Kimball County Manor

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E)Based on observation, record review, and interview, the facility failed to date stored foods, and failed to ensure proper hand hygiene was performed to prevent the potential for cross contamination and food borne illness.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(E) Based on record review and interview, the facility failed to obtain informed consents from the resident or their representative prior to the use of psychotropic medication for 5 (Residents 1, 6, 7, 8, & 31) of 5 sampled residents. The facility identified a census of 39. Findings Are: An interview on 6/23/26 at 1:20 PM with the facility Administrator revealed the facility did not have any policies specific to psychotropic medications and confirmed that the facility had not obtained informed consents prior to the administration of psychotropic medications for any residents who were currently prescribed psychotropic medications. A. A record review of Resident 1's Continuity of Care Document dated 6/24/2026 revealed the resident was admitted to the facility on [DATE]. [...]

Inspectors wroteLicensure reference number 175 NAC 12-006.09Based on record review and interview the facility failed to notify the provider of blood pressures being outside the set parameters per their order for 3 (Residents 5,6, and 31) of 5 sampled. The facility showed a census of 39Findings are: A. Record review of a facility policy with a revision date of 2/28/25 and a subject label of ' Notification of Physicians' revealed the following statements:The nurse will notify the resident's attending physician or physician on call when there has been:- specific instruction to notify the physician of changes in the residents condition-A significant change of condition is a major decline or improvement in the resident's status that: [...]

Inspectors wroteLicensure reference number 175 NAC 12-006.18 & (B) & 1-005.06 The facility failed to ensure hand hygiene was performed to prevent the potential for cross contamination during medication administration for 7 Residents (5, 25, 26, 32, 39, 40, and 43) of 7 residents medications administered. The facility showed a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(S) Based on observations, interview, and record review; the facility failed to preserve 1 (Resident 27) of 1 sampled resident's dignity by ensuring their catheter bag was concealed when in view of other residents. The facility identified a census of 39. Findings Are: A record review of facility policy Resident Dignity Policy with a review date of 5/15/26 revealed the facility would maintain an environment that preserved each resident's dignity. A record review of Resident 27's Continuity of Care Document dated 6/23/2026 revealed the resident was admitted to the facility on [DATE]. A record review of Resident 27's undated Care Plan revealed the resident required an indwelling urinary catheter related to urinary retention. This section of the Care Plan contained an intervention stating, store collection bag inside a protective, dignity pouch. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on record review and interview, the facility failed to ensure 1 (Resident 1) of 5 sampled residents did not suffer adverse consequences from their psychotropic medication as evidenced by increasing Abnormal Involuntary Movement Scale (AIMS, a brief, 12-item clinician-rated examination used to detect and measure the severity of tardive dyskinesia (TD, a neurological movement disorder that causes uncontrollable, repetitive muscle movements, usually in the face, lips, jaw, and tongue)) assessment scores. The facility census was 39. Findings Are: An interview on 6/23/26 at 1:20 PM with the facility administrator revealed the facility did not have any policies specific to the use or monitoring of psychotropic medications. [...]

Inspectors wroteBased on record review and interview, the facility failed to notify the Ombudsman (a state official who works with nursing home and assisted living residents who helps answer resident concerns and complaints and advocates for resident rights and their well-being) of 1 (Resident 47) of 1 sampled resident's discharge from the facility. The facility census was 39. Findings Are: A record review of Resident 47's Interdisciplinary Discharge Summary revealed the resident was admitted to the facility on [DATE] following a right hip fracture. The document revealed the resident was later discharged from the facility on 4/1/2026 to their family home. A record review of Resident 47's medical records revealed no evidence of the Ombudsman being notified of their discharge from the facility. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure an antibiotic was clinically indicated for 1 (Resident 42) of 1 sampled resident. The facility identified a census of 39. Findings Are: A record review of facility policy Antibiotic Stewardship Program with a review date of 2/14/19 revealed the facility's antibiotic stewardship program promotes the appropriate use of antibiotics and a system of monitoring to improve resident outcomes and reduce antibiotic resistance. Antibiotics will be prescribed for the correct indication, dose, and duration to appropriately treat the resident while attempting to reduce the development of antibiotic-resistant organisms or other adverse consequences or outcomes. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(G) Licensure Reference Number 175 NAC 12-006.09(I) Based on record reviews and interviews, the facility failed to determine the root cause of every fall incident, implement interventions that prevented recurrence of falls related to the identified causes, and develop and implement new interventions after subsequent falls occurred for 3 (Residents 1, 2, and 3) of 3 sampled residents. The facility identified a census of 38.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05 (H) Based on observation, record reviews, and interviews, the facility failed to protect 1 (Resident 39) of 1 sample resident after receiving an allegation of staff-to-resident abuse. The facility identified a census of 39. The facility was notified on 4/15/2025 at 5:00 PM of an Immediate Jeopardy (IJ) which began on 4/11/2025. The IJ was removed on 4/15/2025, as confirmed by the surveyor's onsite verification.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(iii) Based on record reviews and interviews, the facility failed to implement their policies and procedures related to screening potential employees prior to employment for 3 [Housekeeper (HSKPG) - U, Actvities Supervisor (AS) - S, and Dietary Aide (DA) - T] of 5 sampled employees. This had the potential to affect all residents who reside within the facility. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii)(1) Based on record reviews and interviews, the facility failed to ensure 5 [Nurse Aide (NA) - P, NA-L, NA-O, NA-N, and NA-K] of 5 sampled nurse aides (NA) had completed at least 12 hours of ongoing training annually based upon their employment date as required. This had the potential to affect all residents who reside within the facility. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number NAC 175 12.006.18 Based on observations and interviews the facility failed to develop Enhanced Barrier Precautions (EBP) policies and procedures and implement EBP for Residents 10, 21, and 27. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(i) Based on record reviews and interviews, the facility failed to ensure each employee received initial orientation within 2 weeks after beginning employment on topics of resident rights, emergency procedures, adult abuse/neglect and training on medical emergency directives and dementia for nursing staff as required for 11 [Nurse Aide (NA) - Q, NA-R, Housekeeper (HSKPG) - U, Activities Supervisor (AS) - S, NA-D, NA-E, NA-F, NA-G, NA-H, and NA-I] of 12 sample employees. This had the potential to affect all residents residing within the facility. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii) Based on record reviews and interview, the facility failed to ensure nurse aides had completed at least 4 hours of dementia training annually as required for 5 [Nurse Aide (NA) - K, NA-O, NA-P, NA-L, and NA-N] of 5 sample employees. This had the potential to affect all residents who reside within the facility. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H) Nebraska Revised Statute 28-372 Based on record review and interview, the facility failed to A) immediately investigate and report an allegation of staff-to-resident abuse within 24 hours of the allegation being made and B) submit an investigation to the State Agency (SA) within 5 working days of the incident for 1 (Resident 39) of 1 sample resident. The facility identified a census of 39.

Inspectors wroteLicensure Reference 175 NAC 12-006.09(E) The facility failed to develop a Comprehensive Care Plan (CCP, a document that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment (CCP) regarding Resident 16's primary diagnoses and high-risk medications and develop and implement a Comprehensive Care Plan including non-pharmacological interventions related to Resident 25's behavioral and emotional well-being. This affected 2 of 12 sampled residents. The facility identified a census of 39.

Inspectors wroteLICENSURE REFERENCE NUMBER 175-12 006.09(G)(i) Based on record review and interviews, the facility failed to document a recapitulation (a complete summary of resident stay in nursing facility from admittance to discharge) for a resident-initiated discharge for one (Resident 40) of one sampled resident. The facility identified a census of 39.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H) Based on record reviews and interviews, the facility failed to attempt the use of appropriate alternatives prior to the installation of bed rails (adjustable metal or rigid plastic bars that attach to the bed. They are available in a variety of types, shapes, and sizes ranging from full to one-half, one-quarter, or one-eighth lengths. Synonymous terms are side rails, bed side rails, and safety rails) as required for 1 (Resident 39) of 1 sample resident. The facility identified a census of 39.

Inspectors wroteLicensure Reference 175 NAC 12-006.09(H) Based on interviews and record reviews, the facility failed to ensure a gradual dose reduction was attempted for psychotropic medications for 1 (Resident 25) of 5 sampled residents. The facility identified a census of 39.

Inspectors wroteLicensure Reference 175 NAC 12-006.11E Based on observations, interviews, and record reviews, the facility kitchen staff failed to utilize handwashing and gloving techniques to prevent the potential for cross contamination during meal preparation. This had the potential to affect all 41 residents who ate from the kitchen. The facility census was 41.

Inspectors wroteLicensure Reference 175 NAC 12-006.17D. Based on observations, record review and interviews, the facility failed to implement hand hygiene during the distribution of resident laundry and during medication administration. This had the potential to affect all residents. The facility census was 41. The Findings Are: A. An observation on 5/6/2024 from 7:23 AM through 7:35 AM revealed Laundry Aide (LA)-G distributing personal laundry to resident rooms. LA-G pushed a rolling cart to room [ROOM NUMBER], took folded laundry from the basket section of the cart and knocked on the door of room [ROOM NUMBER]. The resident told LA-G to come back later, so LA-G took the laundry back to the cart. LA-G then pushed the cart up the hallway and then removed hanging shirts from the cart. [...]

Inspectors wroteLicensure Reference Number 172 NAC 12-006.17A(3) Based on record review and interviews, the facility failed to implement an antibiotic stewardship program. This had the potential to affect all residents who resided within the facility. The facility census was 41. The Findings Are: A record review of facility policy Antibiotic Stewardship Program with last review date of 2/27/23, revealed in the Procedure section #5 If indicated, based upon criteria, an antibiotic is ordered, the practitioner will identify the diagnosis/indication, the appropriate antibiotic, proper dose, duration and route. The policy also revealed in #10. Nursing will track antibiotic use and monitor adherence to evidence-based criteria including: a. Documentation related to antibiotic selection and use, b. [...]

Inspectors wroteBased on interviews and record review, the facility failed to obtain an end date or obtain rationale for the continued use of antibiotics for Urinary Tract Infections (UTIs) for Resident 8 and 28 and for history of eye infections for Resident 39. This affected 3 (Resident 8, 28, and 39) of 3 sampled residents. The facility census was 41.

Inspectors wroteLicensure Reference 175 NAC 12-006.10D Based on observations, interviews, and record reviews, the facility failed to ensure the medication error rate was less than 5% for 4 (Residents 5, 29, 32 and 38) of 8 sampled residents. Observations of 27 medication administered revealed 4 errors resulting in an error rate of 14.81%. The facility census was 41.

Inspectors wroteBased on record review and interviews, the facility failed to ensure 1 (Resident 39) of 3 sampled residents' advance directive was added to their electronic health record. The facility census was 41. The Findings Are: A record review of Resident 39's paper medical chart, located in a room next to the nurse's station, revealed the resident had an advance directive indicating they did not want resuscitation (DNR). A record review of Resident 39's Electronic Health Record (EHR) revealed the statement no advanced directive on file for this resident. An interview on 5/2/2024 at 10:40 AM with Nurse Aide (NA)-E confirmed the staff would look at the resident's MAR (medication administration record), which was located in the EHR, to find out whether the resident was a DNR. [...]

Inspectors wroteLicensure Reference 175 NAC 12-006.09D7 Based on observations, interviews and record reviews, the facility failed to ensure the use of two-persons while utilizing a Hoyer lift for 1( Resident 8) and failed to ensure the oxygen concentrator was turned off when not in use for 1( Resident 35) of 5 sampled residents . The facility census was 41.

Inspectors wroteLicensure Reference 175 NAC 12-006.09D6 Based on observation, record review, and interview the facility failed to ensure oxygen was administered per the physician's orders for 2 (Residents 13 and 35) of 3 sampled residents. The facility census was 41.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on record review and interview, the facility failed to provide a pneumococcal immunization for 1 (Resident 35) of 5 sampled residents. The facility census was 41. The Findings Are: A record review of facility policy Influenza & Pneumococcal Vaccines dated 2/23/23 revealed in the Procedure section, #1. On admission, residents will be interviewed as to immunization status. If pneumococcal vaccine has not been given, the resident/resident representative will be instructed as to the advisability of vaccination, and vaccination shall be given with an order from the physician and resident/resident representative permission, unless contraindicated. #3. If the history of pneumonia or influenza immunization status is unknown, Social Services/Nursing will contact the physician clinic for further records prior to giving the immunization. [...]

Inspectors wroteBased on record review and interview, the facility failed to provide a COVID-19 immunization for 1 (Resident 38) of 5 sampled residents. The facility census was 41.