Purcell Care Center

In the surveyor’s words

From the most serious findings on record at Purcell Care Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF580Jan 9, 2024

  Based on record review and interview, the facility failed to notify the physician of abnormal blood pressures for two (#3 and #5) of five sampled residents reviewed for changes in condition. The administrator identified 37 residents resided in the facility. Findings: 1. A facility Blood Pressure, Measuring policy, reviewed September 2010, documented in part .Hypertension is usually defined as blood pressure over 140/90 mm/Hg .Hypertension should be reported to the physician .Hypotension is defined as blood pressure less than 100/60 mm/Hg .Hypotension should be reported to the physician . Res #3 had diagnoses which included vascular dementia and secondary hypertension. […]

• No harm, potential for more than minimal, patternF755Jan 9, 2024

  Based on record review and interview, the facility failed to administer medications according to physician order for two (#3 and #5) of five sampled residents reviewed for changes in condition. The administrator identified 37 residents resided in the facility. Findings: 1. A facility Administering Mediations procedure, revised April 2019, documented in part .Medications are administered in accordance with prescriber orders .If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall initial and circle the MAR space provided for that drug and dose .The individual administering the medication initials the resident's MAR on the appropriate line after giving each medication and before administering the next one . […]

• No harm, potential for more than minimal, patternF755Sep 19, 2023

  Based on observation, record review, and interview, the facility failed to administer insulin according to physician orders for two (#10 and #26) and failed to notify the physician for FSBS outside of ordered parameters for one (#26) of six residents sampled for medications. The ADON identified seven residents who received insulin. Findings: 1. Res #10 had diagnoses which included diabetes. A physician order, dated 06/22/23, documented to administer insulin deglu[DATE] units subcutaneously one time a day at 6:30 a.m. for DM. The order documented to notify PCP if FSBS is less than 60 or greater than 400 and document in progress notes, do not hold. […]

• No harm, potential for more than minimal, patternF880Sep 19, 2023

  Based on observation and interview, the facility failed to ensure infection control practices were followed during insulin administration. The ADON identified seven residents in the facility received insulin. Findings: On 09/15/23 at 10:40 a.m., LPN #1 was observed during insulin administration. Several insulin pre-filled metered dose syringes were observed stored in the top drawer of the medication cart on top of each other. The pens were labeled with several different resident's names. The pre-filled syringes were not individually packaged or wrapped. The LPN was observed taking a bottle of test strips into the room to perform a FSBS. The nurse was not observed sanitizing the bottle of test strips before returning it to the top drawer of the medication cart. […]

• No harm, potential for more than minimal, patternF727May 5, 2022

  Based on record review and interview, the facility failed to have a weekend RN for eight hours a day. The Resident Census and Conditions of Residents report documented 30 residents lived in the facility. Findings: The daily staffing schedule for May 2022, did not document RN coverage on the weekends. On 05/05/22 at 11:00 a.m., the interim DON reported the facility had not had a weekend RN since 03/16/22.