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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1542 | 1542 | AZRIA HEALTH WAVERLY | 285143 | 11041 NORTH 137TH ST | WAVERLY | NE | 68462 | 2018-07-18 | 801 | F | 0 | 1 | 4N4Y11 | licensure reference number 175 NAC 12-006.04D2a Based on interview and record review, the facility failed to have a full time Dietary Manager/Food Service Director. This had the potential to affect 43 of 45 residents. The facility census was 45. Findings are; On 7/ 11/18 at 2:00 PM an interview with the Administrator (ADM1) revealed the facility currently does not have a full time Food and Beverage Director due to the previous Food and Beverage Director left the end of (MONTH) beginning of July. The facility contracted a Food and Beverage Director for 8 hours a week and on call as needed. On 7/12/18 at 1:00 PM an interview with the Administrator (ADM2) revealed that there had been no full time Food and Beverage Director since the end of may beginning of (MONTH) when the Food and Beverage Director was terminated. The ADM2 then revealed that the facility had placed Cook J as temporarily in charge of the dietary dept and that person had a Bachelor of Science (BS) in nutrition. The facility also had a consultant Dietitian and contract Food Service Manager (FSM) both part time. On 07/17/18 at 02:19 PM an Interview with Contract Dietitian revealed that the facility contracts with the company for a Registered Dietitian and a Certified Dietary Manager, they both are contracted for 8 hours each a week, but frequently work more. They are also contracted to be on call 24/7. On 7/17/18 at 12:15 PM an interview with Cook J revealed no knowledge of being the temporary Food and Beverage Director. Record review of document dated 7/12/18 provided by the ADM2 revealed, the Food and Beverage Director was terminated 5/29/18 and Cook J that has a degree in nutrition was appointed to be in charge of the dietary dept, with assistance from Consultant Dietitian and contract FSM. The contract FSM started 6/5/18 and is contracted for 8 hours per week, the Consultant Dietitian is contracted for 8 hours a week, both are on call 24/7. the new FSM begins 8/1/18. Record review of education transcripts for Cook J revealed course work at Perdue C… | 2020-09-01 |
| 6484 | 6484 | CHIMNEY ROCK VILLA | 285260 | P O BOX A, 106 EAST 13TH STREET | BAYARD | NE | 69334 | 2016-01-07 | 371 | F | 0 | 1 | 2QXH11 | licensure Reference Number 175 NAC 12-006.11E Based on observation and staff interview the facility failed to 1) assure cleanliness of one cupboard holding dishes, one cupboard storing spices, the dish warmers, the floor of the walk in freezer and the bottom shelf of the small freezer and 2) ensure dishwasher sanitizer was working in a low temperature ware washing machine. This had the potential to affect 42 residents. The facility census was 42. Findings are: A) Observations of the kitchen on 1/5/2016 at 10:15 AM, 1/7/2015 at 11:00 AM and 1/7/2016 at 2:00 PM revealed one cupboard storing dishes contained food crumbs and particles; one cupboard storing spices had a residue of spice dust; the dish warmer machine had food particles and other debris on the bottom of the machine; the floor of the walk in freezer contained food particles and other debris and the bottom shelf of the small freezer in the kitchen was littered with food particles and other debris. Interview with the Acting Dietary Manager revealed there was a cleaning schedule that did include cleaning/wiping out of the kitchen cupboards, freezers, and sweeping and checking the sanitizer. Review of the 3/8/2012 on the Food Code, based on the United Stated Food and Drug Administration Food Code and used an an authoritative reference for food service sanitation practices, revealed the following: Regarding 3-304.12(E) In-Use Utensils, Between-Storage were to be stored in a clean, protected location B) Observation on 1/7/2016 at 10:15 PM revealed that the sanitizer used for the warewashing machine to sanitize the dishes, was not being distributed to the warewashing machine. Interview with the Dietary Aide and Acting Dietary Manager on 1/7/2016 at 10:15 AM revealed the dietary aid was knowledgeable in checking the machine sanitizer. The Dietary Manager checked the sanitizer concentration of the warewashing machine utilizing a sanitizer check kit. The Dietary Aid held a test strip in the water compartment and the strip was observed to remain uncolored. The test… | 2019-02-01 |
| 10516 | 10516 | OAKLAND HEIGHTS | 285281 | 207 SOUTH ENGDAHL AVENUE | OAKLAND | NE | 68045 | 2013-01-23 | 225 | D | 1 | 0 | H5FW11 | br>Licensure reference: 175 NAC 12-006.02 Based on record review and interview, the facility failed to report a serious injury to Adult Protective Services for 1 (Resident 1) of 4 sampled residents. The facility had a total census of 44. Findings are: Interdisciplinary Progress Notes for Resident 1 dated 9/13/12 at 5:30 PM stated Resident 1 was observed sitting on the floor next to Resident 1 ' s bed. Resident 1 ' s left knee was bruised and swollen, right knee was cut open, black, blue and bleeding, and there was a cut to right cheek bone. Resident 1 complained of a headache according to Interdisciplinary Progress Note. Resident 1 was transferred to the hospital at 6:15 PM on 9/13/12 according to Interdisciplinary Progress Note. Interdisciplinary Progress Note dated 9/13/12 at 8:30 PM stated Resident 1 was admitted to the hospital unconscious with intracranial pressure. Interdisciplinary Note dated 9/14/12 stated Resident 1 had passed away. In an interview on 1/23/12 at 11:10 AM, the Director of Nursing confirmed incident had not been reported to Adult Protective Services as a possible neglect as Resident had been transferred to the hospital with only a cut on right knee. A review of facility policy titled LTC Facility Abuse/Neglect and Misappropriation Reporting Requirements revised on 2/2009 stated the following: Any allegation of abuse/neglect/misappropriation that results in a resident being physically injured; unreasonably confined; sexually abused; exploited; or resulting in a lack of food, clothing shelter or supervision to resident or residents in the facility. | 2016-01-01 |
| 10588 | 10588 | GOLDEN LIVINGCENTER - SORENSEN | 285107 | 4809 REDMAN AVENUE | OMAHA | NE | 68104 | 2012-12-13 | 463 | E | 1 | 0 | 7O4V11 | br>Licensure Reference: 175 NAC 12-007.04G Based on observation, interview, and record review; the facility failed to ensure the East Shower was equipped with a call system. This practice had the potential to affect 14 residents of the facility that reside on the East Wing. The facility had a total census of 54 residents. Findings are: Observations on 12/10/12 at 3:10 PM revealed the East Shower Room was not equipped with a call light. In an interview at that time, Registered Nurse Consultant A confirmed the East Shower Room did not have a call light. In interviews on 12/10/12 at 3:48 PM and 4 PM, the Acting Director of Nursing reported no resident utilized the East Side Shower Room independently but shower room was used by residents living on the East Side of the building with the assistance of staff. A review of facility documentation revealed a bid had been obtained and accepted for installation of a call system in the East Shower Room on 12/12/12. | 2015-12-01 |
| 10576 | 10576 | INDIAN HILLS HEALTHCARE COMMUNITY | 285091 | 1720 NORTH SPRUCE | OGALLALA | NE | 69153 | 2012-12-11 | 441 | F | 1 | 0 | 1LNO11 | br>Licensure Reference Number: 175 NAC 12-006.17A Based on record review and interview, the facility failed to maintain infection surveillance regarding facility acquired infections to determine if further interventions, additional education, or changes in the infection control program were warranted to prevent the spread of infections. This failure could potentially affect all residents in the facility at risk for developing infectious disease. Facility Census was 44. Findings are: Record review of the faciliy Infection Control Program revealed a surveillance notebook was kept to log facility infections. Further examination of the notebook revealed a tracking form identifying types of infections, locations in the building, and overall infection calculation rates was completed monthly until July of 2012. Between July of 2012 and December of 2012 the only surveillance information in the notebook were resident specific information on symptoms and antibiotics. The forms for this resident specific information were not completed for follow up documentation or surveillance between July of 2012 and December of 2012. Interview with the Administrator and Corporate Nurse Consultant on 12/11/12 at 2:45 p.m. confirmed that the faciliy was not compiling infection control surveillance statistics between July of 2012 and December of 2012. The Administrator agreed that surveillance information was necessary for the Infection Control Program in order to determine if there are certain types of infections peaking, specific areas of the building with more infections, or additional information to determine if interventions, education, or changes in the Infection Control Program needed to be made. The Administrator stated since June of 2012 the facility nursing administration had changed frequently and the infection control program was not being consistently completed. | 2015-12-01 |
| 10304 | 10304 | GOLDEN LIVINGCENTER - SCOTTSBLUFF | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-07-22 | 455 | D | 1 | 0 | VZUL11 | br>Licensure Reference Number 175 NAC 12-007.04E Based on observations and interview the facility failed to ensure that 4 sampled residents ( Room 211-Resident 7, 4 and Room 212- Resident 6 and 5) had electrical power in the residents' rooms to meet the residents' needs. Facility census was 121. Findings are: Observations on: - 7/21/15 at 9:00 AM revealed that the hallway overhead lights by resident Rooms 211 and 212 were on, then flickered off for 5 seconds then came back on. - 7/21/15 at 10:10 AM revealed that the hallway overhead lights by resident Rooms 211 and 212 were on, then flickered off for 5 seconds then came back on. - 7/21/15 at 11:30 AM revealed that the hallway overhead lights by resident Rooms 211 and 212 were on, then flickered off for 5 seconds then came back on. Interview on 7/21/15 at 9:20 AM with Resident 4 revealed that the electricity went off in the resident room often. Further interview revealed that when two oxygen concentrators were plugged in and the air conditioner would come on the power would go out in the room for sometimes 10 - 30 minutes. On 7/21/15 an interview was completed at 10:00 AM with (Medication Aide) D which revealed a light issue in the 200 wing of the building to include resident rooms 211 and 212. Further interview revealed that the power would go off in Rooms 211 and 212. Continued interview revealed that the staff had to walk to the breaker on the wall and flip the breaker back on sometimes as often as 5-10 times a shift. Interview on 7/21/15 at 10:15 AM with (Registered Nurse) RN - C revealed that there was some sort of electrical issue in rooms 211 and 212. Further interview revealed that if both residents in either rooms 211 and 212 had oxygen concentrators or medical equipment plugged in the breaker on the wall in the 200 hall would shut off. Continued interview revealed that the breaker box was #6 and that the RN at times had flipped the breaker back on 12 times during the shift. Further interview revealed that the RN took the concerns to maintenance and was i… | 2016-01-01 |
| 10122 | 10122 | HILLCREST NURSING HOME | 285080 | P O BOX 1087, 309 WEST 7TH STREET | MCCOOK | NE | 69001 | 2013-02-06 | 309 | D | 1 | 0 | V7IZ11 | br>Licensure Reference Number 175 NAC 12-006.09D Based on record reviews and staff interview, the facility failed to assess the neurological status of resident after falls with potential head injuries to identify potential complications for two sampled residents (Resident 1 and Resident 2). The facility census was 85 and the sample was six residents. Findings are: A. Review of the Skilled Documentation for Resident 1, dated 1/11/13 at 4:25 AM, revealed that the resident was found lying on the floor next to the bed. The resident stated that hit head on the floor. Further review revealed that the head injury flow sheet was initiated. The next entry was at 7:30 AM which stated that the resident was transferred to the emergency room via ambulance due to unresponsiveness, resident was lethargic but alert and responsive at the previous assessment at 6:15 AM. Resident now difficult to arouse, right side of mouth drooping, resident unable to grasp this nurse's fingers, unable to communicate verbally, does not follow commands. Review of the Head Injury Flowsheet, dated 1/11/13, revealed a neurological assessment, including vital signs, documented at 4:25 AM. Further review revealed the next assessment was completed at 6:25 AM and did not include the resident's vital signs. B. Review of the facility Head Injury Flowsheet for Resident 2, dated 1/15/13, 1/21/13, 1/22/13 revealed that neurological exams and vital signs were scheduled to be completed at the time of the fall, and subsequently at two hours, four hours, six hours, eight hours, sixteen hours and then twenty four hours. Further review revealed no vital signs documented on 1/15/13 at 12:45 PM (2 hours), no assessment on 1/21/13 at 3:45 PM (24 hour check), and no vital signs documented on 1/22/13 at 6:15 PM ( 2 hour check) and 8:15 PM (4 hour check). Interview on 2/6/13 at 3:30 PM with the Director of Nursing confirmed that the neurological exams should be done more frequently to identify potential complications from the falls and should include the residents' vital … | 2016-02-01 |
| 10301 | 10301 | GOLDEN LIVINGCENTER - SCOTTSBLUFF | 285095 | 111 WEST 36TH STREET | SCOTTSBLUFF | NE | 69361 | 2015-07-22 | 241 | D | 1 | 0 | VZUL11 | br>Licensure Reference Number 175 NAC 12-006.05(21) Based on observation and staff interviews; the facility failed to assure that the residents were treated with respect and dignity. Residents were observed unclothed and covered in a blanket while being transported to bathing room. Findings are: Observation 7/21/2015 at 10:00 AM and again at 1:30 PM two residents were being transported through the hall in wheelchairs by NA-B. The residents were unclothed; their only covering was a blanket, that provided minimal privacy. This occurred in full view of staff, other residents and visitors to the facility. Observation 7/22/2015 at 8:15 AM 1 resident was observed sitting in a wheelchair outside the residents room covered with a shirt on top and only a blanket to cover his lower body. This occurred in full view of staff, other residents and visitors to the facility. Interview with Director of Nursing 7/22/2015 at 9:30 AM confirmed that the residents are being transported to bathing with only a blanket to protect their privacy. The DON revealed it is difficult to undress the resident in the bathing room and it was determined to undress the resident while lying down in residents room and cover resident with a blanket. The DON confirmed there was no explanation for the second resident observed with only a blanket covering them on the way to be bathed. Further interview with the DON revealed that the resident sitting outside the resident's room was expressing behaviors and chose not to get dressed. The DON confirmed the resident is dependent on facility nursing staff for ADLs including dressing. Interview with Social Service Assistant (SSA) 7/21/2015 at 10:30 AM revealed that residents are often transported through the facility halls on the way to be bathed with only a blanket to cover them. | 2016-01-01 |
| 10447 | 10447 | PREMIER ESTATES OF KENESAW, LLC | 285166 | P O BOX 10, 100 WEST ELM AVENUE | KENESAW | NE | 68956 | 2013-01-10 | 371 | E | 1 | 0 | LE5L11 | br>LICENSURE REFERENCE NUMBER: 175 NAC 12-006.11E Based on observations, document reviews, and staff interview; the facility failed to store food in a method to prevent contamination and failed to ensure the cleanliness of the refrigerators. These failures increased the risk that bacterial growth and food borne illness could occur which could pose a food safety risk to the residents. The facility census was 45 and the survey sample size was 36. Findings are: A. Observations during the initial tour of the kitchen on 1/3/13 at 9:50 AM revealed 7 boxes sitting on the floor in the storage room and 5 boxes sitting on the floor in the freezer. The Dietary Manager (DM) stated the boxes came in last evening as I was fixing supper. B. Observation on 1/10/13 at 11:45 AM, revealed 4 boxes of frozen food sitting on the floor of the freezer. The DM explained the facility had just received an order and the boxes would be put away. Observations also revealed the beverage refrigerator had dried, white crumbs and 3 red dried spots on the bottom surface; and the walk-in refrigerator had small pieces of paper and butter cups under the shelves on the floor. C. Observations on 1/14/13 at 6:25 AM, revealed: - 3 boxes of frozen meat, including chicken and Salisbury steak sitting on the floor of the freezer. - The beverage refrigerator had dried, white crumbs and a white dried spot approximately 2 inches in diameter on the bottom surface. - The walk-in refrigerator had 2 butter cups and small pieces of paper under the shelves on the floor. - In the storage room, a box was upside down on the floor, with packages of instant banana pudding mix sitting directly on the floor. D. During interview on 1/14/13 at 8:22 AM, the DM stated I know there are still boxes on the floor in the freezer. The DM explained some of the boxes had been put away on Saturday (1/12/13) and was going to finish on Sunday (1/13/13), but was unable to work. The DM revealed that sometimes other dietary staff helped put food away, but added you know, it's just easier to … | 2016-01-01 |
| 10476 | 10476 | SKYLINE NURSING AND REHABILITATION | 285238 | 7350 GRACELAND DRIVE | OMAHA | NE | 68134 | 2013-01-03 | 309 | D | 1 | 0 | HOGL11 | br>LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09D2 Based on record review and interview; the facility staff failed to evaluate the causal factor of the development of new bruising for 1 (Resident 1) of 5 sampled residents. The facility census was 86. Findings are; Record review of a admission orders [REDACTED]. Record review of Resident 1's MDS (Minimum Data Set: a federally mandated comprehensive assessment tool used for care planning) dated and signed as completed on 8-31-2012 revealed the facility staff assessed the following about the resident; -Resident 1 scored a 10 on the BIMS ( Brief Interview for mental Status. A score of 10 indicated moderately impaired cognition. -Required supervision with eating. -Required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene. -Frequently incontinent of bowel and bladder. -Was at risk for the development of pressure ulcers. -No current skin issue were identified on the MDS. Record review of Resident 1's Comprehensive Care Plan (CCP) dated 8-29-2012 revealed Resident 1 was at risk for impaired skin. Review of the approaches identified on the CCP included staff were to assess for risk factors predisposing to pressure ulcer and other skin impairment and to Monitor skin condition daily. Record review of a Weekly Skin Integrity Data Collection sheet dated 11-03-2012 revealed revealed Resident 1 was identified as having a bruise to the left side of foot and that Resident 1's feet are purple. Record review of Resident 1's Nurse's Notes, dated 11-03-2012, revealed Resident 1 had 'bruising noted to inner left foot upon skin assessment. Further review of Resident 1's Nurse's Notes revealed there was not any evaluation of Resident 1's left foot until 11-06-2012. Resident 1's Nurse's Notes dated 11-06-2012 revealed the evaluating nurse received report . from the previous nurse that res. (resident) had bruise to L (left) great toe. Upon assessment res. no apparent bruise. All five toes to L foot were dark purple and discoloration extending to… | 2016-01-01 |
| 10181 | 10181 | AVERA CREIGHTON CARE CENTRE | 285284 | P O BOX 289, 1603 MAIN STREET | CREIGHTON | NE | 68729 | 2013-02-05 | 312 | D | 1 | 0 | 650211 | br>LICENSURE REFERENCE NUMBER: 175 NAC 12-006.09D1c Based on observation, record review and staff interview; the facility failed to provide feeding assistance for Resident 3 who was identified to require limited to extensive assistance with eating. During observation of the breakfast meal, Resident 3 was not assisted to complete the meal until almost 1 hour following service of the meal. Sample size was 3 current residents and 1 closed resident. Facility census was 45. Findings are: A. Review of Resident 3's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 11/7/12 indicated the resident had severe cognitive impairment and required limited assistance with eating. Review of Resident 3's current Comprehensive Care Plan with a target date of 2/21/13 indicated the resident continued to have poor dietary intakes and required extensive assistance/cueing with eating. The following was observed during service of the breakfast meal on 2/5/13: - At 7:55 AM, Resident 3 was seated at the dining room table with breakfast meal. The meal consisted of a bowl of cold cereal with milk, 1 strip of bacon, 1 pancake with syrup, half a banana, 4 ounces of milk, 4 ounces of orange juice, 4 ounces of juice supplement, and 6 ounces of water. Resident 3 sat without eating. - Resident 3 continued to sit at the dining room table without eating until 8:13 AM when Licensed Practical Nurse (LPN)-C told the resident to eat cereal, and then walked away. Resident 3 continued to sit without eating. - At 8:15 AM, Restorative Aide (RA)-G approached Resident 3 ' s table and visited with the resident and tablemates; however, RA-G left the table without assisting/cueing Resident 3 to eat. Resident 3 continued to sit without eating. - At 8:19 AM, Resident 3 handled the spoon in bowl of cereal but continued to sit without eating. - At 8:25 AM, LPN-C picked up Resident 3 ' s fork, fed the resident 2 bites of pancake, then laid the fork down and walked away saying OK now you try . Resident 3 continued to… | 2016-02-01 |
| 10452 | 10452 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2013-01-24 | 371 | F | 1 | 0 | MFRD11 | br>LICENSURE REFERENCE NUMBER 175 NAC 12-006.17E Based on observation, and interview; the facility staff failed to maintain infection control techniques to prevent cross contamination during ice passes for residents. The facility staff identified a census of 56. This practice has the potential to affect all residents within the facility. Findings are: Interview with NA (Nurse Assistant) D revealed, that NA-D retrieve a cart with a cooler on it from the dining room each time NA-D passed ice. NA-D then took the cart to the ice machine, selected a scoop from the bin next to the ice machine and filled the cooler with ice. NA-D then put the scoop in the ice and proceeded to the residents rooms. NA-D then entered the resident's room and retrieved their ice cup/container. NA-D returned to the cart in the hall, removed the lid, and placed it on the cart. NA-D then retrieved the scoop from the ice and filled the cup/container. NA-D then replaced the scoop in the ice and the lid back on the cup/container. NA-D returned the cup/container to the residents room. On 1/23/13 at 1550, interview with Infection Control Nurse (ICN) revealed that the ICN has no direct knowledge on how ice passes were completed. Record review of water pitcher policy revealed that once a day on designated shift new clean ice cups/containers with ice and water are delivered to each resident. On other shifts, the policy stated, fill pitchers with water and replace ice, if desired by resident. | 2016-01-01 |
| 10453 | 10453 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2013-01-24 | 441 | D | 1 | 0 | MFRD11 | br>LICENSURE REFERENCE NUMBER 175 NAC 12-006.17B Based on interviews and record reviews, the facility failed to prevent cross contamination while distributing food to residents in isolation. Two residents (Resident 1 and 3) from a sample of four tested , with a census of 56 were reported to have confirmed Norovirus Findings are: On 1/23/13 at 1550, interview with the Infection Control Nurse (ICN) revealed, on 1/6/13, staff decided there was an outbreak of suspected norovirus and the health department would be notified. Residents with signs and symptoms of the virus would be isolated and staff was to follow isolation precautions. The ICN did not know how food was dispensed or dirty dishes were retrieved during isolation procedures. On 1/23/13 at 1645, interview with Kitchen Manager revealed that, on 1/6/13 when the outbreak was identified, department heads met and decided to place residents on isolation precaution, which included all meals for the entire facility would be served on disposable dinnerware and no dinner ware would come out of residents rooms and/or return to the kitchen. On 1/24/13 at 0915, interview with Cook G revealed that all food was served on disposable dinnerware during the outbreak. On 1/23/13 at 1100, interview with NA (Nurse Assistant) K revealed that NA-K remembered serving meals during the norovirus outbreak. NA-K reported the meals were served on a combination of disposable and non-disposable dinnerware and utensils. NA-K also remembered returning the used utensils to the kitchen. On 1/24/13 at 1105, interview with NA (Nurse Assistant) L revealed that NA-L remembered serving meals during the norovirus outbreak. NA-L reported that the meals were served on a combination of disposable and non-disposable dinnerware and utensils. NA-L remembered returning the used utensils to the kitchen. On 1/24/13 at 1050, interview with Resident 1, identified as having symptoms of norovirus, revealed that resident remembered staff bringing meals to the resident's room on a tray. The meal was served on a co… | 2016-01-01 |
| 10482 | 10482 | ST. JOSEPH'S VILLA, INC. | 285249 | 927 SEVENTH STREET | DAVID CITY | NE | 68632 | 2013-01-16 | 323 | D | 1 | 0 | V7KM11 | br>LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7B Based on observation, interview and record review; the facility failed to supervise 2 residents, Residents 1 and 2, to prevent accidents and failed to revise interventions to prevent the reoccurrence of falls for 1 resident, Resident 3. The facility census was 51 and 3 residents were taken on sample. Findings are: Review of Resident 1's investigation of fall with injury which occurred on 1/1/13 revealed the resident was being assisted with dressing by NA-A (Nursing Assistant-A) and was left standing at walker unassisted and fell and fractured hip. Review of Resident 1's current care plan stated that the resident was not to be left alone while on the toilet or commode. On 1//16/13 at 1:00 PM NAs B and C were interviewed about whether Resident 1 could be left unattended while on toilet or standing at walker. NA B and C said it was unsafe to leave this resident unattended. Licensed Practical Nurse-D was asked on 1/16/13 at 1:05 PM if this resident could be left alone, at the time of the incident on 1/1/13, while standing at walker and LPN-D indicated it was unsafe to leave the resident unattended. Review of the facility's accident log revealed that on 12/2/12 Resident 2 was found on the floor of the bathroom, having had an unwitnessed fall. Further review of the FALLS INVESTIGATION WORKSHEET revealed that under RECOMMENDATIONS/INTERVENTIONS: Emphasized to NA who left (gender) on the toilet to make sure wheel chair close by and locked and to emphasize call light. Review of Resident 2's care plan revealed that resident needed 1-2 person assist with transfers using a front wheeled walker and gait belt. Observation was made of Resident 2's transfer on 1/16/13 at 1:05 PM. NA-B was washing hands before transferring resident and Resident 2 began to self transfer and had to be asked to wait. NA-B put the wheel chair next to the bed and locked it. NA-B assisted with the transfer by holding on to Resident 2's pant waist. The walker was not used nor was a gait belt for the tra… | 2016-01-01 |
| 9876 | 9876 | GOOD SAMARITAN SOCIETY - GRAND ISLAND VILLAGE | 285285 | 4061 TIMBERLINE STREET & 4055 TIMBERLINE STREET | GRAND ISLAND | NE | 68803 | 2012-09-04 | 371 | F | 0 | 1 | GIO711 | ` LICENSURE REFERENCE NUMBER: 175 NAC 12-006.11E Based on observation in the dietary kitchen/food prep area for two individual unit kitchen areas, interviews with the dietary cooks and Dietary Manager, review of the manufactures directions for cleaning of equipment and the facility records for scheduled cleaning tasks; the facility failed to 1) maintain non-food contact surfaces of equipment from accumulation of soiled residue and spilled baked foods on the inside of the oven sides and lowest shelf, 2) clean/remove dried sticky residue and splattering of debris and dust on the two side panels and front panel of the dishwasher, 3) clean and remove sticky residue substance on exterior cupboard panels, 4) remove and clean an accumulation of food crumbs inside two toasters and a collection of smearing residue on the exterior of the toasters and 5) clean and remove accumulation of rust colored lime deposits on the drip rack/tray under the ice dispenser and lime deposits with a collection of debris in the seams on the external side panels of the ice machine. The facility failure to maintain clean and sanitized non-food contact surfaces of equipment subjected the entire census of the facility to the potential risk of cross-contamination in food born-illness. The facility census was 25. Findings are: A. TOUR/OBSERVATION with the Dietary Manager, of the Ash Grove Kitchen, on 08/28/2012 at 10:00 AM revealed; -Ice machine had deposits of rust coloring and lime covering drain tray and drip pan, external vents on both side panels revealed a layer of dust (dark debris with swipe of the finger); -Dishwashing machine revealed: both side panels are soiled with a covering of dust, right side panel against the wall has an oven rack and a small green dish scrubber stored between the side of the stove and wall. Noted dust and splattering of debris on the side panels and smearing and soiling covering the front panel of the dishwasher; -The floor surrounding the dishwashing machine has an outline of white debris (?lime/soap) that is dr… | 2016-05-01 |
| 5496 | 5496 | PARKVIEW HOME, INC. | 285243 | 930 2ND STREET | DODGE | NE | 68633 | 2016-05-25 | 323 | E | 0 | 1 | SF4R11 | This Requirement is not met as evidenced by Licensure Reference Number: 175 NAC 12-006.18E4 Based on observation, record review, and interviews; the facility failed to ensure medications were not accessible to other residents by leaving them on the table untaken. This had the potential to affect 7 residents (Residents 39, 41, 18, 43, 21)identified as cognitively impaired and self mobile. The facility census was 39. Findings are: A review of the facility policy, for Administration of Oral Medications dated 4/2015 revealed the Purpose of the policy was provide guidelines for the safe administration of oral medications. Steps in Procedure # 24 stated to remain with the resident until all medications were taken. Observation on 05/24/2016 at 8:27:50 AM, in the dining room revealed a medication cup with multiple medications sitting at Resident 2's table. Resident 2 had finished eating on 05/24/2016 at 8:29:40 AM, observation did not reveal a staff member passing medications at this time. Observation on 05/24/2016 at 8:33:16 AM revealed Resident 2 was taking the medications. Observation did not reveal a staff member passing medications at this time. Interview on 05/24/2016 at 8:36:54 AM with Licensed Practical Nurse (LPN) A, at nursing station 2 , revealed that the morning medication pass was completed at this time. LPN A confirmed that Resident 2 did receive medications during that medication pass. LPN stated that Resident 2 was not observed to assure swallowing of the medications. They had been left with Resident 2 at the table. Interview on 05/24/2016 at 8:50:13 AM with LPN B revealed that it was the facility policy to watch the resident swallow the medications. LPN B stated some are reluctant to take them if they know you are watching them, although the nurse can stand out of residents sight, and view them until they swallow the medications. Record review revealed that the medications that were placed in the cup for Resident 2 were: Risperidone (a antipsychotic medication), Nuedexta ( a medication used to treat a mo… | 2020-01-01 |
| 5498 | 5498 | PARKVIEW HOME, INC. | 285243 | 930 2ND STREET | DODGE | NE | 68633 | 2016-05-25 | 428 | D | 0 | 1 | SF4R11 | The facility pharmacy failed to report medication irregularities to the attending physician for Resident 40. This Requirement is not met as evidenced by Based on record review and interview, the facility pharmacist failed to notify the attending physician of irregularity related to blood glucose elevation and request for a change in the insulin dosages for one resident (Resident 40). The facility had a total census of 39 residents. Findings are: The facility Medication Regimen Reviews Policy dated 4/8/15 stated: 8. The consultant Pharmacist will provide a written report to the physicians for each resident with an identified irregularity. 9. The Consultant Pharmacist will provide the Director of Nursing Services and the Medical Director with a written, signed and dated copy of the report, listing the irregularities found and recommendations for their solutions. Record review of The Pharmacy Review dated 3/28/16 revealed that Resident 40's blood sugars had continued to be in the 200's, ( normal is 60-110) at the glucose checks performed before the evening meals and at bedtime. At the time of the Consulting Pharmacist's review, Resident 40 was receiving the Insulin dosages of Levemir ( a insulin that is used to treat high blood sugars and lasts for up to 24 hours) 24 units ( the measurement of the dosage of the insulin injection) in the evening which was administered before bed, by injection. Resident 40 was also receiving an Insulin injection of Novolog (a type of insulin used to treat high blood sugars,and regulates the glucose metabolism as it lowers the blood sugar, it is fast to act and for a short time) of 25 units before breakfast, 15 units before lunch; and 32 units before evening meal. The resident lab value of glycosylated hemoglobin test (HgbA1C) ( a blood test doctors used to determine how a blood sugar has been averaging over the past two to three months, the normal values are 4.6 to 6.2%) was 8.2% on 11/04/15. The pharmacist's request to the physician was to consider an increase in Resident 40's Novolo… | 2020-01-01 |
| 548 | 548 | CONTINENTAL SPRINGS, LLC | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2019-06-13 | 881 | F | 0 | 1 | 0UPJ11 | The facility failed to show a process for documentation of periodic review of antibiotic usage. This had the potential to affect all residents. This practice has the potential to effect all residents. The facility staff identified a census of 44. Findings are: A review of the facilities Antimicrobial Stewardship Program Policy (ASP) reveals the responsibilities include to ensure appropriate use of antimicrobials through development and implementation of institutional policies, procedures, treatment algorithm, monitor facility antimicrobial use, antimicrobial resistance patterns, and compliance to ASP-related processes. An interview with the Director of Nursing (DON) and the Infectious Disease nurse on 6/12/19 at 9:08 AM revealed that they currently are not tracking antibiotic use, resistance pattern and compliance to ASP-related processes. | 2020-09-01 |
| 1393 | 1393 | LIFE CARE CENTER OF ELKHORN | 285134 | 20275 HOPPER STREET | ELKHORN | NE | 68022 | 2019-06-27 | 880 | D | 0 | 1 | QQIY11 | The facility failed to ensure staff performed hand hygiene before medication administration for 4 or 4 residents Residents 17, 19, 22, 256, and failed to dispose of sharps to prevent contamination for one resident resident 256, and failed to clean a glucometer between resident for 3 of 3 residents Resident 17, 19, 256. [NAME] On 6-25-19 at 7:08 AM RN-A was on one cart in Hallway 400. She took Resident 22's Blood Pressure. RN-A did not use hand sanitizer. At 7:33 AM on 6-25-19 RN-A then began to pass medications for Resident 19, RN-A did not use hand sanitizer or wash hands. RN-A poked Residents finger without an alcohol wipe. She then stated she forgot the alcohol wipe, and wiped Residents finger with a cotton ball and stated I'm going to have to do it again. RN-A repeated the Blood Sugar test. No hand hygiene was observed. On 6-25-19 at 0746 AM RN-A did not use hand sanitizer prior to gathering supplies for Resident 256. At 0751 AM RN-A then gathered the pills for Resident 19. She did not use hand sanitizer or hand wash. At 8:16 AM we went to Resident 17. No gloves and no hand sanitizer was used as RN-A gathered supplies for Blood Sugar. Record review of the hand washing policy, obtained 6/27/19 at 09:47 AM from Corporate Clinical Coordinator, reveals that hand hygiene is recommended prior to handling medication. B. RN-A, after administering insulin to Resident 256, carried the uncapped needle through the hallway with 2 residents in wheel chairs and several staff coming at us. RN-A had the exposed needle pointing out from herself. Interview with DON on 6/26/19 at 12:08 PM reveals that the expectation for staff is that they place open needles in a sharps container and never recap them. There is never a time that staff should recap a needle. C. At 7:33 AM on 6-25-19 RN-A poked Resident 19's finger without an alcohol wipe. RN-A then stated the alcohol wipe was forgotten, and wiped Residents finger with a cotton ball and stated I'm going to have to do it again. RN-A then left and retrieved an alcohol wipe and gloves… | 2020-09-01 |
| 10108 | 10108 | GREELEY CARE HOME | 285286 | 201 E O'CONNOR AVENUE | GREELEY | NE | 68842 | 2012-09-27 | 226 | D | 0 | 1 | 3KGB11 | Surveyor Licensure Reference Number: 175 NAC 12-006.04A3b -Based on record review and interview, the facility failed to complete checks of the Sex Offender Registry for four of five employee files reviewed. The facility census was 19. -Findings are: -Review of employee records revealed no documentation of Sex Offender Registry checks for the following employees: -Nursing Assistant E with a hire date of 6/27/12 -Nursing Assistant F with a hire date of 7/12/12 -Nursing Assistant G with a hire date of 6/22/12 -Nursing Assistant H with a hire date of 6/22/12 During a status report on 9/27/12 at 4:00 pm, the administrator confirmed there was no documentation showing four employees had been checked through the Sex Offender Registry. | 2016-03-01 |
| 12835 | 12835 | CHIMNEY ROCK VILLA | 285260 | P O BOX A, 106 EAST 13TH STREET | BAYARD | NE | 69334 | 2010-08-19 | 463 | E | R85I11 | State Licensure Reference Number Title 175 NAC 12-007.04G Based on observation and interview, the facility failed to have operating call lights in rooms 102A, 103A, 103B, 105B and 106B. This had the potential to affect 5 residents. Facility census was 42. Observation on 8/16/10 between 1450 and 1500 revealed the call lights not functioning in rooms 102A, 103A, 103B, 105B and 106B. Observation on 8/19/10 at 1315, during the environmental tour, revealed the call light in room 102B did not function. The Maintenance Director confirmed that the call light did not function at the time of this observation. | 2014-03-01 | ||
| 10569 | 10569 | INDIAN HILLS HEALTHCARE COMMUNITY | 285091 | 1720 NORTH SPRUCE | OGALLALA | NE | 69153 | 2012-01-25 | 282 | D | 0 | 1 | PBED11 | State Licensure Number: 175 NAC 12-006.09C Based on record reviews, and interviews, the facility failed to ensure the restorative nursing aide received education and training in performing restorative nursing interventions for 2 sampled residents (Residents 19 and 49). Sample included 11 current residents. Facility census was 44. Findings are: A. Review of Resident 49's care plan dated 12/28/11 with goals through 3/31/12 revealed a problem related to the resident's need for extensive assistance with activities of daily living. The goal for the problem read: will remain clean, dry, odor free and dressed appropriately for the season each day . An intervention dated 2/1/11 for this problem was documented as range of motion to both upper and lower extremities one to two times weekly by Restorative. Nothing was documented on the care plan related to the resident's restorative nursing walking program. B. Review of Resident 19's Care Plan dated 4/11/11 with goals through April of 2012 revealed a problem identified as needing setup and supervision for bed mobility, transfer, walk in room, walk in corridor, locomotion on/off the unit, dressing, eating, toilet use, and personal hygiene. The goal for this problem was documented as will maintain current level of ADL self functioning over the next 90 days. An intervention for the problem was documented on 10/1/11 as range of motion to both upper and lower extremities one to two times weekly by the Restorative Aide. Nothing was documented on the care plan related to the resident's restorative nursing walking program. Interview with the Restorative Aide, MA (Medication Aide)-F on 1/24/12 at 10:50 a.m. revealed that MA-F works full time in restorative. MA-F verified being responsible to evaluate resident range of motion and provide these assessments to the MDS Coordinator who then documents them on the MDS. MA-F verified having no specific training or competency testing in evaluating range of motion. MA-F verified being unaware in what the specific instructions are from the faci… | 2015-12-01 |
| 4856 | 4856 | SIDNEY CARE AND REHABILITATION CENTER, LLC | 285113 | 1435 TOLEDO STREET | SIDNEY | NE | 69162 | 2018-03-06 | 812 | F | 0 | 1 | 9WK311 | Sidney Care and Rehabilitation Center F812 Licensure Reference Number: 175 NAC 12-006.11E Based on observation and interviews, the facility failed to: 1) Date and label open bags of chicken breasts, 2) prevent build up of condensation and ice where frozen foods were stored inside of the walk in freezer; and 3) provide hand hygiene to prevent cross contamination while preparing meals. These failures had the potential to affect all residents Facility census was 27. Findings Are: [NAME] On 02/27/18 at 8:39 a.m. Kitchen observation revealed an open bag of chicken breasts located in the freezer had not been labeled or dated. On 02/28/18 at 8:00 a.m. Kitchen observation revealed an open bag of chicken breasts located in the freezer had not been labeled or dated. On 03/05/18 at 7:51 a.m. Kitchen observation revealed an open bag of chicken breasts located in the freezer had not been labeled or dated. On 03/06/18 at 10:38 a.m. ani nterview with the Dietary Manager confirmed that any food item opened and reused should have been labeled and dated. On 03/06/18 at 11:23 a.m. an interview with the Administrator and Corporate Nursing Consultant verified that any food items that were opened should have been labeled and dated. Review of the 07/21/2016 version of the Food Code, based on the United States Food and Drug Administration Food Code and used as an authoritive reference for the food service sanitation practices, revealed the following: 3-201.11(C) Packaged Food shall be labeled as specified by law, including 21 CFR 101 Food labeling, 9 CFR 317 Labeling, Marking Devices, and Containers and 9 CFR 381 Subpart Labeling and Containers, and as specified under 3-202.17 and 3-202.18. B. On 02/27/18 at 8:39 a.m. Kitchen observation revealed the walk in freezer was leaking water causing ice build up and condensation on the ceiling, floor and on the frozen foods stored inside of the walk in freezer. The floor was slippery due to ice build up. On 02/28/18 at 7:15 a.m. Kitchen observation revealed the walk in freezer was leaking water… | 2020-03-01 |
| 12284 | 12284 | CAMBRIDGE MANOR | 2.8e+196 | P O BOX 488, WEST HWY 6 & 34 | CAMBRIDGE | NE | 69022 | 2010-09-29 | 253 | E | 0 | 1 | 4R4M11 | STATE LICENSURE REFERENCE NUMBER: 175 NAC 12-006.18B Based on observation and staff interview, the facility failed to ensure the door frames to the resident bathrooms were free from scraped and nicked areas, failed to ensure the doors to the resident bathrooms were free from marred areas that were rough to touch and failed to repair walls in residents room that were scuffed or gouged. The facility census was 23 and the survey sample size was 10. Findings are: Observation during the facility tour with the Maintenance Director on 9/28/ between 8:00 AM and 8:45 AM found the following: -The doors to the resident bathrooms in room 23, 22, 25, 27, 29, and 35 were marred, rough and a non cleanable surface. -The door casings to the resident bathrooms in room 23, 22, 24, 26, 27, 28, 35 were scraped and nicked. -The walls in resident rooms 24, 28, and 35 were scuffed and gouged making the surface non cleanable. Interview with the Maintenance Director on 9/28/2010 at 8:45 AM confirmed the resident bathroom doors were marred and the door casings were scraped and nicked. The Maintenance Director stated the marred walls needed repaired. | 2014-09-01 |
| 12702 | 12702 | GOOD SAMARITAN SOCIETY - ARAPAHOE | 285175 | P O BOX 448, 601 MAIN STREET | ARAPAHOE | NE | 68922 | 2010-09-01 | 253 | E | 3PJX11 | STATE LICENSURE REFERENCE NUMBER: 175 NAC 12-006.18 Based on observation, staff interview and record review; the facility failed to 1) ensure the bathroom vents in the resident bathrooms were clean for 7 of 30 residents (Rooms 44, 43, 81, 42, 74, 58, and 72) and a vent in the "A" hall had a grey debris, 2) ensure the filters in the beauty shop hair dryers were free of grey debris for the 2 hair dryers, 3) enure the molding under the heaters were unclean and not painted for 11 of 30 residents (Rooms 43, 46, 38, 84, 83, 82, 41, 81, 45, 44), 4) ensure the doors to resident rooms were not marred for 5 of 30 residents (Rooms 62, 70, 76, 50, 46), and 5) ensure the hole in the wall was fixed in the bathroom in room 43. The facility census was 30 and the survey sample size was 10. Findings are: A. Observation during the facility tour on 8/30/10 from 9:30 AM to 10:20 AM found vents in the resident bathrooms with grey debris in the following bathrooms: -Bathroom between rooms 44 and 43, -Bathroom in room 81, -Bathroom in room 42, -Bathroom in room 74, -Bathroom in room 58, -Bathroom in room 72. Interview with the Maintenance Director on 8/30/2010 at 9:35 AM confirmed the debris on the vents in the bathrooms. The Maintenance Director stated "I try to clean the vents 1 time a month but don't always get it done". B. Observation of the beauty shop on 8/30/2010 at 10:00 AM found a grey debris on the filters of the # 1 and # 2 hair dryers. Interview with Beautician A on 8/31/2010 at 1:00 PM revealed the beautician tired to check the filter monthly and clean it if needed. Interview with Beautician B on 9/1/2010 at 11:00 AM revealed the beautician did not clean the hair dryers that was not the job of the beautician there was a person that cleaned the room. C. Observation of resident rooms on 8/30/2010 between 9:30 AM and 10:20 AM found the molding under the heaters was unclean and not painted in rooms 43, 46, 38, 84, 83, 82, 41, 81 and 45. Interview with the Maintenance Director on 8/30/2010 at 10:15 AM revealed the molding needed… | 2014-04-01 | ||
| 9562 | 9562 | GOOD SAMARITAN SOCIETY - ST LUKE'S VILLAGE | 285192 | 2201 EAST 32ND STREET | KEARNEY | NE | 68847 | 2013-04-02 | 425 | D | 0 | 1 | 23711 | STATE LICENSURE REFERENCE NUMBER: 175 NAC 12-006.12A Based on observation, record review, and interview; the facility failed to ensure Resident 9 received something to eat within 30 minutes after an intermediate acting insulin was given. This resulted in a medication error. The facility census was 47 and the survey sample size was 35. Observation on 3/27/13 at 12:00pm revealed LPN-M (Licensed Practical Nurse) stated to an unidentified Nursing Assistant that Resident 9's blood sugar was 60 and the resident needed to go eat and drink right away. LPN-M then went and got Resident 9 from their bedroom and took the resident to the dining room. Observation on 3/27/13 at 12:06pm revealed Resident 9 at a dining room table eating pudding. Observation on 4/2/13 at 07:32am revealed Resident 9's blood sugar was 114. LPN-M drew up 20 units of Novolin 70/30 insulin (an intermediate acting insulin) into a syringe and proceeded to give the injection to Resident 9. Interview on 4/2/13 at 08:32am revealed LPN-M to say that Resident 9 should receive something to eat approximately 30 minutes after administration of Novolin 70/30 insulin. Observation on 4/2/13 from 7:32am to 08:31am revealed that Resident 9 did not receive something to eat or drink and at 8:31am, Resident 9 arrived in the dining room and was taken to a dining room table that contained a glass of juice. Record review of the undated Manufacturer's patient information for Novolin 70/30 revealed that the onset of action for Novolin 70/30 was ? hour after injection. The facility Director of Nursing confirmed the Novolin 70/30 onset of action information in the Manufacturer's patient information on 4/2/13 at 10:37am. | 2016-07-01 |
| 12703 | 12703 | GOOD SAMARITAN SOCIETY - ARAPAHOE | 285175 | P O BOX 448, 601 MAIN STREET | ARAPAHOE | NE | 68922 | 2010-09-01 | 371 | E | 3PJX11 | STATE LICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observations and staff interview the facility staff failed to remove jewelry while working in the kitchen. The mixer contained a white substance toward the back of the mixer that had not been cleaned. The sink contained an area toward the back of the sink that was green in color and a non cleanable surface. Mayo and relish was stored in the walk in fridge that had no open date that labeled the opening of the containers and no expirations dates on the containers. The sample size was 10. The facility census was 30. Findings are: A. Observation of the staff on 8/30/2010 at 9:10 AM found Cook-C served the breakfast then stated to prepare the noon meal with rings on the left hand with a stone. Observation of Dietary Aide D on 8/31/2010 at 4:30 PM preparing for the evening meal with a ring on the left hand with a rough surface. Interview with the Dietary Manager on 8/31/2010 at 10:45 AM confirmed the jewelry on the staff fingers and stated they were not to wear rings in the kitchen. Review of the 7/1/07 version of the "Food Code", based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: - statute 2-303.11 Except for a plain ring such as a wedding band, while preparing food, food employees may not wear jewelry including medical information jewelry on their arms and hands. B. Observation of the kitchen found a white debris on the underside of the mixer on 8/30/2010 at 9:10 AM and 8/31/2010 at 10:20 AM. Interview with the Dietary Manager on 8/31/2010 at 10:45 AM confirmed the white debris on the underside of the mixer. Review of the 7/1/07 version of the "Food Code", based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: -statue 4-002.11 Equipment food-contact surfaces and utensils shall be cleaned an any time during the operations when conta… | 2014-04-01 | ||
| 8055 | 8055 | GOOD SAMARITAN SOCIETY - BEATRICE | 285203 | 401 S 22ND STREET | BEATRICE | NE | 68310 | 2014-07-31 | 371 | E | 0 | 1 | NI3Z11 | Review of kitchen sanitation practices and observation of meal service in two of four dining rooms, revealed the facility failed to serve food following sanitary practices, including lack of sanitizing solution in the main kitchen dish machine and failed to ensure dietary staff were handwashing/sanitizing between resident contact of personal items. Facility census 75. Findings are: Nebraska Food Code: 4-501.114 A. During initial kitchen tour at 9:48 am on 7/28/14, test strip utilized to check the sanitizing rinse for proper chemical concentration revealed no color change in two trials. Assistant Dietary Manager, indicated a new bucket of chemical sanitizer had been put in place but unable to ascertain why the solution was not working. A service technician was contacted and arrived in the facility on the morning of 7/30/14 and found that a mechanical failure of the machine required repairs to properly dispense the chemical sanitizer. B. Observation of dining service on 07/29/2014 during the noon meal revealed: -A three tier cart set next to collect dirty dishes and serving supplies was placed directly next to the hot food cart. The meals are serviced from the hot food cart directly onto plates and bowls to the residents table; -The cart was used to collect dirty dishes and silverware from the dining tables and serving supplies used during the meal. The cart remained next to the hot food cart during the entire time that the meal was served and the dining area was cleared of dirty service ware; -The cart also had a plastic bag for trash collection tied to the far end of the cart. It was used during the cleaning/clearing of the dining area; -One pitcher of apricot juice was available for noon meal as a choice of beverage. It was dated 07/20 and date of observation was 07/28/2014. One resident out of 18 at the noon meal 07/28/2014 selected the apricot juice for a drink and served 4 ounces in a glass. -Dietary Aide buttered a biscuit (bare hand) per resident request after prepping the meal plate for this resident. Did … | 2017-11-01 |
| 12598 | 12598 | GOOD SAMARITAN SOCIETY - SUPERIOR | 285187 | 1710 IDAHO STREET | SUPERIOR | NE | 68978 | 2010-10-07 | 225 | E | 0 | 1 | G7JN11 | Resident 1: Based on record review and interview the facility failed to report resident allegations of abuse affecting 4 residents (Residents 6, 18, 29, and 60) from resident sample sample size of 35. The resident census was 65. Findings are: Review of the facility's Suggestion and Concern forms revealed: -On 9/11/09 an allegation was reported that NA (Nurse's Aide) E was yelling and being rough with Resident 6 in the bathroom. NA E yelled at Resident 60 "What do you want and I don't have the time." -On 8/5/10 an allegation was reported that Resident 29 reported that the resident was treated roughly and was thrown in bed. The staff ignored the resident when the resident asked to be toileted. -On 9/16/10 an allegation was made that NA F was loud and had a stern voice while feeding Resident 18. NA F told the resident needed to eat before the resident could go to the resident's room. Interview with the SSD (Social Service Director) on 10/7/10 at 9:20 am revealed that the Suggestion and Concerns for Residents 6, 18, 29, and 60 had not been reported to the appropriate state agency per the facility policy. The SSD stated that the Administrator, DON (Director of Nursing), meets with the SSD with each Suggestion or Concern when there is a potential allegation of abuse and they decide whether to report. Review of the facility's policy Abuse and Neglect, revised 10/2009 revealed that the facility's administrator should be notified immediately of incidents of resident abuse, misappropriation of resident property, alleged or suspected abuse, or injury of unknown origin, neglect, financial exploitation or involuntary seclusion. The facility is to immediately notify the designated state agency. | 2014-06-01 |
| 2709 | 2709 | SKYVIEW CARE AND REHAB AT BRIDGEPORT | 285224 | 505 O STREET | BRIDGEPORT | NE | 69336 | 2018-03-29 | 923 | D | 0 | 1 | V3ZE11 | Regulation Licensure Number 175 NAC 12-007.04D Based on observation and interview, the facility failed to provide ventilation in the restroom for one sampled resident (Resident 25). Census was 31; Sample size was 16. 03/29/18 at 09:45 AM Observation of the restroom for Resident #25 revealed that the bathroom vent was not working. 03/29/18 at 11:00 AM Interview with the Administrator and the Maintenance supervisor confirmed that the bathroom vent for Resident #25 was not working. | 2020-09-01 |
| 811 | 811 | CENTENNIAL PARK RETIREMENT VILLAGE | 285094 | 510 CENTENNIAL CIRCLE | NORTH PLATTE | NE | 69101 | 2018-04-17 | 842 | E | 0 | 1 | DM7M11 | Regulation Licensure Number 175 NAC 12-006.16B Based on observation, record review, and interview the facility failed to maintain complete and accurately documented medication disposition records for 7 residents. Census: 50. Sample size: 29. On 04/16/18 at 11:30 AM observation of med destruction closet along with the review of the medication disposition records showed the following: [NAME] Medication disposition record revealed 1 entry on Resident #27's disposition record. It revealed no destroy date filled in for the medication; observation revealed the medication was not in the medication destroy storage closet. B. Medication disposition record revealed there were 23 entries on Resident #55's disposition record. It revealed there were no discontinue dates recorded, no initials for staff recording data were found, no destruction witness signatures, no destroy date(s) recorded; quantities of medications destroyed were not systematically recorded. The medications in pill/tablet form that were listed on the medication disposition record for Resident #55 were not in the medication destroy storage closet. C. Medication disposition record revealed there were 12 entries on Resident #53's disposition record. It revealed there were no discontinue date for medication due to be destroyed, no initials of staff recording date were found, no witness signatures and no destroy date were recorded. The medication in pill/tablet for that were listed in the medication disposition record for Resident #53 were not in the medication destroy storage closet. D. Medication disposition record revealed there were 2 entries on Resident #52's disposition record. It revealed that a destruction witness signature and destroy date was missing. E. Medication disposition record revealed there were 11 entries on Resident #54's disposition record. It revealed there were initial of staff that recorded data, no destruction witness signatures, and no destroy date were recorded. The medications that were listed on the disposition record for Resident #54… | 2020-09-01 |
| 10380 | 10380 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2012-10-04 | 280 | D | 0 | 1 | VDJI11 | References to Title 175 of the Nebraska Administrative Code, Chapter 12- Regulations Governing Licensure of Skilled Nursing Facilities, Nursing Facilities, and Intermediate Care Facilities have been included in survey report as they apply to deficient practices identified. LICENSURE REFERENCE NUMBER 175 NAC 12-006.09C Based on observations record review and interview; the facility staff failed to review and revise Comprehensive Care Plan (CCP) for dental care for 1 (Resident 2) of 40 sampled residents. The facility staff identified a census of 59. Findings are; Record review of a nutritional Assessment date 1-12-11 revealed Resident 2 had partials and did not wear them. An interview on 10-02-2012 at 3:27 PM was conducted with the Social Services Director (SSD). during the interview, the SSD confirmed Resident 2 had blackened looking,chipped teeth. When asked if Resident 2 had seen the dentist, the SSD reported Resident 2 and the residents family had chosen not to follow up. Record review of Resident 2 CCP dated 5/17/2012 did not identify that Resident 2 did not want dental care. The CCP did not indicate how staff should monitor the resident for potential tooth issue that may need intervention. A follow up interview was conducted with the SSD on 10-03-2012 at 2:36 PM. During the interview the SSD confirmed the care plan had not been updated to reflect Resident 2's indications not to have dental care and how staff should monitor the resident. | 2016-01-01 |
| 3545 | 3545 | HARVARD REST HAVEN | 285272 | 400 EAST 7TH STREET | HARVARD | NE | 68944 | 2018-07-09 | 812 | F | 0 | 1 | DZ2T11 | Reference and License Number 175 NAC 12-006.11E Based on observation, interview, and record review; the facility failed to maintain a clean sanitary food preparation area. This had the potential to affect 26 of 26 residents in the facility. The facility census was 26. Observation revealed that under the dishwasher sink there was a black substance from the bottom of the sink to the floor board. Interview with Kitchen Staff Aides A and B confirmed there was a black substance on the wall underneath the kitchen sink. Interview with the Dietary Manager revealed there were no cleaning schedules. Interview with the Dietary Manager revealed mold under the sink had been addressed with the facility for the past 3 years. Record review of the Dietician Report Sanitation Survey Form dated 10-25-2017 revealed; -Need to address the walls in the dishroom that are stained and unable to be cleaned due to the texture on the walls. | 2020-09-01 |
| 12097 | 12097 | GOLDEN LIVINGCENTER - SORENSEN | 285107 | 4809 REDMAN AVENUE | OMAHA | NE | 68104 | 2011-02-08 | 253 | E | 1 | 1 | RD8X11 | Reference Number: 175 NAC 12-006.18A,B Based on observation and interview, the facility failed to ensure cleanable surfaces with fall mats for Room 149; resident equipment for Residents 16 and 12 and Room 149; and failed to ensure a resident closet door was functioning for Room 127. The facility census at the time of survey was 58 and the sample size was 15 plus 1 un-sampled resident. Findings are: Observation on 2/7/11 between 2:00 PM and 3:15 PM with the Facility Maintenance Supervisor (MS) and the Housekeeping Supervisor (HS), the Administrator and the Maintenance Dept Head, revealed concerns in the following areas: - Wheelchair and cushion were dirty for Resident 16. - Wheelchair dirty and arm rests torn and un-cleanable for Resident 2 . - Closet door in Room 127 was broken and off the track. - Rolling blood pressure machines was dirty at the base. - Grab bar and toilet riser handles were dirty in room 147. - Torn fall mat in Room 149. Interview on 2/7/ 2011 from 2:00 to 3:15 p.m. with Facility Administrator confirmed the observations of the above areas of concern. | 2014-10-01 |
| 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 |
| 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 |
| 10742 | 10742 | THE REHABILITATION CENTER OF OMAHA LLC | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2011-08-10 | 253 | E | 0 | 1 | 3X5D11 | Reference Number 175 NAC 12-006.18A,B Based on observation and interview, the facility failed to maintain cleanliness and condition of ventilation covers, handrails, ceilings, walls, door, resident smoking areas and sink drains. The facility census at the time of survey was 52 and the sample size was 13. Findings are: Observation on 8/9/11 between 1:15 PM and 3:15 PM with the Facility Maintenance Supervisor and the Housekeeping Supervisor revealed concerns in the following areas: - Ventilation covers dirty in rooms 102,107,108,211 , 217 and TV room on 2nd floor - Hand rails are splintered and non-cleanable throughout 2nd floor. - Chair rail around TV parameter splintered and uncleanable - Ceilings are stained on 2nd floor hallway. - Door into the 2nd floor dining room dirty at the base, cupboard doors in 2nd floor dining room dirty, door frame to room 209 peeling paint, room 213 splintered and uncleanable, closet door in activity room 2nd floor has a broken opening mechanism. - Bedside table gouged and uncleanable room 208. - Drapes in room 103 have no handle to open them - Sink Drains in rooms 208 and 217 slow to drain - Mirror in room 113 is rusted and needs replacing - Light Switch plate is missing off of bathroom light of room 113 Interview on 8/9/ 2011 with Maintenance Supervisor and Housekeeping Supervisor during the tour confirmed observation of the above areas of concern. | 2015-11-01 |
| 10899 | 10899 | OMAHA NURSING AND REHABILITATION CENTER | 285240 | 4835 SOUTH 49TH STREET | OMAHA | NE | 68117 | 2011-09-19 | 441 | E | 0 | 1 | R1A211 | Reference Number 175 NAC 12-006.17 Based on observation, interview and record review, the facility failed to utilize hand-washing technics to prevent potential cross contamination during provision of cares and treatments for Residents 4 and 5, and failed to clean glucometer's before and after resident use to prevent cross contamination for Residents 9, 12 and 15. The sample size was 13 plus 2 non-sampled residents and the census at the time of survey was 49. A. Observation was made of a transfer on September 15, 2011 at 12:55 PM with Resident 4, performed by NA-B( Nursing Assistant ). The resident was transferred using a Vera lift which is a lift used to help people stand using some of their own power. The lift is sometimes called a ' sit to stand ' lift. Review of the facility policy revealed hand-washing is to be done before and after providing care to a resident or his or her belongings. Observation revealed no hand-washing was done by NA-B at entrance, while performing cares or upon exit. B. Observation was made on September 15, 2011 at 2:00 PM of NA-C performing catheter care for Resident 5. This surveyor waited in hallway for NA-C to come to room after caring for another resident. No hand sanitizing was done. NA-C donned gloves and wet towels to perform the catheter care. NA-C completed the peri-care, removed gloves and regloved without washing of hands. NA-C then completed the catheter care and removed gloves and took supplies out of the room. NA-C was observed taking the soiled towels to the shower room. No hand-washing was done there. NA-C then went to the dining room. In an interview with LPN-E ( Licensed Practical Nurse),on September 19, 2011, at 10:45 AM, LPN-E stated staff is expected to wash hands when entering the room, before leaving the room and before performing any cares for the resident. C. Observation on 9/19/2011 at 11:50 AM of a accu-check (method of checking blood sugar by sticking finger and obtaining a drop of blood) for Resident 12 revealed Licensed Practical Nurse (LPN) F obtained a la… | 2015-10-01 |
| 7099 | 7099 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 371 | F | 0 | 1 | 5JK911 | Reference Licensure Number: 175 NAC 12-006.11E Based on observation, staff interview and record review; the facility failed to 1) assure cleanliness of 1 cupboard containing spices; 2) 3 freezers located in a dry storage area were free from crumbs and food residue; 3) shelves in the kitchen area were free from grease buildup, and 4) utensils were stored in a location free of crumbs and food residue. This had the potential to affect all residents. Facility census was 31. Findings are: A) Observation on 8/11/2015 at 8:30 AM and 8/13/ at 10:30 AM revealed 1 cupboard located in the kitchen area was unclean with dust and spice spillage on the shelves. B) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed three freezers located in a dry storage area of the kitchen contained crumbs and food debris and residue on the bottom shelves. Crumbs and food residue included ground beef, crumbs, and other un-identifiable debris. C) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed the shelves located above and near the stove/oven area were sticky with a greasy residue. D) Observations on 8/11/2015 at 8:30 AM and 8/13/ 10:30 AM revealed that drawers containing utensils had food residue and dust. Interview with the Dietary Manager 8/13/2015 10:30 AM confirmed there there was spice spillage and dust within the cupboard storing the spices as well as the three identified freezers did have food crumbs and debris on the bottom shelve. The DM also confirmed the shelves above and around the stove area were unclean with a greasy/sticky residue and that the drawers storing the utensils contained food particles and dust. The DM confirmed the existence of a cleaning schedule and that it was not posted or filled out and could not confirm kitchen staff followed the schedule. Record review of the kitchen cleaning schedule revealed that it was not posted, filled in pertaining to specifics of cleaning assignments. No documentation existed to confirm the task had been completed. The potential of cross contamination and f… | 2018-07-01 |
| 7098 | 7098 | GOLDEN OURS CONVALESCENT HOME | 2.8e+200 | 902 CENTRAL AVENUE | GRANT | NE | 69140 | 2015-08-13 | 364 | E | 0 | 1 | 5JK911 | Reference Licensure Number: 175 NAC 12-006.11D Based on observation and staff interview; the facility failed to 1) ensure that the juice and water were served with the meal to maintain a palatable temperature and 2) that the nutritive value of food items (jello, egg beaters, cake mix) was compromised due to expired serving dates. Facility census was 31. A) Observation 08/12/2015 8:47:52 AM before breakfast, beverages (juice and water) were placed on the dining tables for all residents prior to residents being seated at the tables for meals. Interview with Cook-A on 08/12/2015 at 8:50:18 AM revealed the beverages which consist of water, and juice were placed on the dining tables 30 minutes prior to the mealtime which is 7:15 to 8:30 AM. At 8:30 AM it was requested that the cook to take the temperature of the juice which was still sitting at a table where a resident had not arrived. The temperature taken by the cooks thermometer was 62.6 degrees. Cook - A confirmed the temperature was 62.6. This had the potential to affect 31 residents. Interview with Dietary Manager confirmed beverages are set out 30 minutes prior to the beginning of the meals being served to the residents. Reference: Review of the 3/8/2012 version of the Food Code based on the United States Food and Drug Administration Food code and used as an authoritative reference for food service sanitation practices, revealed the following: Regarding 3-202.11(A) Potentially Hazardous food (time/temperature control for safety food) shall be at a temperature of 41 degrees Fahrenheit or below when received. B) Initial tour of the kitchen 8/11/2015 at 8:30 AM revealed expired lemon jello and cake mix and refrigerated egg beaters. Interview with the Dietary Manager (DM) 5/11/2015 at 8:45 AM confirmed that the jello and cake mix were expired. Further interview revealed the egg beaters had been frozen and then thawed and served. The DM confirmed awareness of the expired egg beaters, comprising the flavor and nutritive value of the product. | 2018-07-01 |
| 12687 | 12687 | GOLDEN LIVINGCENTER - BROKEN BOW | 285120 | 224 EAST SOUTH E STREET | BROKEN BOW | NE | 68822 | 2011-01-04 | 364 | E | 45IC11 | REFERENCE NUMBER: 175 NAC 12-006.11D Based on record review, meal observations, and interviews with residents and family members, the facility failed to serve food that were palatable to residents. This had the potential to affect the meal enjoyment and food intake for 7 residents (Residents 46, 59, 02, 45, 48, 26, and 05) that had expressed food palatability concerns and for 6 residents (Residents 31, 32, 34, 35, 38, and 41) that received a pureed diet on the Special Care Unit. The facility census was 61 and the survey sample size was 13. Findings are: A. Review of Resident Council meeting minutes revealed: - 12/17/10 "Pizza - too dry" and "Kitchen is out of everything ... example diet jelly, ranch dressing". 6 residents attended the meeting; Residents 46, 59, 02, 45, 48, and 26. B. Review of the GRIEVANCE TRACKING LOG revealed: - 12/17/10 from Resident Council: "Kitchen is out of everything. Example: diet jelly, ranch dressing. Do not always get what is asked for"; - 10/6/10 from Resident 46: "Food does not taste good"; C. Observation on 1/3/10 from 12:10 PM - 12:30 PM revealed individual packets of salad dressing were served with lettuce salad. Observations revealed French dressing served at the start of meal service, then was substituted for Italian dressing when the kitchen ran out of French dressing. At 12:15 PM, Dietary Aide (DA) - D poured Ranch dressing into 3 small bowls. The Ranch dressing was not served. Observations of nursing staff, serving the plated lunch to residents, revealed residents were not asked their preference of salad dressings. D. During an interview 1/3/11 at 1:45 PM, Resident 05 revealed (gender) did not eat the lettuce salad because the resident only liked Dorothy Lynch salad dressing and "they gave me Italian". Resident 05 stated that the facility had a French dressing that tasted close to Dorothy Lynch, "I would eat that", but wasn't given a choice of salad dressing. E. During an interview on 1/4/11 at 10:50 AM, Resident 45 revealed the pork chops were always tough, sometimes "you … | 2014-04-01 | ||
| 10535 | 10535 | NEBRASKA SKILLED NURSING & REHAB | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2011-10-03 | 364 | F | 0 | 1 | DDQC11 | REFERENCE NUMBER: 175 NAC 12-006.11D Based on meal observation and interviews with residents; the facility staff failed to serve food that was palatable to residents. This had the potential to affect the meal enjoyment for 3 residents (Residents 7, 8 and 13). The sample size was 23 plus 1 non-sampled resident from a facility census of 111. Findings are: Interview on 9/26/11 at 3:15 PM with Resident 7 revealed that sometimes the food was bland tasting and not spiced right. Interview on 9/26/11 at 3:30 PM with Resident 8 revealed that sometimes the food was bland and not very good. Interview on 9/27/11 at 2:00 PM with a group of 9 residents revealed that 4 of the 9 residents felt that the food was bland tasting and not seasoned well. Observation on 9/27/11 at 12:17 PM with the Dietary Manager (DM) revealed that the lunch served on that day was spaghetti, buttered carrots and garlic bread. Observation revealed that the bread appeared very soggy and limp and the spaghetti was dried out in places. The Dietary Manager confirmed that the bread appeared limp and soggy and the spaghetti was dried out in spots. The Dietary Manager stated it did not look very good. Interview on 9/27/11 at 12:17 PM with the Dietary Manager revealed that the DM tasted the food items served for lunch on that day and confirmed that the spaghetti sauce tasted bland, the noodles were dried out and the garlic bread was limp. The DM confirmed that the food was not very good or tasty. Interview on 10/3/11 at 10:40 AM with Resident 13 revealed the concern that over the course of the past weekend, the food tasted bland and that many people were unhappy with the food. | 2015-12-01 |
| 8845 | 8845 | PREMIER ESTATES OF PIERCE, LLC | 285139 | P O BOX 189, 515 EAST MAIN STREET | PIERCE | NE | 68767 | 2014-01-15 | 253 | E | 1 | 0 | H8D411 | Pierce Manor F253 (F) Krista Roeber LICENSURE REFERENCE NUMBER 175 NAC 12-006.18A Based on observations and staff interview; the facility failed to maintain clean ventilation systems in the bathrooms of 5 resident rooms (Resident Rooms 26, 23, 33, 30 and 22), keep trash items off of the floor of resident rooms and bathrooms in 9 resident rooms (Resident Rooms 25, 24, 23, 21, 20, 2, 3, 4, and 7), maintain an odor free environment in Hall 2, as well as maintain a safe and orderly hallway free of clutter in Hall 2. Facility census was 46. Findings are: A. A tour on 1/14/14 from 6:15 PM until 6:44 PM revealed the following: -Bathroom vents were soiled with dust in bathrooms of rooms 26, 22, 23, 33 and 30 - Discarded paper towels were lying on the bathroom floor of rooms 24, 22, 23 and 21. - Discarded tissues were lying on the bathroom floor of rooms 25 and 24. Room 24 also had discarded tissues on the floor of the room - Discarded latex gloves were lying on the bathroom floor of rooms 3 and 4 B. Observations of Resident Room 2 revealed the following: - On 1/14/14 from 6:15 PM until 7:48 PM 2 sugar packets were lying on the floor of the room - On 1/15/14 the sugar packets and a discarded tissue were on the floor next to the trash can at 8:00 AM, 10:06 AM and 10:28 AM. C. Urine odors were observed in the hall of Hallway 2 as follows: - 6:44 PM until 7:17 PM an odor of urine at the east end of the hallway - 8:06 PM until 8:30 PM an odor of urine throughout the entire hallway - 7:53 AM until 8:07 AM an odor of urine at the east end of the hallway - 9:55 AM until 10:11 AM an odor of urine at the east end of the hallway - 1:04 PM until 1:45 PM an odor of urine and feces throughout the entire hallway, strongest near a linen cart containing soiled linens and disposable incontinent briefs was located in the middle of the hallway D. The corridor of Hall 2 was observed to be cluttered with equipment as follows: - 1/14/14 from 6:15 PM until 6:44, 2 laundry hampers, 2 mechanical lifts, a housekeeping cart and a metal treatment ca… | 2017-01-01 |
| 8327 | 8327 | CAMBRIDGE MANOR | 2.8e+196 | P O BOX 488, WEST HWY 6 & 34 | CAMBRIDGE | NE | 69022 | 2014-05-15 | 247 | D | 0 | 1 | 82SZ11 | No Licensure Reference Based on review of medical records, facility policies, and staff interview; the facility failed to document in the medical record that room changes were confirmed and verified with residents/responsible party. Residents 19 and 18. Facility census 26. Findings are: A. Interview with Social Service Director at 11:40am on 5/14/14 revealed that room changes should be charted in progress notes. Review of facility policy for Room changes Reference CMM (Cambridge Manor Manual) - 820, states when a room change is deemed necessary/appropriate, Nursing and or Social Service will: -Notify the resident(s) involved in the needed move and the reason. If there is strong objection, re-evaluation is made to identify other alternatives. -Notify the family of the move and the rationale for the change. -Chart the above contacts and rationale in the medical record - Record the date and time of the move. - B. During Interview with Resident 19 regarding notifications of room changes resident indicated had not been notified prior to room change. Review of medical record for Resident 19 revealed progress notes on 10/17/13 .has private room and loving it and on 1/13/14 . still lives in a private room . No further documentation was available in medical record regarding the notification of room change or date and time of the move. C. During Interview with Resident 18 regarding notifications of room changes resident indicated had not been notified prior to room change. Review of medical record for Resident 18 revealed progress notes on 1/6/14 visited with (resident name) about moving to a room closer to the nurses station. Resident stated didn't want to. Visited with (family member) about it and said feels like resident is being a little stubborn right now and suggested that ask again in a couple of days so will ask again on Thursday and see .and Entry from 1/8/14 recorded Trying to visit with (Resident name) about moving to another room due to recent falls . didn't want to move . spoke with daughter and encouraged me … | 2017-08-01 |
| 12821 | 12821 | GOOD SAMARITAN SOCIETY - WYMORE | 285195 | 105 EAST D STREET | WYMORE | NE | 68466 | 2010-11-04 | 323 | E | LJPL11 | NAC 175 Chapter 12 12-006.18E3a (1) Based on observation, record review, and staff interviews the facility failed to follow their Bathing Procedure to monitor and maintain water temperatures at a safe temperature to protect the residents from burns. Findings are: On 11/3/10 at 11:10am an observation was made of MA A disinfecting the whirlpool tub. MA A pushed the button which runs disinfectant into the tub. MA A plugged the drain of the whirlpool tub, turned on the hot water to fill the tub with water to mix with the disinfectant solution. As the hot water was filling the tub the whirlpool water temperature gauge was reading 114 degrees Fahrenheit. MA A proceeded to scrub the whirlpool tub as needed to prepare the whirlpool for the next resident. Interview with MA A on 11/3/10 at 11:15am revealed that the bath aides do not check manual temperatures on the whirlpool tub. MA A stated that "the usual temperature of the bath water for the residents is 102 degrees Fahrenheit." MA A stated that"the bath aides check the temperatures of the shower with a manual thermometer, but they do not check the temperatures of the whirlpool tub with a manual thermometer." MA A stated that " I think that maintenance checks the temperature of the whirlpool tub every week." Interview with Maintenance A on 11/3/10 at 11:30am revealed that Maintenance A does not check the temperatures of the whirlpool tub with a manual thermometer. Maintenance A said that "there are manual thermometers available in the shop for them to use, and that the bath aides are the ones responsible for checking the manual temperatures of the whirlpool tub. Review of the Bathing Procedure last revision dated 11/09 reveals that the bath aides are to check the water temperature and shower pressure before the resident gets in. Do Not adjust the water control when the resident is in the tub or shower. | 2014-03-01 | ||
| 8548 | 8548 | AZRIA HEALTH MIDTOWN | 285218 | 910 SOUTH 40TH STREET | OMAHA | NE | 68105 | 2014-04-29 | 170 | C | 0 | 1 | D6XM11 | Llicensure Reference Number 175 NAC 12-006.05(12) Based on record review and interview the facility failed to deliver mail to residents on Saturday's. This had the potential to affect all of the residents in the facility. The facility census was 47. Findings are: Interview on 4/21/14 at 10:30 AM with the Resident Council President stated the mail was not delivered to the residents on Saturday's. Interview on 4/22/14 at 12:15 PM with the Administrator stated staff working Saturday's had not been informed they were to deliver the mail to the residents if any was delivered on Saturdays. He said it had been discussed after he first hired on at the facility but had not been implemented. At that time there was no policy/procedure for mail delivery. Record review on 4/28/14 at 3:00 PM revealed that a policy/procedure had been developed on 4/28/14 to ensure mail delivered to the facility on Saturday's would be passed onto the rightful resident that day. | 2017-05-01 |
| 11568 | 11568 | GOLDEN LIVINGCENTER - OMAHA | 285097 | 5505 GROVER STREET | OMAHA | NE | 68106 | 2011-08-02 | 371 | E | 1 | 1 | 66RF11 | Lisencure Reference number: 175 NAC 12-006.11E Based on observation and interviews the facility failed to maintain temperatures of food at a temperature to prevent the growth of micro organisms during service of a meal to prevent the potential for foodborne illnesses. This had the potential to effect 90 residents who were served food from the kitchen. Facility Census was 96. Findings are: Observation on 7/26/2011 at 11:45 AM, during lunch meal service, Cook I removed the foil covering from a steam table pan and took temperature a reading of the turkey prior to service beginning which revealed a temperature of 160 degrees. The foil covering remained partially pulled back during service. At 1:15 PM, when meal service was completed the temperature of the turkey was taken and revealed a temperature of 110 degrees. Cook I then repeated the temperature with a second thermometer which revealed a temperature of 110 degrees. Interview on 7/26/2011 at 1:20 PM with Cook I revealed that 110 degrees was too low for turkey to be maintained. Review of the 7/1/2007 version of the "Food Code", based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food sanitation practices, revealed the following: ? 3-501.16* (A)(1) - potentially hazardous food (time/temperature control for safety food) shall be maintained at 57 degrees Celsius (135 degrees Fahrenheit) or above. Interview on 7/26/2011 at 1:25 PM with DM (Dietary Manager) confirmed that the holding temperature of the turkey was too low at 110 degrees. | 2015-05-01 |
| 121 | 121 | AZRIA HEALTH MONTCLAIR | 285054 | 2525 SOUTH 135TH AVENUE | OMAHA | NE | 68144 | 2019-12-11 | 812 | F | 0 | 1 | WIY511 | Liscensure Reference number 12- C Based on observation and interview the faility failed to ensure that a thermometer was in place in the refrigerator and failed to ensure one staff member had adequate coverage of facilal hair. This had the potential to affect 133 residents that eat food in the facility . The facility census was 134 Findings are: Kitchen 12/04/19 07:04 AM Observation with Assistant Dietician manager B . One,Refrigerator in kitchen did not have a thermometer in it to determine the temperatures. all other Refrigerators did have thermometers. temps were at 41 F. Staff member B confirmed that the refrigerator did not have a thermometer inside to check temperature. Staff member B did have facial hair that was exposed, it was confirmed that he should have facial hair covered while working in the kitchen 12/5/19 Interview with Dietician : Dietian is in building 2 to 3 times per week. She confirmed that Staff member B needs to have facial hair covered and that themometer needs to be in place to check temperatures daily. | 2020-09-01 |
| 2013 | 2013 | GOOD SAMARITAN SOCIETY - ARAPAHOE | 285175 | P O BOX 448, 601 MAIN STREET | ARAPAHOE | NE | 68922 | 2019-08-01 | 813 | F | 0 | 1 | 54MC11 | Lincensure Reference Number 175 NAC 12-006.11 Based on observation, interview, and record review; the facility failed to ensure safe and sanitary conditions, proper temperatures, and storage; for foods brought into facility by family and others, in the residents/employee refrigerator in the employee lounge. This could affect 30 of 30 residents in the facility. The facility census was 30. Findings are: Record review of the policy and procedure for FOOD STORAGE for Good Samaritan Society of Arapahoe revealed the facility did not follow their procedure for resident food storage. The procedure did not identify refrigerator storage for residents use only, cleaning of the refrigerator, and making sure all dates are within the safe use dates; and temperatures unable to be measured without thermometers for storage in freezer and refrigerator. On 07/30/19 at 10:36 AM interview with the Dietary Manager (DM) revealed that food brought in for residents from family or others would be stored in the refrigerator in the employees lounge. Observation on 08/01/19 at 9:01 AM revealed 1 refrigerator in employee lounge, the refrigerator had staining on the bottom of the drawers at bottom of the refrigerator, food containers open with food exposed, no outdate or names of whom it belonged to. The log for refrigerator temperatures should be monitored daily. There was not a log for the refrigerator and freezer to make sure temperatures were kept at appropriate levels: in refrigerator below 41 degrees, and for the freezer, cold enough the frozen items are frozen solid. The freezer had several items that were soft and not frozen. Found some employees food items among the food that were being stored for the residents. In the refrigerator and freezer it was revealed that there was food items that were left beyond safe use by dates. Interview on 08/01/19 at 10:37 AM with the ADM (Administrator), revealed ADM was unaware of the rules and regulations for the refrigerator storage for the residents. | 2020-09-01 |
| 10488 | 10488 | EL DORADO MANOR NURSING HOME | 285253 | 71434 HWY 25, BOX 97 | TRENTON | NE | 69044 | 2012-12-06 | 323 | D | 0 | 1 | HO1211 | Lincensure Reference Number 175 NAC 12-006.09D7a Based on observation during intial tour and subsequent observation and follow up the facility failed to secure potentially hazardous chemicals for two wandering, confused residents( #28, #34), facility census was 29. 12/3/12 15:00 intial tour identified unlocked cupboard in 200 Hallway bath which contained personal care products along with Shower Disinfectant spray bottle ? full; and a spray bottle labeled Glenda Wheelchair fly spray approx. 1/8 of a bottle of milky colored thin liquid. 100 hallway cupboard was locked. 12/5/12 15:30 observed revealed locked cabinets in 200 and 100 hall way bath. 12/6/12 10:55 Observation of unlocked cabinet in 100 hallway bathroom, revealed numerous personal care items and two spray bottles- one labeled Shower disinfectant refill at nurse's station MOP room. PH 7Q (about 1/2 full); other labeled bleach and is(1/3 full). 200 hallway cupboard was locked. | 2016-01-01 |
| 11964 | 11964 | HAMILTON MANOR | 285263 | 1515 5TH STREET | AURORA | NE | 68818 | 2011-04-26 | 369 | D | 0 | 1 | C6I811 | Licnesure Reference Number: 175 NAC 12-006.09D8c Based on record review, observation and interview; the facility failed to ensure that adaptive eating equipment was provided to one resident (Resident 2) as care planned. The facility census was 61 with 15 sampled and 5 non sampled residents. Findings are: Review of Resident 5's Care Plan Minutes dated 3/23/11 revealed ,"Adaptive eating devices indicated? Yes - Divided plate; Red mat." Review of Resident 5's Care Plan revealed, "Pot (potential) for weight loss...12/10 Provide red mat under plate, and 1/11 Divided plate at meals." Observation of Resident 5 on 4/20/11 during the noon meal, again on 4/21/11 during the breakfast and noon meal and 4/26/11 during the noon meal revealed that Resident 5 had a regular plate and a teal colored place mat. Review of an undated list of Adaptive Equipment revealed that Resident 20 was not listed under the divided plate heading and was listed to have a red mesh placemat. Review of Resident 20's diet card made no mention of adaptive equipment needed. Interview with the Dietary Manager on 4/26/11 at approximately 4:30 PM confirmed that Resident 5 was supposed to be recieving food on a divided plate and a red colored place mat per the care plan. The DM further stated that she was unaware that Resident 20 had not been getting these items. | 2014-12-01 |
| 10768 | 10768 | HARVARD REST HAVEN | 285272 | 400 EAST 7TH STREET | HARVARD | NE | 68944 | 2011-12-14 | 371 | F | 0 | 1 | UC5I11 | Licesure Reference Number 175 NAC 12-006.11E Based on observation and interview, the facility failed to maintain the kitchen in a clean, sanitary manner and failed to assure surfaces in the kitchen were cleanable. This had the potential to affect all 37 residents residing in the facility. Findings are: During observation of initial tour of the kitchen on 12/12/2011 at 10:00AM and second tour of observation and interview with the Administrator, Dietary Manager, Director of Nursing and Assistant Director of Nursing on 12/14/2011 areas of concern relating to safety, cleanable surface and sanitation were revealed: -Formica counter tops used for food preparation and support for equipment used in food prep had chips (small pieces) of formica missing along the edges of the counter tops or missing off of the top flat surface. -One long formica piece used as a flashing had pulled away from the counter top and was no longer secured in place. -A white plastic splash board behind the hand washing sink (above and below the sink) was pulled away from the wall. This piece included a seam to hold the piece together and the edges of the plastic and seam had a collection of debris and corrosive appearance . The flat facing of plastic had a splattering of debris across the front. -A stainless steel sink with three individual units to wash large cooking/baking pots and pan had a sticky and bumpy film of splattered matter across the front three panels of the sink. There was also a sticky dusty film across the top on the back splash to the three sink unit. -Two oven doors and lower panels below the doors revealed a bumpy, tacky surface of debris appearance over the entire area. Cob-webs were noted under the legs supporting the oven/stove-top -A support prep stainless steel cart for supplies and food prep next to the oven/stove revealed that each cart leg had a large wheel with dark, tacky debris collection on and around the wheel. The Facility Administrator and Dietary Manager acknowledged that the cleaning could be more thorough. Adm… | 2015-11-01 |
| 10388 | 10388 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2012-10-04 | 467 | E | 0 | 1 | VDJI11 | Licensure reference: 175 NAC 12-007.04D Based on observation and interview, the facility failed to maintain ventilation to prevent odors in 2 (Room 208 and 212) of 32 occupied resident rooms. The facility had a total census of 59 residents. Findings are: Observations conducted during stage 1 on 10/1/12 at 10:30 AM revealed a strong odor in room 208 and exhausted vent in bathroom did not draw well. Observations during the environmental tour conducted between 8:41-9:20 AM on 10/9/12 revealed the bathroom vent in room 212 did not have air flow as evidenced by the inability of the vent to draw and hold a square of tissue paper. In an interview on 10/9/12 between 8:41-9:20 AM, the Maintenance Director reported all vents had been cleaned out during the last month and now the air flow was to be tested in each resident room. A review of email dated 10/10/12 revealed air flow had been tested for each resident room on 10/9/12 and the next step would be to repair any broken or damage exhaust ductwork issues. | 2016-01-01 |
| 12080 | 12080 | NEBRASKA SKILLED NURSING & REHAB | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2011-06-22 | 323 | D | 1 | 0 | 1R8W11 | Licensure reference: 175 NAC 12-006.18E Based on observations and interview, the facility failed to ensure 2 medications were secured which had the potential to affect 2 self-mobile, confused residents living on that floor of the facility. The facility had a total census of 109 residents. Findings are: A. Observations on 6/22/11 at 9:30 AM revealed the following medications lying on top of a medication cart on 3rd floor: -Advair Diskus -Fluticasone Propionate No staff members were observed in the area. Interview with LPN H at approximate 9:35 AM on 6/22/11 revealed LPN I was assigned to the medication cart and paged LPN I. LPN I returned to the floor at approximately 9:40 AM on 6/22/11 and acknowledged medications should have been put away. LPN I reported LPN I had been on break. In an interview on 6/22/11 at 12:50 PM, the Director of Nursing confirmed it was not policy to leave medications unsecured on top of a medication cart. | 2014-10-01 |
| 10587 | 10587 | PREMIER ESTATES OF FREMONT, LLC | 285103 | 2550 NORTH NYE AVENUE | FREMONT | NE | 68025 | 2012-05-23 | 465 | F | 0 | 1 | JHI811 | Licensure reference: 175 NAC 12-006.18A Based on observation and interview, the facility failed to maintain walls, floor, and lower shelves of food preparation tables in good repair or a clean manner. This practice has the potential to affect 97 residents who eat food prepared at the facility. Findings are: A. Observations on 5/21/12 between 10:28-11:30 AM in the main kitchen revealed the floor was soiled with a build-up of dirt and debris by walls, cabinets and around equipment legs; the paint was chipped on the trim around the window to the dishwashing area leaving exposed wood; and the paint was chipped off the lower shelf and legs of the 3 food preparation tables. B. Observations at 11:46 on 5/21/12 in the dining room B kitchen revealed paint peeling off the wall behind the sink. C. In an interview on 5/22/12 at 2 PM, the Executive Director revealed the floor in the kitchen had not been deep clean in 1/12 and needed to be done again. The Executive Director acknowledged trim around dishwashing window need to be replaced and lower shelves of work table need to be redone. | 2015-12-01 |
| 10379 | 10379 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2012-10-04 | 253 | E | 0 | 1 | VDJI11 | Licensure reference: 175 NAC 12-006.18 Based on observations and interviews, the facility failed to maintain walls and bathroom floors in good repair for 5 (Room 112, 114, 116, 211, and 212) of 32 occupied resident rooms. The facility had a total census of 59 residents. Findings are: A. Observations during the environmental tour conducted between 8:41-9:20 AM on 10/9/12 revealed the bathroom floor tiles were discolored in rooms 112 and 116. In an interview on 10/9/12 between 8:41-9:20 AM, the Maintenance Director confirmed tiles were discolored and needed to be replaced. B. Observations during the environmental tour conducted between 8:41-9:20 AM on 10/9/12 revealed scrapes in the bathroom walls in room 114, the bathroom walls in room 212 was patched and needed to be painted, and one wall in room 211 had been patched and needed to be painted. In an interview on 10/9/12 between 8:41-9:20 AM, the Maintenance Director confirmed the walls did need to be painted and Maintenance Director planned to paint the walls as time allowed. | 2016-01-01 |
| 4627 | 4627 | BELLE TERRACE | 285237 | 1133 NORTH THIRD ST | TECUMSEH | NE | 68450 | 2017-01-19 | 159 | D | 0 | 1 | RCWF11 | Licensure reference: 175 NAC 12-006.16E Based on record review and interview, the facility failed to ensure resident trust accounts were current for 2 (Residents 16 and 35) of 3 sampled residents. The facility had a total census of 43 residents. Findings are: [NAME] A review of Resident 16's Trust Fund Transaction List printed on 1/12/17 revealed Resident 16 ' s account was in arrears for $1234.98. A review of listed transaction revealed a disbursement of $989.00 on 9/15/16 and 10/31/16 for room and board. No transactions were listed for (MONTH) (YEAR). In interviews on 1/12/16 at 10:34 AM and 1/17/16 at 2:17 PM, Business Office Manager confirmed that Resident 16's (MONTH) and (MONTH) Social Security checks had not been posted to the account when the transaction list was printed on 1/12/17. B. A review of Resident 35's Trust Fund Statement and Trust Fund Transaction List printed on 1/12/17 revealed a disbursement of $1,823 for room and board on 10/4/16 leaving the account in arrears. Resident 35's Social Security check for (MONTH) (YEAR) was not posted to the account until 10/13/16. A review of Resident 35's Trust Fund Statement and Trust Fund Transaction List printed on 1/12/17 revealed a disbursement of $1,823 for room and board on 11/7/16 leaving the account in arrears. Resident 35's Social Security check for (MONTH) (YEAR) was not posted to the account until 11/13/16. In an interview on 1/17/17 at 2:17 PM, Business Office Manager confirmed Resident 35's rent was disbursed before Resident 35's social security check was received. C. In an interview on 1/12/17 at 11:07 AM, the Administrator reported withdrawal and deposit should be done monthly. Reconciliation should be done when the bank statement came at the end of the month. | 2020-04-01 |
| 12081 | 12081 | NEBRASKA SKILLED NURSING & REHAB | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2011-06-22 | 431 | E | 1 | 0 | 1R8W11 | Licensure reference: 175 NAC 12-006.12E1b Based on record review and interviews, the facility failed to ensure controlled substance counts were completed in accordance with facility policy to protect controlled substances from theft and loss on 5 (2nd floor A hall, 2nd floor B hall, 3rd floor A hall, 3rd floor B hall, and 4th floor A hall) of 6 facility medication carts. The facility had a total census of 109 residents. Findings are: A. A review of Controlled Count Verification for Medication Cart 2B revealed on 18 of 43 shift changes between 6/1/11 and 6/22/11, the Controlled Count Verification was only signed off by one of two staff members. On 1 of 43 shift changes between 6/1/11 and 6/22/11, the Controlled Count Verification was not signed by any staff member. B. A review of Controlled Count Verification for Medication Cart 2A revealed on 4 of 43 shift changes between 6/1/11 and 6/22/11, the Controlled Count Verification was only signed off by one of two staff members. Controlled Count Verification was also signed off by off going staff member although day shift for 6/22/11 had not yet been completed. C. A review of Controlled Count Verification for Medication Cart 3B revealed on 4 of 43 shift changes between 6/1/11 and 6/22/11, the Controlled Count Verification was only signed off by one of the two staff members. D. A review of Controlled Count Verification for Medication Cart 4A revealed on 2 of 43 shift changes between 6/1/11 and 6/22/11, the Controlled Count Verification was only signed off by one of two staff members. E. A review of facility policy titled Safeguarding Controlled Substances dated 1/09 stated the following related to Controlled Drug Count/Change-of-shift Reconciliation -"Each individual controlled substance must be counted when there is a change in shift nurse." -"Both on-going and off going licensed nurses will sign the controlled drug count verification form when deemed accurate. At this time, the on-coming nurse may assume the keys." F. In an interview on 6/22/11 at 10:45 AM, the Direct… | 2014-10-01 |
| 8807 | 8807 | PREMIER ESTATES OF FREMONT, LLC | 285103 | 2550 NORTH NYE AVENUE | FREMONT | NE | 68025 | 2013-07-30 | 371 | E | 0 | 1 | 61ZH11 | Licensure reference: 175 NAC 12-006.11E Based on observations interview, the facility failed to ensure food temperatures were maintained to prevent potential food borne illness and failed to ensure kitchen shelves, ceiling vent, and hood over stove were being maintained in a clean manner. These practices have the potential to affect all 103 residents of the facility. Findings are: -Observations at 11:58 AM on 7/24/13 revealed the temperature of the mechanical soft spaghetti on the steam table was 130 degrees F (Fahrenheit). The mechanical soft spaghetti was to be served at the lunch meal and was reheated prior to meal service. Observations at 12:16 PM on 7/29/13 in dining room B revealed the temperature of the pea salad prepared with salad dressing was 58 degrees F, the turkey sandwich was 48 degrees F, and the tuna salad in the sandwich was 51 degrees F. The sandwiches and pea salad were to be served at the lunch meal. In an interview at 2:38 PM on 7/29/13, the Dietary Director and the Registered Dietitian reported foods were to be held at a temperature above 140 degrees F or below 41 degrees F. A review of the 3/8/2012 version of the Food Code , based on the United States Food and Drug Administration Food code and used as an authoritative reference for food service sanitation practices, revealed the following: -Except during preparation, cooking, or cooling potentially hazardous food shall be maintained at 135 degrees F or above or at 41 degrees F or below. -Observations on 7/29/13 at 10:18 AM revealed a coating of dust on the wire shelves were pots and pans were stored, the hood over the kitchen stove was soiled, and the ceiling vent located by the entrance to the dry storage room. In an interview on 7/29/13 at 3:22 PM, the Dietary Director and the Registered Dietitian confirmed the hood wire shelves and ceiling vent were in need of cleaning. The Registered Dietitian reported the hood is checked on a weekly basis to determine if cleaning is needed but is not cleaned on a scheduled basis. The ceiling vent is sc… | 2017-02-01 |
| 5157 | 5157 | KEYSTONE RIDGE POST ACUTE NURSING AND REHAB | 285238 | 7501 KEYSTONE DRIVE | OMAHA | NE | 68134 | 2016-09-06 | 371 | E | 0 | 1 | L4OC11 | Licensure reference: 175 NAC 12-006.11E Based on observation and interview, the facility failed to maintain food temperatures during serving to protect residents from potential food borne illness. This practice had the potential to effect 16 residents who ate in the Garden level of the facility. Findings are: [NAME] Observations on 8/30/16 at 8:37 AM in the Garden level dining room revealed the following food temperatures of food on the steam table: -Super cereal 120 degrees F (Fahrenheit) -Hard cooked eggs 85 degrees F -Sausage 100 degrees F -Pureed sausage 100 degrees F The steam table was observed to be unplugged. Interview with of Dietary Staff Member [NAME] on 8/30/16 at 8:37 AM revealed the steam table had been unplugged to keep the room from getting too hot. B. Observations on 8/31/16 at 12:21 PM in the Garden level dining room revealed the following food temperatures of food on the steam table: -Pureed chicken 120 degrees F -Gravy 120 degrees F -Ground chicken 120 degrees F -Hamburger patties 120 degrees F C. Observations on 9/1/16 at 12:34 PM in the Garden level dining room revealed the following food temperatures of food on the steam table: -Gravy 120 degrees F -Ham 110 degrees F -Pureed meat 120 degrees F -Mechanical soft meet 110 degrees F In an interview on 9/1/16 at 12:34 PM, Dietary Staff Member [NAME] confirmed the food temperature log stated the temperature of the food should be 145 degrees F. D. In an interview on 9/1/16 at 3:50 PM, the Dietary Department Director reported food on the steam table should be above 135 degrees F at the end of meal service. E. Review of the 3/8/2012 version of the Food Code , based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: except during preparation, cooking, or cooling potentially hazardous food shall be maintained at 135 degrees F or above. | 2020-02-01 |
| 8621 | 8621 | PAPILLION MANOR | 285268 | 610 SOUTH POLK STREET | PAPILLION | NE | 68046 | 2013-12-19 | 371 | F | 0 | 1 | IEE211 | Licensure reference: 175 NAC 12-006.11E Based on observation and interview, the facility failed to ensure foods were maintained at temperatures to prevent potential food borne illness, hand washing and glove changes were completed to prevent potential contamination of food, kitchen utensils were sanitized in accordance with manufacturer's instructions and dietary staff wore a facial hair restraint. The facility had a total census of 103. Findings are: A. Observations on 12/18/13 at 10 AM revealed a full, heaping pan of chicken salad in walk-in refrigerator. The chicken salad temperature was measured at 43.2 F (Fahrenheit). Chef D reported the chicken salad had been made at 4 PM the previous day and placed in the refrigerator. Observation on 12/18/13 at 11:13 AM revealed a full pan of pasta salad being served at lunch. The temperature of the pasta salad was 43 degrees F when it was removed from the walk in refrigerator. Chef D reported the pasta salad had been made a 4 PM the previous day and placed in the refrigerator. In an interview on 12/19/13 at 8:17 AM, Registered Dietitian E reported the salads should have been at 40 degrees F. Review of the 3/8/2012 version of the Food Code, based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: potentially hazardous food shall be cooled to within 4 hours to 41 degrees F or less if prepared from ingredients at ambient temperature. B. Observations on 12/18/13 between 8:30-8:51 AM revealed Cook F opened refrigerator door with gloved hands, touched face and returned to handle toast directly without changing gloves or washing hands. Observations on 12/18/13 at 10:08 AM revealed Cook F handled dirty dishes and then handled clean dishes without changing gloves or washing hands. Observations on 12/18/13 at 11:33 AM revealed Chef D placed bread into a toaster without donning gloves. Chef D then left serving area, opened canvas drape and opened refrigerator using the doo… | 2017-04-01 |
| 4636 | 4636 | BELLE TERRACE | 285237 | 1133 NORTH THIRD ST | TECUMSEH | NE | 68450 | 2017-01-19 | 364 | E | 0 | 1 | RCWF11 | Licensure reference: 175 NAC 12-006.11D Based on observations, interview, and record review, the facility failed to ensure food was served hot to residents receiving room trays. This has the potential to affect 12 residents receiving room trays. The facility had a total census of 43 residents. Findings are: [NAME] Observations on 1/9/17 at 12:35 PM revealed 12 room trays set up on a rack in the kitchen area. Observations revealed the room trays left the kitchen area at 12:39 PM. The last room tray was distributed to a resident at 1:04 PM. B. Observations on 1/11/17 at 8:45 AM revealed room trays were set up in the kitchen for 12 residents. The meals were set up on plates and the plates were covered with a thermal cover. Each tray was then placed in a rack. There was no heating element to keep the plates warm. C. Observations on 1/11/17 at 9:01 AM revealed racks of room trays had not left the kitchen/dining area. The last room tray was served to a resident at 9:40 AM. D. Temperatures were checked on a sample tray at 11:41 AM on 1/11/17 after the last tray was passed. The temperature of the sausage was 81 degrees F (Fahrenheit) and the hot cereal temperature was 101 degrees F. | 2020-04-01 |
| 8683 | 8683 | GRETNA CARE CENTER | 285146 | 700 HIGHWAY 6 | GRETNA | NE | 68028 | 2013-12-04 | 520 | G | 0 | 1 | T6KG11 | Licensure reference: 175 NAC 12-006.07 Based on record review and interview, the facility failed to identify deficient practices and develop a quality assurance plan as evidence by a repeat deficiency at F 464 and a new deficiency at F323. The facility had a total census of 57. Findings are A. A review of survey results revealed a deficiency was cited at F 464 related to adequate dining space during survey completed 10/4/12. A repeat deficiency was cited for survey completed F464 related to adequate dining space to prevent moving residents in the dining to allow other residents to enter and exit the dining room. In an interview on 12/3/13 at 10:49 AM, the Dietary Manager reported horseshoe shaped had been removed to provide more room in the dining room. The Dietary Manager reported monitoring the dining room on a daily basis to ensure all residents have adequate space to allow resident to enter and exit the dining room without having to move other residents. Interview with Administrator on 12/3/13 at 5 PM revealed dining room space had been reviewed by the quality assurance committee during the quarterly quality assurance meeting for 10/12, 11/12 and 12/12. B. A deficiency was cited at F323 for failure to provide adequate supervision to prevent falls for two residents. Care plan interventions for both Resident 81 and 31 included having residents by nurses ' station while up in wheelchair. Interviews with Nurse Aide D at 12/3/13 and 1:53 PM and Nurse Aide G on 12/3/13 at 9:42 AM revealed nurse aides were not aware of changes in interventions to prevent falls. Interview with the Director of Nursing on 12/3/13 at 1:22 PM revealed would be trigger for follow up by the quality assurance committee if a certain threshold is reached. C. In interviews on 12/3/11 at 11:15 AM and 11:17 AM, Nurse Aides K and L reported being unaware of concerns being addressed by the quality assurance committee. | 2017-03-01 |
| 5012 | 5012 | RIVER CITY NURSING AND REHABILITATION | 285058 | 7410 MERCY ROAD | OMAHA | NE | 68124 | 2016-07-07 | 241 | D | 0 | 1 | XQQR11 | Licensure reference: 175 NAC 12-006.05 (21) Based on observation, interview, and record review; the facility failed to ensure labels on resident clothing were not visible for one resident (Resident 127). The facility had a total census of 101 residents. Findings are: Observations on 6/30/16 at 8:27 AM revealed Resident 127 seated in a wheelchair. Resident 127's room number was written on the outside of the white socks the resident was wearing with black marker. Room number was clearly visible to anyone walking by Resident 127. Observations on 7/6/16 at 8:20 AM revealed Resident 127 seated in a wheelchair in the resident's room. Resident 127's name and room number was written on outside of white socks the resident was wearing with a black marker. In an interview on 7/6/16 at 8:20 AM, Registered Nurse C confirmed presence of Resident 127's name and room number on outside of Resident 127's socks. In an interview on 7/6/16 at 3:56 PM, the Director of Nursing confirmed resident names were not to be on the outside of resident clothing where it could be seen. A review of an undated facility policy titled Marking Resident Clothing revealed socks were to be marked on the outside bottom of the foot or toe area or a label tacked to the inside. The policy also stated that resident's room number and bed was not to be marked on clothing as the resident might be moved to another room. | 2020-02-01 |
| 4535 | 4535 | GOOD SAMARITAN SOCIETY - AUBURN | 285112 | 1322 U STREET | AUBURN | NE | 68305 | 2016-07-28 | 225 | E | 0 | 1 | GPU211 | Licensure reference: 175 NAC 12-006.04A3d Based on record review and interview, the facility failed to complete nurse aide registry checks for 2 direct care staff members (Nurse Aide D and E). The facility had a total of 59 nursing staff members. Findings are: A review of personnel files revealed no evidence of a nurse aide registry check being completed for 2 direct care staff members: -Nurse Aide D was hired on 4/15/16 according to the list of staff members hired in the last 4 months. A review of Nurse Aide D's personnel file did not reveal any evidence of a completed Nurse Aide Registry check. -Nurse aide [NAME] was hired on 4/22/16 according to the list of staff members hired in the last 4 months. A review of Nurse Aide E's personnel file did not reveal any evidence of a completed Nurse Aide Registry check. In an interview on 7/27/16 at 10:31 AM, Human Resources Staff Member G confirmed no evidence of completed nurse aide registry checks were in Nurse Aide D's and Nurse Aide E's personnel files. Human Resources Staff Member G reported nurse aide registry checks are usually completed when the application is received but may not be printed and placed into the staff member's personnel file. | 2020-04-01 |
| 5231 | 5231 | THE LIGHTHOUSE AT LAKESIDE VILLAGE | 285280 | 17600 ARBOR STREET | OMAHA | NE | 68130 | 2016-05-25 | 225 | E | 0 | 1 | R78C11 | Licensure reference: 175 NAC 12-006.04A3b Based on record review and interview, the facility failed to complete APS/CPS (Adult Protective Services and Child Protective Services) registry checks prior to hire for 5 direct care staff members (Nurse Aide A, Nurse Aide B, Licensed Practical Nurse C, Nurse Aide D and Nurse Aide E). The facility had a total of 35 nursing department employees who provided direct care to residents. Findings are: [NAME] Nurse Aide A was hired on 5/5/16 according to list of employees hired in the last 4 months. A reviewed of Nurse Aide A's Background Report revealed no results from an APS/CPS registry check. B. Nurse Aide B was hired on 5/5/16 according to list of employees hired in the last 4 months. A review of Nurse Aide B's Background Report revealed no results from an APS/CPS registry check. C. Licensed Practical Nurse C was hired on 1/4/16 according to list of employees hired in the last 4 months. A review of Licensed Practical Nurse C's Background Report revealed the APS/CPS registry check was completed on 1/15/16. D. Nurse Aide D was hired on 5/3/16 according to list of employees hired in the last 4 months. A review of Nurse Aide D's Background Report revealed APS/CPS registry check was completed on 5/19/16. Information provided by the Director of Nursing on 5/25/16 at 7:48 AM revealed Nurse Aide D finished orientation on 5/6/16 and started working independently on 5/9/16. E. Nurse Aide [NAME] was hired on 1/11/16 according to list of employees hired in the last 4 months. A review of Nurse Aide E's Background Report revealed APS/CPS registry check was completed on 2/22/16. Information provided by the Director of Nursing on 5/25/16 at 7:48 AM revealed Nurse Aide [NAME] finished orientation on 2/4/16 and started working independently on 2/5/16. F. In an interview on 5/24/16 at 3:38 PM, the Director of Nursing reported Nurse Aide A and Nurse Aide B were in orientation and had not worked independently. The Director of Nursing reported being unaware that Nurse Aide A and Nurse Aide B's … | 2020-02-01 |
| 9752 | 9752 | GOOD SHEPHERD LUTHERAN HOME | 285148 | 2242 WRIGHT STREET | BLAIR | NE | 68008 | 2013-06-03 | 225 | D | 1 | 0 | FC0O11 | Licensure reference: 175 NAC 12-006.02 Based on record review and interview, the facility failed to ensure one allegation of alleged abuse involving 1 (Resident 1) of 75 residents was reported to APS (Adult Protective Services) and an investigation was forwarded to the survey agency within 5 working days. Findings are: A review of facility concern file revealed an Employee Counseling form dated 5/9/13. The Employee Counseling form stated Resident 1 alleged that Nurse Aide A had called Resident 1 an ass and used the sit-stand lift to transfer Resident 1. Documentation of follow up completed on 5/16/13 revealed Resident 1 was interviewed a second time regarding whether the term ass was directed at Resident 1. The follow up indicated therapies was to screen Resident 1 for transfers. In an interview on 6/3/13 at 1:10 PM, Resident 1 confirmed Nurse Aide A had called Resident 1 an ass. In an interview on 6/13/13 at 2:31 PM, the Director of Nursing reported that the Director of Nursing did not feel the incident was abuse as the term ass was not directed at the resident. In an interview on 6/13/13 at 2:17 PM, the Administrator confirmed the allegation had not been reported to APS in accordance with facility policy nor was an investigative report forwarded to the survey agency. The Administrator reported that the allegation was not reported as the Administrator felt the allegation was not correct. A review of facility policy titled Abuse/Neglect/Misappropriation of Property revised 3/11 stated the Administrator or designee will report alleged violations and substantiated incidents to the state agency and other agencies as required. | 2016-06-01 |
| 7132 | 7132 | FALLS CITY NURSING AND REHABILITATION CENTER | 285055 | 1720 BURTON DRIVE | FALLS CITY | NE | 68355 | 2015-01-15 | 364 | E | 0 | 1 | O6JN11 | Licensure reference: 12-006.11D Based on observation, interview, and record review; the facility failed to prepare pureed food in a manner to conserve nutritional value for five residents (Residents 16, 17, 18, 29 and 30). The facility had a total census of 28 residents. Findings are: A. Observations on 1/14/15 at 11 AM revealed Dietary Manager A placed 6 servings of tater tot casserole into the robot coupe utilizing a # 8 (4 ounces) scoop. Three slice of bread were added and casserole was blended to the desired consistency. Five 2/3 cup, 6 ounce, servings of pureed tater tot casserole was prepared. B. A review of recipe for pureed casserole revealed a 6 ounce portion of casserole was to be pureed with 1 tablespoon of gravy or broth for each serving of pureed casserole. The recipe does not call for any bread to be added to the pureed casserole. C. In an interview on 1/14/15 at 11 AM, Dietary Manager A reported the 4 ounces scoop of casserole was used instead of a 6 ounce scoop to accommodate for the addition of the bread that is not included in the recipe. D. In an interview on 1/14/15 at 12:28 AM, Dietary Manager A confirmed that pureeing only 4 ounces of casserole instead of 6 ounces for each serving reduced amount of meat/protein that each resident received. | 2018-05-01 |
| 11883 | 11883 | CARL T. CURTIS HEALTH EDUCATION CENTER | 28A065 | P O BOX 250 | MACY | NE | 68039 | 2011-09-22 | 328 | D | 1 | 0 | JXXE11 | Licensure reference number: 175 NAC 12.006.9D6 Based on Interview and observation the facility failed to assure that physician orders were followed related to PICC line dressing changes for 1 resident (resident 4) Sample size was 4. Facility Census was 21. Review of Resident 4 ' s medical record revealed a document titled " Provider Orders and Interagency Referral Form " from the transferring hospital dated 8/19/2011 and signed by the physician. The document contains the following order with no instructions as to how often to change the dressing are included. ? PICC line ( a form of intravenous access that can be used for a prolonged period of time) flushes and dressing changes per protocol Review of Resident 4 ' s Physician orders revealed no physician order to clarify how often to change PICC line (a form of intravenous access that can be used for a prolonged period of time) dressing. No note regarding notification of physician for clarification of the order was contained in the nurse ' s notes. Review of the TAR ' s (Treatment Administration Record) dated for 8/2011 and 9/2011 for Resident 4 revealed no order or documentation for PICC line (a form of intravenous access that can be used for a prolonged period of time) dressing change. Review of Resident 4 ' s Nurses notes revealed no documentation regarding a PICC line (a form of intravenous access that can be used for a prolonged period of time) assessment or dressing change. Interview on 9/22/2011 at 1:30 PM with the Director of Nursing revealed the dressing change for PICC line (a form of intravenous access that can be used for a prolonged period of time) are to be documented on the Treatment Administration Record (TAR) and confirmed that no entries regarding the order for a PICC line(a form of intravenous access that can be used for a prolonged period of time) dressing or documentation of PICC line dressing changes being completed for Resident 4 ' s. | 2015-01-01 |
| 7717 | 7717 | VALHAVEN CARE AND REHABILITATION CENTER, LLC | 285117 | 300 WEST MEIGS STREET | VALLEY | NE | 68064 | 2014-10-16 | 441 | E | 0 | 1 | LX4E11 | Licensure reference number: 175 NAC 12-006.7 Based on observation,record review and interviews; the facility failed to prevent bare hand contact with medications for one resident (Resident 67); and failed to clean the accucheck machine for one resident (Resident 77) to prevent cross-contamination. This had the potential to affect 29 residents on the 100 hall that receive medications and 5 residents on the 200 hall that receive accuchecks. Facility census was 60. Findings are: A. On 10/15/14 at 7:12 AM during medication pass revealed LPN (Licensed Practical Nurse) D removed a senna tablet from the stock bottle for Resident 67 using an un gloved index finger . Interview on 10/16/14 at 9:05 AM with the DNS (Director Nursing Services) revealed no bare hand contact with medication should occur. A spoon or gloved hand should be used if unable to access medication without contact. B. Obervation on 10/16/14 at 7:15 AM revealed LPN E placed a multi-use accu check (method to measure residents blood sugar) device on a disposable paper barrier on the medication cart. The resident's blood sugar was obtained and LPN E took the machine from Resident 77's room and placed the accucheck machine on the barrier on the medication cart. LPN E used disinfectant wipes to clean the accu check machine then placed the machine back on the barrier without changing the barrier paper. LPN E then continued to the next resident and used the machine without further disinfecting. Interview on 10/16/14 at 9:05 AM with the DNS revealed LPN E should have disinfected monitor prior to setting on barrier on cart or changed barrier after disinfecting to prevent monitor coming in contact with potential unclean surface. C. Review of the updated facility policy titled Blood Glucose Monitor Decontamination revealed the following: - the blood glucose monitor will be cleaned and disinfected with wipes following use on each resident when monitors are shared by multiple residents - after performing the glucose testing, the nurse, wearing gloves, will use a Dispa… | 2018-01-01 |
| 12246 | 12246 | GOOD SAMARITAN SOCIETY - BEATRICE | 285203 | 401 S 22ND STREET | BEATRICE | NE | 68310 | 2011-05-26 | 166 | D | 1 | 0 | LGEV11 | Licensure reference number 175NAC 12-006.06B Based on record review and staff interview the facility failed to resolve concerns from 2 residents (Residents 11 and 12) related to delayed call light answering and provide resolution following Neighborhood Council meetings. The facility census was 66 and sample was 12. Findings are: A. Review of the March 28, 2011 Neighborhood Council Minutes revealed Resident 11 expressed a concern related to call light answering. Review of the call light report for Resident 11 created March 28, 2011 at 2:28 PM by the Director of Nurses (DON) revealed : -3/25/11 6:57 PM the call light was on 10 minutes before being answered. -3/26/11 10:10AM the call light was on 17 minutes before being answered. -3/26/11 8:11 PM the call light was on 12 minutes before being answered. -3/27/11 5:18 PM the call light was on 13 minutes before being answered. B. Review of the April 25, 2011 Neighborhood Council Minutes lacked follow up of the call light issues reported at the March 28, 2011 Neighborhood Council meeting. C. Review of the Suggestion or Concern forms revealed on May 9, 2011 Resident 12 reported a concern that the call light went unanswered on May 8, 2011. A call light report created May 9, 2011 at 8:40AM by the DON revealed: -5/8/11 7:52 AM the call light was on 35 minutes before being answered. -5/8/11 8:59 AM the call light was on 25 minutes before being answered. Interview with the DON on 5/26/11 at 4:45 PM revealed, "It is our expectation that the call lights are answered in 8 minutes." | 2014-09-01 |
| 2799 | 2799 | SUNRISE COUNTRY MANOR | 285232 | PO BOX A, 610 224TH STREET | MILFORD | NE | 68405 | 2020-01-21 | 812 | F | 0 | 1 | CCP811 | Licensure reference number 175 NAC 12-006.11E Based on observations, interviews and record reviews the facility failed to prevent cross contamination and food borne illness by keeping hair enclosed in hairnets, maintaining clean and sanitary kitchen and kitchen equipment, and complete hand hygiene according to facility policy. This affected 69 residents that received food prepared in the kitchen. The facility failed to ensure table surfaces were cleaned prior to seating residents at the table for Resident 272. Findings are: [NAME] Hairnets According the Nebraska Food Code 2-402.11 Hair Restraints Food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints and clothing that covers body hair that are designed and worn to effectively keep their hair form contracting exposed food, clean equipment, utensils, and linens, and unwrapped single service and singe use articles. An observation on 01/14/20 at 10:55AM revealed DA (Dietary Aide) H was wearing baseball cap with no hairnet, multiple chunks of hair were outside hat. DM and Cook B had hair exposed outside of hairnets. An observation on 01/14/20 at 11:25AM revealed MA (Medication aide) I and J; NA (Nursing Assistant) K were behind drink prep counter without hairnets in place were food was being served and drinks were being prepared. Record review of dress code policy dated 4/13 revealed under Dietary Services Attire number 3. Hair Restraints: Employee entering the kitchen must have all hair covered by a hair bonnet. No stocking caps are to be worn. Caps may be worn with a hairnet. An interview on 01/13/19 at 11:30AM with DM confirmed all staff behind drink prep counter and kitchen must wear a hairnet and have all hair enclosed in net per facility policy and Nebraska Food Code. B. Kitchen cleaning and sanitation An observation on 01/15/20 at 1:40PM revealed stove top was covered in brown grease substance. Oven inside and out was coated in a black burned on substance. Drain under sink has strong sour odor; brown substance covers dr… | 2020-09-01 |
| 8405 | 8405 | THE LIGHTHOUSE AT LAKESIDE VILLAGE | 285280 | 17600 ARBOR STREET | OMAHA | NE | 68130 | 2014-03-17 | 280 | D | 0 | 1 | F1O811 | Licensure reference number 175 NAC 12-006.09C1c Based on record review and interview; the facility staff failed to review and revise a Comprehensive Care Plan (CCP) related to nutritional interventions to address weight loss for Resident 39. The facility census was 28. Findings are: Record review of Resident 39's Weight Report dated 3/13/14 revealed that Resident 39 had a 10 pound (LB) weight loss between 10/2/13 and 3/6/14, from 141 pounds (lb) to 131(lb). Record review of Resident 39's March 2014 Medication Administration Record [REDACTED]. This order was started on 3/8/14. The interventions were changed on 3/12/14 to Magic cup ice cream (a brand of nutritional supplement) daily and Ensure (a brand of nutritional supplement) 1 can daily (may split into 120 cc bid). Weights were to be done weekly x 2 months. This order was started on 3/14/14. Record review for Resident 39's Nutrition Assessment completed on 3/13/14 revealed that Resident 39 was provided with nutritional supplements due to weight loss. Record review of Resident 39's Care Plan (CP) dated 3/6/14 contained the problem: I am at risk for weight loss. The outcome was listed as: my weight will be maintained at what I need to be healthy. Interventions included: I am on a regular diet but prefer to have no added salt and I like chocolate. The care plan did not contain specific information related to identified weight loss, past supplement use or recent changes to supplements, Interview and record review on 3/13/14 at 3:33 PM with the facility MDS Coordinator confirmed that Resident 39's CP had not been revised to include information related to weight loss, supplement use, changes in interventions or specific interventions to address weight loss. Record review of the facility Policy and Procedure for Interdisciplinary Care Plans (ICP) dated 12/12 (no year) revealed that at any time, a discipline may create an interim plan based on the identified need and enter the information into the ICP with documentation in the progress notes. | 2017-07-01 |
| 11217 | 11217 | LOGAN VALLEY MANOR | 285090 | 1035 DIAMOND STREET | LYONS | NE | 68038 | 2013-11-20 | 465 | E | 1 | 1 | BIWI11 | Licensure reference Number: 175 NAC 12-006.18A Based on observation and interview; the facility staff failed to ensure non-resident use area's in the facility (exterior gutters, 100 hall janitor closet, exterior concrete, public restrooms, laundry are) were maintained in a clean, sanitary manner and in good physical condition. The facility census was 26. Findings are: Observation on 11/19/13 between 12:20 PM and 2:05 PM with the facility Maintenance Director (MD) during the environmental tour revealed the following concerns in non-resident use area's in the facility: - Exterior of the building: 200 hall: gutter fallen down onto the ground. - Janitor closet 100 hall: missing floor tile near door. - Wing 5 west exterior: concrete cracked - Wing 3 south wall exterior of the building: gutter down on the ground. - Men's public bathroom: corroded faucet, stained toilet base, wax buildup on floor - Women's public bathroom: corroded faucet, stained toilet base, wax buildup on floor - Floor tile cracked and missing in the laundry room. Interview on 11/19/13 at 2:00 PM with the MD confirmed that the above cited area's of concern had not been addressed prior to the environment tour on 11/19/13. The MD stated that the MD worked 70-90 hours per week salaried and was the only staff to handle environmental issues in the facility. | 2015-07-01 |
| 10890 | 10890 | SUNRISE HEIGHTS OF WAUNETA | 285220 | PO BOX 520, 427 LEGION STREET | WAUNETA | NE | 69045 | 2012-10-04 | 441 | E | 0 | 1 | 7V6Q11 | Licensure reference Number: 175 NAC 12-006.17 Based on observations and interviews, the facility failed to: 1) provide coverings for stored items to reduce the risk of cross contamination for elimination products stored in resident bathrooms for 6 sampled residents (Residents 5, 6,7, 12, 21, 31) and one non-sampled resident (Resident 33). Sample size was 20 current residents. Facility census was 31. Findings are: A. Environmental observations on 10/3/12 at 9:30 a.m. and 10/4/12 at 8:30 a.m. revealed the following: - Resident 5's bathroom was observed with an uncovered fracture bedpan stored on the floor and an uncovered fluid measuring graduate stored by the sink. - Bathroom shared by Resident 6 and Resident 7 was observed with two uncovered pilgrim hats (urinary measuring devices) on the floor. -Resident 12's bathroom was observed with an uncovered urinal hanging on a railing. - Resident 21's bathroom was observed with an uncovered fracture bedpan stored on the floor. - Resident 31's bathroom was observed with an uncovered urinal on the floor. - Resident 33's bathroom was observed with an uncovered fracture bedpan stored on the floor. Interview on 10/4/12 at 9:15 AM with the DON (Director of Nursing) confirmed that the urinals, fracture pan, and the pilgrim hats were to be covered in the bathrooms to reduce the risk of cross contamination. B. Observation in the dining room on 10/3/12 at noon revealed NA (Nurse Aide)-B was assisting residents with setup of meals and intake. During the observation NA-B was observed wiping his/her mouth and nose with a napkin and disposing the napkin in a garbage container. NA-B then returned to assisting residents and handling utensils without hand washing or using a sanitizing gel to reduce the potential for cross contamination. Interview with the DON on 10/4/12 at 10:30 a.m. confirmed that staff are expected to wash hands or use sanitizing gel between tasks and following any contamination of the hands during resident cares. | 2015-10-01 |
| 6013 | 6013 | HEMINGFORD COMMUNITY CARE CENTER | 285265 | P O BOX 307, 605 DONALD AVENUE | HEMINGFORD | NE | 69348 | 2018-12-11 | 812 | F | 0 | 1 | 831V11 | Licensure reference Number: 175 NAC 12-006.11E Based on observations and interviews, the facility failed to ensure one freezer containing items for consumption by residents was free of ice buildup. The failure could potentially affect foods provided and consumed by all residents. Facility census was 29. Findings are: Observation on 12/6/18 at 8:55 a.m. revealed the white upright freezer located in the Kitchen across from the stainless steel freezer and refrigerator had ice build up present. Observation on 12/10/18 at 8:20 a.m. Revealed the white upright freezer located in the kitchen across from the stainless steel freezer and refrigerator had ice build up and appeared that it had not been thawed out. Staff interview on 12/10/18 at 11:24 a.m. Administrator and Dietary Manager verified the white upright freezer located across from the stainless steal refrigerator and freezer had ice build up and identified it required thawing out. Review of the 7/21/16 version of the Food Code, based on the United States Food and Drug Administration food Code and used as an authorative reference for food services sanitation practices, revealed the following: 3-3-3.12-(A) Packaged food may not be stored in direct contact with un-drained ice. Source: Quality Assurance and Food Safety, (MONTH) (YEAR) quotes the Food and Drug Administration and the United States Department of Agriculture/Food and Safety Inspection Service Related to Condensation in guidance documents with the most recent a draft guidance from the Food Safety Modernization Act. The preventive rule discusses condensation buildup as a hazard for listeria, salmonella, and molds that produce mycotoxins Substances produced by mold growing in food that cause illness or death when ingested by man). | 2019-07-01 |
| 4334 | 4334 | HEMINGFORD COMMUNITY CARE CENTER | 2.8e+302 | P O BOX 307, 605 DONALD AVENUE | HEMINGFORD | NE | 69348 | 2018-12-11 | 812 | F | 0 | 1 | UVU411 | Licensure reference Number: 175 NAC 12-006.11E Based on observations and interviews, the facility failed to ensure one freezer containing items for consumption by residents was free of ice buildup. The failure could potentially affect foods provided and consumed by all residents. Facility census was 29. Findings are: Observation on 12/6/18 at 8:55 a.m. revealed the white upright freezer located in the Kitchen across from the stainless steel freezer and refrigerator had ice build up present. Observation on 12/10/18 at 8:20 a.m. Revealed the white upright freezer located in the kitchen across from the stainless steel freezer and refrigerator had ice build up and appeared that it had not been thawed out. Staff interview on 12/10/18 at 11:24 a.m. Administrator and Dietary Manager verified the white upright freezer located across from the stainless steal refrigerator and freezer had ice build up and identified it required thawing out. Review of the 7/21/16 version of the Food Code, based on the United States Food and Drug Administration food Code and used as an authorative reference for food services sanitation practices, revealed the following: 3-3-3.12-(A) Packaged food may not be stored in direct contact with un-drained ice. Source: Quality Assurance and Food Safety, (MONTH) (YEAR) quotes the Food and Drug Administration and the United States Department of Agriculture/Food and Safety Inspection Service Related to Condensation in guidance documents with the most recent a draft guidance from the Food Safety Modernization Act. The preventive rule discusses condensation buildup as a hazard for listeria, salmonella, and molds that produce mycotoxins Substance | 2020-09-01 |
| 3042 | 3042 | SARAH ANN HESTER MEMORIAL HOME | 285241 | P O BOX 646, 407 DAKOTA STREET | BENKELMAN | NE | 69021 | 2019-10-24 | 812 | F | 0 | 1 | 0FJ411 | Licensure reference Number: 175 NAC 12-006.11E Based on observations and interviews, the facility failed to ensure ice condensation buildup for one upright freezer and one chest freezer was removed. This could potentially result in cross-contamination of freezer items served to all residents. Facility census was 27. Findings are: Kitchen Observation on 10/22/19 at 11:10 a.m. revealed the white up right freezer located between the Kitchen and the Dietary Managers Office and the white chest freezer located in the pantry room located on the left side as you walked in to the pantry had ice condensation buildup. Kitchen Observation on 10/23/19 at 11:58 a.m. revealed the white up right freezer located between the Kitchen and the Dietary Managers Office and the white chest freezer located in the pantry room located on the left side as you walked in to the pantry had ice condensation buildup. Staff interview on 10/24/19 at 9:22 a.m. Dietary Manager and Director of Nursing confirmed the white up right freezer located between the Kitchen and the Dietary Managers Office and the white chest freezer located in the pantry room located on the left side as you walked in to the pantry had ice condensation buildup. Dietary Manager reported this would be taken care of immediately. Staff interview on 10/24/19 at 9:23 a.m. Administrator and Dietary Manager verified the white up right freezer located between the Kitchen and the Dietary Managers Office and the white chest freezer located in the pantry room located on the left side as you walked in to the pantry had ice condensation buildup. Review of the 07/21/16 version of the Food Code, based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: 3-303.12-A) Packaged food may not be stored in direct contact with undrained ice. Source: Quality Assurance and Food Safety, (MONTH) (YEAR) quotes the Food and Drug Administration and the United States Department of Agriculture/Food and… | 2020-09-01 |
| 10661 | 10661 | MITCHELL CARE CENTER | 285287 | 1723 23RD STREET | MITCHELL | NE | 69357 | 2013-01-10 | 371 | F | 0 | 1 | G8FL11 | Licensure reference Number: 175 NAC 12-006.11E Based on observations and interviews the facility failed to store, and distribute food under sanitary conditions. Findings are: Observation on 1-7-13 at 09:50 during initial kitchen tour, revealed fans coated in thick gray fuzzy particulate inside the walk-in freezer. 1-9-13 8:30 revealed a second observation of fans in the walk-in freezer coated in thick fuzzy gray particulate/substance. Observation on 1-9-13 10:40 revealed cart with 15 dishes of fruit cocktail in walk-in cooler/refrigerator uncovered and labeled Nursing Home. Observation 12:00-12:15 in dining room revealed Trays of fruit cocktail uncovered on separate food carts pushed and served from by staff H and I ; Each cart was pushed out to dining-room from the small kitchenette-and back ; without covering over fruit dishes during entire observation. Each cart went past surveyor a minimum of three instances, across the floor and two blue rugs in kitchenette . Staff interview with Dietary Manager 1-10-13 1:20 PM verified thick fuzzy gray matter on fans in walk-in freezer. She verified that dishes of fruit cocktail were uncovered yesterday at noon meal. Review of the 3/8/2012 version of the Food Code, based on the United States Food and Drug Administration Food Code used as an authoritative reference for food service sanitation practices, reveals the following: 3-305.11 Food Storage (A) Food shall be protected from contamination by storing the food: (2)Where it is not exposed to splash, dust, or other contamination. Review of the 3/8/2012 version of the Food Code, based on the United States Food and Drug Administration Food Code used as an authoritative reference for food service sanitation practices, reveals the following: 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils. (C)Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris. | 2015-12-01 |
| 12889 | 12889 | MITCHELL CARE CENTER | 2.8e+247 | 1723 23RD STREET | MITCHELL | NE | 69357 | 2013-01-10 | 371 | F | K9TY11 | Licensure reference Number: 175 NAC 12-006.11E Based on observations and interviews the facility failed to store, and distribute food under sanitary conditions. Findings are: Observation on 1-7-13 at 09:50 during initial kitchen tour, revealed fans coated in thick gray fuzzy particulate inside the walk-in freezer. 1-9-13 8:30 revealed a second observation of fans in the walk-in freezer coated in thick fuzzy gray particulate/substance. Observation on 1-9-13 10:40 revealed cart with 15 dishes of fruit cocktail in walk-in cooler/refrigerator uncovered and labeled "Nursing Home". Observation 12:00-12:15 in dining room revealed Trays of fruit cocktail uncovered on separate food carts pushed and served from by staff H and I ; Each cart was pushed out to dining-room from the small kitchenette-and back ; without covering over fruit dishes during entire observation. Each cart went past surveyor a minimum of three instances, across the floor and two blue rugs in kitchenette . Staff interview with Dietary Manager 1-10-13 1:20 PM verified thick fuzzy gray matter on fans in walk-in freezer. She verified that dishes of fruit cocktail were uncovered yesterday at noon meal. Review of the 3/8/2012 version of the "Food Code", based on the United States Food and Drug Administration Food Code used as an authoritative reference for food service sanitation practices, reveals the following: 3-305.11 Food Storage (A) Food shall be protected from contamination by storing the food: (2)Where it is not exposed to splash, dust, or other contamination. Review of the 3/8/2012 version of the "Food Code", based on the United States Food and Drug Administration Food Code used as an authoritative reference for food service sanitation practices, reveals the following: 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils. (C)Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris. | 2014-03-01 | ||
| 10651 | 10651 | IMPERIAL MANOR NURSING HOME | 285252 | P O BOX 757, 933 GRANT STREET | IMPERIAL | NE | 69033 | 2012-03-05 | 371 | F | 0 | 1 | WRK211 | Licensure reference Number: 175 NAC 12-006.11E Based on observation and interview, the facility failed to cover food to reduce the risk of contamination during transportation from the kitchen to the dining room. The facility census was 34, with the potential for all residents eating in the dining room to be effected by this practice. Findings are: Observation of Food service on 2/28/12 at 12:15 P.M. and 5:15 P.M. revealed Dietary Assistant delivered uncovered plates of food from the kitchen window to the residents in the main dining room. Further observation revealed that the dining area was located across from the kitchen, separated by the front entrance walkway and the living area. Visitors and staff entered the facility going past the serving area while food was transported to the residents. The meal was served from kitchen and was carried across entry walkway, and through the living area to dining room, without being covered. Observation of food service on 2/2912 at 8:15 A.M. revealed Dietary Assistant delivered uncovered plates of food from the kitchen window to residents in the main dining room. Interview with Dietary Food Manager on 2/29/12 verified that food should be covered when transported from the kitchen to the dining room to reduce the risk of contamination from visitors, staff, and other residents walking through the main hallway. Interview with Administrator on 3/1/12 verified that food was served uncovered to the residents from the kitchen window to the dining room and verified that it had been a problem in the past. A review of the 7/1/2007 version of the Food Code, based on the United States Food and Drug Administration Food Code and used as an authoritative reference for food service sanitation practices, revealed the following: Preventing Contamination from Other Sources 3-307.11, Food shall be protected from contamination that may result from a factor or source not specified under Subparts 3-301-3.306. | 2015-12-01 |
| 240 | 240 | HIGHLAND PARK CARE CENTER | 285063 | P O BOX 950, 1633 SWEETWATER | ALLIANCE | NE | 69301 | 2019-07-02 | 801 | F | 0 | 1 | TTUV11 | Licensure reference Number: 175 NAC 12-006.04D2a Based on record reviews and interview, the facility failed to ensure the Dietary Manager had the credentialing to meet the regulatory requirements for the position. This had the potential to affect all residents. Facility Census was 60. Findings are: Record review of the Dietary Manager's employee record verified the Dietary Manager didn't have the regulatory required training to meet the required credentials. Staff interview on 06/27/17 at 09:06 a.m. Dietary Manager verified not having the required credentials for the Dietary Manager Position. The Dietary Manager reported being enrolled in a food service management course that would be completed within a year. Staff interview on 07/01/19 at 11:00 a.m. Administrator verified the Dietary Manager did not have the required credentials for the Dietary Manager Position. | 2020-09-01 |
| 311 | 311 | HERITAGE ESTATES | 285071 | 2325 LODGE DRIVE | GERING | NE | 69341 | 2019-02-28 | 801 | F | 0 | 1 | 4LDU11 | Licensure reference Number: 175 NAC 12-006.04D2a Based on record review and interviews the facility failed to ensure the Dietary Manager had the credentialing to meet the regulatory requirements for the position. This had the potential to affect all residents. Facility census was 93. Findings are: Record review of the Dietary Manager's employee records on 02/26/19 verified the Dietary Manager did not have the regulatory required training to meet the required credentials. Staff interview on 02/25/19 at 8:29 a.m. Dietary Manager verified not having the certification and education required for the Dietary Manager Position. Dietary Manager reported being enrolled in the required training course to meet the required credentials for the Dietary Manager Position. Staff interview on 02/27/19 at 8:35 a.m. Dietary Manager and Administrator vitrified the Dietary Manager did not have the required credentials for the Position of Dietary Manager. Administrator reported the Dietary Manager is enrolled in the food services management course and would be completed in the very near future. | 2020-09-01 |
| 8655 | 8655 | MATNEY'S COLONIAL MANOR | 285082 | 3200 G STREET | SOUTH SIOUX CITY | NE | 68776 | 2013-11-07 | 256 | E | 0 | 1 | 6E4V11 | Licensure reference Number 175 NAC 12-007.04E2, 12-006.18A3 Based on observation and interview; the facility staff failed to maintain even lighting levels in a portion of the main dining area in the facility. This had the ability to affect 2 residents (Residents 24 and 51) that sat at the affected table in the main dining room. The facility census was 52. Findings are: Observation on 11/4/13 at 12:00 PM in the main dining area of the facility revealed a missing light fixture toward the back half of the dining area over 1 specific table. Observation revealed that there were wires were hanging out of the ceiling from the spot where a light should have been. Observation on 11/5/13 at 12:15 PM revealed that a test with a light meter of that particular area in the main dining area revealed that the light registered 10 candle foot light. Interview on 11/05/13 at 12:21 PM with the 2 residents that ate at that table (Residents 24 and 51) confirmed that the light was missing over the table and that area had very low light. Resident 24 stated that it had been like that a long time and that it was hard to see the plates while they were eating. Observation on 11/6/13 at 112:30 PM with the facility Owner and Maintenance Man (MM) C revealed a missing light over a table in a portion of the dining room. Interview on 11/6/13 at 12:30 PM with MM C confirmed that the light was missing and that it was darker than other areas of the main dining room. When asked how long it had been missing MM C replied I have no idea . | 2017-03-01 |
| 10073 | 10073 | KIMBALL COUNTY MANOR | 285256 | 810 EAST 7TH STREET | KIMBALL | NE | 69145 | 2012-11-28 | 253 | E | 0 | 1 | IYOJ11 | Licensure reference Number 175 NAC 12-006.18A 175 NAC 12.006.18B Based on observations and staff interviews, the facility failed to ensure that 1)the floor and wall tiles were cleaned for two sampled rooms rooms 103 and 106 (residents 6, 20 and 27).; 2)the furnace was maintained for one sampled resident (resident 6).; 3)that personal fans were cleaned for one sampled resident (resident 9). Facility census was 39, and the stage 2 sample was X. Findings are: A. Observation of the bathroom wall tiles in room 103 on 11/27/2012 at 08:10 AM revealed thickened black build up in grout lines. The tiles involved were located on the bottom row of wall tiles around the perimeter of the bathroom. Observation of the bathroom floor in room 106 on 11/26/2012 at 08:10 AM revealed the non slip strips on the floor in front of the toilet soiled with a build up of black sticky material around the edges. Staff interviews during Environmental and Infection Control rounds on 11/28/2012 at 2:50 PM with DON, Administrator and Maintenance, verified the grout lines soiled on wall tiles in room 103; the non-skid strips on the floor in front of the toilet in room 106 were soiled. B Observation of the bathroom furnace in room 106 revealed the back section of furnace to be sitting askew and on the floor. Observation during resident interview on 11/27/12 at 1:30 PM revealed loud knocking and swishing noises coming from bathroom furnace, making hearing for the resident and surveyor difficult . Staff interviews during Environmental and Infection Control rounds on 11/28/2012 at 2:50 PM with DON, Administrator and Maintenance to room 106, verified the back section of bathroom furnace to be sitting askew and on the floor . C Observations of Resident 9's room on 11/26/12 at 9:45 AM, 11/27/12 at 8:15 AM, and 11/28/12 at 10:30 AM revealed that two personal fans contained a buildup of gray fuzzy material on the blades and the grill. Interview on 11/28/12 at 2:50 PM with the Administrator verified that the fans were soiled and needed to be cleaned. | 2016-03-01 |
| 10485 | 10485 | EL DORADO MANOR NURSING HOME | 285253 | 71434 HWY 25, BOX 97 | TRENTON | NE | 69044 | 2012-12-06 | 253 | E | 0 | 1 | HO1211 | Licensure reference Number 175 NAC 12-006.18A 175 NAC 12-006 18B 175 NAC 12-007.18B3 Based on observations and staff interviews, the facility failed to ensure that 1) dining room buffet hutch surface was maintained in the (common) resident dining room; 2) resident cushions were covered for three sampled residents (#19, #20, #33) a cleanable sanitary environment; 3) the light fixture was maintained for one resident room ( #11, #17); 4) the walls and door frames in resident rooms were maintained for four sampled residents (#3, #31, #26, #4); 5) Tiles in resident room for one sampled resident were clean (#20). Facility census was 29. 12/3/12 15:00 intial tour, the concerns identified include the Dining Room buffet/hutch surface is worn and chipped, surface is rough and not cleanable. 12/4/12 12:00 Observation of diningroom buffet hutch surface is worn and chipped, surface is rough and not cleanable. 12/6/12 10:40 Observation of diningroom buffet hutch surface is worn and chipped, surface is rough and not cleanable. Were any of the following observed? (Mark all that apply) = 2 (C: Resident care equipment is unclean, in disrepair or stored in an improper or unsanitary manner) Surveyor: and ( 12/6/12 10:40 ) RelevantFindings: (12/04/2012 12:28:28 PM) Room 104-1 Resident foam cushion is worn and uncovered Surveyor: and ( 12/6/12 10:40 ) RelevantFindings: (12/04/2012 02:33:58 PM) Room 204-1 Resident has an uncovered foam cushion. Surveyor: RelevantFindings: (11/04/2012 10:20:05 AM) Room 105-2 Resident sitting on foam pad which was not covered in wheelchair , not cleanable. Foam uncovered, not cleanable surface for resident to sit on. Were any of the following observed? (Mark all that apply) = 1 (B: Walls, floors, ceilings, drapes, or furniture are not clean or are in disrepair) Surveyor: and ( 12/6/12 10:40 ) RelevantFindings: (12/04/2012 12:36:58 PM)Room 201 double room, residents' cover to light in room (fluorescent light) cover is missing the metal cover and holder ( for the plastic light cover). Surveyor: and ( 12/6/… | 2016-01-01 |
| 10654 | 10654 | MITCHELL CARE CENTER | 285287 | 1723 23RD STREET | MITCHELL | NE | 69357 | 2013-01-10 | 159 | E | 0 | 1 | G8FL11 | Licensure reference Number 175 NAC 12-006.05(19) Based on record review and interviews, the facility staff failed to ensure access to personal funds on weekends, for three residents (44, 33, and 50). Facility census was 38. Findings are: Interview on 1/8/13 3:41 PM, resident 44 revealed she/he could not get her/his money on weekends because the staff who handled access to the money was not in facility on weekends. Interview on 1/8/13 2:00 PM resident 33 revealed she/he could not get money on weekends. Interview on 1/8/2013 1:46 PM resident 50 revealed she/he could not get money on weekends. 1-9-13 Review of residents' council minutes for past 12 months identified no issues/complaints brought to the council in regards to Personal funds or accessibility of the funds. Staff interview with Administrator on 1-10-13 2:30 PM revealed that residents are allowed access to funds any time the business office was open. Administrator verified that there was not a system/procedure in place to provide access to funds on weekends. Additionally it was reported that administration did not know it was an issue for residents. Review of NHCA (Nebraska Health Care Association) Resident Rights booklet provided by Mitchell Care Center, in the section labeled Funds and Property revealed The resident has the right to Manage his or her financial affairs. | 2015-12-01 |
| 12882 | 12882 | MITCHELL CARE CENTER | 2.8e+247 | 1723 23RD STREET | MITCHELL | NE | 69357 | 2013-01-10 | 159 | E | K9TY11 | Licensure reference Number 175 NAC 12-006.05(19) Based on record review and interviews, the facility staff failed to ensure access to personal funds on weekends, for three residents (44, 33, and 50). Facility census was 38. Findings are: Interview on 1/8/13 3:41 PM, resident 44 revealed she/he could not get her/his money on weekends because the staff who handled access to the money was not in facility on weekends. Interview on 1/8/13 2:00 PM resident 33 revealed she/he could not get money on weekends. Interview on 1/8/2013 1:46 PM resident 50 revealed she/he could not get money on weekends. 1-9-13 Review of residents' council minutes for past 12 months identified no issues/complaints brought to the council in regards to Personal funds or accessibility of the funds. Staff interview with Administrator on 1-10-13 2:30 PM revealed that residents are allowed access to funds any time the business office was open. Administrator verified that there was not a system/procedure in place to provide access to funds on weekends. Additionally it was reported that administration did not know it was an issue for residents. Review of NHCA (Nebraska Health Care Association) Resident Rights booklet provided by Mitchell Care Center, in the section labeled "Funds and Property" revealed "The resident has the right to Manage his or her financial affairs." | 2014-03-01 | ||
| 1328 | 1328 | YORK GENERAL HEARTHSTONE | 285131 | P O BOX 159, 2600 NORTH LINCOLN AVENUE | YORK | NE | 68467 | 2017-07-20 | 441 | E | 0 | 1 | DQEK11 | Licensure and Reference Number: 175 NAC 12-006.17B and 12-006.17D Based on observation, interview and record review; the facility failed to ensure that a barrier was placed between a glucometer test strip container and a potentially contaminated surface. This had the potential to affect 2 of 9 residents requiring acuchecks (a routine blood test to determine the level of sugar in the blood) on hall 600 (Residents 56 and 119). The facility also failed to ensure required hand washing while caring for residents. This had the potential to affect all 19 residents on the 600 hall. The facility census was 111. Investigation On 07/19/2017 at 11:49 AM, observation of RN (Registered Nurse) D revealed RN D administered eye drops for Resident 27 . RN D entered the resident's room and washed hands for 10 seconds, then put on gloves. The gloves did not fit so RN D then left the room to get a proper sized glove, returned to the room and put on the glove. RN D then administered the eye drops and then washed hands for 10 seconds. 07/19/2017 11:54:03 AM, RN D conducted an accucheck for Resident 56. RN D gathered material and placed the instrument and test strip container on a bedside table. RN D administered the accucheck then washed hands for 10 seconds. After exiting the room, RN D cleansed the accucheck instrument per general standards of practice and returned them to the medication cart. The test strip container was not cleansed, just returned to the medication cart. On 07/18/17 at 12:09 PM, RN D conducted an accucheck for Resident 119. RN D gathered material, entered the room and place the instrument and the test strip container on the dresser next to the residents bed. RN D administered the accucheck and then washed hands for 10 seconds. After exiting the room, RN D cleansed the accucheck instrument per general standards of practice and returned to the medication cart. The test strip container was not cleansed, just returned to the medication cart. On 7/19/17 at 3:15 PM, an interview with the DON (Director of Nursing) reveale… | 2020-09-01 |
| 2820 | 2820 | NYE POINTE HEALTH & REHAB CTR | 285235 | 2700 LAVERNA STREET | FREMONT | NE | 68025 | 2019-06-25 | 923 | E | 0 | 1 | G2H011 | Licensure and Reference Number 175 NAC 12-007.04D Based on observation, interview and record review, the facility failed to ensure that ventilation fans in the residents restrooms were functioning. this had the potential to affect 7 out of 25 resident restrooms. Resident rooms; 103,104, 105, 202, 203, 209, and 210. The facility census was 40. Findings Observations on 6/19/19 of resident restroom vent fans in rooms; 103, 104, 105, 202, 203, 209 and 210 revealed the ventilation fans could not hold a one ply 4 / 4 section of toilet tissue. On 6/24/19 at 11:00 AM observations with the Administrator and the Maintenance Director revealed the vent fans in Resident restrooms 103, 104, 105, 202, 203, 209 and 210., would not hold a 1 ply 4 x 4 section of toilet tissue. On 6/24/19 at 11:00 AM an interview with the Maintenance Director confirmed the vent fans in resident room s 103, 104, 105, 202, 203, 209 and 210. were not functioning and had not been checked this month for functioning and there was no documentation as to when the last time the vent fans were inspected. Record review of maintenance records revealed no documentation the vent fans were checked for functioning in (MONTH) or June. | 2020-09-01 |
| 3049 | 3049 | PARKVIEW HOME, INC. | 285243 | 930 2ND STREET | DODGE | NE | 68633 | 2018-08-09 | 689 | E | 0 | 1 | HYDQ11 | Licensure and Reference Number 175 NAC 12-006.18E3 Based on observation, interview and record review, the facility failed to protect residents from scalding from hot water in resident rooms, this had the potential to affect 3 residents, Resident #s 37, 42 and 43. The facility census was 45. Findings are; On 8/6/18 observations revealed water temperatures in rooms 37, 42 and 43 were between 123 and 124 degrees. On 08/09/18 at 8:56 AM a tour of the facility revealed the water temperatures in rooms 43, 42 and 37 were between 123 and 124 degrees. On 08/09/18 at 9:00 AM during an interview, the Maintenance Director confirmed the water temperatures in rooms 43, 42 and 37 were all between 123 and 124 degrees. Further interview revealed that the water temperatures have not been checked recently and the last water temp log was done in (MONTH) (YEAR). The facility does not have maintenance prevention program to routinely monitor the water temperatures in resident rooms. Record review of the facility maintenance prevention program revealed no procedure for checking the water temperatures in the resident rest rooms. Record review revealed the last water temperature log dated (MONTH) (YEAR). | 2020-09-01 |
| 269 | 269 | GOLD CREST RETIREMENT CENTER | 285065 | 200 LEVI LANE | ADAMS | NE | 68301 | 2019-03-05 | 584 | E | 0 | 1 | MX7V11 | Licensure and Reference Number 175 NAC 12-006.18A(1) Based on observation, interview and record review the facility failed to ensure the vent fans in the resident restrooms were free of dust, this had the potential to affect 4 resident rooms, rooms numbered; 502, 503, 505, and 508, and the facility had 28 rooms. The facility census was 35. On 03/05/19 at 10:25 AM an observation revealed a brown fuzzy substance on the restroom vents in room #s 502, 503, 505, and 508. On 03/05/19 at 10:25 AM an interview with the Maintenance Director, confirmed the vents in the resident restrooms in rooms; 502. 503, 505, and 508 were covered in a brown fuzzy substance. On 03/05/19 at 10:27 AM an interview with the housekeeper on 500 hall confirmed the vents were covered with a brown fuzzy substance and should be cleaned, the housekeeper also revealed the vents are cleaned once or twice a year. On 03/05/19 at 12:00 PM an interview with Administrator / Housekeeping Director revealed; there is no routine cleaning schedule for the resident restroom vent fans, and the vent fans should be cleaned when dirty. | 2020-09-01 |
| 3054 | 3054 | PARKVIEW HOME, INC. | 285243 | 930 2ND STREET | DODGE | NE | 68633 | 2018-08-09 | 800 | E | 0 | 1 | HYDQ11 | Licensure and Reference Number 175 NAC 12-006.17D Base on observation and record review, the facility failed to ensure that the kitchen staff washed their hands or changed gloves after coming into contact with contaminated surfaces. This had the potential to affect all residents eating food prepared in the kitchen. The facility census was 45. Findings are; On 8/5/18 at 5:30 PM an observation revealed the dining room staff serving meals on trays and then returning the trays to the kitchen staff by handing the trays that had been touched by the serving staff, touched the tables, and touched the staffs clothing, over the prepaid trays at the serving window, the kitchen staff then placed the trays on a cart and continued the serving process without washing hands or changing gloves. On 5/8/18 at 11:45 AM an observation revealed the dining room serving staff after serving residents handed the used trays after touching them, or setting the trays on the tables, or touching the staffs clothing were handing the trays back to the kitchen staff through the serving window over the prepared trays. The kitchen staff were then placing the trays on a cart and returned to preparing food trays without washing hands or changing gloves. Record review of hand washing policy revealed hands are to be washed and gloves changed after hands have been contaminated. | 2020-09-01 |
| 2401 | 2401 | FAIRVIEW MANOR | 285206 | 255 F STREET | FAIRMONT | NE | 68354 | 2018-11-08 | 583 | F | 0 | 1 | WJG711 | Licensure and Reference Number 175 NAC 12-006.16C Based on observation, record review and interview, the facility failed to ensure that residents electronic medical records were not accessible from computers on top of medication carts. This had the potential to affect all residents in the facility. The facility census was 39 Investigation; On 11/6/18 at 12:00 PM an observation on hall 100 revealed a computer on top of a medication cart was open an unlocked and unattended so that resident information was visible and accessible to anyone passing the medication cart. On 11/6/18 at 12:03 an Interview with LPN A, who was responsible for the medication cart revealed no knowledge the computer should be locked when unattended. On 11/6/18 at 12:08 PM an observation on hall 200 revealed a computer on top of a medication cart was open and unlocked and unattended so that resident information was visible and accessible to anyone passing the medication cart. On 11/6/18 at 12:10 PM, an Interview with LPN B who was responsible for the medication cart revealed no knowledge the computer should be locked when unattended. On 11/6/18 at 12:15 PM an interview with the DON revealed no knowledge the computer needed to be locked when unattended. Record review of Workstation Security document revealed no documentation that computers with resident information needed to be locked or inaccessible to unauthorized people. | 2020-09-01 |
| 4103 | 4103 | CARL T CURTIS HEALTH EDUCATION CENTER NURSING HOME | 28A065 | PO BOX 250, 100 INDIAN HILLS DRIVE | MACY | NE | 68039 | 2018-11-01 | 761 | F | 0 | 1 | P5NX11 | Licensure and Reference Number 175 NAC 12-006.12E1 Based on observation, interview and record review; the facility failed to ensure that the medication cart was secured when unattended. This had the potential to affect all residents in the facility. The facility census was 18. Findings On 10/30/18 at 2:08 PM an observation revealed the medication cart on the west side of the nurses station was unlocked. RN A (Registered Nurse) was observed standing in the nurses station with their back to the cart. On 10/30/18 at 2:10 PM an interview with the DON (Director of Nurses) confirmed the medication cart was unlocked and should be locked when unattended. On 10/30/18 at 2:12 an interview with RN A revealed RN A thought the cart was locked. Record review of storage of medications document revealed, only licensed nurses, consultant pharmacist and those lawfully authorized to administer medications (such as medication aids) are allowed to access the medications. Medication rooms, carts and supplies are locked or attended by persons with authorized access. | 2020-09-01 |
| 2683 | 2683 | HERITAGE OF EMERSON | 285222 | 607 NEBRASKA STREET | EMERSON | NE | 68733 | 2018-10-25 | 812 | F | 0 | 1 | XKR211 | Licensure and Reference Number 175 NAC 12-006.11E Based on observations, interviews and record reviews; the facility failed to ensure the dietary staff sanitized their hands after contact with residents and other non sanitized objects. This had the potential to affect all the residents served in the dining room. The facility also failed to ensure that open and stored food in the refrigerators were dated. This had the potential to affect all the residents eating food served from the kitchen. The facility census was 32. [NAME] On 10/22/18 from 12:05 PM - 12:45 PM an observation of dietary staff serving a meal revealed; dietary aid A was observed to touch Resident # 17's silverware to cut food, then hand Resident # 17 the silverware. Dietary Aid A then touched genders own clothing, touched other residents, touched tables, while delivering meals. Dietary Aid A also delivered meals with thumb on plates, at serving window took spoons from container and placed them in bowls of chili 11 times then delivering the bowls of chili to the residents. Dietary Aid A was observed to entered the kitchen 2 times, touching the door handles, getting items from the kitchen returned to the dinning area. Dietary Aid A then was observed to cut up Resident # 11's food with the residents silverware and then handed the silverware to Resident # 11. During this dining observation Dietary Aid A was observed to not sanitize or wash hands at anytime. B. On 10/23/18 from 12:08 PM - 12:35 PM an observation of Dietary staff serving resident lunch reveled Dietary Aid A entered the kitchen and touched the door handle, exits the kitchen holding a coffee pot in right hand, served 3 residents coffee by picking up the cup by the handle and then placing the cup on there table for the resident, at no time did Dietary Aid A sanitize hands. On 10/23/18 at 12:30 an interview with the Dietary Manager confirmed the dietary aid had served the residents touching the door handle and coffee cups without sanitizing hands. The expectation is for the staff to wash the… | 2020-09-01 |
| 4356 | 4356 | BCP MILFORD, LLC | 285132 | 1100 WEST 1ST STREET | MILFORD | NE | 68405 | 2019-07-18 | 812 | E | 0 | 1 | UNXJ11 | Licensure and Reference Number 175 NAC 12-006.11E Based on observation, record review, and interview; the facility failed to ensure that the dietary staff sanitized their hands after contact with residents and other non sanitized objects. This had the potential to affect 21 residents served in the dining room. Facility Census was 48. Findings are: 7/15/19 at 11:30 AM observation of DC-J (Dietary cook) go to staff sink in the kitchen to wash hands; revealed this staff person wash hands 3 to 5 seconds, did not use soap, and dried hands; then go over to steam table serve a plate of food, open a closed container, pour it into a pan, then set it down, serve another tray, then go back to the sink for another 3 to 5 second handwashing, without soap. The DC-J was observed in this meal service wash hands 3 to 5 seconds 14 times, until 12:15 PM when dinner service was completed. 7/15/19 at 11:33 AM observed the kitchen staff's hand washing sink, revealed there was not any sign or procedure posted for handwashing in the sink area. 7/15/19 at 12:30 PM interview with Dietician revealed she had observed the same hand washing technique from the DC-J during the dinner service. The Dietician confirmed that the procedure for handwashing is 15 to 20 seconds, using soap and water, and would have the expectation of having the staff perform handwashing in this manner. | 2020-08-01 |
| 1324 | 1324 | BEATRICE HEALTH AND REHABILITATION | 285130 | 1800 IRVING STREET | BEATRICE | NE | 68310 | 2019-02-07 | 921 | E | 0 | 1 | QSDF11 | Licensure and Reference Number 175 NAC 12-006.09D7a Based on observation and interview, the facility failed to ensure that the covers on the heating units in the south dining room and the north hall of Southern Meadows were free of jagged or sharp edges. This had the potential to effect the 22 residents that used this dinning room and that were capable of self ambulation in wheelchairs through out the facility, ( Residents 37, 35, 34, 204, 47, 205, 50, 36, 3, 25, 17, 19, 6, 13, 29, 41, 20, 4, 24, 14, 40, 8) the facility census was 29. FACILITY Environment On 02/04/19 at 12:15 PM during observations in the south dinning room it was observed the heating units along the east wall along the floor had loose and bent covers with sharp edges that could be a safety hazard to the residents. On 2/7/19 at 11:15 AM observations revealed the heating units along the west and east walls on the north end of Southern Meadows had loose covers with sharp edges exposed. On 02/07/19 at 11:15 AM an interview with the Maintenance Director and the Administrator confirmed the covers were loose with sharp edges. | 2020-09-01 |
| 5479 | 5479 | GOOD SAMARITAN SOCIETY - WOOD RIVER | 285198 | 1401 EAST STREET | WOOD RIVER | NE | 68883 | 2018-04-19 | 607 | D | 0 | 1 | 3PVU11 | Licensure and Reference Number 175 NAC 12-006.02.8 Based on record review and interview, the facility failed to ensure the staff followed the facility policy regarding reporting allegations of abuse to the State Authority. This had the potential to affect two residents, Residents #98 and #5. The facility census was 43. Findings [NAME] Record review of a facility incident report revealed, Resident #6 made an allegation of rape to an aid at approximately 1:40 PM on Sunday 12/31/17. On Monday 1/1/18 at 1:20 AM the night nurse noticed a note on the report sheet related to the resident's allegation of rape the previous day. The night nurse then notified the DON (Director of Nursing) and the ADON (Assistant Director of Nursing). Neither the day nurse on 12/31/17 nor the Night nurse on 1/1/18 notified APS (Adult Protective Services) or the State Agency. Record review of the facility Abuse policy dated 2/2013 revealed; alleged violations involving any mistreatment, neglect, or abuse will be reported immediately to the Administrator and to other officials in accordance with state law, including the state survey and certification agency. On 4/18/18 at 3:30 PM an interview with the DON confirmed that neither the day nurse nor the night nurse notified APS regarding this allegation of rape as per the facility policy. B. Record review of a Report to State of Nebraska, dated 6/22/17, revealed an allegation of a resident kissing another resident. On (MONTH) 19, (YEAR) the interdisciplinary team were reviewing progress notes, and discovered that on (MONTH) 16, (YEAR) at 1:20 PM, Resident 98 got up and walked down the hall and kissed Resident 5 on the mouth. On 4/18/18 at 2:28 PM an interview with the DON confirmed the charge nurse had not notified the DON or called APS as per facility policy. | 2020-01-01 |
| 7422 | 7422 | SKYVIEW AT BRIDGEPORT | 285224 | 505 O STREET | BRIDGEPORT | NE | 69336 | 2015-07-15 | 371 | F | 0 | 1 | R14911 | Licensure Reverence Number 175 NAC 12-006.11E Based on observations and interview, the facility failed to assure that 1) freezers located in the dry storage areas were free from crumbs and food residue. 2) the aluminum back splash located above the steam table had rust 3) the floor mat located in front of the steam table was sticky with an unidentified residue 4) utensils were stored in a location free of crumbs and food residue. 5) serving staff failed to sanitize their hands between serving to residents. Findings are: A. Observations on 07/13/2015 at 9:59:45 AM initial kitchen tour and 07/14/2015 at 11:07:37 AM revealed the three freezers located in the dry storage area of the kitchen contained crumbs and food debris on the bottom shelves. Further observation revealed that in freezer 1, the crumbs and food debris included a piece of frozen ground beef; freezer 2 contained crumbs and food debris and freezer 3 contained crumbs and food debris along with a frost buildup. B. Observations on 07/13/2015 at 9:59:45 AM initial kitchen walk tour and 07/14/2015 at 11:07:37 AM revealed the aluminum back splash located above the steam table was rusted. Further observation revealed that the rust residue was running along and down the wall above the steam table used to hold food to maintain temperature during meals. C. Observation 07/14/2015 at 11:07:37 AM revealed the floor mat situated on the floor in front of the steam table was sticky when stepped upon. The sticky residue was unidentified. D. Observation 07/13/2015 at 9:59:45 AM initial kitchen walk tour and 07/14/2015 at 11:07:37 AM revealed that a drawer and container containing utensils was littered with food debris and dust. E. Observation on 07/13/2015 12:02:19 PM and 7/14/2015 at 12:15 PM revealed the dietary serving staff serving trays of food to residents were observed without washing hands between tasks after touching residents, residents equipment, and resident chairs. Interview with Dietary Manager and Administer on 7/15/2015 at 2:30 PM confirmed that there we… | 2018-04-01 |
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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 );