Adept Nursing & Rehab of Grand Island

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09. Based on record reviews and interviews, the facility failed to follow standards of practice for diabetes management for 2 (Resident 1 and Resident 2) of 3 sampled residents. The facility census was 60.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(iii)(2)(a) Based on observation, record review, and interview; the facility failed to ensure that Nurse Aide Registry Checks (a state required record of a successful completion of training and competency to be a nurse aide and any findings of abuse, neglect, or misappropriation of property) were completed prior to hire as required for 4 of 5 sampled staff. This had the potential for residents to be cared for by staff with adverse findings related to abuse or neglect. The facility census was 58.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure that the Daily Nurse Staff posting was posted as required. This had the potential to affect all residents residing within the facility. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(E)(1) Based on observation, interview, and record review the facility failed to ensure stock medication bottles were labeled with the date indicating when they bottle was opened or should be discarded for 2 (Residents 17 and 23) of 3 sampled residents and the facility failed to store medication in a sanitary manner which had the potential to affect all the residents receiving medications from the facility. The facility census was 58.

Inspectors wroteBased on interview, observation, and record review; the facility failed to review and revise the Facility Assessment as needed to assure the facility had the resources to meet the needs of 1 (Resident 26) of 1 sampled resident. The facility census was 58.

Inspectors wroteLicensure Reference Number 175NAC 12-006.04(A)(ii) Licensure Reference Number 175NAC 12-006.17 Licensure Reference Number 175NAC 12-006.17D Based on observations, record review, and inteviews; the facility failed to ensure that the pre-employment health history screening (a medical evaluation conducted on prospective employees before they start working to identify any infectious disease or health risks) was completed as required for 1 of 5 sampled staff; the facility failed to follow enhanced barrier precautions when providing high contact resident care for 2 of 3 sampled residents (Residents 17 and 41); and failed to perform hand hygiene during wound care for 1 of 1 residents (Resident 41). The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B) Based on record reviews, and interviews; the facility failed to trained staff on Trilogy Non-invasice ventilator. This had the potential to affect 1 (Resident 26) of 1 sampled resident in the facility. The facility census was 58. Record review of the Facility Assessment received from the facility on 05/21/2025 revealed a revision date of 04/15/2025 and a review date with the Quality Assurance (QA) committee on 04/16/2025. Record review of the Facility Assessment included all residents within their population, however, did not include ventilation services. Record review of Resident 26 physician orders dated May 2025 revealed an order: -Trilogy Non-invasive ventilator - Resident to wear at bedtime or napping; Not to be worn 24 hours per day, resident to be up in chair as needed for while napping; [...]

Inspectors wroteLicensure Reference Number 175NAC 12-006.04(B)(ii)(1) Based on record review and interview; the facility failed to ensure that nurse aides completed a minimum of 12 hours of continuing education annually as required for 2 of 5 sampled staff. This had the potential to prevent residents from receiving competent care. The facility census was 58.

Inspectors wroteC. Record review of the admission Record dated 5/20/25 for Resident 9 revealed that Resident 9 admitted into the facility on 4/1/25 with diagnoses of schizophrenia (a serious mental illness in which people interpret reality abnormally), anxiety, and major depression. Record review of the Order Summary Report (a concise listing of physician ordered treatments and medications) dated 5/19/25 for Resident 9 revealed an active order for Paliperidone (an antipsychotic medication used to treat schizophrenia ) with a start date of 4/2/25; Quetiapine (an atypical antipsychotic medication used to treat a range of mental health conditions) with a start date of 4/1/25; and Vraylar (an atypical antipsychotic medication used to treat several mental health conditions) with a start date of 4/2/25. [...]

Inspectors wroteLicensure Reference Number 175NAC 12-006.05(E) Based on record review and interview the facility failed to ensure a resident wishes in regard to code status was accurately reflected in the resident's electronic medical health record for 1 resident, Resident 23 of 23 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(D) Based on record review and interview, the facility failed to ensure psychotropic medications had approved indications for use for 2 (Residents 7 and 54) of 5 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H) Based on record review and interviews, the facility failed to report and submit an investigation for an injury of unknown origin to the State Agency and adult protective services within the required time frames for 1 (Resident 8) of 1 sampled resident. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(D) Based on record review and interviews, the facility failed to accurately code the Minimum Data Set (MDS, a federally mandated comprehensive assessment tool used to determine a resident's functional capabilities and helps nursing home staff identify health problems), for 1 (Resident 41) of 13 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(A)(i) Based on record review and interview the facility failed to ensure that a Preadmission Screening and Resident Review (PASRR) Nebraska Level 1 Form (an initial pre-screening for mental illness and intellectual/developmental disabilities prior to admission) screening was completed prior to resident admission into the facility for 1 (Resident 9) of 1 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on interview and record review the facility failed to ensure bowel care services were provided for 3 residents (Residents 8, 54, and 26) of 5 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(v) Based on observation and interview the facility failed to ensure 1 (Resident 41) of 1 sampled resident maintained their range of motion (full movement potential of a joint) to promote the resident's highest practicable level of independence. The facility census was 58.

Inspectors wroteLicensure Reference Number 175NAC 12-006.08(B)(i) Based on observation, record review, and interview the facility failed to ensure that the physician completed the initial post-admission visit (30 day visit) for 2 of 4 residents reviewed (Residents 38 and 25). The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.14 Based on observation, interview, and record review; the facility failed to promptly provide and obtain dental services for 1 (Resident 41) of 4 sampled residents. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.0911(A) Based on observation, record reviews, and interviews; the facility failed to ensure 1 resident, (Resident 52) of 1 sampled resident received diet and preferences as requested. The facility census was 58.

Inspectors wroteLicensure Reference Number 175NAC 12-0006.09(H)(iii)(1) Licensure Reference Number 175NAC 12-006.09(H)(iii)(2) Based on observation, record review, and interview; the facility failed to provide care and services to prevent pressure related skin conditions and promote the healing of pressure related skin conditions for 1 resident (Resident #1) of 3 sampled residents. The facility census was 50. Review of the facility policy titled Skin Assessment and not dated revealed that a full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission, daily for three days, and weekly there after. The section labeled documentation of skin assessment stated documentation should include date and time of assessment observations, type of wound, description of wound, and if the resident refused the assessment and why. [...]

Inspectors wroteLicensure Reference Number 175NAC 12-006.17B Licensure Reference Number 175NAC 12-006.17C Licensure Reference Number 175NAC 12-006.17D Licensure Reference Number 175NAC 12-006.04A2a Based on observation, interview, and record review the facility failed to ensure that staff followed requirements for wearing and discarding of Personal Protective Equipment (PPE) (specialized equipment worn by an employee for protection against infectious disease) in resident rooms for residents with Covid-19 infection and for residents requiring Enhanced Barrier Precautions (use of PPE to reduce transmission of multi-drug resistant germs that employs targeted gown and glove use during contact with a resident) to prevent the potential for Covid-19 and cross contamination. This had the potential to affect all facility residents; [...]

Inspectors wroteLicensure Reference Number 175NAC 12-006.18B3 Based on observations and interview the facility staff failed to ensure 3 of 27 rooms were maintained in good repair and failed to maintain wallpaper and walls in good repair in 2 of 3 halls in good repair. The facility census was 37.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09C(2) Licensure Reference Number 175NAC 12-006.09C(5) Licensure Reference Number 175NAC 12-006.09C2 Based on observation, record review, and interview the facility failed to ensure the comprehensive care plan (a written plan detailing how staff are to meet the resident's needs) included interventions to meet resident needs related to urinary elimination for 1 resident (Resident 39 and failed to include a discharge plan for 1 resident (Resident 1) of 12 total sampled residents. The facility census was 37.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09C1c Based on record review and interview the facility failed to ensure care plan meetings were completed to allow residents/resident representatives to participate in development and revision of the resident's plan of care (a written interdisciplinary comprehensive plan detailing how to provide quality care for a resident) for 5 of 12 sampled residents (Residents 11, 18, 14, 1, and 25). The facility census was 37.

Inspectors wroteLicensure Reference Number 175NAC 12-006.10D Based on observation, record review, and interview the facility failed to ensure 4 (Residents #19, #11, #193, and #21) of 13 residents were free of significant medication errors for. The facility census was 37.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09D3(5) Based on record review, and interview the facility failed to ensure routine bowel movements for 1, (Resident #19) of 4 sampled residents. The facility census was 37.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D Based on record review and interviews; the facility staff failed to manage complaints of pain for 1 (Resident 192) of 2 sampled residents. The facility staff identified a census of 37.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview, the facility failed to request emergency medical services promptly to provide emergency care services for 1 (Resident 1) of 1 sampled resident. This caused the resident to not receive timely emergency care services resulting in the death of the resident. The facility census was 45.

Inspectors wroteG. Record Review of the Administrative admission Packet, dated 3/2/23, revealed Resident 27 was admitted to facility on 3/2/23. Record review of nursing notes dated 3/16/23 at 5:20 PM revealed Resident 27 was sent to ER. Record review of a nursing note dated 3/17/23 at 1:03 PM revealed that Resident 27 returned to the facility. Record review of Resident 27's medical record revealed no documentation that the Ombudsman was notified of Resident 27's transfer to the hospital. Record Review of MDS (Minimum Data Set- an assessment that gives a summary of resident's health and condition) dated 3/16/23 revealed that resident discharged with return anticipated H. Record review of Resident 27's Nursing note dated 3/28/23 revealed that the resident was sent to the hospital on 3/27/23 following a follow up appointment with the Primary Care Provider for Resident 27. [...]

Inspectors wroteBased on record review and interview the facility failed to ensure that a required written bed hold notification (written information outlining options for holding or reserving a resident's bed while the resident is absent from the facility for hospitalization) was provided to the resident/resident representative at the time of transfer for 5 residents (Residents 16, 28, 36, 18, and 27). This prevented the resident/resident representative from making an informed decision to either request a bed hold (a reservation that allows a resident to return to the facility) or release the resident bed. The facility census was 37.

Inspectors wroteLicensure Reference Number 175NAC 12-006.11E Based on observation, interview, and record review; the facility failed to maintain the ice and water dispenser machine to prevent the potential for foodborne illness. This had the potential to affect 33 residents who received thin liquids; and the facility failed to ensure that dietary staff handled dishware to prevent the potential for cross contamination and foodborne illness for 4 residents (Residents 140, 1, 21, and 36). The facility census was 37.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7a Based on observation and interview, the facility failed to maintain equipment to prevent a potential accident hazard for 1 of 6 sampled residents, Resident 5. The facility identified a census of 37 at the time of survey.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.11D Based on observation, interview, and record review; the facility failed to maintain food temperatures to preserve palatability and prevent the potential for foodborne illness. This affected 1 of 1 sampled residents. The facility identified a census of 37 at the time of survey.