Keystone Ridge Post Acute Nursing and Rehabilitati

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11 (A)(iv) Based on observation, record reviews and interviews, the facility failed to follow physician ordered diets for 1 (Resident 9) of 5 sample residents. The facility identified a census of 71.

Inspectors wroteLicensure Reference Number; 175 NAC 12-006.18Based on observation, record review and interview the facility failed to implement Enhanced Barrier Precautions for 2 (Resident 6 and 7) of 5 residents sampled , and failed perform hand hygiene between gloving for 1 resident (Resident 7) of 4 sampled residents, and failed perform peri care and catheter care in a manor to prevent cross contamination for 1 (Resident 7) of 4 residents sampled. The facility staff identified a census of 71.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.11(E) Nebraska Food Code 2017 4-602.13; 6-201.11 Based on observation, interview and record review; the facility failed to maintain the dual ovens, kitchen stand mixer, and floor in a manner to prevent food borne illness. This had the potential to affect all 69 residents that ate food prepared in the facility kitchen. The facility staff identified a census of 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.07C Based on record review and interviews; the facility failed to ensure the Quality Assurance Performance Improvement Program [QAPI, a facility process that identifies problems in the facility and works to correct the concerns] identified and addressed concerns related to deficient practice identified on the annual survey 2025 ( F 584, F 791, F 812, F 865 and F880) and to ensure correction for repeat deficient practice from previous surveys (March 2023 and May 2024 for F 584 and May 2024 survey for F 812) was maintained. This had the potential to affect 69 residents that resided in the facility. The facility census was 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.19(A) Based on observation and interview, the failed to maintain the cleanliness and condition of fixtures, doors, walls, ceilings, baseboards, door jams, curtains, grip strips, lights, beds and odor control in 17 (rooms 511, 514, 516, 518, 520, 525, 528, 5099, 5101, 5102, 5104, 5105, 5106, 5109, 5115, 5119, 5126) of 41 occupied resident rooms. The facility had a total of 50 rooms and the facility census was 69.

Inspectors wroteLicensure Reference Number 175NAC 12-006.15 (A) &(B) Based on record reviews and interviews, the facility failed to assist residents in making a dental appointment. This had the potential to affect 2 (Resident 11 and Resident 5) out of 2 residents sampled. The facility staff identified a census of 69.

Inspectors wroteLICENSURE REFERENCE NUMBER 12-006.18(B) Based on observation, interview, and record review; the facility failed to store a urinary catheter drainage bag in a manner to prevent cross-contamination for 1 (Resident 66) of 2 sampled residents; and failed to disinfect the glucometer during blood glucose checks. This had the potential to affect 1 (Resident 16) of 2 sampled residents. The facility staff identified a census of 69.

Inspectors wroteLicensure reference: 175 NAC 12-006.04(F)(i)(5). Based on record review and interview, the facility failed to ensure medical provider was notified of blood pressures outside of established parameters for 1 [Resident 6] of 10 sampled residents. The facility had a total census of 67 residents.

Inspectors wroteBased on record review and interview, the facility failed to report and submit an investigation of potential neglect for 1 [Resident 1] of 10 sampled residents. The facility had a total census of 67 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on record review and interview, the facility failed to complete INR monitoring tests to ensure therapeutic dosing of Coumadin for 1 [Resident 1] of 1 sampled resident requiring INR monitoring. The facility Administrator and Director of Nursing was notified on 10/9/24 at 5:00 PM of an Immediate Jeopardy (IJ) which began on 7/10/24. The IJ was removed on 10/9/24, as confirmed by surveyor onsite verification.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D) Based on record review and interview, the facility failed to ensure medications were administered in accordance with physician orders for 2 [Residents 1 and 4] of 4 sampled residents which resulted in significant medication errors. The facility Administrator and Director of Nursing was notified on 10/9/24 at 5:00 PM of an Immediate Jeopardy (IJ) which began on 7/10/24. The IJ was removed on 10/9/24, as confirmed by surveyor onsite verification.

Inspectors wroteLicensure Reference Number 175 NAC 006.09(H) Based on record review and interview, the facility failed to evaluate 1 (Resident 4) of 3 sampled residents following identification of an injury from unknown sources. The facility had a total census of 67 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D(l) Based on record review, interviews, and observations, the facility failed to implement assessed interventions to prevent potential injuries for 3 of 3 residents (Residents 1, 4, and 5). The facility identified a census of 65.

Inspectors wroteLicense Reference Number 175 NAC 12.006.04C2 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 03-31-2024 and 4-28-2024, which had the potential to affect all residents that reside in the facility. The facility census was 73.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11D Based on observation, interviews, and facility documentation review, the facility failed to prepare and serve food that is palatable, attractive and at a safe and appetizing temperature. This failure could place all residents who received food prepared in the facility kitchen at increased risk of exposure to food-borne illnesses. Total census was 73 and potentially affected all 73 residents. Observation on 5/01/2024 at 9:10 AM revealed [NAME] -E was preparing lunch meal for the facility residents. [NAME] -E had previously placed ham in 4 different pans and was observed adding brown sugar and pineapple on top of each ham. [NAME] -E placed foil over the top of the pans with ham and placed the ham into the oven. [NAME] -E performed hand hygiene for 12 seconds and applied gloves. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11E Based on observation, interviews, and facility documentation review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in accordance with professional standards for food service safety, in that foods were kept past their expiration date, and foods were not labels or dated when they were opened. The facility failed to ensure the food equipment and food preparation areas are clean and sanitized. This failure could place residents who received food prepared in the facility kitchen at increased risk of exposure to food-borne illnesses. Total census was 73 and potentially affected all 73 residents.

Inspectors wroteBased on record review and interview the facility failed to maintain staff documentation of offering the COVID 19 vaccine, education on COVID 19 vaccine, and the current Covid 19 vaccination status of 1 of 1 staff record audited. This has the potential to affect all the current residents in the facility. The facility reported a census of 73.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on observation and interview, the facility failed to maintain the cleanliness and condition of walls, floors, curtains, fixtures, ceiling tiles, ventilation covers, baseboards, doors and nightlight's in 23 (Rooms 511, 512, 513, 514, 516, 520, 521, 525, 526, 528, 5101, 5104, 5106, 5109, 5110, 5116, 5118, 5119, 5121, 5123, 5124, 5126 and 5128 ) of 43 total occupied resident rooms, the bath house on both levels of the facility, the activity room on the garden level of the facility, the walls across from the elevator and across the nurses station on the garden level and hand rails on both levels of the facility. The facility failed to ensure that rooms were homelike as evidenced by no closet doors present in 19 (Rooms: [...]

Inspectors wroteLicensure Reference Number 175 12-007.04D Based on observation and interview, the facility failed to ensure that ventilation systems were operational in resident bathrooms in 6 (rooms 5116, 5119, 5121, 5124, 5126, and 5128) of 43 occupied rooms in the facility. The facility census was 73.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(21) Based on observation and interviews, the facility failed to treat 2 of 2 sampled residents (Residents #36 and #8) with dignity, respect, and care that promotes maintenance and enhancement of the resident's quality of life while recognizing the individuality of each resident. The facility identified a census of 73.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(15) Based on observation and interview; the facility failed to ensure full visual privacy in 3 (resident rooms 511, 513 and 529) of 49 dual occupancy rooms as evidenced by no privacy curtains present that would surround the bed to ensure visual privacy from the doorway or the resident's roommate. This had the ability to affect 3 residents, Residents 8, 38 and 63, that resided in those rooms. The facility census was 73.

Inspectors wroteBased on record review and interview the facility failed to submit an abuse investigation to the state agency in 5 working days for 2 (Resident 61 and 80) of 7 residents. The facility staff identified a census of 73.

Inspectors wroteLicensure Reference Number 12-006.05(5) Based on record review and interview the facility failed to notify 1( Resident 43's and Resident 43's family representative) of 1 sampled in writing of the resident's transfer to the hospital. The facility had a census of 73.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D1C Based on record review, interview, and observation, the facility failed to provide bathing per resident preference for 1(Resident 4) of 3 sampled residents. The facility identified a census of 73.

Inspectors wroteLicensure Reference Number 175 NAC 12.006-18 Based on observation and interview, the facility failed to maintain the cleanliness and condition of electrical outlets, phone cord, walls, doors, baseboard trim, ceilings, toilet paper holders and lights in 16 (Resident rooms 511, 512, 513, 514, 515, 516, 517, 518, 519, 520, 522, 524, 527, 528, 5110 and 5128) of 46 occupied resident rooms. The facility census was 74.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D3 (1) Based on observation, interview and record review; the facility failed to provide catheter care in a manner that would prevent Resident # 50 from a potential urinary tract infection (UTI). The facility census was 74.