Omaha Nursing and Rehabilitation Center

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I)(i)(1). Based on observation, interview and record review, the facility failed to ensure fall interventions were implemented for 1(Resident 2) of 4 residents sampled. The facility census was 57.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)Based on observation, interview, and record review; the facility failed to implement pain management interventions during the provision of wound care for 1 (Resident 1) of 2 sampled residents. The facility staff identified a census of 50.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.06(D)Based on observation, interview, and record review; the facility failed to perform hand hygiene between glove changes during the provision of wound care for 1 (Resident 2) of 3 sampled residents. The facility staff identified a census of 50.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(I) Licensure Reference Number 175 NAC 12-006.09(I)(i)(1)Based on observation, interview, and record review, the facility failed to transfer a resident according to the plan of care resulting in a significant injury for 1 (Resident 32) of 1 resident sampled for transfers; and the facility failed to implement call interventions identified on the plan of care for 1 (Resident 68) of 3 residents sampled for falls. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10(D). Based on interview and record review the facility failed to ensure resident's were free of significant medication errors for 1 (Resident 47) of 5 residents sampled. The facility census was 64.

Inspectors wroteLicensure Reference Number NAC 175 12-006.19(A)Based on observations and interviews, the facility failed to ensure an intact door seal was present on a refrigerator in the kitchen, resulting in the potential for inconsistent food temperatures. This had the ability to affect 62 of 64 residents who ate food produced by the kitchen.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05 (G) The facility failed to ensure residents were free from chemical restraints for 1 (Resident 47) of 5 sampled residents. The facility census was 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)The facility failed to report a transfer which resulted in significant injury to the State Agency for 1 (Resident 32) of 1 resident sampled. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview, the facility failed to investigate a resident transfer which resulted in significant injury for 1 (Resident 32) of 1 resident sampled. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 (c)(ii)Based on interview and record review, the facility failed to perform a significant change assessment for 1 (Resident 44) of 21 sampled residents. The facility staff identified a census of 64. Record review of the Centers for Medicare and (&) Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User's (RAI) Manual dated October 2023 revealed: -A significant change is a major decline or improvement in a resident's status that: -1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, the decline is not considered self-limiting; -2. Impacts more than one area of the resident's health status; and -3. Requires interdisciplinary review and/or revision of the care plan. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(E)Licensure Reference Number 175 NAC 12-006.09(F)(iii)Based on observation, interview, and record review, the facility failed to develop a respiratory care plan including the use of a bilevel positive airway pressure (BiPAP, a technique that is used for relieving breathing problems (such as those associated with sleep apnea or congestive heart failure) by pumping a flow of air through the nose to prevent the narrowing or collapse of air passages or to help the lungs expand) non-invasive ventilator for 1 (Resident 65) of 1 sampled resident. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 12-006.09(H)(v)Based on observation, interview, and record review, the facility failed to implement interventions to prevent a potential decrease in range of motion for 1 (Resident 7) of 1 sampled resident. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iv)(1). Based on observation, interview and record review, the facility failed to perform catheter care in a manner to prevent cross contamination for Resident 9; and the facility failed to assess an indwelling catheter for continued use for Resident 7. The facility census was 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(vi)(3)(g)Based on observation, interview, and record review, the facility failed to obtain and implement physician's orders for the use of a continuous positive airway pressure (CPAP) non-invasive ventilator for 1 (Resident 65) of 1 sampled resident. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 The facility failed to notify the practitioner of irregularities identified in the admission medication regimen review for 1 (Resident 47) of 1 resident's sampled. The facility census was 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-005 (G) The facility failed to ensure residents were free of unnecessary medications for 1 (Resident 47) of 5 residents sampled. The facility census was 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17Based on record review and interview, the facility failed to maintain an accurate medical record for 1 (Resident 32) of 1 sampled resident. The facility staff identified a census of 64.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18B Based on observation, interview and record review, the facility staff failed to use Personal Protective Equipment (PPE (gowns, gloves, masks and face shields)), during cares for 2 (Resident 10 and Resident 16) of 2 sampled residents, which were both identified to require Enhanced Barrier Precautions (EBP (A form of infection control to minimize transmission of infectious disease).

Inspectors wroteNebraska Licensure Reference Number 175 NAC 12-006.09(H)Based on interview and record review, the facility failed to manage pain for 1 (Resident 5) of 4 sampled residents. The facility staff identified a census of 65.

Inspectors wroteNebraska Licensure Reference 175 NAC 12-006.12Based on interview and record review, the facility failed to ensure medications were available for 1 (Resident 5) of 4 residents sampled. The facility staff identified a census of 65.

Inspectors wroteNebraska Licensure Reference 175 NAC 12-006.09(H)Based on record review and interviews, the facility failed to evaluate the potential for allergy to medication for 2 (Resident 4 & 5) of 4 residents sampled. The facility staff identified a census of 65.

Inspectors wroteBased on record review and interview, the facility failed to ensure a signed Advance Directive Code Status Form was completed to confirm resident's directives for Cardiopulmonary Resuscitation (CPR, an emergency lifesaving procedure performed when the heart stops beating) for 1 [Resident 1] of 6 sampled residents. The facility had a total census of 63 residents.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(J)(i)(1) Based on observation, record review, and interview; the facility staff failed to evaluate and implement interventions to prevent significant weight loss for 1 (Resident 2) of 3 sampled residents. The facility staff identified a census of 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(1) Based on observations, record review, and interview; the facility staff failed to implement interventions to prevent the development of pressure ulcers for 1 (Resident 2 and 4) of 3 sampled residents. The facility staff identified a census of 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(l) Based on record review and interview; the facility staff failed to implement additional interventions to prevent falls for 1 (Resident 4) of 4 sampled residents. The facility staff identified a census of 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(iii) Based on record review and interview; the facility staff failed to complete background and registry checks for 2 of 5 employee file reviewed. The facility staff identified a census of 63.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iii)(3) Based on observation, record review and interview; the facility staff failed to follow practitioners orders for wound care for 1 (Resident 3) of 3 sampled residents. The facility staff identified a census of 60.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18B3 Licensure Reference Number 175 NAC 12-006.18A(1) Based on observation and interview, the facility failed to maintain walls, floors, resident equipment, fixtures, air conditioning and ventilation covers in a clean, safe and functional manner in 9 rooms (Rooms 231, 232, 234, 235, 236, 237, 238, 239, 240), which had the potential to affect 14 of 14 residents that utilized those rooms. The total number of occupied resident rooms on the second-floor north hallway, rooms 231 thru 240, was 9. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09D1b Based on record review and interview; the facility staff failed to to maintain functional ambulation for 1 (Resident 19), failed to follow up a audiology appointment for 1 (Resident 1) of a total sample of 4. The facility staff identified a census of 59.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.090 Based on observation, record review and interviews, the facility failed to ensure a resident received a complete dose of seizure medication as ordered for 1 (Resident 34) of 5 residents observed during medication administration. The facility census was 58.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.17B Based on observation, interview, and record review, the facility failed to follow the Enhanced Barrier Precautions (EBP) while preforming cares for Resident's 34,53 and 215 and failed to ensure an oxygen nasal cannula did not come in contact with the floor for Resident 3. The total sample size was 11 resident reviewed for infection control practices. The facility census was 58.

Inspectors wroteLicensure Reference 175 NAC 12.006.09 Based on observations, interviews and record review, the facility failed to implement interventions for pain management for 2 residents (Resident #4 and Resident #8) of 8 residents sampled. The facility census was 55.

Inspectors wroteLicensure Reference Number: 175 NAC 12-006.17D Based on observation, record review and interview, the facility staff failed to utilize handwashing and gloving techniques to prevent the potential for cross contamination for Resident #5 and while handling linen for Resident #6. The sample size was 8 and the facility identified a census of 55.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D7 Based on record review and interview; the facility staff failed to implement interventions to prevent elopement for 2 (Resident 31 and 50) of 2 sampled residents. The facility staff identified a census of 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12.006.09D2a Based on observation, record review and interview; the facility staff failed to ensure an air loss mattress was set to relieve pressure and failed to reposition for pressure relief for 1(Resident 16) of 3 sampled resident resulting in additional pressure ulcers. The facility staff identified a census of 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.09D8a Based on observation, record review and interview; the facility failed to ensure interventions were in place to prevent a significant weight loss and ensure hydration for 1 (Resident 16) of 4 sampled residents. The facility staff identified a census of 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.10D Based on record review and interview; the facility staff failed to ensure 2 (Resident 44 and 171) of 10 sampled residents were free of significant medication errors. The facility staff identified a census of 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC12-006.04D2 Based on record review and interview; the facility failed to ensure there was a qualified Dietary Manager (DM). This had the potential to affect 59 of 62 residents in the building. The facility staff identified a census of 62.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(15) Based on observation, record review and interview; the facility failed to ensure full visual privacy in 11 (resident rooms 103, 104, 105, 206, 207, 209, 224, 228, 229, 237, 238) of 20 dual occupancy rooms as evidenced by no privacy curtains present that would surround the bed near the doorway to ensure visual privacy from the doorway or the resident's roommate. The facility census was 62.

Inspectors wroteLicensure Reference Number 175 NAC 12.006-15 Based on observation and interview, the facility failed to ensure that resident rooms were home like with personal items in use in 5 (resident rooms 129, 130, 132, 136, 140) of 17 occupied resident rooms on the 1st floor of the facility. The facility census was 62.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B2 Based on record review and interview, the facility failed to ensure that residents' Minimum Data Set (MDS, a required comprehensive assessment of the resident used to create an individualized comprehensive care plan) assessments were completed within the required 14 days after the Assessment Reference Date (ARD, the last day of the observation period that the assessment covered for that resident) for 5 (Residents 26, 24, 43, 40 and 1) of 5 residents reviewed. The facility census was 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.02 Based on observations, record review, and interviews; the facility administration staff failed to ensure effective management of facility resources to maintain the highest practical wellbeing of residents and the facility environment as evidenced by failure to implement an effective plan of action to maintain correction for previously cited areas of deficient practice and failure to ensure the facility identified and developed plans of action to identify multiple issues of deficient practice. The facility staff identified a census was 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12-006.07C Based on record review and staff interviews; the facility Quality Assessment Performance Improvement Plan (QAPIP) failed to identify ongoing issues relevant to F550, F580, F609, F657, F676, F689, F712, F730, F755, F758, F761, F812, F835 and F867 and implement plans of action to identify and correct the deficient practice. The QAPI failed to ensure repeated deficiencies at F692 and F697 were corrected and the correction maintained. This deficient practice had the potential to affect all residents who reside in the facility. The facility staff identified a census of 92.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(21) Based on observation, record review and interview; the facility failed to ensure that resident's dignity was maintained for 2 (Resident 40 and 24) of 3 residents reviewed as evidenced by exposure of an incontinence brief and tube feeding bottles in visual sight in a common area of the facility for Resident 40 and the use of a sign on Resident 24's door that described personal hygiene care needs. The sign was in sight of visitors and other residents that passed by the room. The facility census was 62.

Inspectors wroteLICENSURE REFERENCE NUMBER 175 NAC 12.006-02(8) Based on record review and interview; the facility failed to report an elopement for 1 (Resident 50) of 1 sampled resident to the required state agency within the required time frame of 2 hours. The facility staff identified a census of 62.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(5) Based on record review and interview, the facility failed to ensure the resident and /or the resident's representative were notified in writing of the reason for transfer to the hospital for 1 (Resident 66) of 1 resident reviewed for hospitalization. The facility census was 63.

Inspectors wroteBased on record review and interview, the facility failed to ensure a new PASARR (Pre-admission Screening and Resident Review, a screening to determine the presence of a mental illness or intellectual disability) review had been completed after a diagnosis of a mental disorder was identified for 1 (Resident 19) out of 1 reviewed for PASARR. The facility census was 62.

Inspectors wroteLICENSE REFERENCE NUMBER 175 NAC 12.006.09D2 Based on observation, record review and interview; the facility failed to ensure geri sleeves (a protective covering for arms) were in place as ordered for 1 (Resident 43) of 2 sampled residents. The facility staff identified a census of 62.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17B Based on observation, record review and interview; the facility staff failed to apply personal protective equipment and perform hand hygiene and glove changes in a manner to prevent cross contamination for 1 (Resident 64) of 11 residents observed for personal care and wound cares. The facility census was 62.