Hilltop Estates

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11Based on record review, observation, and interview the facility failed to follow the menus and recipes to ensure that residents were receiving the required nutritional intake during meals. This affected all residents eating meals from the kitchen. The facility census was 39. Record review of the facility policy The Dining Experience; Staff Responsibilities copyright dated 2013 revealed the goals of the dining experience are to enhance the individual's quality of life through person centered dining: providing nourishing, palatable, and attractive meals that meet the individual's daily nutritional needs. The food service manager will perform meal rounds routinely to determine if the meals are timely, attractive, nutritious, and meet the needs of the individual. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E) Based on record review, observation, and interview, the facility failed to perform handwashing when working with foods, failed to perform temperature checks of the facility's kitchen refrigerator and freezer units, and failed to maintain potentially hazardous foods at the appropriate temperature. This affected all residents in the facility. The facility census was 39. A. Record review of the facility policy Hand Hygiene dated June 2022 revealed that all staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel residents and visitors. This applies to all staff working in all locations with in the facility. Hand Hygiene is defined as a general term for cleaning your hands by handwashing with soap and water or the use of an antiseptic hand rub, also known as alcohol based hand rub. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05 (D)(E)Based on record review and interview the facility failed to ensure that all residents and/representatives were given the risks and benefits of psychotropic medications prior to the first dose of a medication or when the psychotropic medication dosage was increased. This affected 3 of 5 sampled residents (Resident 2, 21, and 26). The facility census was 39. Record review of the facility policy dated 6/2026 revealed that it is the intent of the policy to ensure residents only receive psychotropic medications when other non-pharmacological interventions are clinically contraindicated. Additionally, these medications should only be used to treat the resident's medical symptoms and not used for discipline or staff convenience, which would deem it a chemical restraint. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(c)(ii)Based on record review and interview the facility failed to complete a Significant Change 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) Assessment with in 14 days of a identified significant status change for 2 (Resident 6 and Resident 43) of 12 sampled residents. The facility census was 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-00.09 (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 2 residents (Resident 6 and Resident 43) of 12 sampled residents. The facility census was 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on record review, observation, and interview the facility failed to complete glucometer control testing per manufacturer recommendations for 2 residents (Resident 4 and Resident 6), Failed to provide cares of a PICC (peripherally inserted central catheter) line (a long, thin, flexible tube inserted into a vein in the upper arm and threaded to a large vein near the heart) per professional standards of practice for 1 resident (Resident 6), failed to follow provider orders for performing flushing of a PICC line for 1 resident (Resident 6), failed to ensure orders for the administration of an intravenous medication contained components directing reconstitution and duration of administration of administering an intravenous medication for 1 resident (Resident 6). The facility census was 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.12(D)(vii)Based on observation, record review, and interview the facility failed to dispose and or destroy a medication in a manner in compliance with applicable state and federal requirements for 1 resident (Resident 21) of 3 residents. The facility census was 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18Based on observation, record review, and interviews, the facility failed to dispose of items of regulated waste (items potentially or contaminated with blood or other potentially infectious material) in a manner consistent with manufacturer and facility policy for 2 residents (Resident 21 and Resident 6) of 2 sampled residents. The facility census was 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E) Based on observations and interviews, the facility failed to ensure the walk-through refrigerator maintained safe temperatures and failed to ensure the dishwashing machine reached the required temperatures during cycles to prevent the potential for foodborne illness. This had the potential to affect all facility residents eating out of the kitchen. The facility census was 44. Findings Are: A. A record review of the Nebraska Food Code, dated 2017, revealed ready to eat foods should be held at a temperature of 41 degrees Fahrenheit (F) or below. On 03/12/2025 at 8:44 AM an initial observation of the kitchen revealed a walk-through refrigerator with a temperature log labeled March with annotations of greater than 41 degrees F on the following dates: -On March 5th: 42, -On March 9th: 42, -On March 11th: 45. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B) Licensure Reference Number 175 NAC 12-006.04(A)(ii) Based on observation, record review, and interview the facility failed to ensure an insulin pen tip was cleansed prior to use for 1 (Resident 20) of 1 sampled resident, ensure the glucometer was disinfected after use for 1 (Resident 20) of 1 sampled resident, and failed to ensure an employee health screening was completed and reviewed for 2 of 5 sampled staff. The facility census was 44.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on observation interview and record review the facility failed to observe 1 (Resident 41) of 1 sampled resident for changes in their psychosocial or mood state and failed to monitor the resident for adverse effects from their psychotropic medication in accordance with the resident's plan of care. The facility census was 44.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D) Based on observation, interview, and record review the facility failed to maintain a medication error rate of 5% or less with an actual medication error rate of 12%. This affected 2 residents (Resident 9 and Resident 37) of 4 sampled residents. The facility census was 44.

Inspectors wroteLicensure Reference Number 175NAC 12-006.11E Based on observations, record reviews and interviews, the facility failed to ensure that the high temperature dishwashing machine maintained the required high temperature for sanitization of facility dishware. This affected all 43 facility residents that receive meals out of the facility kitchen. The facility census was 43.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on observation, interview, and record review the facility failed to follow transmission-based precautions to prevent the spread of communicable disease. This had the potential to affect 43 residents. Facility stated census was 43.

Inspectors wroteBased on record review, observation, and interview the facility failed to ensure the Advanced Beneficiary Notice of Non-Coverage (a required notice of the cost of continuing to receive skilled services) and the Notice of Medicare Non-Coverage (a required notice allowing the resident to appeal the facility decision to end Medicare Part A coverage) was given to a beneficiaries at least two days prior to the end of covered services which affected 1 (Resident 29) of 3 sampled residents. The facility census was 43.