) residents reviewed for unnecessary medications (Resident #42) and was evidenced by the following: On 5/28/24 at 8:38 AM, the surveyor interviewed the Certified Nursing Aide (CNA) providing care for Resident #42. The CNA stated the resident sometimes refused care, screamed, and threw things like the walker. The surveyor asked if the resident would become physical with the CNA who stated, resident will try. The CNA also stated the resident spoke in a foreign language but could understand English. [...]

Inspectors wroteComplaint NJ #158377 Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) document medications and treatments according to physician's orders for one (1) of 32 residents (Resident #18) reviewed for medication and treatment administration, and b.) consistently document catheter urinary output according to the physician's orders for one (1) of three (3) residents reviewed for urinary catheters (Resident #125) according to standards of clinical practice and facility policy. This deficient practice was evidenced by the following: Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the state of New Jersey states: [...]

Inspectors wroteBased on interview and review of pertinent facility provided documentation, it was determined that the facility failed to ensure that the employed designated Infection Preventionist (IP) had completed specialized training in infection prevention and control per Centers for Medicare & Medicaid Services (CMS) guidance prior to assuming the IP role for one (1) of one (1) employee reviewed for IP. This deficient practice was evidenced by the following: On 5/23/24 at 11:28 AM, the surveyor interviewed the IP who stated that he started as the facility's IP on June 23, 2023. He added that he started the specialized training after he started as the facility's IP. On 5/24/24 at 8:14 AM, the surveyor reviewed the facility provided signed job description for the IP which was dated 6/26/23. [...]

Inspectors wroteBased on the observation, interview, and review of pertinent facility documentation it was determined that the facility failed to accurately code the Minimum Data Set (MDS) for one (1) of the 32 residents reviewed, Resident #89. This deficient practice was evidenced by the following: On 5/21/24 at 9:53 AM, the surveyor observed Resident #89 in the unit day room in a wheelchair feeding themselves during breakfast. The surveyor reviewed the hybrid (combination of paper and electronic) medical records of Resident #89 as follows: [...]

Inspectors wroteComplaint #: NJ00164594 Based on observations, interviews, and record review, as well as a review of pertinent facility documents on 03/21/24, it was determined that the facility failed to administer the medications in accordance with the acceptable standard of nursing practice and follow the facility policy on Medication Administration and Physician Services in 1 of 6 floors for 5 of 5 sampled residents, (Residents#1, #2, #3, #4, and #5). This deficient practice was evidenced by the following: On 03/21/24 at 10:12 am, the surveyor conducted a medication pass observation on the Nursing Unit with the Registered Nurse (RN #1). The surveyor observed a red color on the Electronic Medication Administration Record (EMAR) screen for Resident #2, #3, #4, and #5. [...]

Inspectors wroteComplaint# NJ 00164594 Based on observations, interviews, and record review, it was determined that the facility failed to a.) ensure that expired medications were removed from the medication cart, b.) ensure that each medication cabinets and refrigerator (Unit 2B) were locked. This deficient practice was identified for 2 of 2 units and was evidenced by the following: During the medication administration observation with the surveyors on 3/21/24 at 9:46 am, the surveyor observed Registered Nurse (RN #1) went to Unit 2B nurses' station (observed there was no one at the nurse's station) to look for a medication for an unsampled resident. RN #1 was able to open the cabinets without using a key and started looking for the medication. [...]

Inspectors wroteBased on observation, interviews, record review, and review of other pertinent documentation, it was determined that the facility failed to ensure that the puree consistency diet was free of large particles of food which could promote aspiration risk for residents who were on pureed diets. This deficient practice was identified for 1 of 3 residents (Resident #383) for 1 of 1 pureed lunch entree (meatballs) on 4/26/22. On 4/26/22 at 11:42 AM, the surveyor observed the Daytime [NAME] puree meatballs for the lunch meal without following a standard recipe or manufacturer instructions for puree consistency. Upon interview, the Daytime [NAME] reported that she eyeballed what the puree consistency should be. [...]

Inspectors wroteBased on interview and review of facility documents, it was determined that the facility failed to ensure the facility-wide assessment included: a.) competencies for dietary staff and, b.) employee competencies for pureed texture diets. This deficient practice was identified by the following: On 4/19/22 at 10:55 AM, during the entrance conference with the Director of Nursing (DON) and Director of Marketing, the surveyor requested a copy of the Facility Assessment. On 4/27/22 at 9:58 AM, the surveyor reviewed the Facility assessment dated completed 3/29/22. A review of the facility's report for services and care provided for nutrition individualized dietary requirements, liberal diets, specialized diets, IV [intravenous] nutrition, tube feeding, cultural or ethnic dietary needs, assistive devices, fluid monitoring or restrictions. [...]

Inspectors wroteBased on interview and review of pertinent facility documents, it was determined that the facility failed to ensure that: a.) their Quality Assurance and Performance Improvement (QAPI) Program was being implemented and b.) a QAPI plan for food concerns was implemented. This deficient practice was identified during the standard survey and was evidenced by the following: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a.) ensure that the physician responsible for supervising the care of residents conducted face-to-face visits and wrote progress notes at least every thirty days for the first ninety days of admission. b.) Ensure all residents were seen by the physician or nurse practitioner every thirty days with a physician visit at least every sixty days. This deficient practice was identified for 4 of 4 residents (Resident #4, #9, #92, and #109) reviewed for physician visits and evidenced by the following: On 4/28/22 at 9:50 AM, the surveyor observed Resident #9 sitting in their wheelchair in their room. The resident stated that he/she had trouble sleeping at night, so the physician had prescribed a sleep medication to take as needed. The resident stated that the medication was effective. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure all medications were administered without error of 5% or more. During the medication pass on 4/21/22, the surveyor observed two (2) nurses administer medications to four (4) residents. There were 25 opportunities and four (4) errors observed, which calculated a medication administration error rate of 16.0%. The deficient practice was identified for 1 of 2 nurses administering medications to 2 of 4 residents (Resident #131 and #78) and was evidenced by the following: 1. On 4/21/22 at 8:03 AM, the surveyor observed the Licensed Practical Nurse (LPN) during the medication pass administer five (5) medications, including one 10 milliequivalent (meq) tablet of potassium chloride (a medication used to treat and prevent low potassium). [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide foods that were maintained at the appropriate temperature. This deficient practice was identified during 2 of 2 observed lunch meal services and was evidenced by the following: 1. On 4/26/22 at 11:34 AM, the surveyor informed the Food Service Director (FSD) that they wanted to observe temperatures taken of both the hot and cold lunch meal items as well as observe the thermometer used calibrated. The FSD informed the surveyor that the cook was the person who took the meal temperatures and instructed the cook to calibrate the thermometer. At this time, the cook informed the surveyor and FSD that she was unaware of how to calibrate a thermometer, that she might have been shown previously but forgot how to, and that she did not calibrate the thermometer prior to taking temperatures. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure standardized recipes were utilized to ensure food was prepared to conserve nutritive value and flavor. This deficient practice was identified for 3 of 3 observed lunch meals prepared and the evidence was as follows: During a standard survey form 4/19/22 through 5/2/22, the survey team received the following food complaints from sampled residents: 1. On 4/19/22 at 10:44 AM, the surveyor interviewed Resident #9 who stated he/she disliked the food here. The resident stated they talked to the Licensed Nursing Home Administrator (LNHA) who informed them that the facility had a new chef. The resident stated he/she ate eggs and wheat soup; that their family brought sandwiches for them because the food was inedible. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure life-sustaining treatment wishes were reviewed with the resident or their representative and documented consistently within the medical record. This deficient practice was identified for 1 of 26 residents (Resident #121) reviewed for Advance Directive (AD) planning and was evidenced by the following: On 4/19/22 at 10:57 AM, the surveyor observed Resident #121 seated near the nurse's station with his/her eyes closed. The surveyor reviewed the medical records for Resident #121. A review of the Face Sheet (an admission summary) reflected the resident was admitted to the facility in July of 2020 with diagnoses that included diabetes mellitus, sepsis, and dementia. The record indicated the resident was responsible for him/herself, and the section for Code Status was blank. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow a physicians order for a psychiatric consultation for a resident receiving an antidepressant medication in accordance with professional standards of nursing practice for 1 of 5 residents (Resident #9) reviewed for unnecessary medications. Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure that a resident who was dependent on staff for assistance with activities of daily living was provided oral care consistent with their needs and preferences. This deficient practice was identified for 1 of 3 residents (Resident #40) reviewed for activities of daily living and was evidenced by the following: On 4/19/22 at 10:48 AM, the surveyor observed Resident #40 in bed with their eyes closed. The resident did not respond to the surveyor. On 4/20/22 at 12:02 PM, the surveyor observed the resident in bed. The surveyor asked the resident about the care they received with their activities of daily living (ADLs). [...]

Inspectors wroteBased on observation and interview, it was determined that the facility failed to a.) maintain the kitchen environment and equipment in a sanitary manner to prevent contamination from foreign substances and potential for the development a food borne illness and b.) separate the hand washing sinks from the food preparation area to prevent splashing and contamination of the clean food preparation area. This deficient practice was evidenced by the following: On 4/19/22 at 9:53 AM, the surveyor in the presence of the Food Service Director (FSD) observed the following: 1. In the food preparation area, the surveyor observed two of two handwashing sinks with no partitions between the hand washing sinks and the food preparation area. Next to one of the hand washing sinks, on the food preparation area, there was a container of clean silverware. [...]

Inspectors wroteBased on observation, staff interviews, family interviews and record review it was determined that the facility failed to allow easy access for family members to have visitation in accordance with state and federal guidelines for 2 of 2 Residents, Resident #57 and Resident #98. This deficient practice was evidenced by the following: 1. On 4/14/21 at 9:15 AM, the surveyor observed Resident #57 in bed, eyes closed with oxygen being delivered via a nasal cannula at the rate of 2 liters. The surveyor reviewed Resident # 57's medical record which reflected that Resident #57 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included but were not limited to acute respiratory failure, dementia, bilateral contractures of the knees and an unstageable deep tissue injury to the left lateral foot. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to maintain complete, accurate, and readily accessible medical records. This deficient practice was identified for 4 of 27 residents reviewed, Resident #14, Resident #56, Resident #57, and Resident #96 and was evidenced by the following: 1. On 4/19/21 at 11:20 AM, the surveyor observed Resident #56 in bed with eyes closed. On 4/19/21 at 11:30 AM, the surveyor reviewed the medical record for Resident #56. The resident was admitted to the facility on [DATE] with diagnoses that included but was not limited to Encephalopathy, Dysphagia, Hypothyroidism, and Vascular Dementia. A review of the quarterly Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, dated 2/5/21 reflected that the resident was not interviewable. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to maintain proper infection control practices. This was identified during 1 of 1 wound treatment observations for Resident # 57. This deficient practice was evidenced by the following: On 4/20/21 at 9:24 AM, the surveyor observed the Registered Nurse (RN) perform a wound treatment for Resident #57's hospital-acquired unstageable pressure ulcer to the left foot; the Hospice Aide assisted the RN with the positioning of the resident during the treatment. The surveyor reviewed the April 2021 Physician Order Summary, which reflected a Physicians' order (PO) to cleanse the left foot wound with Normal Saline, pat dry, apply Betadine, and cover with a border dressing twice daily at 9:00 AM and 5:00 PM. The PO was noted on the April 2021 Electronic Treatment Administration Record. [...]