Emerald Nursing & Rehab Lancaster LLC

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12) (1)Based on observation, interview and record review, the facility failed to store medications securely in the medication rooms and failed to ensure medications were not left unattended at the resident's bedside for Residents 5, 12, 87, 111, 125, and 137. This had the potential to affect all the residents receiving medications in the facility. The facility census was 191 at the time of survey.

Inspectors wroteThe facility failed to ensure Personal Protective Equipment (PPE) was being used as indicated for three residents (Resident 6, 13, and 99) of 5 sampled residents, hand hygiene was done for the 20 seconds for two resident (Resident 12 and 199), wound care to prevent cross contamination for one resident (Resident 4) of 3 sampled residents, catheter care for one resident (Resident 12) of one sampled resident, food prep, and cleaning and storing nebulizer treatment for one resident (Resident 83) of 1 sampled residents were completed within standards of care to prevent the potential for cross contamination and failed to review and update infection prevention and control policies. The facility census was 191. A. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.19 Based on observations and interviews, the facility failed to ensure an uncluttered physical environment that is neat and well-kept for rooms 211, 215, 230, 234, 235, 412, 415, 428, and 436. The facility census was 191. Record review of facility Operations Management Policy on Physical Environment, dated 01/2024 revealed: -Policy: The facility will maintain all mechanical, electrical and patient care equipment in a safe operational condition. -Policy Explanation and Compliance Guidelines: 3. Routine rounding will include observations of the facility to determine whether the areas are large enough to comfortably accommodate the needs of the residents who usually occupy the space. Observations of resident rooms conducted on June 16, 2026, revealed the following: [...]

Inspectors wroteLicensure reference number 175 NAC 12-006.09BBased on record review and interview, the facility failed to ensure the Minimum Data Set (MDS- a comprehensive assessment of each resident's functional capabilities used to develop a resident's plan of care) accurately reflected the resident's status for 1 (Resident 87) of the 6 sampled residents. The facility census was 191.

Inspectors wroteLicensure reference number 175 NAC 12.006.09(H)(iv)(4)Based on observation, record review and interview, the facility failed to provide incontinence care after completing wound care for 1 (Resident 87) of 3 sampled residents. The facility census was 191.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review, observation and interview the facility failed to follow wound care orders for 1 (Resident 125) of 10 sampled and administer as needed blood pressure medication for 1 (Resident 125) of 5 sampled. The facility identified a census of 191.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(ii) Based on record review and interview, the facility failed to ensure new interventions where put in place to prevent falls for one (Resident 115) of 5 sampled residents. The facility census was 191.

Inspectors wroteLicensure reference number 175 NAC 12-006.11 (D)Based on record reviews, observations, and interviews, the facility failed to ensure recipes for pureed foods (a pudding like consistency for residents who are unable to eat solid foods due to a variety of medical conditions) was followed. This had the potential to affect the 7 residents who eat pureed foods from the kitchen. The total census at the time of the survey was 191.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E)Based on observations and record reviews, the facility failed to maintain ice machines on Stations 1 and 3 in a clean and sanitary manner in order to prevent the spread of foodborne illness. This had the potential to affect 55 residents on Station 1 and 33 residents on Station 3. The facility census was 191.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04 (F) (i) (5)Based on interviews and record review, the facility failed to notify the physician and family representative of one resident (Resident 1) of 3 sampled residents of a change in condition. The facility census was 190.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(D) (i) (3)Based on record review and interview the facility failed to maintain a professional standard of practice with assessing one (Resident 1) of 3 sampled residents after Resident 1 had a change in condition. The facility census was 190.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5)Based on record review and interview, the facility failed to notify the physician of a urinary analysis results (UA-analyzing urine's physical, chemical, and microscopic properties to detect disorders like UTIs {urinary tract infections}, kidney disease, and diabetes) and the culture and sensitivity (detects infection-causing germs (bacteria or fungi) and identifies the most effective antibiotic to treat them) for one resident (Resident 3) of 3 sampled resident. The facility census was 190.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E) Based on observations, interviews, and record review, the facility failed to drain the standing water and sanitize four (station one, station two, station three, and station four) out of four observed dining room steam tables, and to clean and sanitize the toaster in the station four dining area. This had the potential to affect 170 residents that utilized the dining area for meals. The facility census was 171.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09(I) Based on observation, interview, and record review, the facility failed to implement interventions to prevent potential accidents for 1 (Resident 1) of 3 sampled residents. The facility census was 174.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.04(F)(i) Licensure Reference Number 175 NAC 12.006.04(G) Based on interview, and record review, the facility failed to ensure a sufficient number of nursing staff were present on all shifts. This had the potential to affect all residents in the facility. The facility census was 176.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(i)(3) Based on observation and interview, the facility failed to ensure soiled bed linens was changed for 1 resident (Resident 2). The sample size was 5. The census was 183.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.06(D) Based on observations, record reviews and interviews the facility failed to prevent the potential for cross-contamination between residents by not performing hand hygiene at the required intervals during the provision of care for 3 (Residents 1, 2, and 3) of 3 sampled residents and failed to apply and remove gloves using infection control practices while performing cares for 1 (Resident 2) out of 3 sampled residents. The facility census was 183.

Inspectors wroteStatute 71-6018.02 Based on record review and interview, the facility failed to ensure a Registered Nurse (RN) was present in the facility for at least 8 consecutive hours on 1/4/25 and 1/5/25. This had the potential to affect nursing care for all the residents that reside in the facility. The facility census was 174 at the time of survey.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii) Based on record review and interview, the facility failed to provide the required 12 hours of ongoing training for 5 (Nursing Assistants (NA): NA-N, NA-O, NA-P, NA-R and Unit Director: UD-Q) of 5 sampled direct care staff. This had the potential to affect all the residents in the facility. The facility had a census of 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11C Based on interviews, observations, and record reviews, the facility failed to perform hand hygiene for 20 seconds and wear a hair restraint while in the kitchen to prevent the potential for food-borne illness. The facility failed to ensure the ice machine was clean, food items were sealed, labeled, and dated, and outdated food were disposed of. The facility failed to ensure the scoop was not left in an ice cooler to prevent cross contamination. Facility reported that 173 residents receive food from kitchen. The facility census was 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B) Based on record review, interviews, and observations, the facility failed to transport laundry in a way to prevent cross contamination, place dirty linens into a soiled linen container, ensure Continuous Positive Airway Pressure (CPAP, a single pressure machine used to treat sleep apnea) and Bilevel Positive Airway Pressure (BiPAP, an inspiratory and expiratory pressure machine used to treat sleep apnea) cleaning for Resident 101, and change oxygen tubing for Residents 60 and 66 to prevent cross contamination.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.19(A) Based on observation, interview, and record review, the facility failed to ensure the wall mounted oscillating (moved back and forth) fans' shrouds (cage around the blades) and blades in Rooms 204, 210, 213 and 233, the vent above the whirlpool in the Station 2 bathhouse, and the pivot stand (a device used to assist with resident transfers) in the Station 2 hallway were clean from lint and debris. The facility census was 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04J(i) Based on record review and interview, the facility failed to have a qualified Activity Professional. The failure to have an Activity Professional had the potential to affect all residents that participate in activities in the facility. The facility had a census of 174.

Inspectors wroteBased on record reviews and interviews, the facility failed to provide written notice of transfer to residents or their representatives prior to a transfer for 4 (Residents 16, 85, 99, and 115) of 4 sampled residents for hospitalizations. or their representatives prior to a transfer to the hospital. The facility census was 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B Based on record review and interview; the facility failed to ensure the Minimum Data Set (MDS-a comprehensive assessment of each resident's functional capabilities used to develop a resident's plan of care) reflected the current number of unhealed pressure ulcers/injuries (injury to the skin and underlying tissue resulting from prolonged pressure on the skin) for one (Resident 153) of 34 sampled residents. The facility census was 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(2) Based on observations, interview and record review the facility failed to ensure activities were provided to meet the resident's needs for 3 (Residents 109, 133, and 168) of 3 sampled residents on the Alzheimer's Unit. The facility had a total census of 174.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3) Based on observation, interview and record review; the facility failed to ensure a complete, valid prescription was obtained for a Continuous Positive Airway Pressure (cpap-a machine used to deliver positive airway pressure to a resident's airway to prevent it from closing during sleep) for 1 (Resident 60) of 3 sampled residents. The facility census was 174.

Inspectors wroteLicensure Reference Number NAC 12-005.06(H) Based on interviews and record review the facility failed to employ an Infection Preventionist (IP). This had the potential to affect all the residents living at this facility. The census of the facility was 178.

Inspectors wroteLicensure Reference Number 175 NAC-12.006.09 Based on record review and interviews the facility failed to assess and monitor for potential signs and symptoms of a urinary tract infections for 1 (Resident 2) of 3 sampled residents. The census of the facility was 178.

Inspectors wroteLicensure Reference Number NAC 12.005.06(D)(E) Based on observations, interviews and record review the facility failed to perform hand hygiene for 20 seconds and wear personal protective equipment (PPE) throughout wound care for 1 (Resident 9) of 1 sampled residents. The facility census was 178.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(2) Based on interview and record review; the facility failed to follow the medical practitioner's orders regarding wound care and failed to ensure wound treatment was completed for 1 (Resident 1) of 4 sampled residents. The facility census was 177.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(E) Based on observations, record reviews, and interviews, the facility failed to honor preferences for religious practices for Resident 2 and bathing preferences for 5 residents (Residents 1, 4, 5, 6, and 7). This affected 6 of 7 residents sampled for choices. The facility census was 175.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09(I) Based on observation, interview, and record review, the facility failed to ensure interventions were implemented to prevent elopement (when a resident leaves the premises or a safe area without authorization) for 2 (Residents 1 and 2) of 3 sampled residents. The facility census was 198. The facility Administrator for Emerald Nursing and Rehab [NAME] was notified on 07/02/2024 at 5:30 PM of an Immediate Jeopardy (IJ) which began on 06/29/2024. The IJ was removed on 07/02/2024, as confirmed by surveyor onsite verification.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.02(G) and (H) Based on record review, observation, and interviews; the facility failed to ensure a formal investigation was completed and the State Agency was notified for 2 (Residents 1 and 2) of 3 sampled resident's elopement. The facility census was 198.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04C3a(6) Based on record review and interviews, the facility failed to notify the physician of change of condition for 1 (Resident # 1) of 3 sampled residents. The facility census was 210.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview the facility failed to provide an escort and or family member to a Cat Scan appointment for 1 (Resident #2) out of 3 sampled residents. The facility census was 210.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D7 Based on observation, interview, and record review, the facility failed to ensure 1 (Resident 1) of 3 sampled residents was assessed for the ability to safely use the resident's recliner/chair lift to prevent a fall with major injury. The facility census was 203.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D7 Licensure Reference Number 175 NAC 12-006.18B Based on record review and interviews, the facility failed to ensure elopement (unsupervised wandering that leads to the resident leaving the facility without facility staff knowledge) door alarms were functioning, which affected 1 (Resident 3) of 14 sampled residents. The facility failed to ensure all staff were aware of residents who were at risk for elopement which affected 1 (Resident 3) out of 5 sampled residents. This had the potential to affect 14 residents identified at risk for elopement. The facility census was 206.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D Based on observation, interview, and record review; the facility failed to ensure interventions were in place as care planned for one (Resident 1) of three sampled residents. The facility censure was 209.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(4) Based on interview and record review, the facility failed to provide bathing preferences for 1 (Resident 4) of 7 sampled residents. The facility census was 216. Record review of Resident 4's undated admission Record revealed that Resident 4 admited to the facility on 7/20/22. Record review of Resident 4's Minimum Data Set (MDS -a comprehensive assessment of each resident's functional capabilities used to develop a resident's plan of care) dated 12/20/23 revealed a Brief Interview for Mental Status (BIMS-a test used to get a quick snapshot of a resident's cognitive function, scored from 0-15, the higher the score, the higher the cognitive function) of 15, which indiciated the resident was cognitively intact. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11E Based on observation, interview, and record review; the facility kitchen staff failed to label, and date opened packages of food and failed to dispose of expired food and fluids from the walk-in refrigerators and walk in freezer to prevent the potential for food borne illness. This had the potential to affect 206 residents. The facility census was 207.

Inspectors wroteF. A record review of the untitled and undated list provided by the Director of Nursing (DON) revealed that the facility had 19 residents that had tested positive for Covid-19 (a mild to severe respiratory illness that is caused by a coronavirus) and that Station 5 had 3 residents in room isolation due to testing positive for Covid-19. An observation on 01/17/24 at 10:43 AM revealed NA-W to be standing at the nurses' desk with an isolation mask below (gender) nose. During the observation, the Unit Manager had instructed NA-W to wear (gender) mask correctly. An observation on 01/18/24 at 8:08 AM revealed MA-X to be standing at the medication cart with an isolation mask below (gender) nose. An interview on 01/18/24 at 8:08 AM with MA-X confirmed that staff are to wear their isolation masks above their nose. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12.006.18A1 Based on record review, observations, and interviews, the facility failed to ensure that station 2's clean utility refrigerator, microwave, and icemaker were clean, open items in the refrigerator were dated, exhaust vent fans were cleaned in resident restrooms 234, 214, 216, 211, 204, 231, 306 and 431, and that the wall fans were clean in resident rooms 214, 204, 231, 228, 228, 315, 306, 424, and 431. The total facility census was 207.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(21) Based on record review, observation, and interview, the facility failed to treat 1 resident (Resident 18) of 2 sampled with dignity and respect by failing to provide privacy while performing peri-care. The facility census was 207.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.02(8) Based on interview and record review, the facility failed to ensure Adult Protective Services (APS) and the State of Nebraska Department of Health and Human Services (DHHS) were notified of a resident-to-resident abuse incident on 11/17/2023 between 2 (Residents 88 and 140) of 4 sampled residents. The total facility census was 207.

Inspectors wroteB) A record review of Resident 143's undated Face Sheet revealed, that Resident 143 was admitted on [DATE] with the diagnosis of Mood disorder, Major depressive disorder, Bipolar disorder, and anxiety disorder. Resident 143 had a score of 14 on the BIMS indicating Resident 143 is cognitively intact. A record review of Resident 143's PASSAR II (is a comprehensive evaluation required as a result of a positive level I screening. A level II is necessary to confirm the indicated diagnosis noted in the level I screening and to determine whether placement or continued stay in a Nursing Facility is appropriate.) dated 2/28/23 revealed: The PASRR reported Resident 143 has a reported mental health diagnosis of anxiety, bipolar disorder, and major depressive disorder. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09 Based on record review, observations, and interviews, the facility failed to ensure blood pressures, pulses, and labwork were completed as ordered for 1 (Resident 140) of 1 sampled resident, failed to maintain wheelchair positioning for 1 (Residents 62) of 2 sampled residents, and failed to ensure Dycem (a material used to prevent sliding) was placed on wheelchair, scoop mattress provided, failed to unsure the recommeded lift was used during transfers, and did not provide built up silverware for 1(Resident 34) of 1 sampled residents. The total facility census was 207.

Inspectors wroteLicensure Reference 175 NAC 12-006.12E1 Based on observations, interviews and record review, the facility failed to ensure that medications were secured in a locked compartment for 1 (Resident 92) of 1 sampled resident for medication storage. The facility census was 207.