Excell Health Care Center

Inspectors wroteBased on interview and record review, for one of three sampled residents (Resident 1), the facility failed to ensure Resident 1, identified as a high risk for falls, was provided consistently close monitoring/supervision to minimize complications and prevent multiple falls. This resulted in Resident 1 sustaining fall injuries from a third unwitnessed fall. Resident 1 was transferred to the emergency department (ED) for evaluation and was found with multiple facial fractures (breaks in the facial bones such as the jaw, nose, or eye sockets, typically caused by accidents, falls, or assaults, and often required prompt medical attention). [...]

Inspectors wroteBased 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.

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.