Life Care Center of Omaha

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Licensure Reference Number 175 NAC 12-006.09 Based on record review and interview; the facility staff failed to monitor lab values related to thyroid medication for 1 (Resident 30) of 5 residents sampled and failed to hold blood pressure medication when the blood pressure was outside of parameters for 1 (Resident 71) of 5 residents sampled. The facility census was 98. The findings are:A. Record review of the facility policy titled Unnecessary Medication dated 08-30-2022 revealed the facility will ensure only medications required to treat the resident's assessed condition are being used, reducing the need for and maximizing the effectiveness of medications. The facility's medication management process will support and promote the monitoring of medications for efficacy and adverse consequences. Record review of Resident 30's Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) dated 08-08-2025 revealed the facility staff assessed the following about the resident:-BIMS was scored as a…

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 12-006.10(D) Based on observation, interview and record review the facility failed to ensure a medication error rate of 5% or less as evidenced by 2 medication administration errors out of 25 opportunities for error, resulting in an error rate of 8%. The facility census was 98. The findings are:Record review of the facility policy titled Medication Administered through an Enteral Tube (feeding tube) dated 11-15-2024 revealed medications are administered by authorized and qualified facility staff, as prescribed, in accordance with standard nursing principles and practices. Insert medication syringe into the appropriate port and pour each medication through the syringe. Medications should be prepared and given separately. Do not mix medications together in a medication syringe. Record review of Resdient 3's Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) revealed the facility staff assessed the following about the resident:-required total assistance with eating, hygiene, bathing, dressing, toileting, transfers and…

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 record review and interview the facility failed to provide a report to the receiving healthcare institution after an emergent transfer from the facility for 2 (Resident 1 and 3) of 4 residents sampled. The facility census was 95. The findings are: A. Record review of Resident 1's admission assessment dated [DATE] revealed the facility staff assessed the following about the resident: -was alert and oriented to person, place and time. -was receiving dialysis. -required extensive assistance with transfers. -required limited assistance with bed mobility, dressing, toileting and hygiene. -had an active infectious disease that required transmission-based precautions. Record review of Resident 1's progress notes dated 05-24-25 revealed Resident 1 and spouse wanted to be sent to the hospital due to body pain and had declined treatment for this at the facility. Furthermore, the progress note reveals the on-call supervisor was notified and 911 was called and an ambulance arrived at the facility to take Resident 1…

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 12-006.04 Based on record review and interview the facility failed to train licensed staff on an external cardiac defibrillator, prior to providing care to 1 (Resident 1) of 1 residents sampled. The facility census was 95. The findings are: Record review of Resident 1's admission assessment dated [DATE] revealed the facility staff assessed the following about the resident: -was alert and oriented to person, place and time. -was receiving dialysis. -required extensive assistance with transfers. -required limited assistance with bed mobility, dressing, toileting and hygiene. -had an active infectious disease that required transmission-based precautions. Record review of Resident 1's discharge orders from the hospital revealed an order for a life vest (an external defibrillator designed to protect individuals at risk of Sudden Cardiac Arrest by monitoring heart rhythms and delivering a shock when abnormal rhythms are detected) was to be worn at all times. An interview with…

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 1-005.06(E & F), 12-006.18(B) Based on observation, interview and record review the facility failed to utilize contact precautions for 1(Resident 2) of 3 residents sampled and failed to utilize enhanced barrier precautions for 2 (Resident 3 and 4) of 2 residents sampled. The facility census was 95. The findings are: A. Record review of Resident 2's Minimum Data Set, (MDS: a federally mandated assessment tool used for care planning) dated 04-16-2025 revealed the facility staff assessed the following about the resident: -Brief Interview of Mental Status (BIMS) was scored as a 15. According to the MDS Manual a score of 13 to 15 indicate a person is cognitively intact. -was legally blind -had a C. Difficile infection (a bacterium that can cause inflammation of the colon and diarrhea) -was on isolation for an active infection. -required supervision and minimal assistance with toileting, bathing and transfers. -was occasionally incontinent of bowel and bladder. An observation on…

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.

175 NAC 12-006.09(H)(vi)(3)(a) Based on observation, interview and record review the facility failed to administer enteral tube feedings and water flushes according to the practitioner's orders for 1 (Resident 5) of 1 residents sampled. The facility census was 99. The findings are: Record review of Resident 5's Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) dated 12-24-2024 revealed the facility the following about the resident. -Brief Interview of Mental Status (BIMS) was scored as a 3. According to the MDS Manual a score of 0-7 indicates severe cognitive impairment. -had a diagnosis of Protein Calorie Malnutrition -required total assistance with eating, hygiene, toileting, bathing, dressing, transfers and bed mobility. -had a feeding tube and was receiving 51% or more of the daily total calories through the feeding tube. Record review of Resident 5's order summary printed on 03-13-2025 revealed an order Nepro enteral feeding at 45 milliliters (ml) per hour through the feeding tube for 24 hours a day continuously. Additionally, the order summary…

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 12-006.10(D) Based on observation, interview and record review the facility failed to ensure a medication error rate of less than 5%. Observation of 29 medications administered revealed 3 errors resulting in a medication error rate of 10.34%. The medication errors affect 2 (Resident 2 and 3) of 4 residents. The facility census was 99. Findings are: A. Record review of Resident 3's Medication Administration Record (MAR) printed on 03-13-2025 revealed the following medications to be administered for 8:00 AM: -Amlodipine Besylate (medication used for blood pressure management) 10 milligrams (mg) -Baclofen (muscle relaxant) 15 mg -Calcium Carbonate Chewable 500 mg -Culturelle Capsules 1 capsule -Donepezil (medication used to improve mental function) HCl 10 mg -Fluticazone Propionate Nasal Suspension 1 spray each nare -Gabapentin (anticonvulsant medication) 300 mg -Isosorbide mononitrate ( ER 30 mg -Refresh Tears Solution 0.5 % 1 drop in both eyes. An observation on 03-13-2025 at 7:35 AM of Registered Nurse (RN) B administering medications for Resident…

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.

175 NAC 12-006.12(D)(iii) Based on observation, interview and record review the facility failed to ensure 10 insulin pens were labeled with the date opened for Residents 5, 6 and 8 during an observation of 1 medication cart sampled. The facility census was 99. The findings are: Record review of the facility policy Guidance for Using Insulin Products revealed the following information: -insulin products should not be used if they were frozen. -Before opening all unused vials, pens, and cartridges of insulin are best stored in a refrigerator between 36 and 46 degrees Fahrenheit and can be kept until the expiration date printed on the packaging. -Storage of unopened insulin products outside of the refrigerator is permissible but results in an earlier expiration date. -Upon opening all vials, cartridges, pens should be dated and stored away from direct heat or light. Insulin pens should not be refrigerated once opened. -Lantus insulin opened and stored at room temperature will expire in 28 days. -Lispro insulin opened and stored at room temperature will expire in 28 days. Observation on…

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 12-006.05(E) Based on record review and interview; the facility staff failed to include the resident/ family member in the quarter care planning process for 1 (Resident 2) of 3 sampled residents. The facility staff identified a census of 90. Findings are: Record review of a Order Summary Report printed on 10-28-2024 revealed Resident 2 admitted to the facility on [DATE]. Record review of Resident 2's Electronic Medical Record (EMR) under the section identified as census revealed Resident 2 discharge from the facility on 8-23-2024. Further review of Resident 2's EMR revealed the last quarter care planning process was completed on 10-24-2023. There was no indication a quarter care planning process was conducted as of 10-29-2024. On 10-28-2024 at 10:10 AM an interview was conducted with a Family Member (FM) of Resident 2's. During the interview Resident 2's FM reported not being invited or being aware of the quarterly care planning process. Resident 2's FM reported being involved…

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 Refernce Number 175 NAC 12-006.09(l) Based on observations, record review and interview; the facility staff failed to implement assessed interventions to prevent accidents/falls for 3 (Resident 1,3 and 4) of 4 sampled residents. The facility staff identified a censu of 90. Findings are: A. Record review of Resident 1's Comprehensive Care Plan (CCP) printed on 10-28-2024 revealed Resident 1 was admitted to the facility on [DATE]. Further review of Resident 1's CCP revealed Resident 1 had a fall initiated on 7-03-2023. According to Resident 1's CCP the goal for Resident 1 was Resident 1 would not sustain a serious injury requiring hospitalization. Interventions to meet this good were as follows: -Anticipate and meet the residents needs. -Call light in reach. -Complate a fall risk assessment. -Fall mate next to the bed. -Parameter mattress to the bed. Observation on 10-28-2024 at 7:26 PM revealed Resident 1 was in bed and did not have a fall mat in place. On 10-28-2024 at 7:28 PM Licensed Practical nurse…

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 12-006.10D Based on observation, record review and interview; the facility staff failed to ensure a medication error rate of less than 5%. Observation of 34 medication revealed 4 errors resulting in an error rate of 11.76%. The medication errors effect 3 (Resident 10,11 and 13) of 5 sampled residents. The facility staff identified a census of 90. Findings are: A. Record review of Resident 10's Medication Administration Record (MAR) for October 2024 revealed Resident 10 practitioner had ordered Atorvastation(medication to treat high cholesterol level) 20 milligrams (mg) and Metamucil 4 in 1 fiber oral packet to be given 4 times a day. According to Resident 10's MAR for October 2024, the Atorvastation was schedule to be given at 5:00 PM. Observation on 10-28-2024 at 7:33 PM revealed Licensed Practical Nurse (LPN) A prepared Resident 10 medications that included the Atorvastatin 20 mg. In addition LPN A scooped out 1 scoop of the Metamucil using a plastic spoon and place the medication into a plastic cup. LPN A took the medications and administered…

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.

Based on record review and interview, the facility failed to ensure a Preadmission Screening and Resident Review (PASARR, a federal requirement to help ensure that individuals who have a serious mental disorder or intellectual disabilities are not inappropriately placed in nursing homes for long term care, requires that all applicants to a Medicaid-certified nursing facility be evaluated for a serious mental disorder and/or intellectual disability, be offered the most appropriate setting for their needs, and receive the services they need in those settings) Level II was completed on a resident with a serious mental disorder for 1 of 1 resident's reviewed (Resident 6). The facility identified a census of 81. Findings are: Record review of Resident 6's PASARR Level I screening determination notification dated 6/1/2023 revealed the following statement: There were no signs of a serious mental illness, intellectual disability or a related condition found during the Level I screen. No further clinical review or onsite evaluation is needed. Record review of Resident 6's Census Sheet…

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(F)(i) Based on record review and interview, the facility failed to complete a baseline care plan (a person-centered plan developed and implemented to meet the resident's needs) on admission for 1 (Resident 79) of 29 sampled residents. The facility identified a census of 81. Findings are: Record review of Resident 79's (Electronic Medical Record) EMR revealed the admission date of 06/21/2024. Record review of Resident 79's baseline care plan that was initiated in (Point Click Care, a system for documenting clinical information on residents) PCC on 06/21/2024 revealed the facility staff had not developed a baseline care plan for Resident 79. Interview concluded on 07/18/2024 at 1:29 PM with the (Assistant Director of Nursing) ADON confirmed that baseline care plans should be completed within 48 hours of admission. The ADON confirmed Resident 79 baseline care plan in PCC were blank and had no information about Resident 79's physical or medical needs, goals or interventions to maintain or improve Resident 79's health or physical needs. Record…

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(E) Based on record review and interview, the facility staff failed to complete a Comprehensive Care Plan (CCP, the plan of care is developed from a comprehensive assessment to ensure the resident achieves optimal functional status.) for Resident 79 after the completion of the comprehensive assessment. This affected 1 (Resident 79) of 29 sampled residents. The facility identified a census of 81. Findings are: Record review of Resident 79's (Electronic Medical Record) EMR revealed the admission date of 6/21/24. Record review of Resident 79's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 06/28/2024 identify Resident 79 used a wheelchair and a walker. The MDS section GG- Functional Abilities and Goals, identified Resident 79 needed setup or clean-up assistance with oral hygiene. Further review of Resident 79's MDS revealed Resident 79 was dependent for showering, toileting, and lower body dressing. Resident 79 required substantial/maximal assistance with transferring from one surface to another per…

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: 175 NAC 006.09(H)(vi)(2) Based on observation, interview, and record review, the facility failed to ensure activities were provided to meet resident needs and interests for 1 [Resident 63] of 1 sampled resident. The facility had a total census of 81 residents. Findings are: A review of Resident 63's electronic medical record revealed Resident 63 was admitted on [DATE] with a diagnosis of dysphagia, oropharyngeal phase [difficulty swallowing], and anoxic brain damage [brain injury caused by lack of oxygen]. A review of Resident 63's annual MDS [Minimum Data Set; a comprehensive assessment used for care planning] dated 5/17/24 identified the following: -Brief Interview for Mental Status was not completed -Resident 63 was identified as having short-term and long-term memory problems -The following activities were identified as being very important to Resident 63: listening to music, doing things with groups of people, going outside to get fresh air when the weather is good A review of annual…

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: 175 NAC 12-006.09(I) Based on observation, interview, and record review, the facility failed to ensure interventions to prevent potential falls were implemented for 1 [Resident 63] of 3 residents sampled for falls. The facility had a total census of 81 residents. Findings are: A review of Resident 63's electronic medical record revealed Resident 63 was admitted on [DATE] with a diagnosis of dysphagia, oropharyngeal phase [difficulty swallowing], and anoxic brain damage [brain injury caused by lack of oxygen]. A review of Resident 63's annual MDS [Minimum Data Set; a comprehensive assessment used for care planning] dated 5/17/24 revealed Resident 63 has had 2 falls with no injury since admission/entry or reentry or prior assessment whichever is more recent. A review of Resident 63's care plan identified of focus area dated 5/17/23 of being at risk for falls related to confusion, incontinence, and unaware of safety needs with a goal of Resident 63 not sustaining a serious injury that required…

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: 175 NAC 12-006.09(H)(vi)(3) Based on observation, interview, and record review, the facility failed to ensure enteral feeding was provided in accordance with physician order for 1 [Resident 63] of 1 resident sampled for enteral feeding. The facility had a total census of 81 residents. Findings are: A review of Resident 63's electronic medical record revealed Resident 63 was admitted on [DATE] with a diagnosis of dysphagia, oropharyngeal phase [difficulty swallowing], and anoxic brain damage [brain injury caused by lack of oxygen]. A review of Resident 63's annual MDS [Minimum Data Set; a comprehensive assessment used for care planning] dated 5/17/24 revealed Resident 63 received greater than 51% of total calories from enteral tube feeding. A review of Resident 63's 7/2024 MAR [Medication Administration Record] revealed the following orders: -Jevity 1.5 [tube feeding formula] 300 cc [cubic centimeters] bolus via G-tube [a tube inserted in resident's stomach], flush with 50 ml [milliliters]…

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: 175 NAC 12-006.02 (8) Based on record review and interview, the facility failed to report to Adult Protective Service and submit investigation to state agency within 5 working days 2 elopements involving 1 [Resident 1] of 4 sampled residents. The facility had a total census of 85 residents. Findings are: A. A review of the admission Record revealed Resident 1 was admitted to the facility on [DATE] with a diagnoses of hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. A review of the MDS [Minimum Data Set; a comprehensive assessment used for care planning] dated 2/8/24 revealed Resident 1 had a BIMS [Brief Interview for Mental Status is used to get a quick snapshot of how well you are functioning cognitively at the moment] score of 3 indicating severe cognitive impairment. A review of Resident 1's Care Plan revealed a problem of being at risk for elopement with history of attempts to leave facility unattended and impaired safety awareness dated 7/27/23…

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: 12-006.04B2a Based on record review and interview, the facility failed to ensure 2 [Nurse Aide C and D] of 5 sampled nurse aides had completed 12 hours of yearly in-service training and failed to complete dementia and abuse in-service training for 1[ Nurse Aide C] of 5 sampled nurse aides. The facility had a total census of 85 residents. Findings are: A review of employee list with an effective date of 3/7/24 revealed a hire date of 11/28/17 for Nurse Aide-C. A review of Nurse Aide-C's completion certificates revealed Nurse Aide-C completed 1.95 hour of continuing education between service dates of 11/28/22 to 11/28/23. The completion certificates did not include any training on abuse prevention or dementia for the service year. A review of employee list with an effective date of 3/7/24 revealed a hire date of 10/5/18. A review of Nurse Aide-D's completion certificates revealed Nurse Aide D completed 1.03 hours of continuing education between service dates of 10/5/22-10/5/23. In an interview on 4/3/24 at 10:30 AM, the Director of Nursing confirmed Nurse Aide-C…

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 12-006.02(8) Based on record review and interview; the facility staff failed to investigate and report within 5 working days of a potential allegation of neglect for 1 (Resident 1) of 3 sampled Resident. The facility staff identified a census of 90. Record review of the facility Abuse-Identification of Types policy and procedure dated 10-04-2022 and a policy review date of 7-18-2023 revealed the following: -Neglect: -Neglect is defined as a failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. a. neglect includes cases where the facility's indifference or disregard for the residents care, comfort or safety, result in or could have resulted in, physical harm, pain, mental anguish, or emotional distress. Neglect may be the result of a pattern of failures or maybe the result of one or more failure of one resident and one staff person. b. Neglect of goods or services may occur when staff are aware, or should be aware,…

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 12-006.09D4 Based on observation, record review and interview; the facility staff failed to ensure complete personal cares for 1 (Resident 3) of 4 sampled residents. The facility staff identified a census of 90. Findings are: Record review of Resident 3's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 12-13-2023 revealed the facility staff assessed Resident 3's Brief Interview of Mental Status (BIMS) as a 15. According to the MDS [NAME] a score of 13 to 15 indicates the resident is cognitively intact. Further review of Resident 3's MDS dated [DATE] revealed the following information about resident 3: -Dependent for toilet use, personal hygiene and transfers. -Required substantial to maximal assistance with rolling side to side, sitting and laying and dressing upper body. -Limited range in motion to the upper and lower extremities. Observation on 1-08-2024 at 11:20 AM revealed Nursing Assistant (NA) A entered Resident 3's room and…

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 12-006.09D Based on observations, record review and interviews; the facility staff failed to implement pain management interventions for 1 (Resident 3) of 3 sampled residents. The facility staff identified a census of 90. Findings are: Record review of Resident 3's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 12-13-2023 revealed the facility staff assessed Resident 3's Brief Interview of Mental Status (BIMS) as a 15. According to the MDS Manual a score of 13 to 15 indicated the resident is cognitively intact. Further review of Resident 3's MDS dated [DATE] revealed the following information about Resident 3: - dependent for toilet use, personal hygiene and transfers, - required substantial to maximal assistance with rolling side to side, sitting and laying and dressing upper body, - limited range in motion to the upper and lower extremities, - frequent pain that affected [gender] sleep at times and occasionally interfered with day to…

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 12-006.17D Based on observations, record review and interview; the facility staff failed to apply Personal Protective Equipment (PPE) in a manor to prevent the potential spread of COVID-19 on the west section of the facility. This had the potential to effect 54 of 88 facility residents. The facility staff identified a census of 88. Findings are: On 8-21-2023 at 8:55 AM the facility Administrator reported the facility was in an outbreak status related to residents in the facility testing positive for COVID-19 and that N 95 mask were required when in the facility. Observation on 8-21-2023 revealed the following information: - 11:25 AM, Licensed Practical nurse (LPN) C standing at nursing station with mask below nose - 11:40 AM, Housekeep E was in the 400 hall with the mask below the chin. - 11:40 AM, Occupational Therapist I in room [ROOM NUMBER] with resident with mask below chin. - 11:42 AM, Certified Medication Assistant (CMA) D in hall 400 with mask below nose. - 11:52 AM,…

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 12-006.04C3a(6) Based on record review and interview; the facility staff failed to notify a family representative of the discontinuation of tube feeding treatment for 1 (Resident 9) of 1 resident. The facility staff identified a census of 88. Findings are: Record review of a Order Recap Report (ORR) printed on 8-21-2023 revealed Resident 9 was admitted to the facility on [DATE] with the diagnoses that included Protein Calorie Malnutrition, Depression, Diabetes and Hypertension. Further review of the OOR printed on 8-21-2023 revealed Resident 9's practitioner ordered a diet of regular texture with fluids at a thin consistency. Record review of a ORR printed on 8-22-2023 revealed Resident 9 had been receiving tube feedings of a feeding formula two times a day. Further review of the OOR printed on 8-22-2023 revealed the tube feeding was discontinued on 8-01-2023. Record review of Resident 9's Nutrition/Dietary Note dated 7-31-2023 revealed Resident 9 had been refusing all tube…

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 12-006.09D2b Based on observations, record review and interviews; the facility staff failed to implement assessed intervention and additional interventions for pressure ulcer prevention and treatment for 2 (Resident 4 and 16) of 3 sampled residents. The facility staff identified a census of 88. Findings are: A. Record review of a Order Summary Report (OSR) printed on 8-22-2023 revealed Resident 4 was admitted to the facility on [DATE] with the diagnoses that included Diabetes, Hypertension,Chronic Respiratory Failure and absence of right leg below the knee. Further review of Resident 4's OSR printed on 8-22-2023 revealed an order Resident 4 was to wear a Prevalon boot (protective foot wear) to the left foot at all times. Record review of Resident 4's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 6-14-2023 revealed the facility staff assessed Resident 4's Brief Interview of Mental Status (BIMS) as a 15. According to the MDS [NAME] a…

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 Nebraska Food Code 4-602.13 Based on observation, interview and record review; the facility failed to maintain a fan, air conditioner units and ceiling ventilation covers in clean condition in the facility kitchen. This had the ability to affect 87 of 91 residents who ate food prepared in the facility kitchen. The facility census was 91. Findings are: Observation on 6/26/23 of the facility kitchen between 6:35 AM and 6:55 AM revealed the following: - A fan was present in the facility dish room. The fan was on and blowing toward the clean side of the facility dishwasher. The exterior of the fan cover had a gray substance present that resembled dust. - Two air conditioners that were in the wall in the main kitchen over the food prep areas had covers that were coated with a gray, dark fuzzy substance that resembled dust. The air conditioners were on and blowing into the kitchen toward the food preparation areas, the stove, and oven and the steam table areas. - 2 large ceiling ventilation covers over the food preparation area in the facility…

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 12-006.18 Based on observation and interview, the facility failed to maintain walls, fixtures, ceiling tiles, outlets, baseboards and doors in 21 ( Rooms 100, 102, 105, 107, 200, 201, 204, 205, 303, 306, 402, 407, 409, 410, 505, 604, 605, 606, 700, 707, 708) of 101 occupied resident rooms. The facility census was 91. Findings are: Observation on 06/28/23 between 1:00 PM and 2:01 PM with the Director of Environmental Services and the Director of Maintenance [DM] revealed the following concerns with the facility environment: - The caulking surrounding the sink was cracked and broken and the sink was pulled away from the wall in resident bathrooms in rooms 100, 105, 107, 201, 205, 605 and 700. - There were scrapes present in the drywall on walls by beds in resident rooms 102, 107, 200, 205, 407 and 606. - There were stained, brown areas present around the base of the toilet in resident bathrooms in rooms 105, 204, 409, 410, 604, 707 and 708. - The ceiling tile was cracked and…

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 12-006.17D Based on record reviews, observations, and interviews, the facility failed to ensure hand hygiene was completed between glove changes for 2 residents (Resident 54 and 19) of 2 sampled residents, and failed to perform hand hygiene during catheter care for Resident 19. The facility staff identified a census of 91. Findings are: A. Record review of facility policy on Hand Hygiene dated 6/13/23 revealed Associates perform hand hygiene (even if gloves are used) in the following situations; a) before and after contact with the resident, b) after contact with blood, body fluids, or visibly contaminated surfaces, c) after contact with objects and surfaces in the resident's environment, d) after removing personal protective equipment (e.g. gloves, gown, eye protection, facemask), e) before performing a procedure such as an aseptic task (e.g. insertion of an invasive device such as urinary catheter, manipulation of central venous catheter, and/or dressing care). Record review…

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 12-006.09D1c Based on observations, interviews, and record review; the facility failed to provide nail care for a dependent resident for 1 (Resident 5) of 2 sampled residents. The facility census was 91. Findings are: Observation on 6/26/23 at 9:32 AM of Resident 5's toenails revealed both great toenails approximately 2 centimeters (cm) above the tip of the toe, yellow in color, and curved in towards 2nd toe on each foot. The observation further revealed the rest of Resident 5's toenails approximately 1 cm above the tip of the toe, yellow in color, and the 2nd toe on Resident 5's right foot grown into the tip of the toe. Interview on 6/26/23 at 9:32 AM with Resident 5 revealed that Resident 5 experienced pain due to the length of Resident 5's toenails, experienced increased pain when a sheet rubbed against Resident 5's toenails, that Resident 5 had not been offered to see a podiatrist (a doctor that treats the foot, ankle and related structures of the leg) and that staff 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 175 NAC 12-006.09D Based on record reviews and interviews, the facility failed to provide emergency care for Resident 13 as evidenced byt he facility contacting an ambulance transport company as opposedd to calling 911 for immediate transport for emergency services. This affected 1 of 5 sampled residents. The facility census was 91. Findings are: Record review of Resident 13's admission Record revealed that Resident 13 was initially admitted to the facility on [DATE] with diagnoses of Nontraumatic Intracerebral Hemorrhage (bleeding in the brain, not caused by trauma), Other Symptoms and Signs Involving Cognitive (thinking) Functions Following Nontraumatic Intracerebral Hemorrhage, Cognitive Communication Deficit, Other Reduced Mobility, and Need for Assistance with Personal Care. Resident 13 also had Hemiplegia (one-sided paralysis) and Hemiparesis (one-sided weakness) Following Unspecified Cerebrovascular (blood flow in the brain) Disease Affecting the Right Dominant Side. The resident…

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 Based on record review and interviews, the facility failed to monitor a hemodialysis access (is a way to reach the blood) site for 1 resident of 1 (Resident 8) sampled. The facility identified a census of 91. Findings are: Record review of facility Policy on Dialysis dated 11/23/22 revealed general guidelines to monitor vascular access site for signs of clotting every 8 hours. Monitor for any complaints of pain or discomfort at vascular site. Notify physician of any change in mental or physical status. Avoid taking blood pressure and performing venipuncture on the arm with the shunt in place. Document in the clinical nursing record: dialysis treatment completed, order changes, condition of shunt site, complaints from resident if applicable, and whether physician and responsible part notification. Record review of resident 8's Face Sheet revealed diagnoses of End Stage Renal Disease in which the resident requires hemodialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly) 3…

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.