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| Link | rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid ▼ | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7443 | 7443 | HILLCREST COUNTRY ESTATES | 285293 | 6082 GRAND LODGE AVENUE | PAPILLION | NE | 68133 | 2015-04-30 | 225 | D | 1 | 0 | Deficiency Text Not Available | 2018-04-01 | |
| 7053 | 7053 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 225 | E | 0 | 1 | 000N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.04A3a and 12-006.04A3b Based on record review and interview; the facility staff failed to ensure that criminal background check specific information, Adult and Child Protective Services (APS/CPS) checks and Sex Offender Registry (SOR)checks were included in 5 employee files (Licensed Practical Nurse (LPN) E, Nurse Aide (NA) F, Registered Nurse (RN) G, Dietary Aide (DA) H and Nurse Aide (NA) I) The facility census was 43. Findings are: Record review of the facility policy and procedure for Abuse Prevention dated revised 1/25/15 revealed that screening of potential employees for history of abuse, neglect, or mistreatment of [REDACTED]. 3. Criminal background check pursuant to center or state and federal law. 5. Any pre-employment verification will be conducted per state requirements Record review of 5 employee files( LPN E, NA F, RN G, DA H and NA I) revealed that there were no SOR checks, APS/CPS checks or specific information on criminal background checks present in the employee files. Interview on 04/08/2015 at 8:08 AM with the facility Bookkeeper J confirmed that there were no records of SOR checks, APS/CPS checks or details of the criminal background checks in the 5 employee files reviewed. Bookkeeper J confirmed that there was information from the company that showed that the employees had passed a background check but there were no specific details related to what was found in the background check in the employee files. | 2018-07-01 |
| 7054 | 7054 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 226 | E | 0 | 1 | 000N11 | Based on record review and interview; the facility staff failed to follow and implement the facility policy related to reporting of sexual contact between Resident 14 and Resident 34 immediately to the facility administrative staff. This had the ability to affect 3 (Residents 3, 28 and 31) residents that were cognitively impaired and unable to tell staff if they had concerns with other residents. The facility census was 43. Findings are: Record review of the facility Abuse Prevention Policies and Procedures dated revised 1/25/15 revealed the policy that the Center would take the following steps to prevent, detect and report allegations of abuse or neglect: Reporting: 1. All staff will be trained to report incidents immediately to the administrator or designee to include: mistreatment, neglect, abuse, exploitation. Record review of a facility Investigation Report dated 4/3/15 revealed that Nurse Aide (NA) K had witnessed an incident of sexual abuse between Resident 14 and 34 at 6:30 PM after supper. NA K immediately stopped the incident and redirected Resident 34 away From Resident 14. Record review of staff interviews related to the investigation revealed that NA K had reported the incident directly after it had happened to Licensed Practical Nurse L, the charge nurse. The record review of the investigation indicated that the facility administrative staff was not made aware of the incident until the morning of 3/29/15 when a formal grievance was filed by a friend of Resident 14. The Grievance revealed that Resident 14 had informed the friend of the incident the previous evening. Interview on 4/8/15 at 1:57 PM with the facility Director of Nursing (DON) confirmed that the sexual contact took place between Resident 14 and Resident 34 on the evening of 3/28/15. The DON confirmed that the facility staff did not notify the administrative staff immediately per the facility policy and procedures for abuse prohibition. The DON confirmed that there was not notification to administration until the morning of 3/29/15 when a… | 2018-07-01 |
| 7055 | 7055 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 253 | E | 0 | 1 | 000N11 | Licensure Reference Number 12-006.18A Based on observation and interview; the facility failed to maintain odor control in resident bathrooms (rooms 110 and 111) and failed to maintain walls, door frames, doors, fixtures and call system cords in a clean and sanitary manner in resident rooms 102, 104, 105, 107, 109, 110, 111,112, 202, 204, 205, 206, 207, 208, 212, 213, 214, 215). This affected 18 of 30 occupied resident rooms in the facility. Findings are: Observation on 4/6/15 at 11:09 AM revealed that resident room 110 had a strong urine odor in the resident bathroom and the floor was wet and sticky. Observation on 4/7/15 at 7:47 AM revealed that resident room 111 had a strong urine odor in the resident bathroom. Observation on 04/07/2015 at 3:50 PM revealed that resident room 110 had a lingering, strong urine odor in the resident bathroom and the floor was sticky. Observation on 04/08/2015 at 10:16 AM revealed that resident room 110 had a continuing, lingering strong urine odor in the resident bathroom and the floor was wet and sticky. Observation on 4/8/14 between 10:30 AM and 11:00 AM during the environmental tour with the facility Administrator, Maintenance Supervisor (MS) and Housekeeping Supervisor revealed the following concerns in resident shared bathrooms: - Scrapes on the wall: rooms 102/104. - Door frames paint scraped : rooms 102/104, 109/111, 112/110 - Door scraped and gouged: rooms 102/104, 110/112 - Hole in the bathroom door: room 111. - Brown and reddish stains surrounding the base of the toilets: rooms 102/104, 105/107, 109/111, 112/110, 212/214, 205/ 2/204. - Brown stains on nylon call light cords in bathrooms: rooms 105/107, 109/111, 112/110, 202/204, 206/208, 205/207, 212/214. - Urine odors present in shared bathrooms: rooms 105/107, 112/110, 109/111, - Discolored and pink stained toilet seat: rooms 205/207. - Missing arm rest bathroom: rooms 109/111. Interview on 4/8/15 at 10:50 AM with the MS confirmed the above concerns and that those concerns needed to be addressed, fixed and cleaned. The … | 2018-07-01 |
| 7056 | 7056 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 279 | D | 0 | 1 | 000N11 | LICENSURE REFERENCE NUMBER 12-006.09C Based on interview, observation and record review; the facility failed to develop a comprehensive care plan for Resident 13 related to dental care and services. The facility census was 43. Findings are: An observation of Resident 13 was made on 4-6-15 at 3:22 pm revealed the resident did not have any teeth. An interview with Resident 13 was conducted on 4-6-15 at 3:22 pm, Resident 13 stated that (gender) does have dentures but they do not fit, they are too loose so (gender) does not wear them. Resident 13 reported being able to eat but must chew food with (gender) gums. A review of Resident 13's care plan with an onset date of 8-19-13 revealed no care planning noted on Resident 13's dental status. An interview with Resident 13 on 4-8-15 at 10 pm revealed (gender) would like to be able to wear dentures but they don't fit right, so (gender) doesn't wear them, but would if they were fixed. An interview with the Social Worker on 4/8/15 at 11:25 am revealed Resident 13 was last seen in (MONTH) 2014 by dentist to see if dentures could be realigned, the dentist submitted authorization to medicaid however no follow up was ever completed and that Resident 13 does not have any teeth and had not been wearing dentures. An interview with the MDS (Minimum Data Set assessment) Coordinator on 4-9-14 at 8:45 am confirmed that Resident 13's dental status and plan was not care planned and should have been due to the risk factors that go along with not having teeth. | 2018-07-01 |
| 7057 | 7057 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 309 | D | 0 | 1 | 000N11 | **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 a [MEDICAL TREATMENT] access port site used in [MEDICAL TREATMENT] (a procedure used to remove certain elements from the blood) treatments for Resident 65. The facility census was 43. Findings are: Record review of facility policy titled Care of [MEDICAL TREATMENT] Resident revised date 10/10/07, revealed: #5. Ateriovenous (combination of both arteries and veins) (AV) Shunt. a. AV shunt site will be inspected for functionality and sign and symptoms of complication. Record review of Resident 65's admission Face sheet dated 3/6/2015, revealed a [DIAGNOSES REDACTED]. Record review of Resident 65s Comprehensive Care Plan dated 3/27/15 revealed: A problem statement, resident has [MEDICAL CONDITION] and receives [MEDICAL TREATMENT]-goes to the Veterans Administration [MEDICAL TREATMENT] Program, with an intervention to monitor [MEDICATION NAME] (area beneath the clavicle) access site. Record review of Resident 65's Treatment record revealed no space for documentation of monitoring of [MEDICAL TREATMENT] or separate sheet for documentation of monitoring of [MEDICAL TREATMENT]. Interview with the ADON on 4/8/15 at 3:46 PM confirmed that Resident 65's [MEDICAL TREATMENT] should be monitored and assessed and that this was not done. | 2018-07-01 |
| 7058 | 7058 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 332 | E | 0 | 1 | 000N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** License Reference Number: 175 NAC 12-006.10D Based on observation, interviews and record review; the facility staff failed to ensure a medication error rate of less than five percent as evidenced by 3 medication errors out of 28 opportunities resulting in a medication error rate of 10.71 %. This affected 3 residents (Residents 24, 31 and 44). The facility census was 43. Findings are: A. Observation on 4/7/15 at 3:45 PM of Licensed Practical Nurse (LPN)- A administering medication for Resident 44 revealed [MEDICATION NAME] (blood thinner) was given with medication administration. Interview with on 4/7/15 at 3:45 PM with LPN-A revealed [MEDICATION NAME] was administered to Resident 44. Review of medical record revealed an Telephone order dated 4/7/15 for staff to hold the [MEDICATION NAME] on 4/7 and resume [MEDICATION NAME] on 4/8. B. Observation on 4/9/15 at 7:50 AM of LPN C administering medication revealed Resident 24 was given [MEDICATION NAME](acid reducer) at the breakfast meal. Review of Resident 24's medical record revealed the physician order [REDACTED]. Observation on 4/9/15 revealed Resident 24 had a meal tray at 6:10 am and was eating. C. Observation on 4/9/15 at 8:00 AM of LPN C administering medication revealed Resident 31 was given [MEDICATION NAME] at the breakfast table. Review of Resident 31's medical record reveals the physician order [REDACTED]. Order for to be given 30-60 min prior to meal. Observation on 4/9/15 revealed Resident 31's breakfast was served and Resident 31 was eating at 8:15. Interview on 4/9/15 at 8:30 AM with LPN-C revealed the medication should have given 30 minutes prior to breakfast meal. | 2018-07-01 |
| 7059 | 7059 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 333 | D | 0 | 1 | 000N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.10D Based on observation, interviews and record review; the facility staff failed to ensure that resident's were free of significant medication errors related to [MEDICATION NAME] therapy for Resident 44. This had the potential to effect 3 residents identified as being on [MEDICATION NAME] therapy. The facility census was 43. Findings are: Observation on 4/7/15 at 4:00 PM of Licensed Practical Nurse (LPN)- A administering medication for Resident 44 revealed [MEDICATION NAME](blood thinner) was given with medication administration. Interview with on 4/7/15 at 4:00 PM with LPN-A revealed [MEDICATION NAME] was administered to Resident 44. Review of medical record revealed an Telephone order dated 4/7/15 for staff to hold the [MEDICATION NAME] on 4/7 and resume [MEDICATION NAME] on 4/8. A Departmental note dated 4/7/2015 at 12:28 PM indicated the order was received. Review of Resident 44's Medication Administration Record (MAR) revealed LPN-A initialed the [MEDICATION NAME] dose for 4/7/15 to indicate it was given. Interview on 4/9/15 at 9:00 AM with ADON revealed on 4/7/2015 the MAR was not marked to hold the [MEDICATION NAME] dose and LPN-A did give the [MEDICATION NAME] dose to Resident 44. Review of Resident 44's Physician's Progress Note dated 3/10/15 revealed the Advanced Practice Registered Nurse documented Resident 44 required [MEDICATION NAME] changes often and had abnormal labs. Review of facility policy titled Administration of Medication dated 1/03 states: Standard: All medication are administered safely and appropriately. Under the heading of Procedure are the following: 3. Check Medications Administration Record (MAR). 4. Read each order entirely 5. Removed medication from drawer. Read label three times. 6. If there is any discrepancy between the MAR and the label, check the physician orders. 9. Initial each medication in the correct box on the MAR as each medication is administered. Review… | 2018-07-01 |
| 7060 | 7060 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 412 | D | 0 | 1 | 000N11 | LICENSURE REFERENCE NUMBER:175 NAC 12-006.14 Based on observation, record review and interviews; the facility staff failed to ensure dental services were provided to Resident 13 related to poor fitting dentures. The facility census was 43. Findings are: An observation of Resident 13 was made on 4-6-15 at 3:22 pm revealed the resident did not have any teeth. An interview with Resident 13 was conducted on 4-6-15 at 3:22 pm, Resident 13 stated that (gender) does have dentures but they do not fit, they are too loose so (gender) does not wear them. Resident 13 reported being able to eat but must chew food with (gender) gums. An interview with Resident 13 on 4-8-15 at 10 pm revealed (gender) would like to be able to wear dentures but they don't fit right, so (gender) doesn't wear them, but would if they were fixed. Review of Dietitian notes on 4-7-15 revealed Resident 13's wt down 2.4 pounds in 30 days. Average meal intake was 69%. Resident ok with gradual weight loss. Review of Resident 13's wight Change History log revealed a gradual weight loss since (MONTH) 2014, when weight was 174 pounds to (MONTH) (YEAR) when weight was 155 pounds. Review of last annual MDS (minimum data set assessment) dated 7-12-14 all oral/dental assessment questions were left unmarked. An interview with the social worker on 4/8/15 at 11:25 am revealed Resident 13 was last seen in (MONTH) 2014 by the dentist to see if dentures could be realigned, the dentist submitted authorization to medicaid however no follow up was ever completed and Resident 13 did not have any teeth and had not been wearing dentures. When asked if this should have been followed up on before now, the social worker shook head yes. Review of the facility policy titled Oral Health (no date) revealed: Policy: The facility will assist the resident in making appointments by arranging transportation to and from the dentist office and will promptly refer residents with lost or damaged dentures to a dentist. | 2018-07-01 |
| 7061 | 7061 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 431 | E | 0 | 1 | 000N11 | Licensure Reference Number: 175 NAC 12-006.12E1 Based on observation and interview, the facility staff failed to ensure that medications were secure related to an unlocked and unattended medication cart. This had the potential to affect 24 residents that resided on the first floor. The facility census was 43. Findings are: Observation on 4/7/15 at 4:00 PM revealed Licensed Practical Nurse (LPN) A enter Resident 44's room to administer medications to Resident 44. LPN-A left medications on top of the unlocked medication cart, and when entering Resident 44's room the medication cart was out of the nurse view. Interview on 04/08/2015 at 10:22 AM with Assistant Director of Nursing revealed the cart should be locked or in view of the nurse at all times and no medication should be left out of the cart. | 2018-07-01 |
| 7062 | 7062 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 441 | D | 0 | 1 | 000N11 | Licensure Reference Number: 175 NAC 12-006.17 Based on observation, record review and interview; the facility staff failed to ensure infection control practices were followed to prevent the potential for cross contamination related to bare hand contact with medications for Resident 44 and administration of medications through a gastric tube without gloves for Resident 3. The facility census was 43. Findings are: A. Observation on 04/07/2015 at 3:40 PM of Licensed Practical Nurse (LPN) A observed preparing medications for Resident 44. Nurse removed medications from the bubble packs into the palm of LPN A's bare hand and dropped pill into cup. This process was repeated for four medications. LPN A then picked up the cup and took Medications and administered them to Resident 44. Interview on 04/08/2015 at 10:44 AM with the Assistant Director of Nursing (ADON) revealed that bare hand contact with medication did occur and is not considered a standard of practice. B. Observation on 04/08/2015 at 10:10 AM revealed Registered Nurse (RN) B administered medication and water flush to Resident 3 per Gastric tube without gloves. Gastric contents did spill out of tube onto resident and RN-B hand. Interview on 04/08/2015 at 10:39 AM with ADON revealed the expectation would be that RN-B should have worn gloves during administration of fluids and medication through a Gastric tube. Interview on 04/08/2015 at 10:42 AM with Registered Nurse (RN) B revealed RN-B confirmed that gloves should have been worn during the administration of Gastric tube medications. | 2018-07-01 |
| 7063 | 7063 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2015-04-09 | 520 | E | 0 | 1 | 000N11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.07C Based on observations, record reviews and interviews; the facility failed to have a Quality Assessment and Assurance (QAA) program that identified potential repeat citations and additional citations. The QAA failed to develop and implement plans of action to maintain correction of repeat citations at F 332, F 412, F 431, and F 520. The facility census was 43. Findings are: Record review of the Quality Assessment and Assurance committee process dated revised 6/15/10 revealed that the policy of the Center was to utilize the QAA committee to monitor, evaluate and promote the overall quality of the Centers services. The committee will integrate Continuous Quality Improvement strategies to improve performance affecting resident care, operations and customer satisfaction. The purpose of the QAA Committee provides and important point of accountability for ensuring both quality of care and quality of life for residents. The Function of the committee was to identify quality deficiencies,develop and implement plans of action to correct these quality deficiencies, including monitoring the effect of implemented changes and making needed revisions to the action plans. Observations, record reviews and interviews conducted during the annual standard survey revealed that the facility was found to be deficient in multiple areas of regulatory compliance after the annual survey was completed. The facility did not maintain correction for the regulations identified as repeat citations (F tags 332, 412, 431 and 520) and did not identify concerns to prevent deficient practice in the area's identified during the annual standard survey (F225, 226, 253, 279, 309, 314, 333 and 441). Interview on 4/9/15 at 9:00 AM with the Director of Nursing stated the QAA committee had not reviewed pressure sores and had not looked specifically at infection control related to medication pass. The Director of Nursing confirmed that the QAA program had not identified any area's of concern cited and that there w… | 2018-07-01 |
| 3742 | 3742 | GOOD SAMARITAN SOCIETY - GRAND ISLAND VILLAGE | 285285 | 4061 TIMBERLINE STREET & 4055 TIMBERLINE STREET | GRAND ISLAND | NE | 68803 | 2018-07-03 | 689 | D | 1 | 0 | 00V911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE 175 NAC 12-006.09D7 and 12-006.09D7b Based on observations, record review and interviews, the facility failed to provide sufficient staff to prevent a resident elopement for Resident 1 and to establish and implement a system for monitoring and assessing residents at risk for elopement for Residents 2 and 3. The sample size was 3 and the facility census was 60. Findings are: [NAME] Review of a nursing progress note on 6/29/18 at 4:37 PM stated that Resident was not able to be found in their room or common areas. Started building and grounds search. Wheelchair found in parking lot. Staff member stated their car was missing. 911 was called and information was given to them. Policy for elopement was followed from the time noted they were missing. Review of the state agency report on 6/29/18 at 5:17 PM revealed that the DON (Director of Nursing) stated that the facility was conducting a fire drill exercise at the time of the Resident 1's elopement. Review of the facility document titled Fire Report, dated 6/29/18, identified that the fire drill was conducted at 2:40 PM, however, during an interview with the ADM (Administrator) on 7/03/18 at 1:00 PM revealed that the review of the security camera footage identified that the fire drill was conducted at 3:29 PM and Resident 1 went out the door at 3:39 PM and got into the facility staff's car at 3:41 PM. The facility was not aware that the resident left the building until 4:37 PM per documentation in the nursing progress notes. Review of the facility policy titled Fire Drills/Reports did not address how the staff were to monitor the exit doors when the fire alarm goes off. Interview on 7/03/18 at 10:30 AM with the ADM confirmed that the facility policy did not identify how the facility monitored the residents, who have been identified as at risk for elopement, from going out the exit doors during a fire drill, when the magnetic locks disengaged when the fire alarm was activated. … | 2020-09-01 |
| 12448 | 12448 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 315 | D | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09D3(6) Based on record review and interview; the facility staff failed to evaluate the clinical indications for the use of an indwelling catheter for 1 (Resident 2) of 10 sampled and 1 non-sampled residents. The facility staff identified a census of 24. Findings are: Record review of an information sheet dated 6/03/2010 revealed Resident 2 was admitted to to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 2's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 6/08/2010 revealed the facility staff assessed the following about the resident: -Resident 2 had short and long term memory was ok. -Reduced social interaction. -Required extensive assistance with personal hygiene. -Required total assistance with bed mobility, transfers, locomotion, dressing and toilet use. -Occasionally incontinent of bowel and had an indwelling catheter. -Average time involved in activities was assessed as none. Record review of the Urinary Incontinence and Indwelling Catheter assessment dated [DATE] revealed Resident 2 had the catheter "d/t (due to) mobility issues". The catheter assessment did not contain evidence that staff evaluated the continued clinical need for the catheter for Resident 2. On 9/01/2010 at 10:35 AM an interview was conducted with the Director of Nursing. During the interview, the DON confirmed Resident 2's medical record did not contain evidence that the facility staff had evaluated the clinical need for the indwelling catheter. The DON stated " we need to work on that". | 2014-07-01 |
| 12449 | 12449 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 250 | D | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.04E3 Based on record review and interview; the facility Social Service failed to re-evaluate potential depression and the initiation of a anti-depressant medication for 1(Resident 2) of 10 sampled and 1 non-sampled Residents. The facility staff identified a census of 24. Findings are: Record review of an information sheet dated 6/03/2010 revealed Resident 2 was admitted to to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 2's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 6/08/2010 revealed the facility staff assessed the following about the resident: -Resident 2 had short and long term memory was ok. -Reduced social interaction. -Required extensive assistance with personal hygiene. -Required total assistance with bed mobility, transfers, locomotion, dressing and toilet use. -Occasionally incontinent of bowel and had an indwelling catheter. -Average time involved in activities was assessed as none. Record review of an Geriatric Depression Scale (GDS) evaluation dated 4/13/2010 revealed Resident 2 had a score of 4. According to the information on the GDS, a score of 5 "is suggestive of depression". Record review of an Physician's Fax Communication Sheet dated 5/17/2010 revealed Resident 2's Physician was informed the family was requesting that Resident 2 have an anti-depressant medication. Resident 2's Physician ordered Celexa (anti-depressant medication) 20 milligrams (mg), 1 per day. Record review of a Physicians's Fax Communication Sheet dated 6/6/2010 revealed Resident 2's Physician gave depression for the use of the Celexa. Record review of Resident 2's Social Progress Notes did not contain evidence that the Social Services Director (SSD) followed up with Resident 2 and the initiation of the anti-depressant medication. Record review of a GDS dated 6/28/2010… | 2014-07-01 |
| 12450 | 12450 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 371 | F | 0 | 1 | 021Z11 | LICENSURE REFERENCE NUMBER: 12-006.11E LICENSURE REFERENCE NUMBER: 12-007.04A3 Based on observation, interview and record review; the facility utilized un-cleanable drinking straws to provide fluids, failed to ensure that plumbing had been installed to prevent backflow cross-contamination between the vegetable sink, garbage disposal and sewer drain in the kitchen area of the facility and failed to ensure an air gap was present on 1 of 1 ice machines in the facility. These practices created the potential for cross contamination for 24 residents that resided in the facility. The facility census at the time of survey was 24. Findings are: A Record review of the Nebraska Food Code 4-202.11(A) (1, 3) revealed the following: "Multi-use food-contact surfaces shall be: (1) smooth (2) free of breaks,open seams, cracks, chips, inclusions, pits, and similar imperfections (3) free of sharp internal angles,corners and crevices." Observation on 8/31/10 between 1:45 PM and 2:00 PM with the Director of Nursing between during the initial tour of the facility revealed water pitchers with a heavy duty plastic flexible straw inserted into each pitcher. These pitchers sat on the bedside tables in each of the 24 occupied resident rooms in the facility. Observation during the initial tour revealed that no names were written on the outside of the pitchers that would identify them as belonging to an individual resident. Interview on 8/31/10 at 1:20 PM with the Dietary Manager revealed that the water pitchers were cleaned daily in the dishwasher, then redistributed to the residents and that the pitchers were not assigned to specific individual residents. B. Record review of the Nebraska Food Code 5-402.11 (A) revealed the following: "a direct connection may not exist between the sewage system and a drain originating from equipment in which food, portable equipment or utensils are placed." Record review of the Nebraska Food Code 5-203.14 (A,B) revealed the following: " A plumbing system shall be installed to preclude backflow of a solid, l… | 2014-07-01 |
| 12451 | 12451 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 225 | D | 0 | 1 | 021Z11 | LICENSURE REFERENCE NUMBER 12-006.05(9), 12-006.04A3b Based on record review and interview; the facility staff failed to report injuries of unknown origin to the State Investigative Agency for 2 (Residents 4 and 3) and failed to ensure pre-employment reference check screening for 2 of 5 employee files reviewed. The sample size was 10 plus 1 non-sampled residents. The facility census at the time of survey was 24. Findings are: A. Record review of a Physicians Fax Communication Sheet dated 7/18/10 for Resident 4 revealed a report of a bruise on Resident 4's anterior right hand between the thumb and index finger. The report indicated that Resident 4 was unable to explain what had caused the bruise. Record review of Resident 4's Nurses Notes dated 7/18/10 indicated that the physician had been notified of the bruise of unknown origin. There was no evidence that the injury of unknown origin had been investigated or was reported to the required State Agencies. Record review of a Physicians Fax Communication Sheet dated 8/4/10 for Resident 4 revealed a report of bruising on Resident 4's anterior left hand, left elbow, and a reddened area on Residnet 4's right upper back. The report indicated that Resident 4 was unable to explain what had caused the bruises. Record review of Resident 4's Nurses Notes dated 8/4/10 indicated that the physician had been notified of the bruise of unknown origin. There was no evidence that the injury of unknown origin had been investigated or was reported to the required State Agencies. The Facility Abuse Reporting Policy and Procedures dated 4/26/05 stated that for an injury of unknown source, an investigation should be done immediately, the administrator notified and a completed investigation sent in to the Department of Health, Regulation and Licensure within 5 working days. Interview on 9/1/10 at 10:05 AM with Director of Nursing confirmed that those incidents for Resident 4 had not been investigated or reported to the required State Investigation Agencies. B. Record review conducted on 8/… | 2014-07-01 |
| 12452 | 12452 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 514 | D | 0 | 1 | 021Z11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.16B2 Based on record review and interview; the facility staff failed to document notification of family of injuries of unknown origin for 1 (Resident 4) of 10 sampled residents plus 1 non-sampled resident. The facility census was 24. Findings are: A. Record review of a Physicians Fax Communication Sheet dated 7/18/10 for Resident 4 revealed a report of a bruise on Resident 4's anterior right hand between the thumb and index finger. The report indicated that Resident 4 was unable to explain what had caused the bruise. Record review of Resident 4's Nurses Notes dated 7/18/10 revealed no documentation that the family had been notified of the bruise of unknown origin. Record review of a Physicians Fax Communication Sheet dated 8/4/10 for Resident 4 revealed a report of bruising on Resident 4's anterior left hand, left elbow, and a reddened area on Resident 4's right upper back. The report indicated that Resident 4 was unable to explain what had caused the bruises. Record review of Resident 4's Nurses Notes dated 8/4/10 revealed no documentation that the family had been notified of the bruise of unknown origin. Interview on 9/1/10 at 9:20 AM with the Director of Nursing (DON) confirmed that there was no documentation in Resident 4's medical record that the family had been notified of the injuries of unknown origin. The DON stated that an incident report had not been filled out and the Nurses Notes did not include documentation that the family had been notified of the areas. The DON stated that the facility staff should have filled out an incident report and documented that the family had been notified. | 2014-07-01 |
| 12453 | 12453 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 253 | E | 0 | 1 | 021Z11 | Reference Number 175-NAC-12-006.18A,B Based on observation and interview, the facility failed to maintain sanitary and clean environment related to peeling paint, raised wall paper, raised flooring, dirty floors, vents and patio and an un-cleanable surface. The facility census at the time of survey was 24 and the sample size was 10 plus 1 non-sampled resident. Findings are: Observation on 9/1/10 between 1:30 PM and 2:30 PM with the Facility Maintenance Supervisor (MS) and the Housekeeping Supervisor (HS), the Administrator and the Facilities Director, revealed concerns in the following areas: - Wallpaper raised in the dining room. - Build up of grime and soil on the floor of room 305. - Outer doors have peeling paint. - Dusty vents in Resident Rooms 108 and room 305. - Old grass clippings and debris on the patio area. - Raised linoleum in room 108. - End table in dining room finish has worn off and is un-cleanable Interview on 9/1/ 2010 with Facility Administrator during the tour confirmed observation of the above areas of concern. | 2014-07-01 |
| 12454 | 12454 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 248 | D | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D5b Based on observation, record review and interview; the facility staff failed to provide ongoing activities of interest and failed to re-evaluate current activities interventions for 1 (Resident 2) of 10 sampled and 1 non-sampled Residents. the facility staff identified a census of 24. Findings are: Record review of an information sheet dated 6/03/2010 revealed Resident 2 was admitted to to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 2's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 6/21/2010 revealed the facility staff assessed the following about the resident: -Resident 2 had short and long term memory was ok. -Reduced social interaction. -Required extensive assistance with personal hygiene. -Required total assistance with bed mobility, transfers, locomotion, dressing and toilet use. -Occasionally incontinent of bowel and had an indwelling catheter. -Average time involved in activities was assessed as none. - Resident 2's preferences for activities was assessed as reading/writing, trips,shopping, watches T.V. and talking or conversing. Record review of Resident 2's Initial Activity assessment dated [DATE] revealed the Activity Director (AD) assessed Resident 2's current activities of interest as sports, music, reading, spiritual/religious activities, T. V., watching movies, talking/conversing and radio. An interview with Resident 2 was conducted on 8/31/2010 at 1:40 P.M. During the interview, Resident 2 was asked if (gender) had enough activities, Resident 2 stated "no". Resident 2 stated " I am in my room most of the time and I get tired of just watching T.V. I would like more things to do". On 9/02/2010 at 8:35 AM an interview was conducted with the AD. During the interview, the AD stated "staff are doing 1 to1's" with Resident 2. When asked of act… | 2014-07-01 |
| 12455 | 12455 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 323 | D | 0 | 1 | 021Z11 | Reference Number 175-NAC-12.006.09D7 Based on observation and interview, the facility failed to monitor and maintain functioning of door security alarms. The facility staff identified 1 resident who was self-mobile and had wandering behaviors. The facility census at the time of survey was 24 and the sample size was 10 plus 1 non-sampled resident. Findings are: During the environmental tour for survey on September 1, 2010, it was discovered that the alarm for the interior door was not working. The alarm is suppose to go off when someone opens the door without pushing a red button next to the door. It was then discovered that the Wander Guard alarm that was wired to the outer door in the same entry way was also not working. In an interview with the Administrator on 09/1/10 at 07:40 AM, the Administrator stated no one tests the doors alarm systems and no log is kept. | 2014-07-01 |
| 12456 | 12456 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 176 | D | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.10A1 Based on observation, record review and interview; the facility staff failed to re-evaluate 1 (Resident 9) of 10 sampled residents ability to self administer medications safely. The sample size was 10 plus 1 non-sampled residents. The facility census at the time of survey was 24. Findings are: Record review of a facility policy entitled Self Administration of Medication dated 4/10/10 revealed a policy that if authorized personnel identify issues about the ability of a resident to self-administer medications, the RN (registered nurse) performs a safety evaluation to address the residents ability and provides written recommendations. Observation on 9/2/10 at 8:15 AM with the Director of Nursing (DON) revealed a locked safe in Resident 9's room at the facility. The DON confirmed that Resident 9 self administered some medications. A visual check on 9/2/10 at 9:20 AM of the inside of the safe revealed several bottles of medications secured in the safe. Record review of Resident 9's Face Sheet dated 8/4/10 revealed [DIAGNOSES REDACTED]. Record review of Resident 9's MDS dated [DATE] revealed that Resident 9 had long term memory problems, modified independence with daily decision making skills and was easily distracted. Record review of Resident 9's Nurses Notes from 7/31/10 through 8/30/10 revealed that Resident 9 experienced several episodes of active hallucinations. Record review of Resident 9's Doctors Orders dated 8/4/10 revealed the addition of [MEDICATION NAME] (an antipsychotic drug) 25 milligrams (mg) to be given every AM. Record review of Resident 9's Medication Administration Record [REDACTED]. Record review of a Physicians Fax Communication Sheet on 8/23/10 revealed that Resident 9 continued to have delusions and hallucinations. New orders received indicated that if the hallucinations persisted, a dose increase in the bedtime [MEDICATION NAME] would be recommended. Record review of Resident … | 2014-07-01 |
| 12457 | 12457 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 441 | E | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.17 Based on observation, record review and interview; the facility staff failed to utilize handwashing, gloving techniques and failed to clean glucometer before and after use for 3 (Resident 2, 3 and 11) to prevent potential cross contamination . The survey sample consisted of 10 sampled and 1 non-sampled residents. The facility staff identified a census of 24. Finds are: A. Record review of an information sheet dated 6/03/2010 revealed Resident 2 was admitted to to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 2's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 6/08/2010 revealed the facility staff assessed the following about the resident: -Resident 2 had short and long term memory was ok. -Reduced social interaction. -Required extensive assistance with personal hygiene. -Required total assistance with bed mobility, transfers, locomotion, dressing and toilet use. -Occasionally incontinent of bowel and had an indwelling catheter. Observation with the Director of Nursing (DON) on 9/01/2010 at 7:50 AM of personal cares revealed Nursing Assistant (NA) A and NA B entered Resident 2's room and donned gloves. NA A and NA B did not wash their hands prior to donning the gloves. NA A began to cleans the front peri-area, cleaning front to back. NA A without changing the soiled gloves or completing handwashing, touch a plastic drawer, Resident 2's gown, and a wipes container. Resident 2 was placed onto the right laying position revealing Resident 2 had been incontinent of stool. NA B cleansed Resident 2 of the stool. NA B without changing the soiled gloves, touch Resident 2's arms and hip. NA A with the same soiled gloves touched catheter tubing, bed pad and pillows. An interview on 9/01/2010 at 8:10 AM was conducted related to the personal cares identified in the above.… | 2014-07-01 |
| 12458 | 12458 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 492 | F | 1 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12.006.04C1 Based on record review and interview; the facility staff failed to ensure the Director of Nursing\ (DON)Registered Nurse license was maintained as current. This had the potential to affect all residents that resided in the facility at the time of the non-compliance. The sample size was 10 plus 1 non sampled resident. The facility census was 24. Findings are: Record review of a facility self report dated [DATE] revealed that, on that date, the former DON discovered that the former DON's nursing license had expired. The former DON immediately reported this to the facility Administrator, who in turn reported it to the required state agencies. The former DON's license had been expired since ,[DATE]/ 09. Review of the facility self report dated [DATE] indicated that, during this period of time, the former DON worked a total of 15 shifts as the Registered Nurse covering the 8 hour shift. On [DATE], the former DON was suspended from work and subsequently resigned the position on [DATE]. Record review of the self report dated [DATE] revealed that the facility took immediate action and immediately changed their policies and procedures to require that all employee licenses and certifications were to be checked on a quarterly basis to ensure that all were current and in effect. Additionally, all license renewals would be reviewed quarterly by the Quality Assurance (QA) Committee. Record review of all current employees licenses and certifications revealed that all were current and in effect. Record review of QA minutes for the last quarter dated [DATE] related to staff license checks revealed that the facility conducted the license checks per their revised policies and procedures and reported the findings to the QA committee on [DATE]. Interview on [DATE] at 9:15 AM with the Administrative Assistant (AA) confirmed the policy that licenses were to be checked on a quarterly basis and findings reported to the Q… | 2014-07-01 |
| 12459 | 12459 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 279 | D | 0 | 1 | 021Z11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C Based on observation, record review and interview; the facility staff failed to develop a Comprehensive Care Plan (CCP) related to self administration of medication for 1 ( Resident 9) of 10 sampled residents. The sample size was 10 plus 1 non-sampled residents. The facility census at the time of survey was 24. Findings are: Observation on 9/2/10 at 8:15 AM with the Director of Nursing (DON) revealed a locked safe in Resident 9's room at the facility. The DON confirmed that Resident 9 self administered some medications. A visual check on 9/2/10 at 9:20 AM of the inside of the safe revealed several bottles of medications secured in the safe. Record review of Resident 9's CCP dated 6/14/10 revealed no information related to self administration of medications. Interview on 9/2/10 at 9:30 AM with the DON confirmed that a CCP for Resident 9 had not been developed related to self administration of medications. The DON stated that information related to this should have been included on Resident 9's CCP. | 2014-07-01 |
| 12460 | 12460 | LEGACY GARDEN REHABILITATION & LIVING CENTER | 285186 | 200 VALLEY VIEW DRIVE | PENDER | NE | 68047 | 2010-09-02 | 329 | D | 0 | 1 | 021Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview; the facility staff failed to monitor Anti-Depressant medication and failed to evaluate the need to increase the medication for 1 (Resident 2) of 10 sampled and 1 non-sampled residents. the facility staff identified a census of 24. Findings are: Record review of an information sheet dated 6/03/2010 revealed Resident 2 was admitted to to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 2's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 6/08/2010 revealed the facility staff assessed the following about the resident that included: -Reduced social interaction. Record review of an Geriatric Depression Scale (GDS) evaluation dated 4/13/2010 revealed Resident 2 had a score of 4. According to the information on the GDS, a score of 5 "is suggestive of depression". Record review of an Physician's Fax Communication Sheet dated 5/17/2010 revealed Resident 2's Physician was informed Resident 2's family was requesting that Resident 2 have an anti-depressant medication. Resident 2's Physician ordered [MEDICATION NAME] (anti-depressant medication) 20 milligrams (mg), 1 per day. Record review of a Physicians's Fax Communication Sheet dated 6/6/2010 revealed Resident 2's Physician gave depression for the use of the [MEDICATION NAME]. Record review of a GDS dated 6/28/2010 revealed Resident 2 scored a 3. Record review of a Physician's Fax Communication Sheet dated 8/2/2010 revealed Resident 2's son request the anti-depressant medication be increased as Resident 2 was "only gets up for meals, stays in (gender) room with door shut". Resident 2's Physician ordered the dose of [MEDICATION NAME] be increased to 40 mg per day. Review of Resident 2's record did not contain any evidence the facility staff had evaluated the need for an anti-depressant medication or the need to increase the anti-… | 2014-07-01 |
| 2015 | 2015 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 167 | C | 0 | 1 | 02OK11 | Licensure Reference Number: 175 NAC 12-004.08 Based on interviews and observations, the facility failed to display survey inspection results (a legal document describing facility violations of state and/or federal regulations) in a manner that was accessible and identifiable for residents and/or resident representatives. The failure could prevent all residents from access to the records. Facility census was 37. Findings are: Interview with Resident 21 on 3/28/17 at 9:55 a.m. revealed Resident 21 attended Resident Council meetings. During the discussion of the resident council, Resident 21 was asked if the facility informed residents about accessing the survey inspection results, and whether or not the resident was aware where the results were located and if the resident could access the reports without assistance. Resident 21 answered not being aware of where the survey results were kept. Observations on 3/29/17 at 8:30 a.m., 3/29/17 at 12:30 p.m., and 3/30/17 at 8:35 a.m. revealed a red three-ring binder with a label attached to the spine reading: Current Survey Results was atop a call light system box attached to the wall at the entry of the dining room. The font on the label measured 1/2 inch and was obstructed by a microphone cord. The binder was placed atop the call light system box and was 65 inches above the floor. Interview with the Administrator on 3/30/17 at 8:35 a.m. verified the red three-ring binder atop the call light system box by the entry of the dining room contained the survey inspection results. The Administrator confirmed the binder was not accessible to residents in wheelchairs and was not easily identified due to the position of the binder and the obstructed label from the microphone cord. | 2020-09-01 |
| 2016 | 2016 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 241 | E | 0 | 1 | 02OK11 | Licensure Reference Number: 175 NAC 12-006.05 (21) Based on observations, record reviews, and interviews; the facility failed to: 1) serve two sampled resident trays (Residents 33 and 34) during the same time of other residents in the Back Dining Room; and 2) provide privacy during obtaining resident vital signs for one sampled resident (Resident 25). Sample size included 13 residents receiving meal trays in the Back Dining Room. Facility census was 37. Findings are: [NAME] Observations of the Back Dining Room revealed the following: - 3/29/17 from 7:35 a.m. through 8:20 a.m. Residents 33 and 34 were observed seated in wheelchairs in the dining room at 7:35 a.m. The first tray was delivered to Resident 15 at 7:35 a.m. and the dietary staff and feeding assistant continued delivering trays to residents in the Back Dining Room following the first tray. At 7:55 a.m. all trays were delivered to residents in the Back Dining Room except for Residents 33 and 34 while the dietary staff began serving the Front Dining room. Residents 33 and 34 remained seated in the Back Dining Room from 7:35 a.m. to 8:10 a.m. before being served. - 3/29/17 from 11:05 a.m. through 12:15 p.m. Residents 33 and 34 were observed seated in wheelchairs in the dining room at 11:05 a.m. At 11:35 a.m., the first tray was delivered in the Back Dining Room to Resident 9 at 11:35 a.m. Dietary and nursing staff continued passing trays to residents in the Back Dining Room until all residents were served except Residents 33 and 34. Cook-B then began serving the Front Dining Room. At 11:55 a.m. Cook-B returned to serving the Back Dining room and Residents 33 and 34 were served. -3/30/17 from 7:30 a.m. through 8:00 a.m. At 7:30 a.m., Residents 33 and 34 were observed seated in wheelchairs in the dining room. The staff began serving trays to the Back Dining Room between 7:30 a.m. and 7:45 a.m. All residents in the dining room were served by 7:45 a.m. except Residents 33 and 34. The dietary staff then began serving the Front Dining Room until 7:50 a.m. when R… | 2020-09-01 |
| 2017 | 2017 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 272 | D | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09B Based on record reviews and interview, the facility failed to complete an assessment of contractures (loss of joint motion due to structural changes in non-bony tissue) for one sampled resident (Resident 9). The facility census was 37 with 13 current sampled residents and one closed record reviewed. Findings are: Review of the Admission Record, printed 3/25/17, revealed that Resident 9 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the care plan, goal date 4/13/17, revealed that the resident had a need for restorative interventions due to limited physical mobility due to contractures. Further review revealed interventions including passive range of motion to upper and lower extremities with morning and evening cares. Review of the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 1/4/17, revealed that the resident had functional limitations in range of motion on both sides with impairments at the upper and lower extremities. Interview with the DON (Director of Nursing) on 3/28/17 at 8:40 AM revealed that the resident had contractures in both arms and was dependent on staff for all activities of daily living. Interview with the DON on 3/29/17 at 2:00 PM revealed no assessment of the resident's arm contractures were completed. Further interview confirmed that an assessment should be completed to ensure that the care provided met the resident's needs to improve range of motion or to maintain or to prevent further decline in joint function. | 2020-09-01 |
| 2018 | 2018 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 279 | D | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.04C3a(5) Based on record review and interviews, the facility failed to ensure that the care plan for one sampled resident (Resident 37) had been developed to include the PSARR II (Pre-Admission Screening and Resident Review Level II tool) recommendations for treatment and follow-up. The sample size was 13 current residents with 1 closed record. The facility census was 37. Findings are: Review of the Admission Record for Resident 37 dated as printed (MONTH) 28, (YEAR) revealed an admitted to the facility of 2/23/16. Further review revealed a [DIAGNOSES REDACTED]. Review of the Ascend Form for Resident 37 dated 1/28/16 for a hospital visit for this resident revealed a date of 1/31/16 with a Pre-Admission outcome of a Positive Level II PSARR for [MEDICAL CONDITION] and situational depression. Further review revealed recommendations were for ongoing medication review by a psychiatrist and physician. Review of the Care Plan for Resident 37, dated as revised on 3/7/17 revealed no written documentation that this resident was a PSARR level II with recommendations of ongoing medication review by a physician and psychiatrist. Interview on 3/30/17 at 9:00 AM with the Director of Nursing verified that the care plan for Resident 37 had not been developed to include that the resident was a PSARR Level II. Further interview verified that the PSARR II recommendations had not been added to the resident's care plan. Interview on 3/30/17 at 9:30 AM with the Administrator verified that the Care Plan for Resident 37 had not been developed to include the PSARR Level II recommendations. Further interview confirmed that the care plan should have had interventions of ongoing medication review with the psychiatrist and physician for this resident. | 2020-09-01 |
| 2019 | 2019 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 280 | E | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09C1c Based on observations, record reviews and interviews; the facility failed to update care plans to 1) address falls for two sampled residents (Residents 11 and 12) and 2) include current fall interventions in place for one sampled resident (Resident 14). The facility census was 37 with 13 current sampled residents and one closed record reviewed. Findings are: [NAME] Interview with the DON (Director of Nursing) on 3/28/17 at 8:45 AM revealed that Resident 11 fell on [DATE]. The DON stated that the resident slid out of bed. Review of the care plan, goal date 6/3/17, revealed that the resident was at risk for falls related to gait and balance problems. Further review revealed no care plan to address the resident's fall on 3/17/17. Interview with the DON on 3/29/17 at 2:15 PM confirmed that the care plan should have been updated to address the resident's actual fall. B. Interview with the DON on 3/28/17 at 9:17 AM revealed that Resident 12 fell on [DATE]. Review of the care plan, goal date 5/18/17, revealed that the resident was at risk for falls. Further review revealed no care plan to address the resident's fall on 3/22/17. Interview with the DON on 3/29/17 at 2:10 PM confirmed that the care plan should have been updated to address the resident's actual fall, including interventions to reduce the risk for further falls. C. Record review of Resident 14's Admission Record printed on 3/29/17 revealed the resident was admitted to the facility on [DATE]. Interview with RN (Registered Nurse)-C on 3/28/17 at 9:11 a.m. revealed Resident 14 experienced a fall on 3/16/17 and stated the resident had pain following the incident and was sent to the emergency room for x-ray which was negative. RN-C stated the facility uses a low bed and floor mat next to the bed to prevent injuries and reduce the risk for falls. Observations of Resident 14 on 3/28/17 at 12:01 p.m. and 3/29/17 at 1:00 p.m. revealed the resident … | 2020-09-01 |
| 2020 | 2020 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 309 | D | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D Based on record reviews and interview, the facility failed to follow up on a pain rating of extreme for one sampled resident (Resident 18). The facility census was 37 with 13 current sampled residents and one closed record reviewed. Findings are: Review of the Admission Record, printed 3/29/17, revealed that Resident 18 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the care plan, goal date 6/15/17, revealed that the resident had generalized pain and discomfort related to aging. Review of the resident's Medication Record, dated (MONTH) (YEAR), revealed that on 3/11/17, during the morning medication pass, the resident rated pain at 10 and on 3/27/17, during the bedtime medication pass, the resident rated pain at 8. Further review of the resident's medication sheets and progress notes revealed no follow up on the resident's pain. Interview with the Director of Nursing on 3/30/17 at 9:00 AM revealed that pain rated 8 - 10 on the pain scale indicated extreme pain. Further interview confirmed that there was no documentation in the resident's medical record of further assessment or follow up of the resident's extreme pain. The DON confirmed that the nurses were to complete further pain assessments and follow up to ensure that the resident's pain was management to meet the resident's needs. | 2020-09-01 |
| 2021 | 2021 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 325 | G | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D8b Based on record reviews and interviews, the facility failed to implement interventions recommended by the Registered Dietician to maintain weight and prevent significant weight loss for one sampled resident (Resident 11). The facility census was 37 with 13 current sampled residents and one closed record reviewed. Findings are: Review of the Admission Record, printed 3/29/17, revealed that Resident 11 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the care plan with a goal date of 6/3/17, revealed that the resident had potential nutritional problems related to weakness and sporadic meal intake. The goal was to maintain weight within one to five pounds by the review date. Interventions included if weight goes below 110 pounds, the RD (Registered Dietician) recommended offering 4 ounces of Ensure Plus (nutritional supplement) two times a day or 206 Juice (high calorie juice) six ounces two times a day. Review of the RD Progress Notes, dated 3/19/17, Initial Nutritional Assessment revealed that the resident's usual weight was around 110 pounds and will add supplements if weight decreases to less than 110 pounds. Review of the resident's Weights and Vitals Summary revealed the following weights including: 3/6/17 - 117.5 pounds; 3/7/17 - 113 pounds; 3/10/17 - 112 pounds; 3/14/17 - 108 pounds; 3/17/17 - 112 pounds; 3/21/17 - 102 pounds; 3/24/17 - 103 pounds; 3/38/17 - 102 pounds (- 15.5 pounds or 13.2% weight loss). Interview with the DON (Director of Nursing) on 3/29/17 at 2:15 PM confirmed that the resident had a significant weight loss, current weight was 102 pounds and the resident was not taking a supplement as recommended by the RD. Interview with Cook - B on 3/29/17 at 2:45 PM confirmed that the resident was not on the supplement list and was not receiving a supplement. Interview with the Dietary Manager on 3/30/17 at 8:45 AM confirmed that the resident had a signif… | 2020-09-01 |
| 2022 | 2022 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 371 | E | 0 | 1 | 02OK11 | Licensure Reference Number: 175 NAC 12-006.11E Based on observations, record reviews, and interviews; the facility failed to deliver and setup resident food items without utilizing hand hygiene between residents and ensuring single-use gloves were not touching items of possible cross-contamination during use while assisting residents in the Back Dining Room. The failure had the potential of cross-contaminating food items for the 13 sampled residents dining in the Back Dining Room. Facility census was 37. Findings are: Observations of breakfast dining in the Back Dining Room on 3/28/17 beginning at 7:25 a.m. through 8:25 a.m. revealed the following: - FA (Feeding Assistant)-D was observed delivering trays and setting up breakfast trays for residents in the Back Dining Room. FA-D was observed applying single-use gloves prior to delivering trays to residents and handling food record cards, delivering the plates, opening jelly containers, touching salt and pepper shakers, a newspaper, and touching utensils with the gloves during the meal service. FA-D was then observed picking up toast with the potentially contaminated gloved hands and applying jelly. FA-D was also observed removing gloves between resident trays and returning to the serving window without performing hand hygiene by washing hands or applying a sanitizing hand gel. - NA (Nurse Aide)-E was observed delivering trays and setting up breakfast trays for residents in the Back Dining Room. NA-E was observed applying single-use gloves prior to delivering trays to residents and handling food record cards, delivering the plates, opening jelly containers, touching salt and pepper shakers, and touching utensils with the gloves during the meal service. FA-D was then observed picking up toast with the potentially contaminated gloved hands and applying jelly. FA-D was also observed removing gloves between resident trays and returning to the serving window without performing hand hygiene by washing hands or applying a sanitizing hand gel. - NA-F was observed assisting… | 2020-09-01 |
| 2023 | 2023 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 431 | E | 0 | 1 | 02OK11 | Licensure Reference Number: 175 NAC 12-006.12E1 Based on observations, record reviews and interview; the facility failed to ensure that the refrigerator, used for medication storage in the medication room, temperatures were monitored and documented at least daily to ensure the integrity of the medications stored in the refrigerator. The facility census was 37 with more than three residents' medications stored in the refrigerator. Findings are: Observations on 3/29/17 at 2:30 PM revealed a refrigerator in the medication room which contained insulin vials and suppositories for several residents. Review of the Refrigerator/Freezer Temperature Log, dated (MONTH) (YEAR) and posted on the refrigerator, revealed no refrigerator temperature documented on 3/13/17 - 3/25/17. Interview with the Director of Nursing on 3/29/17 at 2:30 PM confirmed that the refrigerator was used to store insulin and suppositories as recommended by the manufacturer's for several of the residents. Further interview confirmed that the refrigerator temperature was to be monitored and documented at least daily to ensure the integrity of the medications stored in the refrigerator. | 2020-09-01 |
| 2024 | 2024 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 441 | E | 0 | 1 | 02OK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.17 Based on observations and interviews, the facility failed to: 1) ensure a urinal container for one sampled resident (Resident 47) was covered during storage; and 2) ensure towel bars in semi-private rooms shared by four residents (Residents 25 and 27; and Residents 24 and 9) were marked to identify towels and washcloths for each resident. The failure could potentially cause cross-contamination of towels and washcloths. Sample size was 18 residents residing in semi-private rooms. Findings are: [NAME] Observations on 3/28/17 at 12:15 a.m. and 3/30/17 at 7:50 a.m. revealed the bathroom in a private room occupied by Resident 47 had a urinal container without a cover attached to a towel bar in the bathroom. Interview with the Infection Control Practitioner, RN (Registered Nurse)-L on 3/30/17 at 7:50 a.m. verified the urinal container in the bathroom for Resident 47 didn't have a cover to the container or wasn't covered to prevent potential cross-contamination. B. Observations on 3/28/17 at 12:15 a.m. and 3/30/17 at 7:50 a.m. revealed the bathroom shared by Residents 25 and 27 had two towel racks of towels and washcloths. Further observation of the towel bars revealed there were no markings on them to identify which resident's towels and washcloths belonged to either Resident 25 or 27. Interview with the Infection Control Practitioner, RN (Registered Nurse)-L on 3/30/17 at 7:50 a.m confirmed the towel racks of towels and washcloths in the bathroom shared by Residents 25 and 27 hadn't been marked. RN-L confirmed there was no way for the residents to identify the towels and washcloths for their use and could potentially cause cross-contamination if the items were used by both residents. C. Observations of the bathroom in room [ROOM NUMBER] (Residents 24 and 9) on 3/28/17 at 9:20 AM and on 3/30/17 at 8:00 AM revealed that the towel bars containing washcloths and hand towels were not labeled to indicate whi… | 2020-09-01 |
| 2025 | 2025 | GOOD SAMARITAN SOCIETY - VALENTINE | 285176 | 601 WEST 4TH STREET | VALENTINE | NE | 69201 | 2017-03-30 | 463 | D | 0 | 1 | 02OK11 | Licensure Reference Number: 175 NAC 12-006.04C3a(5) Based on observations and interviews, the facility failed to ensure that the call light was operational for one sampled resident (Resident 37). The sampled size was 13 current residents with 1 closed record review. The facility census was 37. Findings are: Observation on 3/28/17 at 9:49 AM of no call light cord present on the wall for Resident 37. Further observation revealed a plug in the call light fixture but no cord. Continued observation revealed that there was no cord on the floor or attached to the recliner. Observation on 3/28/17 at 2:00 PM of the call light cord the same with a plug in the call light fixture but no cord present or push button to call for Resident 37. Observation and interview on 3/28/17 at 2:38 PM with the Administrator and the Maintenance Supervisor verified that the call light in Resident 37's room was not operational. Further interview confirmed that the MS did checks monthly on the call light. Continued interview with the Administrator verified that Resident 37 was independent and never used the call light. Further interview verified that all residents call lights should be operational. | 2020-09-01 |
| 8019 | 8019 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 167 | F | 0 | 1 | 03FZ11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.05 Based on observation, staff, resident and family interview; the facility failed to post a notice of the availability of the most recent survey results in an area noticeable to both residents and facility visitors. Facility census was 45. Findings Are: During an interview on 2/25/14 at 11:33 PM the resident council president voiced that it was not known where the survey results were located. The Resident went on to state the only way the results could be found would be to ask staff. During confidential interviews on 2/25/14 from 1:48 PM until 4:14 PM, 2 residents and 1 community member stated they were unaware of where the survey results were located. Observations on 2/25/14 at 4 PM revealed a sign measuring 3 inches x 5 inches posted in the activity room on a bulletin board, approximately 5 foot 9 inches above the ground. Another sign, measuring the same size and the same distance from the ground was observed on a bulletin board in the entry between the exterior doors and the doors leading into the facility. The survey results were found in sitting room on a corner table directly inside the facility. On 2/26/14 at 11:07 AM an interview with a confidential family member stated that if the family member would like to read the state survey results, the family member would have to ask staff where they are. The family member stated they have never seen any notification of where the results are kept. During an interview with the Administrator and Director of Nursing on 2/26/14 at 5:20 PM it was revealed that the only way the facility notifies the residents of the state survey results is with the posting found on bulletin boards in the activity room and the area between the exterior and interior doors of the facility. During a confidential interview on 2/25/14 at 9:25 AM, a family member admitted being unaware of the location of the survey inspection results until inquiring from a staff member who revealed the location in the living room area at the front of the building. | 2017-11-01 |
| 8020 | 8020 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 242 | E | 0 | 1 | 03FZ11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.05(4) Based on resident and staff interview and record review; the facility failed to allow 3 residents (41, 29 and 22) a choice in relation to the number of baths they receive. Facility census was 45. Findings Are: A. During an interview with Resident 22 on 2/24/14 at 9:49 AM it was revealed the resident received only one bath a week and would like to have more than this. The resident went on to state a choice of the number of baths was never offered. Resident 22 ' s Minimum Data Set (MDS; a federally mandated comprehensive assessment tool used for care planning) dated 1/9/14 revealed Resident 22 was admitted to the facility on this date. Review of the bath schedule for the months of January and February 2014 revealed Resident 22 received 3 baths in January (for Resident 22 to have 2 a week 7 baths would be given) and 4 baths in February (for Resident 22 to have 2 a week 7 baths would be given). B. During an interview with Resident 41 on 2/25/14 at 11:23 AM it was revealed the resident was to receive two baths a week but at times has only received one bath a week. Review of the bath schedules for the months of December, January and February 2014 revealed Resident 41 received 7 baths in December (for Resident 41 to have 2 a week 9 baths would be given), 6 baths in January (for Resident 41 to have 2 a week 9 baths would be given) and 6 baths in February (for Resident 41 to have 2 a week up to the present date in February 7 would be given). C. During an interview with Resident 29 on 2/24/14 at 1:54 PM it was revealed the resident received 1 bath a week and would like at least 2 a week. A review of the bath schedule for the months of December, January and February 2014 revealed Resident 29 received 4 baths in December (for Resident 29 to have 2 a week 9 baths would be given), 5 baths in January (for Resident 29 to have 2 a week 9 baths would be given), and 4 baths in February (for Resident 29 to have 2 a week up to the present date in February 7 would be given). D. During an… | 2017-11-01 |
| 8021 | 8021 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 280 | D | 0 | 1 | 03FZ11 | LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09C1c Based on record review and staff interview; the facility failed to revise Resident 30's care plan in relation to pressure ulcer interventions and Resident 11's care plan in relation to therapy interventions. Facility census was 45. Findings Are: A. Review of Resident 30's medical record revealed the resident developed a stage 1 pressure ulcer to the right heel on 12/2/13. Review of Resident 30's care plan, with an initiated date of 11/1/13, revealed the resident had potential for skin issues and/or development of pressure ulcers. Interventions included to transfer the resident to bed as tolerated after meals and to notify the nurse immediately of any new areas of skin breakdown. Stage 1 pressure ulcer, which developed 12/2/13, was not identified on the care plan. Review of Resident 30's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for Care Planning) dated 11/27/13 revealed interventions including a pressure reducing device for chair and bed as well as a turning/repositioning program. B. During an interview with the Director of Nursing (DON) on 2/26/14 at 4:56 PM it was verified Resident 30's pressure ulcer was not identified on the care plan. Furthermore, it was verified the interventions of the pressure reducing device in the chair and bed as well as the turning/repositioning program were not listed on the care plan. C. Review of Resident 11's medical record revealed orders dated 8/29/13 for the resident to work with speech therapy, occupational therapy and physical therapy. Review of Resident 11's care plan revealed no goals or interventions related to therapy. D. Interview with the DON on 2/27/14 at 7:47 AM verified therapy interventions were not on the care plan. | 2017-11-01 |
| 8022 | 8022 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 282 | E | 0 | 1 | 03FZ11 | Licensure Reference Number 175 NAC 12-006.09C Based on observation, record review and staff interview; the facility failed to implement pressure ulcer prevention interventions for Resident 6 and 50, fall interventions for Resident 18 and provide baths for Residents 29 and 41 in accordance with their Care Plans. Facility census was 45. Findings are: A. Review of Resident 6's Care Plan with revision date of 2/16/14 revealed the resident had the potential for skin issues and pressure ulcers with pressure ulcer development to right heel on 10/22/13 and identified the following interventions: -Transfer the resident to bed after meals, resident to be one of the last up before meals and one of the first down after meals. -Position the resident from side to side and assist to reposition frequently. -Notify charge nurse immediately of any new areas of skin breakdown, redness, blisters, bruises or discoloration noted with bath and with daily cares. -Heels to be kept off bed and wheelchair pedals at all times. During observations, Resident 6 was observed seated in a wheelchair with no pressure relieving device to heels and right heel resting directly on the surface of an unpadded foot pedal at the following times: -On 2/25/14 from 11:45 AM to 1:54 PM. -On 2/26/14 from 7:35 AM to 9:15 AM and from 11:30 AM to 2:15 PM. -On 2/27/14 from 8:00 AM to 1:30 PM. During an interview on 2/27/14 from 10:30 AM to 10:50 AM, the Director of Nursing (DON) confirmed a pressure relieving device should have been used when the resident was in the wheelchair to keep pressure off of right heel and the resident should have been transferred to bed as soon as the resident had completed meals in accordance with the resident's Care Plan. B. Review of Resident 50's Care Plan with revision date of 1/29/14 revealed the resident had the potential for skin issues and pressure ulcers with pressure ulcer development to buttocks on 10/7/13 and identified the following interventions: -Transfer the resident to bed to rest after meals, resident to be the last up… | 2017-11-01 |
| 8023 | 8023 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 309 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2c Based on observations, record review, resident and staff interview; the facility failed to identify the presence of bruising on Resident 6's left hand and Resident 26's bilateral arms. Furthermore, there was no documentation to indicate the bruising was assessed and/or monitored for cause, extent and/or healing. Facility census was 45. Findings are: A. Review of Resident 6's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 2/13/14 indicated the resident had short and long term memory loss with severely impaired decision making skills. Furthermore the resident required total assistance for bed mobility, transfers, toileting, personal hygiene and bathing. Review of Resident 6's care plan with revision date of 2/16/14 revealed the resident had the potential for skin issues and pressure ulcers with pressure ulcer development to right heel on 10/22/13 and identified the following interventions: -Transfer the resident to bed to rest after meals, resident to be the last up and the first down. -Position the resident from side to side and assist to reposition frequently. -Notify charge nurse immediately of any new areas of skin breakdown, redness, blisters, bruises or discoloration noted with bath and with daily cares. During observation on 2/24/14 at 3:21 PM, Resident 6 was noted to have a dark purple bruise that covered the top of the resident's left hand. Resident 6 was unable to answer questions as to how the bruise occurred. During an interview on 2/26/14 at 7:45 AM, Registered Nurse (RN)-Q denied any knowledge of bruising to the top of Resident 6's left hand. RN-Q indicated Nursing Assistants (NA) were expected to report any bruising, skin tears, or other unusual skin conditions to the charge nurse right away, and the charge nurse would investigate the cause of the injury. RN-Q indicated the charge nurse would document this assessment in the res… | 2017-11-01 |
| 8024 | 8024 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 312 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D1c Based on observations, record review, staff and resident interview; the facility failed to provide toileting assistance for Resident 20, who required assistance with activities of daily living. Facility census was 45. Findings are: Review of Resident 20's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 12/18/13 revealed [DIAGNOSES REDACTED]. The same assessment indicated the resident required extensive staff assistance with transfers and toileting and the resident was frequently incontinent of bladder and occasionally involuntary of bowel. Review of Resident 20's Bowel and Bladder assessment (undated) revealed the resident did not have an issue with incontinence unless the resident did not get to the bathroom fast enough. The assessment further indicated the resident would use the call light to seek assist with toileting but would attempt to self-transfer to the bathroom if help was not provided when needed. Observations of Resident 20 on 2/26/14 revealed the following: -At 8:58 AM, the resident's call light was on and the resident was seated in room in a wheelchair. The resident indicated call light had been turned on as the resident needed to use the bathroom. -At 9:11 AM, NA-D and NA-C entered Resident 20's room, closed the door and turned off the call light. -At 9:30 AM, Resident 20 remained seated in wheelchair in room. Resident 20 was crying and stated, They still haven't taken me to the bathroom. The resident's call light was turned back on. -At 9:45 AM, NA-D entered Resident 20's room, closed the door, and turned off Resident 20's call light (47 minutes after Resident 20 initially turned on the call light to seek assist with toileting). During an interview on 2/26/14 from 10:08 AM to 10:10 AM, NA-C confirmed Resident 20's call light had been turned off at 9:04 AM. NA-C indicated the resident needed to go to the bathroom and NA-D was … | 2017-11-01 |
| 8025 | 8025 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 314 | G | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Numbers: 175 NAC 12-006.09D2b Based on observations, record review and staff interviews; the facility failed to implement interventions and to revise interventions as needed to promote healing of pressure ulcers for 2 residents (Residents 6 and 50). Facility census was 45. Findings are: A. Review of facility policy titled Skin Assessment and Pressure Ulcer Prevention (revised 1/14) revealed the following procedures: -Residents who are unable to reposition themselves independently should be repositioned as often as directed by the care plan approaches. Developing an individualized repositioning schedule is recommended based on observation of the resident's skin over a period of time. -A systematic skin inspection will be made daily by the Nursing Assistant assigned to those residents at risk for skin breakdown. The Nursing Assistant responsible for this will report any abnormal findings or signs of skin impairment to the Licensed Nurse. -Dietary will automatically be notified when the Wound Data Collection is signed and locked in the computer. B. Review of Resident 6's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 2/13/14 indicated [DIAGNOSES REDACTED]. The MDS further indicated Resident 6 had an unstageable pressure ulcer (The staging system is a method of summarizing certain characteristics of pressure sores, including the extent of tissue damage. Unstageable refers to a full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed. Until enough eschar or slough is removed to expose the base of the wound, the true depth, and therefore the stage cannot be determined). The MDS identified use of pressure reducing devices to chair and bed, a turning and repositioning program, nutritional and hydration interventions and pressure ulcer care. Review of Resident 6's Braden Scale completed 10/9/13 indicated the resident was at … | 2017-11-01 |
| 8026 | 8026 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 323 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.18 E 4 Based on observations, record review and staff interview the facility failed to assure Resident 18 was protected from falls, as fall prevention measures were not consistently provided. Facility census was 45. Findings are: Review of Resident 18's Minimum Data Set (MDS, a federally mandated comprehensive assessment tool used for Care Planning) dated 2/11/14 with current [DIAGNOSES REDACTED]. The MDS identified Resident 18 required extensive assist of 1 staff for all transfers, bed mobility, dressing, toileting and bathing. This assessment reflected the resident had a history of [REDACTED]. Review of Resident 18's Care Plan with revision date of 2/19/14 revealed the resident was at risk for falls related to a history of previous falls, frequent urinary incontinence, and safety impairment with the following interventions identified: -Wander-guard (a bracelet worn by the resident and sounds an alarm if the resident comes within a certain distance of the door) and TABs monitor (a personal alarm with a pull string that attaches magnetically to the alarm with a garment clip to the resident. When the resident attempts to rise out of the chair or bed the pull string magnet is pulled away from the alarm which causes the alarm to sound, alerting the care giver) used while in meri-walker (walker/chair combination which allows a resident who would normally be placed in a wheelchair to ambulate independently), recliner or bed to alert staff to resident's movements and to assist staff to monitor movements. -Ensure resident is wearing appropriate footwear/shoes when walking or mobilizing in meri-walker. Review of Resident 18's Progress Notes revealed the following: -On 2/11/14 at 11:10 PM, Resident found seated on the floor next to bed. Resident assisted to the bathroom and transferred back to bed. TABs alarm alerted staff to resident's fall. -On 2/13/14 at 10:48 AM, Resident referred to Restorative due to fal… | 2017-11-01 |
| 8027 | 8027 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 325 | G | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D8b Based on record review and staff interviews; the facility failed to revise and implement nutritional interventions to address weight loss and poor appetite for Resident 50. Facility census was 45. Findings are: Review of Resident 50's MDS dated [DATE] indicated [DIAGNOSES REDACTED]. The MDS further indicated Resident 50 had an unstageable pressure ulcer (The staging system is a method of summarizing certain characteristics of pressure sores, including the extent of tissue damage. Unstageable refers to a full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed. Until enough eschar or slough is removed to expose the base of the wound, the true depth, and therefore the stage cannot be determined) and identified use of nutritional and hydration interventions for pressure ulcer care. The MDS identified a weight of 104 lbs. (pounds) and use of a therapeutic diet. Review of Resident 50's Progress Notes revealed the following: -10/7/13 at 4:00 PM, The resident was readmitted from the hospital following a fall with subsequent left [MEDICAL CONDITION]. The resident's readmission orders [REDACTED]. -10/8/14 at 4:07 PM, Resident's weight identified as 124 lbs (pounds). Food and fluid intakes are poor and resident does not accept assist from staff with eating. -10/8/13 at 4:46 PM, Resident noted to have pressure ulcers to left and right buttocks. Protective dressing applied and physician notified. -10/9/13 at 9:55 AM, Resident took 25% of breakfast meal. -10/11/13 at 4:57 PM, Resident refused nutritional supplement drink. -10/20/13 at 7:07 PM, Resident refused nutritional supplement drink. -10/22/13 at 9:27 AM, Resident noted to have increase size with open area to buttock. Area to buttocks noted to be fairly superficial and clean and area covered to protect. -10/28/13 at 9:28 AM, Resident reported to have incontinent BM (bowel movement) over weekend with … | 2017-11-01 |
| 8028 | 8028 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 329 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview; the facility failed to assure Resident 28's medication regimen was free from unnecessary medications as the resident was receiving [MEDICATION NAME] (a medication used to treat psychotic symptoms) without the appropriate [DIAGNOSES REDACTED]. Furthermore, facility staff failed to monitor the resident's behaviors in an effort to evaluate the appropriateness of use of an antipsychotic medication in treating the resident. Facility census was 45. Findings are: A. Review of the facility procedure titled Psychopharmacological Medications and Sedative/Hypnotics, revised 9/13, included the following: - Prior to administration of non-emergency psychopharmacological and/or sedative/hypnotics, the following must be completed: a. Documentation in the . medical record observations of mood symptoms or behaviors that cause the resident distress and/or endangers the resident or others and response to interventions used. - If, after reviewing the Mood and Behavior Record (GSS #2600), the behavior committee and/or care plan team determines psychopharmacological medications and sedative/hypnotics may be necessary, the reduction committee must be notified. - If the reduction committee determines that a medication is warranted, then the committee nurse will ensure the following is completed: a. Contact the physician and describe the behavior, attempted interventions/alternatives and behavior committee recommendations. b. Obtain an order for [REDACTED]. - If a resident is admitted on psychopharmacological medications and sedative/hypnotics or returns from hospitalization on new psychopharmacological medications and sedative/hypnotics, the following must be completed: a. The reduction committee must be informed. - Throughout the administration of the psychopharmacological medications and sedative/hypnotic drugs, the following must be completed: a. Document on the Mood and Behavior Record (GSS #2600) Behavior documentation… | 2017-11-01 |
| 8029 | 8029 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 353 | F | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** C. Confidential interviews revealed the following complaints regarding lack of sufficient nursing staff: - On 2/24/14 at 10:22 AM, a resident indicated they are short of help all the time. The resident further revealed timing a call light at 2 hours and 15 minutes before it was answered. - On 2/25/14 at 9:13 AM, a family member indicated the facility was short of staff. The family member revealed finding the resident's bathroom a mess quite a few times, and at times finding the resident unclean. The family member further indicated staff did not take the resident to the noon meal 1 day, and therefore, the resident was taken to the dining room by a family member who also fed the resident. The following complaints were received regarding lack of sufficient nursing staff: -During a confidential family interview on 2/25/14 at 10:01 AM, a family member stated, The staff are overworked and whenever new staff is hired they leave right away because they are expected to work so many hours. I have witnessed call lights on in the evenings for over 45 minutes. In addition, family member indicated their (gender) recently had an order for [REDACTED]. The family member stated, I refused to pay for the treatment as she never really received it. -During a confidential resident interview on 2/24/14 at 1:43 PM, the resident stated, There is not enough staff in the place; I can't have as many baths as I would like and there are never enough staff available to get you up or put you to bed when you want. -During a confidential family interview on 2/24/14 at 2:49 PM, the family member indicated call lights were on for over 30 minutes in the evening and due to lack of sufficient staff, snacks were rarely passed on the evening shift. D. Observations of untimely call light response and failure to provide toileting assistance revealed the following: Observations of Resident 54 on 2/26/14 revealed the following: -At 8:48 AM, the resident's call light was on and resident … | 2017-11-01 |
| 8030 | 8030 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 425 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview; the facility failed to monitor parameters of pulse (heart rate) and oxygen saturation (SaO2-a measure of the concentration of oxygen in the blood) ordered by the physician for the administration of Labetalol (a medication used to treat hypertension) and DuoNeb Solution (a combination of medications used by inhalation to treat respiratory disorders) for Resident 23. Facility census was 45. Findings are: A. During observation of the medication pass on 2/25/14 from 8:14 AM until 8:16 AM, Licensed Practical Nurse (LPN)-A prepared and administered medications for Resident 23, including Labetalol 300 mg (milligrams). LPN-A did not obtain any parameters prior to the administration of the Labetalol. Review of current electronic physician's orders [REDACTED]. The physician's orders [REDACTED]. During interview on 2/25/14 at 1:50 PM, LPN-A verified Resident 23's pulse was not taken prior to the administration of Labetalol. However, LPN-A indicated the resident's pulse was obtained earlier when DuoNeb Solution was administered, and the heart rate was 78 at that time. Review of Nursing Progress Notes dated 2/25/14 at 6:39 AM (1 hour and 37 minutes prior to the administration of Labetalol) revealed Resident 23's pulse was 78 beats per minute following the administration of DuoNeb Solution. Review of Resident 23's Medication Administration Record (MAR) dated 2/1/14 through 2/25/14 revealed Labetalol 300 mg was administered every morning and at bedtime. However, there was no documentation on the MAR to indicate the resident's heart rate prior to the administration of each dose of Labetalol. Review of Resident 23's Nursing Progress Notes dated 2/1/14 through 2/24/14 and the Pulse Summary Report dated 2/1/14 through 2/24/14 revealed the following: - There were no pulses recorded in the morning or at bedtime for 12 of 24 days. - There were pulses recorded at bedtime but not in the morning for 2 of 24 day… | 2017-11-01 |
| 8031 | 8031 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 428 | D | 0 | 1 | 03FZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12.006.12B(5) Based on record review and staff interview; the facility consultant pharmacist failed to identify the use of Seroquel (a medication used to treat psychotic behaviors) for Resident 28 without the appropriate [DIAGNOSES REDACTED]. Facility census was 45. Findings are: Review of Resident 28's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 11/27/13 indicated the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The same MDS indicated Resident 28's Brief Interview for Mental Status (BIMS-a brief screen that aids in detecting cognitive impairment) score was 8 (a score of 8-12 indicates the resident is moderately intact cognitively), the resident exhibited no behaviors other than wandering, and the resident was receiving an antipsychotic medication. Review of the History and Physical dated 11/21/13 indicated Resident 28 was admitted to the facility due to increased wandering and progression of memory loss. Review of the admission physician's orders [REDACTED]. Review of Resident 28's medical record revealed here was no documentation of observations of mood or behavioral symptoms that indicated the need for use of an antipsychotic medication. Review of Resident 28's Medication Administration Record [REDACTED]. Review of Consultant Pharmacy Reviews dated 12/2/13, 1/24/14 and 2/14/14 revealed there were no recommendations made related to the use of Seroquel without appropriate [DIAGNOSES REDACTED]. During interview on 2/27/14 at 9:45 AM, the Medical Records personnel verified there were no recommendations made by the consultant pharmacist related to the use of Seroquel for Resident 28. | 2017-11-01 |
| 8032 | 8032 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 441 | E | 0 | 1 | 03FZ11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.17D Based on observations, record review and staff interview; facility staff failed to wash hands at appropriate intervals and/or utilize infection control techniques for the prevention of cross contamination during the provision of cares and treatments for Residents 12, 6, 50 and 18. Facility census was 45. Findings are: A. Review of the facility Procedure titled Perineal Hygiene with a revised date of 11/13 indicated the following: - Perform hand hygiene and put on gloves. (If additional supplies are needed during perineal care, remember to remove soiled gloves, wash hands or use hand sanitizer before touching objects in environment. Re-glove to resume perineal care.) - After removing soiled gloves, use hand sanitizer or wash with soap and water to cleanse hands. Put on clean gloves to put on clean pad and/or clothing. B. Review of the facility Policies and Procedures titled Hand Hygiene and Handwashing, last revision date of 11/11, revealed the following: - Wash hands with plain soap and water or with anti-microbial soap and water: - If hands are visible soiled (dirty) - If hands are visibly contaminated with blood or body fluids - Before eating - After using the restroom - If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub for routinely cleaning your hands: - Before having direct contact with residents - After having direct contact with a resident's skin - After having contact with body fluids, wounds or broken skin - After touching equipment or furniture near the resident - After removing gloves C. During observation of care on 2/26/14 from 7:06 AM until 7:19 AM, Nursing Assistant (NA)-C and NA-D provided incontinence care for Resident 12. The resident's incontinent brief was soiled with urine and smears of feces. NA-C provided perineal hygiene, pulled up the resident's new incontinent brief and pants, and removed the soiled gloves. Without washing hands, NA-C touched own face and rubbed own eyes, touched own unif… | 2017-11-01 |
| 8033 | 8033 | GOOD SAMARITAN SOCIETY - ATKINSON | 285177 | 409 NEELY STREET | ATKINSON | NE | 68713 | 2014-02-27 | 520 | F | 0 | 1 | 03FZ11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.07C Based on observations, record review and staff interview; the facility Quality Assessment and Assurance (QA&A) Committee failed to maintain correction of deficiencies of previously cited issues pertaining to pressure ulcers, infection control, care plans, accidents, choice and staffing. This failure had the potential to affect the well-being of all residents. The facility census was 45. Findings are: Review of the facility's policy Requirements for a Quality Committee (revised 3/12) revealed the following: The facility will maintain a quality committee consisting of the Administrator, Director of Nursing, a physician designated by the facility and representatives of all facility services. The committee will be responsible for: -Monitoring and improving processes and outcomes for the facility. -Assessing and ensuring compliance with regulations and policies and procedures on an ongoing basis. -Identifying issues and the development and implementation of appropriate improvement plans. Review of the facility deficiency statements from the annual standard survey completed on 10/6/11 revealed facility noncompliance with quality of care tag F325. Review of the facility deficiency statements from the Quality Indicator Survey (QIS) completed on 12/12/12 revealed facility noncompliance with quality of care tags related to: -F314 Pressure ulcers -F323 Accidents -F280 Following Resident's care plans -F441 Infection control -F353 Sufficient staffing -F242 Resident bathing choices Review of the preliminary citations for the current survey completed 2/27/14 revealed deficiencies cited with the surveys ending 10/6/11 and 12/12/12 were not corrected. Interview with the QA & A Coordinator on 2/27/14 from 10:00 AM to 10:20 AM, confirmed that the committee had not corrected the identified deficient practices. | 2017-11-01 |
| 4870 | 4870 | ARBOR CARE CENTERS-NELIGH LLC | 285124 | PO BOX 66, 1100 NORTH T STREET | NELIGH | NE | 68756 | 2017-03-02 | 176 | D | 1 | 0 | 042P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.10A1 Based on observation, record review and interview; the facility failed to assess 1 (Resident 2) of 9 sampled residents to determine if the resident could safely administer a prescription medication which was kept at the bedside. The facility census was 44. Findings are: [NAME] Review of the facility policy/procedure for Self-Administration of Medication by Residents (dated 6/2015) revealed the following was to be completed if a resident self-administered medication: -An assessment was to be conducted by the interdisciplinary team of the resident's cognitive, physical, and visual ability to carry out the responsibility of self-administering medications; -The interdisciplinary team was to determine the residents ability to self-administer medications by means of a cognitive and skill assessment; and -The results of the interdisciplinary team assessment were to be recorded on a Medication Self-Administration assessment form, which was to be placed in the resident's health care medical record. B. Review of Resident 2's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 12/5/16 revealed [DIAGNOSES REDACTED]. The MDS further indicated the resident had severe cognitive impairment with behaviors which included delusions and wandering. Review of a Physician Order dated 11/11/16 revealed Resident 2 had an order for [REDACTED]. During an observation on 3/1/17 at 3:15 PM, a container of Vicks [MEDICATION NAME] was observed in the top drawer of a bedside dresser in Resident 2's room. Review of Resident 2's medical record revealed no evidence to indicate the resident had been deemed cognitively and physically capable or had the visual acuity to provide the medication according to physician's directions or completion of a Self Administration of Medication assessment. The Director of Nurses (DON) indicated, during interview on 3/2/17 at 1:13 PM, that a self-a… | 2020-03-01 |
| 4871 | 4871 | ARBOR CARE CENTERS-NELIGH LLC | 285124 | PO BOX 66, 1100 NORTH T STREET | NELIGH | NE | 68756 | 2017-03-02 | 223 | D | 1 | 0 | 042P11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.02(8) Based on record review and interview, the facility failed to ensure Resident 3 was protected from physical abuse by Resident 2. The sample size was 9 and the facility census was 44. Findings are: [NAME] Review of the facility policy titled Preventing Resident Abuse (undated) revealed types of physical abuse included hitting, slapping, pinching and kicking. Review of the policy titled Nursing Facility Abuse/Neglect/Misappropriation Reporting Requirements dated 8/20/12 revealed residents were to be protected when there was reason to suspect or believe abuse occurred. B. Review of a facility investigation of potential resident to resident abuse dated 1/18/17 revealed on 1/15/17 at approximately 9:30 AM, Resident 3 was struck on the right shoulder by Resident 2. Documentation indicated the residents were immediately separated. Additional preventative measures included placing Resident 2 on 15 minute checks (visual observation of the resident at 15 minute intervals) and Resident 2's medications were readjusted due to increased aggression. Review of Resident 3's Care Plan revealed there were no interventions regarding protecting Resident 3 from physical abuse by Resident 2. Review of a facility investigation of potential resident to resident abuse dated 2/6/17 revealed the following: -On 1/31/17 at approximately 4:45 PM, Resident 2 was trying to get past or trying to move Resident 3 out of the way. Resident 2 .lightly tapped Resident 3 on the left arm; -Resident 2 indicated Resident 3 was .following me around; and -The residents were immediately separated and Resident 2 remained on 15 minute checks. Documentation further indicated both residents wandered without direction and staff were closely monitoring to ensure these residents were not near each other. C. Review of Resident 3's Care Plan (undated) revealed there were no interventions to protect Resident 3 from physical abuse by Resident 2. D. Review of Resident 2's Care Plan revealed there were no interventions in p… | 2020-03-01 |
| 4872 | 4872 | ARBOR CARE CENTERS-NELIGH LLC | 285124 | PO BOX 66, 1100 NORTH T STREET | NELIGH | NE | 68756 | 2017-03-02 | 225 | D | 1 | 0 | 042P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.02(8) Based on record review and interview, the facility failed to report an incident of potential abuse/neglect involving 1 resident (Resident 1) who fell and sustained a significant injury. The sample size was 9 and the facility census was 44. Findings are: Review of the facility policy titled Nursing Facility Abuse/Neglect/Misappropriation Reporting Requirements dated 8/20/12 revealed the following: -Physical injury was defined as damage to bodily tissue caused by non-therapeutic conduct, including, but not limited to fractures, bruises, lacerations, internal injuries or dislocations including but not limited to physical pain, illness or impairment of physical function; -Alleged violations involving mistreatment, neglect or abuse were to be reported to the administrator of the facility and to other officials in accordance with State law. Review of a Verification of Investigation form regarding Resident 1 dated 2/3/17 revealed the following: -Resident 1 was seated in a wheelchair at the dining room table at 6:20 PM; -At 6:30 PM the resident was found lying on the floor and sustained a 4 centimeter (cm) circular hematoma (an abnormal collection of blood outside the blood vessels and most commonly caused by injury to the wall of a blood vessel) on the left part of the forehead; -The resident stated yes when asked if the resident had a headache; -The resident's responsible family member, physician and hospice service were notified of the fall; -The resident's responsible family member and physician declined transfer to the hospital for further evaluation; and -The State Agency was not notified of the fall with injury. Review of Resident 1's Progress Notes dated 2/4/17 at 6:33 PM documented the resident continued to have vital signs (temperature, pulse, respiratory rate and blood pressure) and crani checks (assessment used to determine potential head or [MEDICAL CONDITION]) completed due to the fall. … | 2020-03-01 |
| 4873 | 4873 | ARBOR CARE CENTERS-NELIGH LLC | 285124 | PO BOX 66, 1100 NORTH T STREET | NELIGH | NE | 68756 | 2017-03-02 | 282 | D | 1 | 0 | 042P11 | > Licensure Reference Number 175 NAC 12-006.09C Based on observations, record review and interviews; the facility failed to ensure current Care Plan interventions for 2 (Residents 1 and 5) of 6 sampled residents identified at risk for accidents were implemented to assure the residents were protected from injuries. The facility census was 44. Findings are: [NAME] Review of Resident 5's current Care Plan (undated) indicated the resident was at risk for falls related to history of falls, restlessness and occasional confusion. The Care Plan further identified the resident had a fall out of bed on 2/7/17 and another fall on 2/28/17 when the resident attempted to crawl out of a recliner. Nursing interventions included: -Bed/chair alarm at all times, check for proper function. -Floor mat beside bed when occupied. -Footwear to prevent slipping. -High/low bed: keep bed in the low position when occupied. -To sit in recliner with foot rest down. If resident wants to nap or to sleep then to assist the resident to lay down. During an observations of Resident 5 on 3/2/17 at 9:05 AM, Nursing Assistant (NA)-F and Licensed Practical Nurse (LPN)-E positioned the resident in a recliner in the resident's room. The resident was observed to have the fall alarm to the seat of the recliner and the call light positioned within reach of the resident. However, the foot rest of the resident's recliner was placed in the upright position before staff exited the resident's room. Observations of Resident 5 on 3/2/17 revealed the following: -9:30 AM to 11:30 AM, the resident remained positioned in the recliner in the resident's room with the foot rest elevated. -2:30 PM, the resident was positioned in the recliner in the resident's room. The foot rest of the recliner was in an upright position. During an interview with the Director of Nursing (DON) on 3/2/17 at 11:30 AM, the DON verified staff should have followed the resident's Care Plan and kept the foot rest down when the resident was positioned in the recliner. B. Review of Resident 1's curr… | 2020-03-01 |
| 4874 | 4874 | ARBOR CARE CENTERS-NELIGH LLC | 285124 | PO BOX 66, 1100 NORTH T STREET | NELIGH | NE | 68756 | 2017-03-02 | 323 | D | 1 | 0 | 042P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7b Based on observations, record review and interviews; the facility failed to assure 2 (Residents 1 and 5) of 6 sampled residents identified at risk for accidents were protected from injuries as fall prevention interventions were not implemented. The facility census was 44. Findings are: [NAME] Review of Resident 5's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 1/6/17 revealed [DIAGNOSES REDACTED]. The MDS further indicated the resident required extensive assistance with transfers and mobility and was incontinent of bowel and bladder. Review of Nursing Progress Note dated 1/2/17 at 5:39 PM revealed the resident was found sitting on the footrest of the recliner in the resident's room and the resident had the recliner tipped up. Staff assisted the resident up and into a wheelchair. Review of Fall Risk assessment dated [DATE] revealed the resident was at high risk for falls. Review of Nursing Progress Note revealed on 2/7/16 at 2:26 AM the resident was found sitting on the floor beside the resident's bed with back against the side of the bed. The resident's fall alarm was sounding. The resident indicated the resident was trying to get up. A new intervention was identified for a fall mat on the floor next to the resident's bed when the bed was occupied. Review of a Nursing Progress Note dated 2/28/17 at 2:05 PM revealed the resident was found on the floor of the resident's room between the bed and the recliner. The resident's fall alarm was sounding. The resident sustained [REDACTED]. elbow. A new intervention was developed to keep the foot rest of the recliner in the down position when the resident was seated in the recliner in the resident's room. Review of Resident 5's current Care Plan (undated) indicated the resident was at risk for falls related to history of falls, restlessness and occasional confusion. The Care Plan further identified… | 2020-03-01 |
| 4581 | 4581 | WILBER CARE CENTER | 285172 | 611 NORTH MAIN | WILBER | NE | 68465 | 2016-06-20 | 309 | D | 0 | 1 | 04CY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D Based on interview and record review, the facility failed to implement orders for gentle stretching and range of motion to manage neck pain for one resident (Resident 44). The facility census was 52. Findings are: Review of the Nurses Notes dated 6/4/16 revealed Resident 44 was awake at 9 AM and complained of severe pain along the right side of neck. Resident would not turn head complaining that it hurt too much. Puffiness was noted along the right side of neck and jaw. Resident requested to be seen by a doctor and was taken to the hospital. Review of the hospital physician's orders [REDACTED]. -600 milligrams of [MEDICATION NAME] every 8 hours as needed for pain starting at 7:30 PM on 6/4/16, -325-650 milligrams of Tylenol every 4-6 hours for pain, -Ice to neck alternating with heat for comfort, and -Gentle stretching/range of motion for neck. On 6/13/16 at 1:49 PM, Resident 44 was interviewed about pain. Resident 44 indicated was currently having pain in the neck and had been having this pain recently. Resident 44 again complained of neck pain during an interview on 6/15/16 at 3:27 PM. On 6/16/16 at 9:11 AM,the resident indicated asking staff for a neck massage due to the sore neck and no action was taken. During an interview on 6/15/16 at 10:22 AM, Nursing Assistant B (NA B) was asked if Resident 44 ever complained of pain. NA B stated Resident 44 sometimes complained of neck pain. On 6/16/16 at 10:01 AM, Registered Nurse C (RN C) stated in an interview, that Resident 44 was not routinely assessed for pain as the resident was able to report pain. When asked about the hospital order for gentle stretching/range of motion, RN C stated, It must have got missed. | 2020-04-01 |
| 4582 | 4582 | WILBER CARE CENTER | 285172 | 611 NORTH MAIN | WILBER | NE | 68465 | 2016-06-20 | 323 | D | 0 | 1 | 04CY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7 Based on observation, record review, and interview; the facility failed to implement interventions to prevent the potential for falls for one resident (Resident 60). The facility census was 52. Findings are: Review of Resident 60's care plan revealed the resident had fallen and fractured a wrist and a rib prior to admission to the facility. The resident had another fall since admission to the facility on [DATE] resulting in skin tears to the arm. The care plan also indicated the resident was at risk for further falls related to weakness and anemia. The interventions related to falls included extensive assist of one for dressing, toileting, transfers and ambulation. Resident 60 was also to have bed and chair alarms at all times and the call light was to be kept available for use. Observation was made on 6/13/16 at 1:28 PM of Resident 60 in the room with the call light hanging behind the bed and down on the floor. The call light was out of resident's reach. On 6/15/16 at 2:26 PM, Nursing Assistant D (NA D) was observed to assist Resident 60 out of bed, into the bathroom and then into wheel chair. The bed alarm was not hooked up while the resident was in bed. It was still on the wheel chair. After the resident was in the wheel chair, the call light was left on the far side of the bed out of resident's reach. At 3:39 PM on 6/15/16, during an interview, NA D confirmed the bed alarm had not been hooked up when Resident 60 was in bed. Observation was made on 6/16/16 at 9:42 AM of Resident 60 lying in bed. The call light was attached to the privacy curtain at the foot of the bed out of resident's reach. At 9:52 AM on 6/16/16, NA [NAME] stated Resident 60 was assisted to bed after the wheel chair alarm went off, indicating the resident had got up unassisted. NA [NAME] confirmed the call light was not in reach of the resident and that NA E, forgot to put it on the bed. | 2020-04-01 |
| 4583 | 4583 | WILBER CARE CENTER | 285172 | 611 NORTH MAIN | WILBER | NE | 68465 | 2016-06-20 | 441 | D | 0 | 1 | 04CY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference: 175 NAC 12-006.17 Based on observation, record review, and interview; the facility failed to provide peri-care in a manner to prevent the potential for cross contamination for one resident (Resident 42). The facility census was 52. Findings are: Review of Resident 42's 5/5/16 MDS (Minimum Data Set-a federally mandated comprehensive assessment tool used for care planning) dated 5/5/16 revealed Resident 42 required extensive assistance with toileting and personal hygiene and had been diagnosed with [REDACTED]. An observation of Resident care on 6/16/16 at 9:28 AM revealed NA (Nurse Aide) A assisted Resident 42 to bathroom after putting gloves on. NA A pushed the wheel chair to the bathroom doorway and then cued Resident 42 to hold on to the grab bar. NA A noted something dirty on the bottom side of the grab bar and used a wipe to clean it off before placing the wipe in the wastebasket. NA A then assisted Resident 42 in pulling down slacks and depends. Resident 42 was then lowered to the toilet. NA A proceeded to perform perineal cares on Resident 42 while wearing the same gloves after wiping the grab bar and providing perineal care. An interview with the Administrator on 6/20/16 at 12:00 PM revealed this was an infection control issue and acknowledged this could be a problem. | 2020-04-01 |
| 34 | 34 | HOMESTEAD REHABILITATION CENTER | 285049 | 4735 SOUTH 54TH STREET | LINCOLN | NE | 68516 | 2017-05-04 | 166 | D | 1 | 0 | 04EU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.06B Based on record reviews and interviews, the facility failed to resolve grievance / complaints for 1 resident (Resident 603) out of 3 residents sampled. The facility census was 138. Findings are: Review of the undated face sheet for Resident 603 revealed an admission date of [DATE]. Review of the undated face sheet revealed the [DIAGNOSES REDACTED]. Review of the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning) dated 4-11-17 revealed a BIMS (Brief Interview for Mental Status, a brief screening tool that aides in detecting cognitive impairment) score of 15 which indicated Resident 603 was cognitively intact. Resident 603 required extensive assistance of one staff for bed mobility, transfers, dressing, toileting, and bathing. Resident 603 was frequently incontinent of urine. Review of the Grievance Log dated 3-01-16 through 3-30-17 provided by the facility revealed absence of a grievance for Resident 603. Interview via phone on 4-26-17 at 4:35 PM with the Family revealed a grievance was completed on 3-30-17 and the Family handed the grievance to Staff D. The Family never received a response back from the facility since that night for a resolution of the 3 issues the Family had concerns about. Family revealed the 3 issues were. 1) The resident had expressed concern to the staff about wheezing and requested an inhaler to help relieve the resident's lungs wheezing and it took 7 days for any of the staff to believe the resident and obtain the orders and medication from the Physician. 2) The Family had concerns the resident had to sit in incontinent urine for up to 15 minutes on multiple occasions after staff was aware of the situation. 3) The resident was not supposed to be transferring independently but the resident had reported to the Family this had occurred occasionally because staff were not available to transfer the resident. The Family revealed on… | 2020-09-01 |
| 35 | 35 | HOMESTEAD REHABILITATION CENTER | 285049 | 4735 SOUTH 54TH STREET | LINCOLN | NE | 68516 | 2017-05-04 | 312 | D | 1 | 0 | 04EU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D1 Based on observations, record review, and interviews; the facility failed to provide assistance with a shower and left the dependent resident unattended for 2 and 3/4 hours for 1 resident (Resident 603) out of 3 sampled residents. Resident was unable to use the call light to call for needed assistance. The facility census was 138. Findings are: Review of the face undated sheet for Resident 603 revealed an admission date of [DATE]. Review of the undated face sheet revealed [DIAGNOSES REDACTED]. Review of the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning) dated 4-11-17 revealed a BIMS (Brief Interview for Mental Status, a brief screening tool that aides in detecting cognitive impairment) score of 15 which indicated Resident 603 was cognitively intact. Resident 603 required extensive assistance of one staff for bed mobility, transfers, dressing, toileting, and bathing. Interview on 04-26-17 at 10:00 AM in the resident's room revealed a few weeks ago Staff A put the resident into the shower and performed a 10 minute rinse to the left leg. When completed, Staff A left and said Staff A would be back in 5 minutes and the resident was left sitting in the shower without a call light for over 2 and 1/2 hours. At first the resident thought time was just going by slowly, then the resident realized the resident had been forgotten. At one time the resident thought the resident heard someone come into the resident's room so (gender) yelled out is anyone out there. Resident 603 revealed however the resident's voice was very soft and no one came into the bathroom. Resident 603 revealed the bathroom had a call light but it was across the room by the toilet and the cord was not long enough to have reached the resident. The resident revealed at that time, the resident was not to transfer alone and the wheelchair was not close so the resident could have reached it … | 2020-09-01 |
| 11885 | 11885 | KEARNEY COUNTY HEALTH SERVICES | 2.8e+298 | 727 EAST 1ST STREET | MINDEN | NE | 68959 | 2011-09-27 | 225 | D | 1 | 0 | 04FW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.02(8) Based on record review and interview; the facility staff failed to thoroughly investigate the allegation of abuse and submit a report to the required state agencies in accordance with the required time frames for 1 of 3 sampled residents (Resident 20). The facility staff identified a census of 23. Findings are: Review of the Admission and Discharge Summary for Resident 20 revealed admission to the facility on [DATE] with the [DIAGNOSES REDACTED]. A. Review of the facility form entitled Record Addditional Notes dated 8/6/11 at 1700 (5:00 PM) found an entry that stated "Overheard res. (residents) spouse saying the following "you are so G... Damned stupid (resident name)". "Why are you so stupid". "How stupid are you (resident name)". Take these pills. Spouse also was leaning over the resident trying to get the resident to take the herbal meds spouse brought for the resident. Spouse was very agitated and raised spouse voice many times. The Resdient was refusing the meds and spouse was becoming very frustrated. Staff was across the hall watching behavior and I was by the door listening and occassionally getting a look at behavior". Review of the facility investigation dated August 10, 2011 found no documentation the staff were interviewed about the behavior. The Facility Investigation revealed no evidence the staff intervened as the behavior was observed. Interview with the Director of Nurses (DON) on 9/27/2011 at 3:26 PM stated "the staff were not investigated or suspended due to watching the behaviors and not intervening at the time. Review of the Facility Proceudre entitled Protection of Residens During Abuse Investigations, dated reviwed/resvised 2/2008, under Policy Interpretation and Implementation and Points to Remember: The facility has a responsibility to protect the residetns from abuse/neglect. Employees accused of participating in the alleged abuse will be immediately reassigned to dutie… | 2015-01-01 |
| 7117 | 7117 | KEARNEY COUNTY HEALTH SERVICES-COUNTRYSIDE LIVING | 2.8e+298 | 727 EAST 1ST STREET | MINDEN | NE | 68959 | 2017-03-02 | 274 | D | 0 | 1 | 04UA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09B1(2) Based on record review and interviews, the facility failed to complete a significant change assessment for one resident (Resident 18) that went on hospice and for one resident (Resident 16) that went off hospice. Sample size was 17. The facility staff identified the resident census at 21. A. A review of Resident 18's physicians orders revealed an order dated 1/31/17 that said to evaluate and admit Resident 18 to hospice with a [DIAGNOSES REDACTED].). A review of Resident 18's Hospice Certification dated 2/1/17 revealed Resident 18 started on hospice on 2/1/17. A review of Resident 18's medical record revealed the most recent Minimum Data Set (MDS: A federally mandated comprehensive assessment tool used for care planning) was an admission MDS dated [DATE]. B. A review of Resident 16's physicians orders revealed a fax form dated 12/8/16 addressed to Resident 16's physician that stated Resident 16's spouse discontinued hospice/ A review of Resident 16's Hospice Benefit Revocation form dated 12/7/16 revealed Resident 16 was no longer on hospice due to spouse not longer wanting resident on hospice. A review of Resident 16's medical record revealed that Resident 16's most recent MDS was a quarterly assessment dated [DATE]. An interview conducted on 3/2/17 at 9:48 AM with Registered Nurse (RN) A revealed that a significant change MDS had not been completed when Resident 18 went on hospice because it happened not long after admission to the facility. RN A reported that they did not know the scheduling guidelines for significant change assessments after admission to the facility. RN A reported that a significant change assessment was not completed for Resident 16 when the resident went off hospice. RN A reported they did not know that a significant change assessment needed to be completed when a resident goes off hospice. | 2018-07-01 |
| 7118 | 7118 | KEARNEY COUNTY HEALTH SERVICES-COUNTRYSIDE LIVING | 2.8e+298 | 727 EAST 1ST STREET | MINDEN | NE | 68959 | 2017-03-02 | 327 | D | 0 | 1 | 04UA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09D9 Based on observations, interviews and record review; the facility failed to ensure 1 resident (Resident 16) of 2 residents sampled received fluids to meet the resident's assessed fluid needs. The facility staff identified the facility census as 21. A review of Resident 16's Facesheet dated 12/31/15 revealed Resident 16 was admitted to the facility on [DATE]. A review of Resident 16's History and Physical dated and signed by the physician on 8/8/16 revealed Resident 16 had the following [DIAGNOSES REDACTED]. An observation conducted on 2/27/16 at 4:08 PM revealed Resident 16 had dry lips with both moist and dry matter between their lips, teeth, and gums. An observation conducted on 3/1/17 from 8:16 AM to 9:02 AM revealed Resident 16 sat at breakfast table playing with the cups and dishes at their place setting dumping food on the placemat and lifting glass up and down, but did not take a drink. An observation conducted on 3/1/17 from 12:18 PM to 12:57 PM revealed Resident 16 sat at lunch table playing with the cups and dishes at their place setting, but did not take a drink. A review of Resident 16's Nutritional Data Collection Tool dated 8/9/16 revealed under Nutrient Needs section Resident 16's fluid needs was assessed to 1700 milliliters per day. The Tool revealed Resident 16 was also receiving 5 cans of tube feeding a day which provided 449 milliliters of free fluid daily. A review of Resident 16's physician's orders [REDACTED]. A review of Resident 16's Minimum Data Set (MDS: A federally mandated comprehensive assessment tool used for care planning) revealed the Resident 16's average fluid intake from tube feeding was 501milliliters. A review of Resident 16's daily fluid intake documentation from 2/1/17 to 3/1/17 revealed Resident 16 drank the following amounts of fluid per day 2/1/17-0milliliters (mL), 2/2/17-100mL, 2/3/17-0mL, 2/4/17-0mL, 2/5/17-120mL, 2/6/17-120mL, 2/7/17-0mL, 2/8/17-120mL… | 2018-07-01 |
| 7119 | 7119 | KEARNEY COUNTY HEALTH SERVICES-COUNTRYSIDE LIVING | 2.8e+298 | 727 EAST 1ST STREET | MINDEN | NE | 68959 | 2017-03-02 | 431 | F | 0 | 1 | 04UA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC ,[DATE].12E4 Based on observation, interview, and record review; the facility failed to ensure medications available for all residents use were not expired. Sample size was 17. The facility census was 21. Findings are: Observation on [DATE] at 9:42 AM of the medications in the emergency box in the medication room revealed two medications had expired in (MONTH) (YEAR). The medication Albuterol 0.083% inhalation solution, used to treat respiratory conditions, had the expiration date of ,[DATE]. The medication Lorazepam 0.5mg (milligram) tablets, an antianxiety medication, had the expiration date of ,[DATE]. Record review of the Emergency Drug Box form which was attached to the emergency drug box, listed all the medications in the box and their expiration dates. Next to the Albuterol 0.083% inhalation solution was listed the expiration date of ,[DATE]. Next to the Lorazepam 0.5mg tablets was listed the expiration date of ,[DATE]. Interview on [DATE] at 10:46 AM with the DON (Director of Nursing) revealed the Pharmacist checked the emergency drug box every 30 days for outdated medications instead of before the end of each month. | 2018-07-01 |
| 7120 | 7120 | KEARNEY COUNTY HEALTH SERVICES-COUNTRYSIDE LIVING | 2.8e+298 | 727 EAST 1ST STREET | MINDEN | NE | 68959 | 2017-03-02 | 463 | D | 0 | 1 | 04UA11 | License Reference # 175 NAC 12-007.04G Based on observation and interview, the call system for 1 resident (Resident 20) out of 19 residents sampled did not have an operable call system in the resident's room. Facility census was 21. Findings are: Observation on 2/28/2017 at 7:55 AM revealed the call light in Resident 20's room did not light up outside the resident's room to notify staff of the resident's needs or sound off to alert staff at the nursing desk. Observation on 3/2/2017 at 3:50 PM with the Maintenance Director revealed the call light did not light up after being pressed. Interview on 3/2/2017 at 3:50 PM with Maintenance Director revealed the cord of the call light was not plugged into the wall correctly and was not working. | 2018-07-01 |
| 1168 | 1168 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 561 | D | 0 | 1 | 057T11 | Based on record review , observation and interview the facility staff failed to relocate 1 resident (Resident 34) of sampled resident out of the Alzheimer's unit (ACU) per request of Power of Attorney (POA). The facility census was 42. Findings are: On 09/26/19 at 10:03 AM a telephone interview with Resident 34's, Power of Attorney (POA) revealed Resident 34 was admitted in February, 2019. According to Resident 34 POA, 5 months later the facility staff asked Resident 34's POA about placing Resident 34 on the locked unit, Alzheimer's Care Unit (ACU). According to Resident 34's POA both the Resident 34 and Resident 34 POA evaluated the unit and chose not to go back to the ACU According to Resident 34's POA about 1 month later the facility staff requested placement in the ACU as Resident 34 was having a lot of falls. Resident 34 's POA later requested repeatedly for facility staff to move Resident 34 from the ACU, due to, Resident 34 POA did not like Resident 34 being in the ACU. According to the Resident 34's POA the ACU was inconvenient for the POA and family members to visit and they refuse to move Resident 34. He does not try to leave or anything and (gender) does not understand why they are refusing to move Resident 34 back out of the locked unit. The Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 6/7/19 reveals a (Brief interview for Mental Status (BIMS) of 12. According to the MDS Manuel a score of 8-12 indicate moderately impaired cognition. Record review of Resident 34 medical record revealed there was no evidence of evaluating the request by Resident 34s POA to move Resident 34 form ACU. On 9/15/19 after being placed in the ACU Resident 34 MDS reveals a BIMS of 9 with behavior Symptoms occurring 1 to 3 times a day towards others and wandering occurring 1-3 times a day. On 9-30-2019 at 7:31AM Resident 34 was observed in the dining area in the ACU. On 10-01-2019 7:15 AM Resident 34 was observed in the ACU dining room. On 10/02/19 an interview with Director of Nursin… | 2020-09-01 |
| 1169 | 1169 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 603 | G | 0 | 1 | 057T11 | Licensure Reference Number: 175 NAC 12-006.05(9) Based on record review , observation and interview, the facility staff failed to evaluate and reevaluate placement into a secured unit (Alzheimer's Care Unit) and failed to reevaluate continued placement in the secured unit for 1 resident (Resident 34) of sampled resident. The facility census 42. Findings are: Record review of Alzheimer's Care Unit policy: reveals Admission Criteria includes Family/responsible party must agree on placement into the unit. Interdisciplinary team must complete pre-assessments and accept resident into the program. On 09/26/19 at 10:03 AM a telephone interview with Resident 34's, Power of Attorney (POA) revealed Resident 34 was admitted in February, 2019. According to Resident 34 POA, 5 months later the facility staff asked Resident 34's POA about placing Resident 34 on the locked unit, Alzheimer's Care Unit (ACU). According to Resident 34's POA both the Resident 34 and Resident 34 POA evaluated the unit and chose not to go back to the ACU According to Resident 34's POA about 1 month later the facility staff requested placement in the ACU as Resident 34 was having a lot of falls. Resident 34 's POA later requested repeatedly for facility staff to move Resident 34 from the ACU, due to, Resident 34 POA did not like Resident 34 being in the ACU. According to the Resident 34's POA the ACU was inconvenient for the POA and family members to visit and they refuse to move Resident 34. He does not try to leave or anything and (gender) does not understand why they are refusing to move Resident 34 back out of the locked unit. The Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) dated 6/7/19 reveals a (Brief interview for Mental Status (BIMS) of 12. According to the MDS Manuel a score of 8-12 indicate moderately impaired cognition. On 9/15/19 after being placed in the ACU Resident 34 MDS reveals a BIMS of 9 with behavior Symptoms occurring 1 to 3 times a day towards others and wandering occurring 1-3 times a day. … | 2020-09-01 |
| 1170 | 1170 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 609 | D | 1 | 1 | 057T11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.02 Based on record review and interview the facility staff failed to ensure an investigation was sent to the state agency in the required time frame. The facility staff identified a census of 42. Findings are: Record Review of a facility investgation for Resident 12 and Resident 25 dated 8/12/2019 revealed a resident to resident incident. Adult Protective Service was notified of incident on 8/12/19 at 07:58 PM. Interview conducted with the Assistant Director of Nursing on 10/02/19 at 06:52 AM confirmed the completed investigation had not been sent to the state agency within the required time frame. | 2020-09-01 |
| 1171 | 1171 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 657 | D | 0 | 1 | 057T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C1b Based on record review and interview, the facility staff failed to implement interventions on the care plan to prevent falls for 2 (Resident 37 and 34) of 3 sampled residents and failed to update Care Plan for Pressure Ulcers for Resident 19. The facility staff identified a census of 42. Findings are: [NAME] Review of Policy and Procedure for Falls Management dated 04/2015 revealed Fall injury Prevention to include: 1. Adjust/add interventions on the plan of care. 2. Review and revise Interdisciplinary Care Plan. 3. Provide training for caregivers - noting any changes implemented. Record review of Resident 37's progress note dated 07/23/19 revealed Resident 37 had a fall while walking resulting in a raised hematoma to elbow. Record review of Resident 37's CCP (Comprehensive Care Plan) revealed the following: -A focus of Risk for falls related to confusion, dementia, [MEDICAL CONDITION] drug use. Fall with skin tear 09/10/19. -Goal revealed Resident 37 will be free from falls with injury. -Interventions initiated on 09/24/18 include: 1. Anticipate and meet the resident needs 2. Be sure call light is within reach and encourage the resident to use it for assistance as needed. 3. Follow facility fall protocol. 4. The resident needs a safe environment. The CCP did not indicate an intervention for the fall occurring on 07/23/19 or 09/10/19. Interview with the Assistant Director of Nursing on 10/01/19 at 11:30 AM confirmed the CCP had not been updated to include the fall on 07/23/19 with intervention to prevent further falls and there were no interventions to prevent further falls for the fall on 09/10/19. B. An interview on 9/26/19 at 8:48 AM revealed Resident 19 had a pressure ulcer on his buttocks the size of a nickel. Resident 19 states they have been doing dressing changes on it. Record review of the Progress Notes, Weekly Wound Assessment and Weekly Skin Evaluation from (MONTH) 2019 to present re… | 2020-09-01 |
| 1172 | 1172 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 679 | D | 0 | 1 | 057T11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D5b Based on observation, record review and interview, the facility failed to provide an ongoing activity program for 3 (Resident 33, 37, 25) of 6 sampled residents that reside on the Alzheimer's Care Unit. This has the potential to affect 14 residents. The facility staff identified a census of 42. The findings are: Observation of Resident 33 on 09/26/19 at 10:18 AM revealed resident lying in her bed. Observation of Resident 33 on 09/26/19 at 01:16 PM revealed resident lying in her bed. Observation of Resident 33 on 09/30/19 at 09:51 AM revealed resident lying in her bed. Observation of Residetn 33 on 09/30/19 at 11:54 AM revealed resident sitting in her wheelchair in her room. Observation of Resident 37 on 09/25/19 at 01:27 PM revealed resident lying in his bed. Observation of Resident 37 on 09/26/19 at 01:10 PM revealed resident wandering in the hallway. Observation of Resident 37 on 09/30/19 at 02:44 PM revealed resident lying in his bed. Observation of Resident 37 on 10/01/19 at 10:20 AM revealed resident lying in his bed. Random observations conducted throughout the survey 09/25/19 through 10/2/19 revealed no activites provided on the ACU according to the activity calendar. Review of the monthly activity calendar provided by the facility Activity Director revealed the following: 09/26/19 Activites scheduled were 7:00 Good morning Greetings, 9:00 Rest and Hydrate, 10:00 Snack Bar, 11:00 Movin' & Groovin', 11:30 Remember When, 1:00 Sensory Scent, 2:00 Rest and Hydrate, 4:00 Devotions. 09/30/19 Activities scheduled were 7:00 Good Morning Greetings, 9:00 Rest and Hydrate, 10:00 Snack Bar, 11:00 Movin' & Groovin', 11:30 Light Tunes, 1:00 Outside Stroll, 2:00 Rest and HYdrate, 4:00 Devotions. On 10/1/2019 at 09:15 AM an interview was conducted with the Director of Nursing which confirmed that there was no activities provided on the unit. On 10/01/19 at 10:35 AM and interview was conducted with the Activity Director which revealed that activites on the ACU are not provide… | 2020-09-01 |
| 1173 | 1173 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 688 | D | 0 | 1 | 057T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09D4 Based on Record Review and interview the facility staff failed to implement a specific Nursing Restorative Program (NRP) for 1 (Resident 14) of 1 sampled resident. The facility census 42. Finding are: Record Review of Physician orders [REDACTED]. On9-30-2019 at 9:14 AM an interview was conductd with Resident 14. During the interview Resident 14 reported that staff did not work on exercises. Review of Resident 14's record revealed there was not evidence the facility staff were assisting Resident 14 with exercise 2 times per week. On 09/30/19 at 8:52 AM a interview with Director of Nursing (DON) confirmed that they do not have a Nursing Restorative Program and this would be a task for restorative. During the interview the DON confirmed the excercise program was not completed for Resident 14. | 2020-09-01 |
| 1174 | 1174 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 689 | D | 0 | 1 | 057T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006 9D 7b Based on Record Review and interview the facility failed to implement interventions to prevent falls for 1 resident (Resident 34) of 2 sampled resident. The facility staff identified a census of 42. Findings are: Record Review of facility Falls Management Policy created 4/2015 includes Assess and review resident risk factors for falls and injuries upon admission, with a significant change in condition or after a fall. Implement goals and interventions with resident/patient/family for inclusion in the interdisciplinary Plan of Care based on individual needs Record review of Resident34 [DIAGNOSES REDACTED]. Record review of Care Plan (Individualized document to direct plan of care) for Resident 34 reveals Resident 34 is a risk for falls, History of Falls, Poor Safety Awareness, unsteady gait. Record Review reveals Resident 34 was admitted to facility on 2/27/19. Record Review of Resident 34's Event Forms from 4/4/19 thru 09/6/19 reveals the following falls for Resident 34 with no new interventions implemented or put in place on the Care Plan. 4/4/19 fall not entered on Care Plan no intervention. 4/28/29 fall not on Care Plan, no intervention. 5/8/19 fall not on Care Plan, no intervention 6/3 /19 fall not on Care Plan, no intervention 6/17/19 Fall on Care Plan no intervention 7/22/19 fall, Intervention to add Touch Pad call light, Resident 34 did not have in room. 7/24/19 fall, on care plan, no intervention. 7/27/19 not on care plan, no intervention 7/29/19 not on care plan, no intervention 8/3/19 not on care plan, no intervention 8/10/10, not on care plan, no intervention 8/13/19 not on care plan, no intervention 8/15/19 not on care plan, no intervention 8/16/19 not on care plan no intervention 8/17/19 not on care plan no intervention Record Review shows moved to Alzheimer's care unit 8/20/19 8/20/19 not on care plan, no intervention 8/30/19 not on care plan, no intervention 9/5/19 not on care pla… | 2020-09-01 |
| 1175 | 1175 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 741 | D | 1 | 1 | 057T11 | > LICENSURE REFERENCE NUMBER 175 NAC 12-006.04B2 The facility failed to ensure that staff on the ACU (Alzheimers Care Unit) received specific training for specialized needs of Residents with Dementia. This has the potential to affect 14 resident residing on the ACU. The facility staff identified a census of 42. Review of the facility ACU (Alzheimers Care Unit) Policy and Procedure dated 3/21/2017 revealed the ACU is a specialized residence within our facility where the focus is on quality of life and success in daily living activities. Care will be provided by trained staff who focus on the specialty needs of residents who have altered cognitive and communication functioning related to Alzheimers or other dementia related diseases. 09/30/19 11:35 AM Interview conducted with NA A revealed that there was no specialized training provided for working in the ACU. 09/30/19 03:15 PM Interview conducted with Director of Nursing revealed staff is trained on the Hand in Hand Manual prior to working on the unit. 10/01/19 07:04 AM Interview conducted with MA B revealed that there is no specialized training for staff working on the ACU. 10/01/19 07:10 AM observation of MA B telling agency staff NA C about the residents on the unit and the behaviors of each resident. Interview with Agency staff NA C assigned to the ACU alone on 10/01/19 revealed no specialized training provided prior to working on the ACU. Interview with the Administrator on 10/01/19 at 10:35 AM confirmed that the staff on the unit did not have specific training in the specialty needs of Residents with Alzheimers Dementia. | 2020-09-01 |
| 1176 | 1176 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 758 | D | 0 | 1 | 057T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.12B(5) The facility staff failed to implement non-pharmalogical interventions prior to giving PRN antianxiety medication for 1 (Resident 37) of 5 sampled residents. The facility staff identified a census of 42. The findings are: Record Review of the behavior binder located at the nurses station revealed resident 37's had identified behaviors of physical aggression; yelling, cussing, hitting the doors-exit seeking with interventions of give Resident 37 a manual vacuum- enjoys helping out, Resident 37's behavior is diffused quicker with male staff intervention. Offer calls to son to calm, offer snacks and drinks, offer activities, take Resident 37 on a walk, Guide away from distress, engage in calm conversation. Review of TAR (Treatment Administration Record) for (MONTH) 2019 revealed a (+) sign documented for (MONTH) 1, 2, 12, 20, 23, 24, and the 25 for PRN (as needed) [MEDICATION NAME] (a medication used for anxiety). A (+) sign indicates that there should be documentation in the progress note of the behavior. Review of EMAR notes for (MONTH) revealed the following: 9/1/2019 09:56 eMar - Medication Administration Note Text: [MEDICATION NAME] Tablet 0.5 MG Give 0.5 mg by mouth every 8 hours as needed for Breakthrough anxiety for 90 Days resident not wanting to give up silvrware in the kitchen to be washed, being aggressive, exit seeking, pounding on doorway, and cussing. 9/2/2019 20:31 eMar - Medication Administration Note Text: [MEDICATION NAME] Tablet 0.5 MG Give 0.5 mg by mouth every 8 hours as needed for Breakthrough anxiety for 90 Days PRN Administration was: Effective 9/10/2019 14:13 eMar - Medication Administration Note Text: [MEDICATION NAME] Tablet 0.5 MG Give 0.5 mg by mouth every 8 hours as needed for Breakthrough anxiety for 90 Days Given due to increased agitation and aggression 9/20/2019 20:38 eMar - Medication Administration Note Text: un cooperative 9/20/2019 16:53 eMar - Medication Adm… | 2020-09-01 |
| 1177 | 1177 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 801 | E | 0 | 1 | 057T11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.04d2A Based on record review and interview, the facility failed to ensure the Dietary Manger was certified or a full time dietician was employed. This has the potential to affect all of the resident who reside in the facility. The facility staff identified a census of 42. The findings are: Review of the acting DM (Dietary Managers) personnel file revealed no certification for the Dietary Manager position. On 09/30/19 at 10:52 AM an interview conducted with Cook D revealed that Cook D was acting DM due to previous DM no longer employed. Cook D confirmed that Cook D was not certified as a Dietary Manager. On 9/30/19 at 11:10 AM an interview was conducted with the RD (Registered Dietician) which confirmed the DM was not certified and RD is not a full time employee. On 09/30/19 at 02:14 PM an interview was conducted with the DON which confirmed that the facility did not have a certified dietary manager. | 2020-09-01 |
| 1178 | 1178 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 812 | E | 0 | 1 | 057T11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observation and interview, the facility failed to ensure the ceiling vents over the kitchen preparation area were free from foriegn matter. This had the potential to affect all the residents receiving meals from the kitchen. The facility staff identified a census of 42. The findings are: On 09/30/19 at 10:52 AM observation of the vents in the ceiling over the kitchen preparation area revealed a heavy layer of foreign matter. On 09/30/19 at 11:00 AM interview with Cook B confirmed the vents in the ceiling over the kitchen preparation area had foreign matter on them. Cook B also confirmed there was no cleaning schedule for the vents in the kitchen | 2020-09-01 |
| 1179 | 1179 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 814 | D | 0 | 1 | 057T11 | LICENSURE REFERENCE NUMBER 175 NAC 12-006.18A Based on observation and interview the facility staff failed to prevent potential cross contamination by keeping the garbage can covered in the food preparation area of the kitchen. This had the potential to affect all residents who received food from the facility kitchen. The facility staff revealed a census of 42. The findings are: On 09/30/19 from 10:10 AM - 11:15 AM an observation of the meal preparation for lunch revealed Cook [NAME] removed the lid from the garbage can in the kitchen preparation area and put the lid into the sink. The garbage can remained un-covered during meal preparation. On 09/30/19 at 10:45 AM an intervew was conducted with Cook D which revealed that the sink the garbage can lid was placed in was used for washing utensils and pots and pans. On 09/30/19 at10:52 AM an interview was conducted with Cook D which confirmed that the garbage can in the kitchen should have been covered and the lid from the garbage can should not have been placed in the sink. | 2020-09-01 |
| 1180 | 1180 | PRESTIGE CARE CENTER OF NEBRASKA CITY | 285109 | 1420 NORTH 10TH STREET | NEBRASKA CITY | NE | 68410 | 2019-10-02 | 880 | D | 1 | 1 | 057T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSE REFERENCE NUMBER 175 NAC 12-006.17D Based on observation, record review and interview; the facility staff failed to ensure proper hand hygiene during pressure ulcer treatment for [REDACTED]. Findings are: Interview with the Resident on 09/26/19 08:48 AM revealed he had a pressure ulcer about the size of a nickel on his bottom. Observation of wound care to the Resident's buttocks on 10-2-19 at 0815 AM reveals RN G and two aides (CNA H and CNA I) in the room with resident. The Resident was prepped with brief undone, RN G came to the room from the hallway with 4x4's and a dressing (4x4 bordered dressing) marked with date and initials. RN G stated that she had washed her hands prior to entering the room. RN G donned gloves, cleaned area with 2 different 4x4's saturated with an unknown substance, (unwitnessed), after cleaning the area and drying, she then changed gloves with no hand sanitizer or hand washing and applied a new dressing. She then proceeded to take old dressing and used supplies out of the room (not in a bag), wrapped in paper towels. On 10/02/19 at 9:51 AM an interview with the DON states that staff should change gloves after the staff handle soiled material, wash hands, and apply new gloves. Record Review of the facility policy titled Clinical Management Handwashing reveals routine handwashing should be accomplished before and after contact with wounds, whether surgical, traumatic or associated invasive devices. | 2020-09-01 |
| 8508 | 8508 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 164 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.05(21) Based on observation and interview; the facility staff failed to ensure privacy during personal cares for 1 (Resident 41). The facility staff identified a census of 79. Findings are: Record review of a Admission and Discharge Summary sheet dated 2-21-2014 revealed Resident 41 was admitted to the facility with the [DIAGNOSES REDACTED]. Record review of Resident 41's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated as completed on 3-06-2014 revealed the facility staff assessed the following about the resident: -Resident 41 had short and long term memory problems. -Usually understands and is understood. -Required extensive assistance with bed mobility, transfers, dressing, eating, and personal hygiene. -Required extensive assistance with toilet use. -Occasionally incontinent of bowel and had an indwelling catheter (tube placed into bladder to drain urine). -Resident 41 was at risk for developing pressure ulcers and currently had 1, stage 2 ( partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater). Observation on 5-07-2014 at 9:53 AM of personal cares revealed Nursing Assistant (NA) A and NA B washed their hands and donned gloves. Resident 41 was transferred to bed using a mechanical lift. NA A and NA B then removed Resident 41's pants and adult brief. NA A and NA B completed providing the personal care for Resident 41. NA A and NA B removed the soiled gloves and when into the bathroom to wash hand leaving Resident 41 uncovered and exposed. An interview with NA B was conducted on 5-07-2014 at 10:18 AM. During the interview, NA B confirmed that Resident 41 had been uncovered and exposed and should not have been. | 2017-05-01 |
| 8509 | 8509 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 241 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.05(21). Based on observation and interview; the facility staff failed to apply undergarments/briefs to ensure dignity for 1 (Resident 41). The facility staff identified a census of 79. Findings are: Record review of a Admission and Discharge Summary sheet dated 2-21-2014 revealed Resident 41 was admitted to the facility with the [DIAGNOSES REDACTED]. Record review of Resident 41's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated as completed on 3-06-2014 revealed the facility staff assessed the following about the resident: -Resident 41 had short and long term memory problems. -Usually understands and is understood. -Required extensive assistance with bed mobility, transfers, dressing, eating, and personal hygiene. -Required extensive assistance with toilet use. -Occasionally incontinent of bowel and had an indwelling catheter (tube placed into bladder to drain urine). -Resident 41 was at risk for developing pressure ulcers and currently had 1, stage 2 ( partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater). Observation on 5-07-2014 at 9:53 AM of personal cares revealed Nursing Assistant (NA) A and NA B washed their hands and donned gloves. Resident 41 was transferred to bed using a mechanical lift. NA A and NA B then removed Resident 41's pants and adult brief. NA A and NA B completed providing the personal care for Resident 41. Further observation revealed NA A and NA B did not apply undergarments/briefs to Resident 41. An interview was conducted on 5-07-2014 at 10:18 AM with NA B. During the interview, NA B reported that briefs were not applied to allow the resident to air out. On 5-07-2014 at 12:10 PM an interview was conducted with the facility Director of Nursing (DON). During the interview, the DON reported there was not a policy for not … | 2017-05-01 |
| 8510 | 8510 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 312 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D1c Based on observation, record review and interview; the facility staff failed to provide assistance at meals for 1 (Resident 41). The facility staff identified a census of 79. Findings are: Record review of a Admission and Discharge Summary sheet dated 2-21-2014 revealed Resident 41 was admitted to the facility with the [DIAGNOSES REDACTED]. Record review of Resident 41's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated as completed on 3-06-2014 revealed the facility staff assessed the following about the resident: -Resident 41 had short and long term memory problems. -Usually understands and is understood. -Required extensive assistance with eating with staff physically assisting the resident. -Required extensive assistance with toilet use. -Occasionally incontinent of bowel and had an indwelling catheter (tube placed into bladder to drain urine). -Resident 41 was at risk for developing pressure ulcers and currently had 1, stage 2 ( partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater). Observation on 5-07-2014 at 7:54 AM revealed Resident 41 was in the dinning room for breakfast. Resident 41 breakfast consisted of milk, juice, water,coffee, hot cereal, cinnamon roll and a slice of bacon. Resident 41 was observed to eat the cinnamon roll and drink the coffee. Further observation on 5-07-2014 at 8:45 AM revealed Resident 41 had eaten the cinnamon roll and none of the rest of the breakfast. No staff were observed to cue or assist Resident 41 with breakfast. Observation on 5-07-2014 at 12:24 PM revealed resident 41 was in the dinning room for lunch. Resident 41 had been served Salisbury steak, mashed potato's, and vegetables, milk, water, coffee. Resident 41 was not feeding (gender). Observation on 5-07-2014 at 12:27 PM revealed Resident 41 w… | 2017-05-01 |
| 8511 | 8511 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 314 | G | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2b Based on observation, record review and interview; the facility staff failed to evaluate casual factors, monitor and re-evaluate interventions to promote healing and prevent further pressure ulcer development for 2 (Resident 41 and 44). The facility staff identified a census of 79. Findings are: A. Record review of an Admission and Discharge Summary sheet dated 2-21-2014 revealed Resident 41 was admitted to the facility with the [DIAGNOSES REDACTED]. Record review of Resident 41's Minimum Data Set (MDS: a federally mandated comprehensive assessment tool used for care planning) dated as completed on 3-06-2014 revealed the facility staff assessed the following about the resident: -Resident 41 had short and long term memory problems. -Usually understands and was understood. -Required extensive assistance with bed mobility, transfers, dressing, eating, and personal hygiene. -Required extensive assistance with toilet use. -Occasionally was incontinent of bowel and had an indwelling catheter (tube placed into bladder to drain urine). -Resident 41 was at risk for developing pressure ulcers and currently had 1, stage 2 ( partial thickness skin loss involving epidermis, dermis,or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater). Record review of a Braden Scale sheet (tool used to predict pressure ulcer risk) dated 2-21-2014 revealed Resident 41 had scored a 12. According to the information on the Braden Scale sheet, a score of 12 or less Represents high Risk. Record review of Resident 41's Comprehensive Care Plan (CCP) dated 3-13-2014 revealed Resident 41 was identified as having a skin impairment to the groin folds. The goal identified on Resident 41's CCP was Resident 41 would maintain or develop clean and intact skin. Interventions identified on the CCP included assess, monitor and record skin issue per facility policy. Identify and document potential c… | 2017-05-01 |
| 8512 | 8512 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 323 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7 Based on record review, observations and interviews, the facility failed to re-evaluate elopement risk for Resident 36 and failed to implement assessed interventions for Resident 92. The facility census was 79. Findings are: A Review of Resident 36 ' s face sheet revealed and admitted d of 8-15-13 to the facility with a [DIAGNOSES REDACTED]. On 5-5-14 at 3:30pm Resident 36 was observed walking around the facility locked unit independently with a walker. Record review of Nurses Notes (N.N.) dated 9-27-13 stated Resident 36 said she was going to business office and going home, went through unit doors with nurse aide beside her, Resident 36 then went to the office and no one was there, so Resident 36 went out the front door of the facility, and went walking to her house, stated (gender) was angry. Resident 36 was brought back to facility by Social worker and Resident 36 was found to have had her clothes packed and at nurses desk, still trying to leave. Resident 36 was finally convinced by the Social worker to stay at the facility until Monday. Review of N.N. dated 10-1-13 revealed that at 7;04pm Resident 36 was observed going outside twice unattended that shift and was very angry about being in the facility. 11-7-13 note to MD signed by MD stated wander guard removed-res advises staff she wasn ' t going out in the cold she said she would stay till spring, and that ' s what I ' m going to do may we discontinue wander guard at this time MD said yes. Record review revealed no initial elopement evaluation done and none was found on 11-7-13. Elopement risk assessment dated [DATE] stated Resident 36 is cognitively impaired, uses a walker, had one incident of elopement on 9-26-13. Record Review of nurses notes dated 4-24-14 stated at 130pm Res. 36 was observed wandering down the street near super foods, two staff observed Resident 36 and Resident 36 told them (gender) was going to the bank. Res. 36 was ver… | 2017-05-01 |
| 8513 | 8513 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 329 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D Based on record review and interview; the facility staff failed to implement and evaluate the effectiveness of non-pharmacological interventions prior to increasing an anti-psychotic medication for 1 resident (Resident 6). The facility staff identified a census of 79. Findings are: Record review of a Admission Record sheet dated 2-03-2014 revealed Resident 6 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Record review of a Confirmation of a Visit to the Physician sheet dated 3-16-2014 revealed Resident 6 had been on [MEDICATION NAME] ( an anti-psychotic medication) 12.5 mg (milligrams) twice a day. Resident 6's physician ordered a decrease in the [MEDICATION NAME] to 12.5 to be given at bed time, as staff had reported that Resident 6 did not have any behaviors and was at (gender) base line. Record review of Resident 6's Behavior Monthly Flow Sheet for May 2014 revealed Resident had 4 behaviors documented on the flow sheet. According to the documentation, Resident 6's behavior was the same or had improved. Record review of a Physicians Telephone Orders sheet dated 5-04-2014 revealed the practitioner ordered a Urine Analysis (UA) and to increase the [MEDICATION NAME] to 12.5 mg's, twice a day. Review of Resident 6's medical record revealed no documentation of implementation of non-pharmacological intervention and an evaluation of effectiveness. Further review revealed the results of the UA had not been obtained prior to the increase of the anti-psychotic medication. On 5-08-2014 at 10:21 AM an interview was conducted with the Director of Nursing (DON). During the interview, Resident 6's Behavior Flow sheet for May 2014 was reviewed with the DON. When asked if non-pharmacological had been attempted prior to the increase in [MEDICATION NAME], the DON stated no. The DON further confirmed during the interview that Resident 6's interventions to managed the behaviors had not been co… | 2017-05-01 |
| 8514 | 8514 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 332 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 33 medications revealed 2 errors resulting in a medication error rate of 6.06%. The medication errors affected 2 residents (Resident 8 and 32). The facility staff identified a census of 79. Findings are: A. Record review of a Physician order [REDACTED]. Observations on 5-07-2014 at 8:30 AM of the medication administration for Resident 8 by Licensed Practical Nurse (LPN) H revealed LPN H prepared the morning medications for administration including the [MEDICATION NAME] Diskus inhaler. The label on the [MEDICATION NAME] Diskus inhaler instructed that the mouth be rinsed after using the inhaler. LPN H handed Resident 8 the inhaler and Resident 8 inhaled the medication. LPN H did not instruct Resident 8 to rinse the mouth after using the inhaler. An interview with LPN H was conducted on 5-07-2014 at 8:40 AM. During the interview, LPN H confirmed Resident 8 did not rinse (gender) mouth after using the inhaler. B. Record review of a Physician order [REDACTED]. Observation of the administration of Resident 32's morning medications revealed LPN C prepared and administered the medications, including the [MEDICATION NAME] medication to Resident 32. An interview on 5-07-2014 at 8:07 AM was conducted with LPN C. When asked if Resident 32 had a rash, LPN C stated I'm not sure. On 5-07-2014 at 10:20 AM a follow up interview was conducted with LPN C. LPN C reported that Resident 32 did not have a rash and the medication should not have been given. | 2017-05-01 |
| 8515 | 8515 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 356 | C | 1 | 1 | 05IK11 | Based on observation and interview; the facility staff failed to post nurse staffing information in the facility. The facility census was 79. Findings are: Interview on 5/7/14 at 12:15 PM with the Assistant Administrator (AA) revealed that the facility staff used the information found at 42 Code of Federal Regulations (CFR) 483.30 related to Nursing services as their policy and procedure that should be followed. Record review of a regulation review that covered nursing services printed off of the Internet website HTTP://www.law.cornell.edu/CFR/text/42/483.30 revealed the following regulations related to nurse staffing information: (1) Data Requirements: The facility must post the following on a daily basis: Facility name. The current date. The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift. - Registered nurses - Licensed practical nurses or licensed vocational nurses - Certified Nurse Aides Resident census. (2) Posting requirements: (1) The facility must post the nurse staffing data specified in paragraph 1 of this section on a daily basis at the beginning of each shift. (2) Data must be posted as follows: (a) Clear and readable format. (b) In a prominent place readily accessible to residents and visitors. (3) Public access to nurse staff data. The facility must ,upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard. (4) Facility data retention requirements: The facility must maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by state law, whichever is greater. Observation on 5/5/14 at 11:00 AM during the initial tour of the facility revealed no posted nurse staffing information present in the facility. Observation on 5/6/14 at 3:30 PM and 5/7/14 at 12:00 PM during the annual survey revealed no posted nurse staffing information present in the facility. Interview on 5/5/14 at 11:30 AM … | 2017-05-01 |
| 8516 | 8516 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 371 | F | 1 | 1 | 05IK11 | Licensure Reference Number 175 NAC 12-006.11E Nebraska Food Code 4-601.11C Based on observations, record reviews and interviews; the facility staff failed to maintain 2 large fans in the kitchen dish room and the food preparation area in clean condition in the facility kitchen. This had the potential to affect all resident's except 2 that ate food prepared in the facility kitchen. The facility census was 79. Findings were: Observation on 5/5/14 between 10:40 AM and 10:55 AM during the initial tour of the facility kitchen and again on 5/6/14 between 8:01 AM and 8:40 AM in the facility kitchen revealed a large dust coated fan in dishroom. The large fan blew directly on the clean side of the dish rack. Observation revealed a floor fan that was coated with dust. The floor fan blew directly toward the stove and ovens during food preparation services. Record review of cleaning schedules dated 2/10/14 for the past 3 months revealed that the fan in the dishroom had not been identified on the cleaning list as having been cleaned. The fan on the cooks side (stove and oven side of the kitchen) was identified but there was no documentation to identify the last time it had been cleaned. Observation on 5/6/14 between 10:00 AM and 10:10 AM with the facility Food Service Supervisor (FSS) confirmed that the large fans in the dish area and the food prep area were dust covered and blew over clean areas, clean dishes and food prep area's. Interview on 5/6/14 at 10:10 AM with the FSS confirmed that the fans were dust covered and that they were not identified on the master cleaning schedule as having been cleaned in the past 3 months. The FSS stated that maintenance cleaned the 2 large fans in the kitchen and they maintained a log of when they were last cleaned. Record review of a Maintenance Cleaning Log dated 2/10/14 revealed that the fans were last cleaned on 3/17/14 by maintenance. Interview on 5/6/14 at 10:45 AM with the FSS confirmed that the last time the fans were cleaned was on 3/17/14 and that they needed more frequent clean… | 2017-05-01 |
| 8517 | 8517 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 412 | D | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.14(3) Based on record review and interview; the facility failed to follow up with the dentist on mouth sores for 1 (Resident 48). The facility staff identified a census of 79. Findings are: Record review of an Admission Record sheet dated 1-20-2014 revealed Resident 48 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. On 5-05-2014 at 1:44 PM an interview was conducted with Resident 48. During the interview, Resident 48 reported that (gender) had Canker Sores in (gender) mouth. Record review of Resident 48's Physician order [REDACTED]. On 5-07-2014 at 11:54 AM an interview was conducted with Registered Nurse (RN) D. During the interview RN D reported Resident 48 had 2 canker sores in the mouth. On 5-08-2014 at 11:21 AM an interview was conducted with the Social Services Director (SSD). During the interview; review of Resident 48's record was conducted with the SSD related to a follow up dentist appointment. The SSD confirmed during the interview that a follow up dentist appoint had not been made for Resident 48. | 2017-05-01 |
| 8518 | 8518 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 431 | F | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC ,[DATE].12E4 Based on observation and interview; the facility staff failed to ensure expired laboratory vials were not available for use. This had the potential to effect all resident in the facility. The facility staff identified a census of 79. Findings are: A. Observation on [DATE] at 8:09 AM of the the secured unit medication room with Registered Nurse (RN) D revealed 163 vials used for laboratory testing had expired on ,[DATE]. RN D confirmed the vials had expired and were available for staff use. B. Observation on [DATE] at 9:06 AM with RN F revealed 10 vials used for laboratory testing had expired on ,[DATE] and 45 had expired on ,[DATE]. RN F confirmed the vials were out dated and available for staff use. | 2017-05-01 |
| 8519 | 8519 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2014-05-08 | 520 | G | 1 | 1 | 05IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.07C Based on record review and interviews, the facility failed to have an effective Quality Assurance program as identified by repeated citations (F314, F323, F329, and F371) and additional citations (F164, F241, F312, F332, F356, F412, F43). The facility census was 79. Findings are: Review of the findings for the last annual survey conducted on 1-31-13 revealed deficiencies at: F314 (treatment of [REDACTED]. The annual survey conducted on 5-8-14 also cited deficiencies in these areas. Interview with Nurse Aide E on 5-8-14 at 12 pm revealed being unaware when the QA committee met and what they were working on. Interview with the social worker on 5-8-14 at 11am revealed that the Quality Assurance (QA) committee meets monthly and things were brought forth to be QA'd by the old administrator so not sure how things were really chosen to make a QA plan. Interview with the Assistant Administrator, on 5-8-14 at 11:45am revealed they could not find any QA meeting notes or minutes and (gender) did not know how things were chosen to be action planned because the old administrator did that. Review of facility policy dated March 2013 stated: The QAA committee meets quarterly to identify issues with respect to which quality assessment and assurances activities are Separate identified sub-committees will turn in an updated action plan for review by the QAA committee quarterly. Reporting: 1. Residents, family and staff may report to any member of the QAA committee of a concern or idea for quality review, a concern may also be submitted to a supervisor who will forward the issue for review of the committee. 2. Monthly res council meeting minutes will be reviewed by the committee for any quality deficiencies reported at the meeting. 3. General observation of staff that shows evidence to determine practices and processes reflect negative outcomes will be submitted for review by the QAA committee. 4. If the QAA team ide… | 2017-05-01 |
| 4236 | 4236 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 174 | D | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.05 (15) Based on record reviews and interviews, the facility failed to ensure that staff followed up with reports of missing clothing for one current sampled resident (Resident 15). The facility census was 27 with 10 current sampled residents. Findings are: Review of the Resident Face Sheet, not dated, revealed that Resident 15 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Interview with the resident on 9/5/17 at 2:30 PM revealed that had two pairs of pajamas were missing. Further interview revealed that the resident had reported the missing items to staff members but hadn't heard any more about it. Interview with the Social Services Director on 9/7/17 at 11:00 AM confirmed that, when a resident reported missing items, the staff were to complete a missing items report to ensure that follow up would be completed to find the missing items or to replace the items if indicated. | 2020-09-01 |
| 4237 | 4237 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 225 | D | 1 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number: 175 NAC 12-006.02 (8) Based on record review and interview, the facility failed to ensure that: (A) a report was made of an alleged abuse of Resident 12 by a staff member within the required time frame. Sample size was 10 current residents with one closed record. Facility census was 27. Findings are: Record Review of Gordon Memorial Health Services investigation report revealed that, on (MONTH) 25, (YEAR), Resident 12 had a swollen right knee. The charge nurse assessed it and the Director of Nursing was not available for notification. Resident 12 was taken to the emergency room where Resident 12 was assessed and X-Rays were taken. The X-Ray revealed that Resident 12 had a [MEDICAL CONDITION] femur. Resident 12 returned to the facility with a knee immobilizer. Record Review of the facility internal investigation revealed that Resident 12's knee became swollen on (MONTH) 25, (YEAR). The emergency room Provider contacted the Medical Director on 6/26/2017 and 6/28/2017. Family was notified on the morning of (MONTH) 25, (YEAR) that something was wrong with Resident 12. A call was placed to the State Program Manager on (MONTH) 26, (YEAR). The call was returned on (MONTH) 27, (YEAR). A call was then placed to Adult Protective Services on (MONTH) 27, (YEAR). Record Review of Gordon Countryside Care Policy of Suspected Resident Abuse or Neglect revealed that the facility staff report suspected abuse to the charge nurse immediately and the Director of Nursing, Administrator or designee must be notified within 24 hours of the incident or sooner if feasible. On 09/07/2017 2:00:37 PM, interview with the Director of Nursing and Assistant Director of Nursing confirmed that the incident happened on (MONTH) 25, (YEAR) and the Director or Nursing was notified on (MONTH) 26, (YEAR). The Director of Nursing called State Program Manager on (MONTH) 26, (YEAR) and Adult Protective Services on (MONTH) 27, (YEAR), 2 days after the incide… | 2020-09-01 |
| 4238 | 4238 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 248 | E | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D5b Based on record reviews and interviews, the facility failed to offer activities in the evening as requested for three current sampled residents (Residents 15, 5 and 22). The facility census was 27 with 10 current sampled residents. Findings are: [NAME] Interview with Resident 15 on 9/5/17 at 2:30 PM revealed that activities were not offered in the evening. Further interview revealed that the resident would attend activities in the evening if offered. B. Interview with Resident 5 on 9/5/17 at 2:00 PM revealed that activities were not offered in the evening. Further interview revealed that the resident would attend activities in the evening if offered. C. Review of the monthly activities calendars for June, July, (MONTH) and (MONTH) (YEAR) revealed no activities scheduled in the evening. Interview with the Social Services Director (Activities Director) on 9/7/17 at 10:30 AM revealed that the residents had asked for evening activities but no evening activities were scheduled. D. Record review of Resident 22's Resident Face Sheet (undated document) revealed the resident was admitted to the facility on [DATE]. Interview with Resident 22 on 9/5/17 at 3:37 p.m. revealed the resident attended activity programs at the facility. When questioned if there were enough activities as the resident would like, the resident responded no and explained the facility doesn't offer activities at the evening. Interview with NA (Nurse Aide)-B on 9/6/17 at 2:20 p.m. revealed NA-B was a [AGE] year employee at the facility and worked primarily on the evening shift. When questioned if there were group activities or activities offered to residents in the evening, NA-B stated there are some socials and outdoor activities around 2 p.m. and church on Sundays around 2 p.m., but there was not any activities after supper time. A second interview with Resident 22 on 9/6/17 at 3:35 p.m. revealed the resident enjoyed activities at t… | 2020-09-01 |
| 4239 | 4239 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 253 | E | 0 | 1 | 05LY11 | Licensure Reference Number: 175 NAC 12-006.18B Based on observations and interviews, the facility failed to ensure that: 1) Resident 16's room was free from damaged walls, 2) Residents 30 and 24's ceiling in bathroom was free from holes, 3) Bathroom sinks of Residents 16, 1, 13, 23, 22, 6, 2, 20,18, 11, 28,10, 30, and 24 had drain covers. Sample size was 24. The facility census was 27. Findings are: On 9/05/2017 between 1 PM - 4 PM, observation of rooms during resident interviews revealed Residents 16, 1, 13, 23, 22, 6, 2, 20, 18, 11, 28, 10, 30, and 24 were missing drain covers in bathroom sinks. On 9/06/2017 at 8:00 am, observation of Resident 16's room revealed damage to the wall behind the television and the wall next to the entryway door. On 9/06/2017 at 9:00 am, observation of Resident's 30 and 24's bathroom ceiling reveled a hole in it. On 09/06/2017 at 2:58:38 PM, interview with the maintenance person confirmed that Residents 16, 1, 13, 23, 22, 6, 2, 20, 18, 11, 28, 10, 30, and 24 had drain covers missing in the bathroom sinks. Resident 16 had damaged walls behind the television and by entryway door. Residents 30 and 24's bathroom had a hole in the ceiling. | 2020-09-01 |
| 4240 | 4240 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 279 | D | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09C1b Based on record reviews and interview, the facility failed to develop a care plan to address [MEDICAL CONDITION] (inability to sleep) for one current sampled resident (Resident 5) on a routine medication for [MEDICAL CONDITION]. The facility census was 27 with 10 current sampled residents. Findings are: Review of the Resident Face Sheet, not dated, revealed that Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Medication Administration Record, [REDACTED]. Review of the Care Plan, dated 6/13/17, revealed no care plan to address [MEDICAL CONDITION] including non-pharmacological interventions to promote sleep. Interview with the Assistant Director of Nursing on 9/7/17 at 10:00 AM confirmed that a care plan should have been developed to address the resident's [MEDICAL CONDITION]. | 2020-09-01 |
| 4241 | 4241 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 280 | D | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09C1c Based on record reviews and interviews, the facility failed to 1) update the care plan related to changes in assistance needed with activities of daily living for one current sampled resident (Resident 15) and 2) ensure that nursing assistants were included on the interdisciplinary care plan team for two current sampled residents (Residents 15 and 5). The facility census was 27 with 10 current sampled residents. Findings are: [NAME] Review of Resident 15's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 7/11/17, revealed that the resident required extensive assistance with dressing. Review of the MDS, dated [DATE], revealed that the resident required limited assistance with dressing. Review of the Care Plan, dated 7/18/17, revealed that the resident required assistance with dressing. Interview with the ADON (Assistant Director of Nursing), MDS Coordinator, on 9/7/17 at 10:00 AM, confirmed that the care plan should have been updated to state that the resident required extensive assistance with dressing. B. Review of Resident 15's Care Plan Conference sign in sheet, dated 7/17/17, revealed no nursing assistant present. Review of Resident 5's Care Plan Conference sign in sheet, dated 6/13/17, revealed no nursing assistant present. Interview with the ADON on 9/7/17 at 10:00 AM confirmed that nursing assistants did not attend or sign the attendance forms for the interdisciplinary care plan conferences for these residents. | 2020-09-01 |
| 4242 | 4242 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 312 | D | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D1c Based on record reviews and interview, the facility failed to complete an assessment to identify potential causal factors related to a decline in activities of daily living and develop a plan to restore or maintain function for one current sampled resident (Resident 15). The facility census was 27 with 10 current sampled residents. Findings are: Review of Resident 15's MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 7/11/17, revealed that the resident went from requiring limited assistance from the previous MDS, dated [DATE], to extensive assistance with activities of daily living including bed mobility, transfers, dressing and toilet use. Review of the Annual/Quarterly Summary Reviews, dated 7/18/17, revealed no documentation related to the decline in activities of daily living including the potential causal factors and a plan to restore or maintain activities of daily living abilities. Interview with the Assistant Director of Nursing, MDS Coordinator, on 7/9/17 at 10:00 AM confirmed that an assessment, including the causal factors related to the decline in activities of daily living and a plan to restore or maintain function was not included in the nursing summary. | 2020-09-01 |
| 4243 | 4243 | GORDON COUNTRYSIDE CARE | 2.8e+258 | 500 EAST 10TH STREET | GORDON | NE | 69343 | 2017-09-07 | 329 | D | 0 | 1 | 05LY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number: 175 NAC 12-006.09D Based on record reviews and interview, the facility failed to monitor symptoms of depression and [MEDICAL CONDITION] (inability to sleep) for one current sampled resident (Resident 5) on routine antidepressant medication and a medication for [MEDICAL CONDITION] to ensure the therapeutic benefits of the medications and the continued need for the medications. The facility census was 27 with 10 current sampled residents. Findings are: Review of the Resident Face Sheet, not dated, revealed that Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Medication Administration Record, [REDACTED]. Review of the medical record, including Behavior Records and Progress Notes, revealed no documentation that the resident's sleep habits or targeted symptoms of depression were routinely monitored. Interview with the Assistant Director of Nursing (ADON) on 9/7/17 at 10:30 AM confirmed that there was no documentation in the medical record that the resident's sleep habits or symptoms of depression were routinely monitored. The ADON confirmed that the resident's sleep patterns and targeted symptoms of depression should be monitored to ensure that the resident received the therapeutic benefits of the medications and to determine the continued need for the medications. | 2020-09-01 |
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CREATE TABLE [cms_NE] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );