Inspection Reports for Brookefield Park
1405 Heritage Drive, ST PAUL, NE, 68873
Back to Facility ProfileDeficiencies (last 12 years)
Deficiencies (over 12 years)
3.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
21% better than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
87% occupied
Based on a July 2018 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Mar 13, 2025
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related renewal certification for Brookefield Park, verifying the facility's license renewal and compliance with statutory requirements.
Findings
The documents confirm that Brookefield Park meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specialized care services including Alzheimer's/Special Care Unit, Occupational Therapy, Physical Therapy, and Speech Therapy. No deficiencies or inspection findings are reported.
Report Facts
Total licensed beds: 70
Maximum Capacity for Alzheimer's Beds: 15
Renewal application date: Mar 13, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sawyer Boddy | Administrator | Named as Administrator on Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure |
| Sarah Rasmussen | Director of Nursing | Named as Director of Nursing on Nursing Home Licensure Renewal Application |
| Brian Stuhr | Authorized Representative | Signed Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure |
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Mar 23, 2023
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification and disclosure forms for Brookefield Park, verifying licensure renewal and compliance with statutory requirements.
Findings
The documents confirm the renewal of licensure for Brookefield Park Skilled Nursing Facility with a licensed capacity of 70 beds, including special care and treatment for Alzheimer's and memory care. The facility meets statutory requirements and includes detailed disclosures about memory care philosophy, staffing, training, and environmental considerations.
Report Facts
Licensed beds: 70
Maximum capacity for Alzheimer's beds: 15
Renewal application date: Mar 23, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Foxworthy | Administrator | Named as facility administrator on renewal application and Alzheimer's disclosure. |
| Theresa Jorgensen | Director of Nursing | Named as Director of Nursing on renewal application. |
| Brian Stuhr | Authorized Representative | Signed renewal application and Alzheimer's disclosure as authorized representative. |
| Glenn Van Ekeren | Authorized Representative | Signed renewal application as authorized representative. |
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Mar 1, 2021
Visit Reason
This document is a Nursing Home Licensure Renewal Application and related licensing and certification documents for Brookefield Park nursing home, indicating renewal of the facility's license and certification.
Findings
The documents certify that Brookefield Park meets statutory requirements for licensure and renewal as a Skilled Nursing Facility/Nursing Facility with special care units. The renewal application confirms the facility's capacity, ownership, and services offered, including Alzheimer's and special care units.
Report Facts
Total licensed beds: 70
Maximum capacity for Alzheimer's beds: 15
Renewal license fee: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named as administrator on the renewal application and Alzheimer's Special Care Unit Disclosure. |
| Briton Thomas | Director of Nursing | Named as Director of Nursing on the renewal application. |
| Jack D. Vetter | Authorized Representative | Signed the renewal application and Alzheimer's Special Care Unit Disclosure as authorized representative. |
| Glenn Van Ekeren | Authorized Representative | Named as authorized representative on the renewal application and listed as President on corporate documents. |
| Julie Knobbe | Contact | Named as contact on Alzheimer's Special Care Unit Disclosure. |
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Mar 16, 2020
Visit Reason
This document is a renewal licensure application and certification for Brookefield Park Nursing Home, verifying licensure renewal and compliance with statutory requirements.
Findings
The document certifies that Brookefield Park meets statutory requirements for SNF/NF dual certification and includes detailed information about the Alzheimer's Special Care Unit, staffing, training, environmental considerations, resident activities, family support, and fees.
Report Facts
Total licensed beds: 70
Maximum Capacity for Alzheimer’s Beds: 15
Renewal application date: Mar 16, 2020
Renewal licensure fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jack D. Vetter | Authorized Representative, Chairman of the Board and CEO | Named as authorized representative signing the renewal application and listed as Chairman of the Board and CEO in corporate documents. |
| Brenda Ewers-Nordhues | Administrator | Named as Administrator of Brookefield Park in the renewal application and Alzheimer's Special Care Unit Disclosure. |
| Angie Cornelius | Director of Nursing | Named as Director of Nursing in the renewal application. |
| Julie Knobbe | Contact Person | Named as contact person for Alzheimer's Special Care Unit Disclosure. |
| Glenn Van Ekeren | President | Listed as President in corporate documents. |
| Eldora D. Vetter | Secretary | Listed as Secretary in corporate documents. |
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Feb 28, 2019
Visit Reason
This document is related to the renewal of the facility license for Brookefield Park Nursing Home, as indicated by the renewal application and licensing information.
Findings
The document certifies that Brookefield Park meets statutory requirements for SNF/NF dual certification and includes detailed facility information, ownership, and services. It also outlines the facility's philosophy, staffing patterns, and care programs, particularly for memory support.
Report Facts
Total licensed beds: 70
Maximum endorsed capacity: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named as Administrator on page 2 and 6 |
| Jenny Pelster | Director of Nursing | Named as Director of Nursing on page 2 |
| Jack D. Vetter | Chairman of the Board and CEO | Named as Chairman of the Board and CEO of Vetter Senior Living on page 3 |
| Glenn Van Ekeren | President | Named as President of Vetter Senior Living on page 3 |
| Julie Knobbe | Contact Name | Named as contact for legal owning entity on page 6 |
Inspection Report
Annual Inspection
Census: 61
Capacity: 70
Deficiencies: 11
Jul 25, 2018
Visit Reason
Annual survey of Brookefield Park skilled nursing facility to assess compliance with state and federal regulations including resident care, safety, and facility operations.
Findings
The facility was found to have multiple deficiencies including inaccurate resident assessments, incomplete care plans, inadequate assistance with activities of daily living, failure to ensure accident-free environment, improper laboratory and food safety practices, infection control lapses, incomplete staff health screenings, missing discharge summary details, incomplete resident belongings inventory, and a damaged fire sprinkler head.
Severity Breakdown
SS=D: 5
SS=E: 3
SS=F: 1
O: 3
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to document wandering behaviors and anticoagulant use on residents' MDS assessments. | SS=D |
| Failed to update care plan to reflect resident's current status including eye infection interventions. | SS=D |
| Failed to provide toileting assistance as per resident's care plan. | SS=D |
| Failed to ensure resident was free from accident hazards during sit to stand lift transfers; waist strap not tightened causing discomfort and potential hazard. | SS=D |
| Failed to document date opened on glucose meter test solution bottles. | SS=E |
| Failed to serve food at meals to prevent potential foodborne illness by improper handling of serviceware. | SS=E |
| Failed to follow hand hygiene and infection prevention standards during peri-care and glove changes, risking cross-contamination. | SS=D |
| Failed to complete health history screening for one employee prior to job responsibilities. | O |
| Failed to include time of death in resident discharge summary. | O |
| Failed to maintain complete inventory of resident belongings. | O |
| Damaged fire sprinkler head outside facility under canopy not replaced, increasing risk of fire suppression failure. | SS=F |
Report Facts
Deficiencies cited: 12
Facility census: 61
Total licensed capacity: 70
Glucose meter test solution discard timeframe: 90
Random audit frequency for MDS assessments: 1
Random audit frequency for toileting time per care plan: 3
Random audit frequency for toileting time per care plan: 1
Random audit frequency for sit/stand transfers waist strap tightening: 3
Random audit frequency for sit/stand transfers waist strap tightening: 1
Random audit frequency for food serviceware handling: 3
Random audit frequency for food serviceware handling: 1
Random audit frequency for infection control glove changes and hand hygiene: 3
Random audit frequency for infection control glove changes and hand hygiene: 1
Random audit frequency for discharge summaries: 1
Random audit frequency for resident belongings inventory: 1
Fire sprinkler visual safety rounds: 1
Fire sprinkler visual monthly checks: 1
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Jul 1, 2017
Visit Reason
The document set relates to the renewal of the Skilled Nursing Facility license for Brookefield Park due to a change of ownership effective July 1, 2017.
Findings
The documents include the license renewal, change of ownership application, Alzheimer's Special Care Unit Disclosure, facility floor plans, occupancy permit, room and service charges, lease agreement, and related correspondence. The facility is licensed for 70 beds and includes a specialized Memory Support Household for residents with dementia.
Report Facts
Total licensed beds: 70
Memory Support Household maximum capacity: 15
Daily room rates: 166
Daily room rates: 185
Daily level of care rates: 25
Daily level of care rates: 34
Daily level of care rates: 46
Daily level of care rates: 54
Daily level of care rates: 64
Daily level of care rates: 73
Memory support daily rate: 10
Transportation local area: 11
Transportation attendant fee: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named as facility administrator in licensure application and correspondence. |
| Sarah Rasmussen | Director of Nursing | Named as Director of Nursing in licensure application. |
| Julie Knobbe | Contact | Contact person for ownership entity VSL St Paul, LLC. |
| Jack D. Vetter | Chairman of the Board and CEO | Named as Chairman and CEO of Vetter Senior Living, parent entity. |
| Eldora D. Vetter | Secretary | Named as Secretary of Vetter Senior Living. |
| Glenn Van Ekeren | President | Named as President of Vetter Senior Living and signatory on lease. |
| Brian Stuhr | Treasurer | Named as Treasurer of Vetter Senior Living. |
| Shari Terry | Chief Operations Officer | Signed cover letter submitting change of ownership packet. |
Inspection Report
Annual Inspection
Census: 57
Capacity: 70
Deficiencies: 12
Jun 12, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Brookefield Park on June 12, 2017-June 15, 2017, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to be in compliance with complaint allegations related to CPAP use and resident dignity. However, deficiencies were identified including failure to ensure resident bathing preferences, inaccurate MDS assessments related to skin tears, incomplete care plans, improper hand washing and glove use, food safety violations, infection control lapses, unclear medication orders, missing exit signage, lack of fire door maintenance, inadequate hazardous area enclosures, missing fire alarm notification appliances, and insufficient fire drill practices.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure staff were trained in CPAP use, failed to follow physician orders regarding CPAP, failed to treat residents with respect and dignity, and failed to allow family/residents to contact physician of choice. All allegations were found to be unsubstantiated with no violations.
Severity Breakdown
SS=D: 6
SS=E: 4
SS=F: 3
Deficiencies (12)
| Description | Severity |
|---|---|
| Failed to ensure residents received bathing frequency based on preference for 1 of 3 sampled residents. | SS=D |
| Failed to ensure accuracy of MDS related to skin conditions for 1 of 30 sampled residents. | SS=D |
| Failed to review and revise comprehensive care plan related to skin conditions for 1 of 30 sampled residents. | SS=D |
| Failed to ensure hand washing prior to working with ready to eat foods to prevent foodborne illness. | SS=E |
| Failed to provide hand washing and glove use according to infection prevention training during medication administration. | SS=D |
| Failed to maintain complete, accurate, and accessible medical records; unclear blood sugar parameters for 1 of 5 sampled residents. | SS=D |
| Failed to mark courtyard gates with exit signage for 3 of 3 courtyards. | SS=E |
| Failed to have a preventative maintenance plan to inspect and test fire doors annually. | SS=F |
| Failed to separate hazardous areas with smoke resistive partitions; unlatched furnace room doors and unsealed conduit. | SS=E |
| Failed to conduct monthly visual inspections for components of range hood suppression systems. | SS=F |
| Failed to provide fire alarm notification appliances in a common use room and at an interruption in view of an exit corridor. | SS=E |
| Failed to conduct fire drills quarterly under varying conditions spaced at least one hour apart on each shift and failed to activate fire alarm during a fire drill. | SS=F |
Report Facts
Facility census: 57
Licensed capacity: 70
Number of sampled residents: 30
Number of residents affected by bathing deficiency: 1
Number of residents affected by MDS deficiency: 1
Number of residents affected by care plan deficiency: 1
Number of residents affected by infection control deficiency: 1
Number of residents affected by glove use deficiency: 1
Number of residents affected by medication record deficiency: 1
Number of residents affected by exit signage deficiency: 15
Number of residents affected by hazardous area deficiency: 27
Number of residents affected by fire alarm notification deficiency: 4
Number of residents affected by fire drill deficiency: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Brenda Ewers-Nordhues | Administrator | Facility administrator named in report and signed staffing form |
| Maintenance A | Confirmed missing exit signage, unlatched doors, unsealed conduit, missing fire alarm notification appliances, and fire drill timing issues | |
| Licensed Practical Nurse Z | Confirmed presence of skin tear on Resident 82 | |
| Staff Q | Observed failing to wash hands properly in dietary | |
| Dietary Manager | Confirmed contaminated sink edge and dietary hand washing policy | |
| MA A | Medication Aide | Observed improper hand washing during medication administration |
| LPN B | Licensed Practical Nurse | Observed not wearing gloves during insulin administration |
| Director of Nursing | DON | Confirmed issues with MDS accuracy, glove use, hand washing, and medication orders |
| MDS Coordinator | Confirmed skin tear not identified on MDS |
Inspection Report
Renewal
Capacity: 70
Deficiencies: 0
Mar 2, 2017
Visit Reason
This document is related to the renewal of the nursing home license for Brookefield Park, including certification and compliance with statutory requirements for skilled nursing and nursing facility dual certification.
Findings
The documents include the renewal application, facility licensing, occupancy permit, and detailed descriptions of the Alzheimer's Special Care Unit and Memory Support Household philosophy, staffing, environment, and care practices. No deficiencies or enforcement actions are noted.
Report Facts
Total licensed beds: 70
Maximum endorsed capacity for Alzheimer's Special Care Unit: 15
Renewal application date: 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named in renewal application and Alzheimer's Special Care Unit Disclosure |
| Sarah Rasmussen | Director of Nursing | Named in renewal application |
| Jack D. Vetter | Authorized Representative | Signed renewal application and listed as President of Vetter Holding, Inc. |
| Julie A Knobbe | Contact for Heritage of St. Paul, Inc. | Named in Alzheimer's Special Care Unit Disclosure as contact for legal owning entity |
| Mark Manchester | Deputy State Fire Marshal | Named on occupancy permit inspection |
Inspection Report
Complaint Investigation
Census: 53
Deficiencies: 0
Dec 29, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to follow the plan of care to protect residents from injury.
Findings
The facility did follow the plan of care to protect residents from injury, and no violation was found. Care plans, observations, and interviews showed no concerns related to protecting residents from injury.
Complaint Details
The complaint alleged failure to follow the plan of care to protect residents from injury. The allegation was not substantiated as the facility complied with care plans and no concerns were identified.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and identified as the program manager overseeing the investigation |
Inspection Report
Complaint Investigation
Deficiencies: 0
Nov 21, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to protect residents from injury.
Findings
The facility failed to protect a resident from injury. Records were reviewed, staff interviewed, and observations made. Staff involved were disciplined and re-educated, and all staff received inservices on accident prevention. No deficiency was written.
Complaint Details
The complaint alleged the facility fails to protect residents from injury. The investigation found the facility failed to protect a resident from injury but took corrective actions immediately. No deficiency was cited.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and is the contact person for the investigation. |
Inspection Report
Complaint Investigation
Census: 59
Deficiencies: 0
Sep 21, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that the facility fails to put fall interventions into place to prevent injuries.
Findings
The facility did put fall interventions in place to prevent injuries, and no violation was found related to this issue after reviewing records, observing residents, and interviewing staff.
Complaint Details
The complaint alleged failure to implement fall interventions to prevent injuries. The investigation found no concerns and no violation related to this allegation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and responsible for the investigation |
Inspection Report
Complaint Investigation
Census: 62
Deficiencies: 3
Apr 12, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Brookefield Park from April 12, 2016 to April 18, 2016 by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to have no violations related to misappropriation or investigative reports not being completed within five days. However, deficiencies were cited related to expired medications and glucose test strips, and life safety code violations including fire safety door issues and fireplace hearth requirements.
Complaint Details
The complaint alleged the facility failed to ensure residents are free from misappropriation and failed to ensure investigative reports are completed in five working days. Both allegations were found to have no violations.
Severity Breakdown
SS=E: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Expired medications were available for use affecting four residents and expired glucose test strips affecting seven residents. | SS=E |
| Failed to protect openings to fuel-fired furnace rooms with 45-minute rated, self-closing, positive latching fire doors affecting 50 residents. | SS=E |
| Failed to provide a raised hearth for the gas fireplace in one of three smoke compartments, potentially affecting 50 residents. | SS=E |
Report Facts
Facility census: 62
Deficiency count: 3
Residents affected by expired medications: 4
Residents affected by expired glucose test strips: 7
Residents affected by furnace room fire door deficiency: 50
Residents affected by fireplace hearth deficiency: 50
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named as facility administrator in report and plan of correction |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter |
| Don Fritz | Assistant State Fire Marshal | Approved waiver request for fireplace hearth deficiency |
Inspection Report
Routine
Census: 62
Deficiencies: 2
Feb 17, 2016
Visit Reason
The inspection was conducted as a routine survey to assess compliance with Nebraska regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities.
Findings
The facility failed to accurately capture a near fall incident for one resident on the Minimum Data Set (MDS) assessment and failed to include the facility name on the posted nurse staffing information form. These deficiencies had the potential to affect all residents.
Severity Breakdown
SS=D: 1
SS=C: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to capture a near fall for one sampled resident (Resident 3) on the resident's MDS assessment. | SS=D |
| Failed to include required components of information, specifically the facility name, on the posted nurse staffing information form. | SS=C |
Report Facts
Facility census: 62
Inspection Report
Complaint Investigation
Census: 67
Deficiencies: 3
Apr 1, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Brookefield Park from April 1, 2015 to April 7, 2015. The complaint alleged the facility failed to evaluate causal factors for falls.
Findings
The facility did evaluate causal factors for falls and no violation was found related to this issue. During the annual onsite inspection, records were reviewed and staff interviews conducted with no concerns identified. The facility had a total census of 67 residents.
Complaint Details
The complaint alleged the facility failed to evaluate causal factors for falls. The investigation found the facility did evaluate causal factors for falls and no violation was identified.
Severity Breakdown
SS=E: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to provide verification that a wall covering in 1 of 3 smoke compartments met interior finish requirements, potentially allowing smoke and fire to spread rapidly affecting approximately 50 residents using the Chapel. | SS=E |
| Failed to provide a raised hearth for the gas fireplace in 1 of 3 smoke compartments, potentially allowing heat from the fireplace to impinge on the flooring affecting approximately 50 residents using the Commons Area. | SS=E |
| Failed to maintain corridors free of obstructions in 1 of 3 smoke compartments, which could slow evacuation during an emergency affecting approximately 50 residents using the Commons Area. | SS=E |
Report Facts
Facility census: 67
Facility census: 68
Dimensions: 4
Dimensions: 12
Raised hearth height: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named in complaint investigation letter and plan of correction |
| Dan Taylor | RN, Training Coordinator - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Maintenance A | Confirmed lack of documentation for bead board fire rating and hearth height for fireplace |
Inspection Report
Complaint Investigation
Census: 46
Deficiencies: 1
Feb 27, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Brookefield Park on February 23, 2014-February 27, 2014, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to be in compliance with allegations related to therapy, dignity and respect, and resident choice. However, deficiencies were identified related to infection control practices including failure to wear gloves during Accu-checks and failure to remove soiled gloves before touching clean items.
Complaint Details
The complaint alleged the facility failed to ensure residents receive therapy as ordered, failed to ensure residents are treated with dignity and respect, and failed to allow residents to have a choice on being independent with cares. All allegations were found to have no violations.
Deficiencies (1)
| Description |
|---|
| Failure to wear gloves while performing Accu-checks for Resident 17 and failure to remove soiled gloves prior to touching clean items for Resident 36. |
Report Facts
Facility census: 46
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named in letter regarding complaint investigation |
| Travis Castner | Registered Nurse | Investigator in complaint and annual survey |
| Christine Hale | Registered Nurse | Investigator in complaint and annual survey |
| Daniel Woodward | Registered Nurse | Investigator in complaint and annual survey |
| Connie Heavin | Social Worker | Investigator in complaint and annual survey |
| Eve Lewis | Program Manager | Signed letter regarding complaint investigation |
Inspection Report
Annual Inspection
Census: 35
Capacity: 46
Deficiencies: 5
Dec 12, 2012
Visit Reason
The inspection was conducted as an annual survey to assess compliance with state and federal regulations governing skilled nursing facilities, nursing facilities, and intermediate care facilities.
Findings
The facility was found deficient in multiple areas including failure to report verbal abuse allegations, failure to honor a resident's bedtime preference, failure to attempt non-pharmacological interventions prior to administering psychoactive medications, failure to serve food at proper temperature, and lack of a complete automatic sprinkler system as required by building construction type.
Severity Breakdown
SS=D: 3
SS=E: 1
SS=F: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to report an allegation of verbal abuse for one resident (Resident 20). | SS=D |
| Failed to honor one resident's bedtime preference (Resident 20). | SS=D |
| Failed to attempt non-pharmacological interventions for complaints of anxiety prior to administering PRN psychoactive medication to one resident (Resident 45). | SS=D |
| Failed to serve macaroni salad at or below 41 degrees Fahrenheit to all but 4 residents. | SS=E |
| Failed to provide a complete automatic sprinkler system as required by the type of building construction. | SS=F |
Report Facts
Facility census: 35
Total capacity: 46
Number of residents on sample: 31
Number of occasions Xanax administered: 53
Number of occasions non-pharmacological interventions documented: 11
Temperature of macaroni salad: 51.6
Temperature of macaroni salad: 56
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nursing Assistant E | Named in verbal abuse allegation involving Resident 20 | |
| Director of Nursing | Director of Nursing | Interviewed regarding verbal abuse allegation and non-pharmacological interventions |
| Nursing Assistant B | Interviewed about Resident 20's bedtime routine | |
| Licensed Practical Nurse C | Licensed Practical Nurse | Interviewed about Resident 20's bedtime routine |
| Registered Nurse A | Registered Nurse | Interviewed regarding documentation of non-pharmacological interventions |
| Cook D | Measured temperature of macaroni salad | |
| Maintenance A | Confirmed lack of fire sprinkler system |
Inspection Report
Annual Inspection
Census: 32
Capacity: 46
Deficiencies: 2
Aug 24, 2011
Visit Reason
Annual inspection of Heritage Living Center to assess compliance with regulations governing skilled nursing facilities and life safety code standards.
Findings
The facility failed to ensure dietary staff performed proper handwashing and glove use to prevent cross contamination, potentially affecting all residents. Additionally, the facility lacked a complete automatic sprinkler system as required by building construction type, posing a fire safety risk.
Severity Breakdown
SS=F: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Dietary staff failed to perform handwashing properly and did not change gloves before contact with ready-to-eat food, risking cross contamination. | SS=F |
| Facility failed to provide a complete automatic sprinkler system as required by the building construction type, allowing potential fire spread. | SS=F |
Report Facts
Facility census: 32
Facility census: 33
Total capacity: 46
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers | Administrator | Signed the inspection report and plan of correction |
| Mitchell Elliott | Unknown | Prepared Plan of Correction for sprinkler deficiency |
| Maintenance A | Confirmed lack of fire sprinkler system during observation |
Document
Capacity: 70
Deficiencies: 0
APP2016
Visit Reason
The document contains a Nursing Home Licensure Renewal Application, an Occupancy Permit, and program descriptions for Brookefield Park Nursing Home, indicating administrative and licensing purposes rather than an inspection visit.
Findings
No inspection findings or deficiencies are reported. The document provides licensing verification, renewal application details, occupancy permit information, and extensive program descriptions for memory support care.
Report Facts
Total licensed capacity: 70
Number of beds to be relicensed: 70
Memory Support Daily Rate: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Sarah Rasmussen | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Mark Manchester | Deputy State Fire Marshal | Named as inspector on the Nebraska State Fire Marshal Occupancy Permit. |
Notice
Capacity: 70
Deficiencies: 0
APP2018
Visit Reason
This document serves to verify that Brookefield Park's SNF/NF dual certification license is renewed and valid through the date indicated on the renewal card. It includes facility ownership, contact, and capacity information.
Findings
The document confirms the facility's licensure status, ownership details, and capacity. It includes no inspection findings or deficiencies.
Report Facts
Total licensed beds: 70
Maximum endorsed capacity: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named as facility administrator on renewal application. |
| Sarah Rasmussen | Director of Nursing | Named as Director of Nursing on renewal application. |
| Jack D. Vetter | CEO | Named as CEO and authorized representative on renewal application and corporate documents. |
| Glenn Van Ekeren | President | Named as President and authorized representative on renewal application and corporate documents. |
| Julie Knobbe | Contact | Contact person for legal owning entity VSL St. Paul, LLC. |
Notice
Capacity: 70
Deficiencies: 0
APP2022
Visit Reason
The documents serve to verify and renew the nursing home license for Brookefield Park, including renewal of the SNF/NF dual certification and Alzheimer's special care unit endorsement.
Findings
The documents confirm that Brookefield Park meets statutory requirements for licensure renewal and provide detailed information about facility capacity, ownership, services, and special care unit philosophy and staffing.
Report Facts
Total licensed beds: 70
Maximum capacity for Alzheimer's beds: 15
License expiration date: Mar 31, 2023
Occupancy permit date: Jun 21, 2021
License renewal application dates: Application signed on 2022-02-16 and 2022-02-18 (page 2).
Applicant signature date: Mar 3, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Foxworthy | Administrator | Named as administrator on Nursing Home Licensure Renewal Application (page 2). |
| Theresa Jorgensen | Director of Nursing | Named as Director of Nursing on Nursing Home Licensure Renewal Application (page 2). |
| Brenda Ewers-Nordhues | Administrator | Named as administrator on Alzheimer's Special Care Unit Disclosure (page 7). |
| Brian Stuhr | Authorized Representative | Named as contact and authorized representative on multiple documents including Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure (pages 2 and 7). |
| Jack D. Vetter | Chairman of the Board and CEO | Named as Chairman of the Board and CEO on corporate documents and signed Alzheimer's Special Care Unit Disclosure (pages 3 and 12). |
| Glenn Van Ekeren | President | Named as President on corporate documents (page 3). |
| Gary J. Amihone, MD | Chief Medical Officer, Director, Division of Public Health | Named on license renewal card (page 1). |
Notice
Capacity: 70
Deficiencies: 0
APP2024
Visit Reason
This document package serves as a licensure renewal notification and application for the skilled nursing facility Brookefield Park, including certification of statutory requirements, occupancy permit, and Alzheimer's special care unit endorsement.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies noted. It includes details on facility capacity, ownership, specialized care units, and staff training requirements.
Report Facts
Total licensed capacity: 70
Maximum capacity for Alzheimer's beds: 15
Daily room rates: 218
Daily room rates: 224
Daily room rates: 237
Daily room rates: 251
Daily level of care rates: 35
Daily level of care rates: 44
Daily level of care rates: 56
Daily level of care rates: 64
Daily level of care rates: 74
Daily level of care rates: 83
Memory Support Daily Rate: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rob Foxworthy | Administrator | Named as facility administrator in the Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure. |
| Brian Stuhr | Authorized Representative | Signed the Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure as authorized representative. |
| Theresa Jorgensen | Director of Nursing | Named as Director of Nursing in the Nursing Home Licensure Renewal Application. |
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