Brookestone Village

Based on interview and record review, the facility failed to ensure that 1 (Resident 1) of 3 sampled residents' representative's preference of female caregivers only was honored. The facility census was 130. Findings are:A record review of the facility's Resident Rights dated 05/19 revealed the resident had the right to designate a legal representative who can make choices about care and to make choices about aspects of your life in the facility that are significant to the resident. The resident had the right to choose activities, schedules, health care and health providers.A record review of Resident 1's Clinical Census dated 03/23/2026 revealed that Resident 1 was admitted to the facility 12/12/2025. A record review of Resident 1's Medical Diagnosis dated 03/23/2026 revealed the resident had diagnoses that included Major Depressive Disorder and Cognitive Communication Deficit (problems communicating caused by a cognitive impairment).A record review of Resident 1's Physician's Order Sheet And Progress Notes dated 03/20/2021 revealed the physician documented the resident had…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Reference Number 175 NAC 12-006.18Based on observation, interview and record review, the facility failed to ensure a staff member wore a face shield or goggles in a droplet/contact isolation room, failed to restrict sharing of communal food items, and failed to ensure a staff member disinfected goggles between resident rooms in droplet/contact isolation to prevent cross contamination. The facility staff identified a census of 122.Findings are:Record review of an e-mail from an Infection Preventionist at the Nebraska Infection Control Assessment and Promotion Program (ICAP) to the Infection Preventionist and Assistant Director of Nursing (ADON) A at the facility dated February 18, 2026, at 3:20 PM revealed the following list of immediate prevention actions to follow regarding a Norovirus (a highly contagious virus that causes gastroenteritis, leading to vomiting, diarrhea, and stomach cramps) outbreak : -Ill residents should be isolated in contact precautions (gown, gloves, and mask and protective…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to report and investigate an allegation of abuse for Resident 22 within the required timeframe. The facility claimed a census of 122. A record review of the facility's undated Abuse and Neglect Prevention Standard, revised 1/2023, revealed the following Required Elements:It is the responsibility of all team members to immediately report any act of witnessed, suspected, or reported abuse to the Administrator or their supervisor.InvestigationAll allegations of abuse and/or neglect will be investigated and reported in accordance with the state and federal laws.In the situation of an allegation of abuse, the following people will be notified immediately: Administrator, Director of Nursing (DON), and Social Services.The suspected team member(s) will be suspended immediately while an in-depth, documented investigation is conducted.ProtectionResidents will be protected from harm during an investigation.Team members suspected of abuse will be immediately…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure 1 (Resident 129) of 1 Care Plan included a Risk for Elopement along with goals and interventions. The facility identified a census of 122 A record review of the Elopement (a patient or resident leaving a nursing home without authorization, supervision, or proper discharge) Risk Manual (the facility system to identify residents who are at risk for elopement) on the Lakeview unit revealed a resident sheet for Resident 129 containing an up-to-date picture and Resident 129's description details. A record review of the [NAME] Health Services Operating standards manual revealed the following: Elopement Prevention and Management Standard Resident Risk Review.All resident will be evaluated prior to admission for concerns related to elopement risk and resident safety. Appropriate placement of the resident is of utmost importance. Ongoing review will occur with all residents to ensure proper placement and a safe environment.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Reference Number 175 NAC 12-006.09(H)(iii)(1) Based on observation, interview, and record review, the facility failed to implement interventions to prevent pressure injury for 1 (Resident 58) of 1 sampled resident. The facility census was 122. Findings are:A record review of the facility's Skin and Wound Management Standard with a revised date of 04/2019 revealed each resident would be assessed for their risk for developing a pressure ulcer/injury and each high-risk area would have an individualized care plan to address each risk area, and interventions implemented immediately to avoid development of a pressure ulcer. A record review of Resident 58's Clinical Census dated 02/24/2026 revealed the resident was admitted to the facility on [DATE] to room [ROOM NUMBER]-A and transferred to room [ROOM NUMBER]-A on 01/27/2026. A record review of Resident 58's Order Summary Report dated 02/24/2026 revealed the resident had diagnoses of Nondisplaced Intertrochanteric Fracture of the Right Femur (right hip…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Licensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(g) Based on observation, interview, and record review, the facility failed to ensure 2 (Resident 144 and 147) of 2 sampled resident's oxygen (o2) orders contained a dosage (settings) and ensure 1 (Resident 160) of 2 sampled residents had a Positive Airway Pressure (PAP) device order. The facility census was 122. Findings are:A.A record review of the National Library of Medicine's undated Nursing Skills, Chapter 11 Oxygen Therapy revealed that oxygen was considered a medication and required a prescription. www.ncbi.nlm.nih.gov/books/NBK593208/ A record review of the National Library of Medicine's undated Nursing Skills, Basic Concepts of Administering Medications revealed that according to the Centers for Medicare & Medicaid Services, all orders for the administration of drugs and biologicals must contain the following information: - Drug name - Dose, frequency, and route - Name/Signature of the prescriber - Specific instructions for use, when…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Reference Number 175 12-006.09 (F)(III) Based on observation, interview and record review, the facility failed to update the Comprehensive Care Plans (CCP) related to wound care for Residents 7 and 88, anti-anxiety medication use for Resident 87 and targeted behaviors and interventions for Resident 69. The sample size was 5 and the facility census was 132. Findings are: A review of the facility's CCP policy dated [DATE] revealed it is the policy of the facility to develop and implement a comprehensive person centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframe's to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. It further confirmed that the comprehensive careplan will be reviewed and revised by the interdisciplinary team after each comprehensive, quarterly Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Licensure Reference Number 175 NAC 12.006.11E Based on observation, interview, and record review, the facility failed to ensure food was stored in the facility's refrigerators and freezers in a sealed container that was labeled and dated. This had the potential to affect all 130 resident that consumed food from the kitchen. The total census was 130. Findings are: A record review of the facility's Dietary Storage Policy and Procedure dated 08/2023 revealed the facility staff should store food in covered containers or wrap securely and clearly label and date each item. An observation on 08/09/2023 at 07:35 AM revealed the following items were in the facility's reach-in freezer and were unsealed and not labeled or dated: • 2 bags of onion rings • 2 bags of French fries • 1 bag of carrots • 1 bag of waffle fries • 1 bag of hamburger patties • 1 bag of an unknown substance • 1 bag of cookies An observation on 08/09/2023 at 07:35 AM revealed the following items were in the facility's walk-in refrigerator and were opened and did not have an open date: • 1 container of pickles • 1 container…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Number 175 NAC 12-006.17D The facility failed to ensure that staff performed hand hygiene between Residents 9, 59, 77, 87, 91, 95, and 103 during dining and failed to ensure that staff performed hand hygiene when providing wound care to one (Resident 6) of two sampled residents. The total facility census was 130. Findings are: A. A record review of the facility's Hand Hygiene (washing) Policy dated 08/19/2022 revealed that according to the World Health Organization, 5 key moments in patient (resident) care during which hand hygiene should be performed is before touching a patient (resident), before a clean procedure, after touching a patient (resident), after body fluid exposure risk, and after touching a patient's (resident's) surroundings. A record review of the Dietary Handwashing Policy and Procedure dated 10/2017 revealed the staff should wash hands after handling soiled equipment or supplies, after touching bare body parts, and after engaging in other activities that contaminate hands. An…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.