Excel Care Center

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure incontinent care was provided for four residents (#7, #8, #9, #10) out of five residents sampled. Findings Included: On 12/02/25 at 9:37 a.m., Resident #10 was observed and interviewed lying in bed waiting for incontinent care. Resident #10 stated they have been asking for help going to the bathroom all morning and most days they are left sitting in their wet incontinent product for long periods of time. Review of Resident #10's admission record revealed an admission date of 10/20/25, with diagnoses to include Parkinson's disease, diabetes mellitus, hypertension, dementia, anxiety, dizziness, and muscle weakness. A review of Resident #10's Minimum Data Set (MDS) dated [DATE] revealed: a brief interview for mental status (BIMS), a score of 6, meaning severe impairment. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store food under sanitary condition by not ensuring the walk-in refrigerator and the milk box cooler contained thermometers on the inside. This has the potential to affect 108 out of 116 residents who eat orally residing in the facility at the time of the survey.

Inspectors wroteBased on record review and interview the facility failed to complete the Discharge- Return Non-Anticipated Minimum Data Set (MDS) to Centers of Medicare and Medicaid (CMS) within 14 days for one (Resident # 103) out of one resident was discharged to the community who was investigated for Resident Assessment. This deficiency has the potential to affect 116 residents residing in the facility at the time of survey.

Inspectors wroteBased on record review and interview, the facility failed to electronically transmit the Discharge- Return Non-Anticipated Minimum Data Set (MDS) to Centers of Medicare and Medicaid (CMS) within 14 days for one (Resident # 103) out of one resident whose Resident Assessments was investigated that was discharged to the community. There were 116 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure the provision of a safe environment related to safety floor mats to prevent accidents in the event of a fall for one Resident (#83) out of 27 sampled residents. There were 116 residents residing at the facility at the time of the survey.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure pharmaceutical procedures were followed during medication administration. As evidenced by during medication administration the Registered Nurse signed off on Resident #2's medication as given before administering the medications for one out of four residents observed, and left the medication cart unlocked in the hallway during medication administration in Resident #2's room. There were 116 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide wound care in accordance with professional standards for two (#54, #21) of three residents sampled for pressure ulcers out of 11 total residents with pressure ulcers related to failure to change Resident #54's dressings daily as ordered for two of four days, failure to provide positioning and offloading for wound healing for Resident #54, and failure to ensure weekly wound measurements were taken for Resident's #54, and #21. Findings Included: 1. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to provide care and treatment in accordance with professional standards of practice, the plan of care, and physician orders for four (#91,#28, #79, #43) of 41 sampled residents related to removal of surgical staples as ordered for Resident #91, weekly weights as ordered for Resident #28, administration of ordered medication for a non-pressure related skin condition for Resident #79, and lack of modification to the medication schedule to accommodate for scheduled dialysis for Resident #43.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure physician orders were received for monitoring and care of an intravenous (IV) site for one (#54) of one resident sampled for intravenous (IV) care out of two facility residents receiving IV therapy.

Inspectors wroteBased on observation, interview policy, and record review, the facility failed to promote dignity and respect during the dining experience in the main dining room for ten (#s 20, 22, 23, 27, 39, 40, 43, 49, 101, and 211) of 52 sampled residents, during two (1/28 and 1/30/20) of four survey days, and in two (400 and 500) hallways and did not ensure that resident council members felt respected by staff during dining. Findings Included 1. An observation was conducted in the main hallway outside of the main dining room, on 1/28/20 at 12:04 p.m. A CNA was observed wheeling Resident #49 toward the area outside of the dining room. Four residents were observed to already be seated in wheelchairs in that area. [...]

Inspectors wroteBased on observation, interviews, record review, and policy review the facility did not ensure residents were free from significant medication errors, for 3 residents (#5, #33 and #100) of 11 residents observed during medication administration or reviewed for unnecessary medications. Findings Included: 1) Review of the record for Resident # 5 revealed that he was admitted to the facility on [DATE] with diagnoses which included Type II Diabetes Mellitus without Complications. Review of Physician orders on the Order Summary Report revealed an order dated 12/17/19 for Humulin R U-500 Kwik-Pen Solution Pen -Injector 500 Unit/ML: Inject 90 unit subcutaneously with meals related to Type II Diabetes Mellitus without complications . Resident # 5 also had a physician's order, dated 11/13/19 for Novolog Solution 100 Unit/ML (Insulin Aspart): [...]

Inspectors wroteBased on observation and interview, it was determined that the facility did not ensure that one (#22) of fifty two residents reviewed was provided the right to make choices regarding her dining experience.

Inspectors wroteBased on resident record review and staff interview, it was determined that the facility did not ensure that the plan of care was followed related to Diabetes Mellitus, Type II, for one of five residents reviewed for unnecessary medications (#5). Findings Include: Review of the admission Record for Resident # 5 revealed that he was admitted to the facility on [DATE] with diagnoses which included Type II Diabetes Mellitus without Complications. Review of Physician orders on the Order Summary Report revealed an order, dated 12/17/19, for Humulin R U-500 Kwik-Pen Solution Pen-Injector 500 Unit/ML: Inject 90 unit subcutaneously with meals related to Type II Diabetes Mellitus without complications . Resident # 5 also had a physician's order, dated 11/13/19 for Novolog Solution 100 Unit/ML ( Insulin Aspart): [...]

Inspectors wroteBased on observations, record review, interviews, and policy review the facility failed to provide care and treatment in accordance with professional standards of practice for two(#34, #108) of 53 residents reviewed in regards to 1) not ensuring physician's orders were obtained for care and services for a urinary catheter, a nephrostomy tube, and a midline IV(intravenous) line and 2) failing to identify and obtain orders to treat a skin tear.

Inspectors wroteBased on observation, interview, and medical record review the facility failed to ensure that a pressure injury for one (#103) out of four residents with a pressure injury were provided treatment without an active Physician order. Findings Included: On 1/30/2020 at 12:15 p.m. Resident #103 was observed lying in her bed and was receptive to an interview. She appeared comfortable and said she had received a pain medication. She indicated and was in agreement to the observation of her treatment to her pressure injury. LPN F walked over to the treatment cart that was positioned with the drawers facing inside the bedroom doorway entrance. She donned a clean pair of gloves and went to the left side of the resident bed. [...]

Inspectors wroteBased on observations, interviews and medical record review, and policy review the facility failed to ensure that care was provided according to standards of practice for two (#277 & 29) out of ten residents with enteral tubing feedings who were not positioned appropriately to prevent possible aspiration.

Inspectors wroteBased on record review, observation, interview, and policy review, the facility did not ensure acceptable practices were implemented during care of a tracheostomy for one resident (#267) of one resident observed for tracheostomy care and services.

Inspectors wroteBased on resident interview, observation, record review and staff interview, it was determined that the facility did not ensure that consistent pain management was provided for one of fifty three residents reviewed ( # 165). Findings Included: An interview was conducted with Resident # 165, on 1/28/20 at 3:03 p.m. Resident # 165 stated he was in pain from a fractured knee and recent abdominal surgery. He stated the facility does not have his pain medications at times or it gets discontinued for a day or two then starts again. He stated he is in a lot of pain when he does not get his pain medication. Review of the record for Resident # 165 revealed that he was admitted to the facility for rehabilitation on 1/9/20. Diagnoses included Displaced comminuted fracture of left patella, Acute embolism and thrombosis of left popliteal vein. [...]

Inspectors wroteBased on observation, interview, record review, policy review, and manufacturer's instructions the facility did not ensure that the medication error rate was below 5% for three (#5, #33, and #100) of six sampled residents who were administered medications. This resulted in five errors from twenty-five medication administration opportunities, for a medication error rate of 20%.

Inspectors wroteBased on observation and resident record review, it was determined that the facility did not ensure all staff were aware of adaptive equipment required during meals for one of fifty three residents reviewed (#101). Findings Include : On 1/30/20 at approximately 12:40 p.m. Resident # 101 was observed to be seated at a square table in the main dining room. A sippy cup was on the square table across from Resident # 101 near the middle of the table. The Administrator in Training (AIT) was observed to be serving beverages to residents in the dining room. She approached Resident # 101 and asked her what she would like to drink. Resident # 101 was heard to choose cranberry juice. There was no meal ticket or tray slip on the table. She was not observed to determine what consistency and in what form Resident # 101's beverages should be. [...]

Inspectors wroteBased on observations, interviews and record reviews the facility failed to implement their quality assessment and assurance measures for corrective action related to deficient practice identified on the annual survey conducted on 1/31/2020 Annual Survey. Continued non-compliance was identified for 2 (F810, F880) out of 12 deficiencies cited.

Inspectors wroteBased on observations, interviews, record review, policy review, manufacturer's instructions, and CDC (Centers for Disease Control) guidelines the facility did not ensure appropriate infection practices were implemented related to 1) glucometer disinfection for two (#15 and #33) of two residents observed during glucometer use, and 2) the facility did not ensure appropriate personal protective equipment (PPE) was worn during care for one resident (#34), on contact precautions, and appropriate hand washing after exiting a contact isolation room for Resident #267, of two residents on contact isolation, and 3) the facility did not ensure staff wore gloves during eye drop administration for one (#89) of six residents observed during medication administration.