Mid-Nebraska Lutheran Home

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H) Based on record review and interview; the facility failed to report, to investigate and then to submit the results of the investigation to the required state agency, an allegation of potential neglect for 1 (Resident 3) of 3 sampled residents. The facility census was 35.

Inspectors wroteNumber of residents sampled: 5Number of residents cited:4 Licensure Reference Number 175 NAC 12-006.12Based on record review and interview; the facility failed to have signed informed consent in advance for the use of psychotropic medications (medications which alter consciousness, mood and thoughts) for Residents 1, 2, 11, and 21. The sample size was 5 and the facility census was 30.

Inspectors wroteLicense Reference Number: 175 NAC 12-006.18(A)Based on record review and interviews; the facility failed to offer and/or provide the influenza vaccine to Resident 14 and to ensure Residents 11 and 22 were offered and/or provided the pneumococcal vaccine and the residents were educated about the risks and benefits associated with the vaccines. The sample size was 5 and the facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on observation, record review and interview; the facility failed to report an injury of unknown origin for 1 (Resident 8) of 2 sampled residents. The facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on observation, record review and interview; the facility failed to complete an investigation and report the results of the investigation to the State Agency for an injury of unknown origin for 1 (Resident 8) of 2 sampled residents. The facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on observation, record review and interview; the facility failed to identify a change of condition for 1 (Resident 1) of 1 sampled resident. The facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05Based on record review and interview; the facility failed to ensure Resident 21 had a resident specific rationale as to why a Gradual Dose Reduction (GDR) was not attempted for psychotropic medications (medications which alter consciousness, mood and thoughts). The sample size was 5 and the facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18Based on observation, record review and interview; the facility failed to wash hands and change gloves at appropriate intervals during the preparation of medication for administration for Resident 9. The facility census was 30.

Inspectors wroteLicense Reference Number: 175 NAC 12-006.18(A)Based on record review and interviews; the facility failed to provide evidence 2 (Residents 11 and 22) of 5 sampled residents were offered the COVID-19 vaccine and/or were educated about the risks and benefits associated with the vaccine. The facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on record review and interviews; the facility failed to notify Resident 1's Primary Care Practitioner of changes in the resident's condition related to behaviors, increased confusion, and back pain. The sample size was 5 and the facility census was 30.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D Based on record review and interviews; the facility failed to monitor and to assess Resident 1 for a change of condition after a fall with injury. The sample size was 4 and the facility census was 30.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09(I)(i). Based on record review and interview; the facility failed to identify causal factors and to revise and/or develop additional interventions for the prevention of ongoing falls for Resident 29 and falls with injury for Resident 135. The sample size was 5 and the facility census was 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on record review and interview, the facility failed to ensure Resident 4's antibiotic ointment use had an ordered duration to prevent potential adverse outcomes. The sample size was 5 and the facility census was 34.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.12E1 Based on observation, record review and interview; the facility failed to provide safe storage of drugs and biological's as a medication cart was left unlocked and unattended, and medications were left unsecured in Resident 21's room. The sample size was 6 and the facility census was 34.

Inspectors wroteBased on record review and interview: the facility failed to submit their Payroll Based Journal (PBJ) data for quarter 3 of 2024 as required. This had the potential to affect all residents residing within the facility. The facility identified a census of 34.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04C3a(6) Based on record review and interview, the facility failed to notify the physician of a significant change for Resident's 8 and 29. The sample size was 18 and the facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on interview and record review; the facility failed to ensure the designated Infection Preventionist (IP-staff who looks for patterns, observes and educates staff on infection control and compiles infection data) met the required qualifications for the position and was not the Director of Nursing (DON) . This had the potential to affect all residents. The total sample size was 18 and the census was 33. A. Review of the facility policy Infection Preventionist with a revision date of 9/22 revealed the following responsibilities were identified for the role: -coordinates the development and monitoring of infection prevention and control program; -reports information related to compliance with the infection prevention and control program to the Administrator and the Quality Assurance team; [...]

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.10A3 Based on record review and interview; the facility failed to ensure staff had the required certification when administering medications for 1 Medication Aide (MA-S). The total sample size was 18 and the facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09A Based on record review and interview, the facility failed to ensure Resident 14's Pre-admission Screening and Resident Review (PASRR-screening used to determine if a person had or was suspected of having Mental Illness (MI), Intellectual Disability (ID) or a Related Condition (RC)) was completed accurately. The sample size was 6 and the facility census was 16.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7(a) (b) Based on record review and interview; the facility failed to identify causal factors, to develop new interventions and/or revise current interventions to prevent ongoing falls for 2 (Residents 10 and 19) of 4 sampled residents. The facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12.006019D Based on record review and interview, the facility failed to ensure that PRN (as needed) orders for psychotropic (any drug capable of affecting the mind, emotions, and behavior) drugs are limited to 14 days or have a duration documented by the prescriber for 1 sampled resident (Resident 85). Facility census was 33 and the sample size was 5.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on record review and interview the facility failed to prevent the potential spread of COVID-19 by not testing Residents 8 and 29 when potential symptoms of COVID -19 were present. The sample size was 16 and the facility census was 33.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04A3b Based on record review and interview, the facility failed to ensure background checks through the state nurse aide registry were completed on 3 of 5 employees. The facility census was 33.