Excel Care At Manalapan

F 0755 Level of Harm - Minimal harm or potential for actual harm

A review of the electronic progress notes (EPN) for Resident #55 revealed the following eMAR administration notes:

1. 1. On 8/1/25 at 18:29 (6:29 PM) the LPN #3 documented “awaiting delivery” for the

Cefuroxime 500 MG dose.

Residents Affected - Few

2. 2. On 8/12/25 at 9:02 AM the LPN #4 documented “awaiting delivery” for the Escitalopram 5

MG dose.

3. 3. On 8/12/25 at 9:03 AM the LPN #4 documented “awaiting delivery” for the Pantoprazole 40

MG dose.

There were no progress notes regarding the physician being notified.

On 8/13/2025 at 11:02 AM, the surveyor interviewed LPN #5 who stated that she was the nurse administering medications to Resident #55 that day but was not here yesterday. LPN #5, in the presence of

the surveyor, reviewed the medication cart and removed Escitalopram 5 MG and Pantoprazole 40 MG labelled for Resident #55. LPN #5 stated they were in the bottom drawer of the medication cart. LPN #5 added that sometimes agency nurses do not look for the medications.

On 8/13/2025 at 11:25 AM, the surveyor interviewed Resident #55 in their room. The resident stated that

the nurses brought their medications and had no concerns. The resident added that they had a lot of medications and was unable to speak to which medications or what times the nurses gave them their medications.

On 8/13/2025 at 11:50 AM, the surveyor interviewed the DON, who stated that she would have to educate

the nurses who indicated “awaiting delivery” for Resident #55’s medications. The DON stated that Cefuroxime, Escitalopram and Pantoprazole were medications stocked in the back up supply and should have been administered. The DON added that she would expect the nurses to notify a supervisor if a medication was not available and there would be follow up such as getting the medication from the backup system, calling the provider pharmacy, or emergency pharmacy. The DON stated that the goal was to get the medication and administer it and if that was not possible then the physician needed to be notified for follow up.

A review of the electronic medication back up supply list reflected that Cefuroxime 250 MG tablets, Escitalopram 10 MG tablets and Pantoprazole 20 MG tablets were available.

A review of the facility policy dated as revised April 2019 for “Administering Medications” provided by the DON reflected “Medications are administered in a safe and timely manner, and as prescribed.” In addition, the policy interpretation and implementation included but not limited to; “4. Medications are administered in accordance with prescriber orders, including any required time frame. 7. Medications are administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders).” NJAC 8:39-11.2(b), 29.2(a)(d)

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Excel Care at Manalapan

104 Pension Road Manalapan, NJ 07726

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the surveyor interviewed the Registered Dietician (RD), who stated that the meal ticket specified no straw if

the resident were ordered thickened liquids. The RD further stated that the aide, or the nurse could identify if the ticket specified no straw upon review for tray accuracy and remove it at that time if indicated. On 8/7/25 at 12:08 PM, the surveyor interviewed the Food Service Director (FSD), who stated that the staff usually fed the resident, and the nurse should have noticed the straw at that time. The FSD stated that the resident should not have been provided with a drinking straw because the resident was ordered thickened liquids. The RD who was present at that time, stated that the reason that the resident was not permitted to have a straw had something to do with their swallowing, but she did not know the correct answer. On 8/7/25 at 1:41 PM, the surveyor informed the Director of Nursing (DON) of the concerns with Resident #43 who received a drinking straw on their tray during the lunch meal service on 8/6/25 and 8/7/25, despite the meal ticket indicating No Straw.A review of the facility's undated Tray Accuracy included:.Routine tray line audits to confirm tray accuracy will be conducted by the Food Service Director or designated employee.A review of the facility's Preparing the Resident for a Meal policy, revised September 2010, included: .Review the resident's care plan and provide for any special needs of the resident.NJAC 8:39-17.4(a)1

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Excel Care at Manalapan

104 Pension Road Manalapan, NJ 07726

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

resident with the soiled brief instead of a washcloth CNA #1 stated that it was okay since the resident was going to get a shower anyway. CNA #2 then continued to clean the resident with the soiled brief and prepared the resident to shower. On 8/7/25 at 10:30 AM, the surveyor interviewed CNA #3 who stated that Resident #43 was changed today at 9:30 AM and was not saturated with urine. CNA #3 stated that he obtained all supplies needed before he rendered care to the resident. CNA #3 stated that the facility offered both disposable and washable wash cloths for incontinence care. CNA #3 stated that two wash cloths were needed for incontinence care for a female, and it was important to clean from front to back so that it would not get contaminated. CNA #3 stated that if we used a soiled brief to wipe a resident it was not appropriate for infection control purposes because the resident could get an infection. On 8/7/25 at 11:19 AM, the surveyor interviewed CNA #2 who stated that she used the resident's soiled brief to clean Resident #43's urine and stool because it was there, and CNA #1 wanted to clean the resident in the shower. CNA #2 stated that there were wipes that were not used and the resident was not properly cleaned. CNA #2 further stated that by using the brief to clean the resident instead of a wipe the resident could get an infection. On 8/7/25 at 11:28 AM, the surveyor interviewed Registered Nurse (RN) #1 who stated that the aides could have pressed the call bell and called for wash cloths to cleanse the resident. RN #1 further stated that there was a potential for infection because the resident had a history of urinary tract infection. On 8/7/25 at 11:36 AM, the surveyor interviewed Licensed Practical Nurse/Unit Manager (LPN/UM) #1, who stated that a soiled brief should not be used to do incontinence care because you must use a wet washcloth to clean the resident appropriately. The LPN/UM #1 stated that it could cause an infection if a soiled brief were used instead. The LPN/UM #1 further stated that Resident #43 has had UTIs since day one and had been going to the urologist, but they have not specified the cause of the resident's UTIs. On 8/7/25 at 12:20 PM, the surveyor interviewed the Infection Preventionist (IP), who stated that even if a section of the resident's brief that was not soiled were used to clean the resident it was still soiled and dirty. The IP stated that he would have instructed the aides to wait and get the appropriate supplies to clean the resident because there was

a concern for infection, and it could cause a potential UTI. On 8/7/25 at 1:41 PM, the surveyor interviewed

the Director of Nursing (DON), who stated that it was not appropriate to use a soiled brief to clean the resident. The DON stated a clean diaper maybe, or a washcloth, wipe or toilet tissue could be used to clean

the resident but not a soiled diaper, until the aides showered the resident. The DON stated, A soiled brief was not clean, and it is an infection issue because there was both urine and bowel movement in the diaper and it can cause an infection. The DON stated that the doctor has deemed the resident chronic for UTI. A

review of the facility's Urinary Continence and Incontinence-Assessment and Management policy, revised September 2010, included: The staff and practitioner will appropriately screen for, and manage, individuals with urinary incontinence. Management of incontinence will follow relevant clinical guidelines.A review of a staff in-service that was provided to staff which included CNA #2 on 7/2/25, revealed the following:.Nurses and CNA play a key role in UTI prevention through patient education and promoting healthy habits.Female Patients: Spread the labia majora and wipe down the center, using a clean part of the washcloth for each stroke. Then, clean each side, rinsing and drying the area thoroughly. Finally, have the patient turn on their side to clean the anal area.Male Patients: For circumcised males, start cleaning at the top of the penis and move downwards in a circular motion to the base. For uncircumcised males, gently retract the foreskin

before cleaning and remember to reposition it afterward. NJAC 8:39-19.4

Event ID:

Facility ID:

If continuation sheet