Inspection Reports for Cloverlodge Care Center
301 North 13th Street, ST EDWARD, NE, 68660
Back to Facility ProfileDeficiencies (last 12 years)
Deficiencies (over 12 years)
3.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
12% better than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
58% occupied
Based on a February 2018 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Capacity: 47
Deficiencies: 0
Date: Mar 13, 2025
Visit Reason
The document is a Nursing Home Licensure Renewal Application and renewal card verifying that Cloverlodge Care Center is licensed through the indicated renewal date.
Findings
The document confirms that Cloverlodge Care Center meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specified services including occupational therapy, physical therapy, and speech therapy.
Report Facts
Number of beds to be relicensed: 47
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named in Nursing Home Licensure Renewal Application |
| Katie Sindelar | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Glenn Van Ekeren | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
| Brian Stuhr | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
Inspection Report
Renewal
Capacity: 47
Deficiencies: 0
Date: Mar 23, 2023
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification verifying that Cloverlodge Care Center is licensed through the renewal date.
Findings
The documents confirm that Cloverlodge Care Center meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specified services including occupational, physical, and speech therapy.
Report Facts
Number of beds to be relicensed: 47
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named in Nursing Home Licensure Renewal Application |
| Eydie Schrad | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Brian Stuhr | Treasurer | Named as officer in ownership information |
| Glenn Van Ekeren | President | Named as officer in ownership information |
Notice
Capacity: 55
Deficiencies: 0
Date: Jan 21, 2020
Visit Reason
This document serves as a renewal application and license renewal notice for Cloverlodge Care Center, a skilled nursing facility, to maintain its licensure through the specified expiration date.
Findings
The document confirms that Cloverlodge Care Center meets statutory requirements for licensure renewal as a skilled nursing facility with physical, occupational, and speech therapy services. It includes ownership and business organization details, renewal fees, and certification signatures.
Report Facts
Licensed capacity: 55
Number of beds to be relicensed: 47
Renewal license fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named on renewal application form |
| Eydie Schrad | Director of Nursing | Named on renewal application form |
| Jack D. Vetter | Authorized Representative | Signed renewal application and listed as Chairman of the Board and CEO of parent corporation |
| Glenn Van Ekeren | Authorized Representative | Signed renewal application and listed as President of parent corporation |
Notice
Capacity: 47
Deficiencies: 0
Date: Jul 1, 2019
Visit Reason
The document serves to notify and acknowledge changes in the number of certified beds at Cloverlodge Care Center, including a decrease in licensed beds effective July 1, 2019.
Findings
The letter confirms the amendment of the Health Insurance Benefits Agreement reflecting certified bed counts and acknowledges the decrease in licensed beds from 55 to 47 due to transfer of 8 beds to another facility.
Report Facts
Certified beds: 47
Certified beds: 55
Licensed beds decrease: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | RN, BSN, Program Manager | Signed letter acknowledging bed changes |
Inspection Report
Routine
Census: 32
Capacity: 55
Deficiencies: 5
Date: Feb 26, 2018
Visit Reason
Routine inspection of Cloverlodge Care Center to assess compliance with federal regulations including quality of care, accident prevention, infection control, and life safety.
Findings
The facility was found deficient in multiple areas including failure to implement interventions to prevent choking/aspiration for a resident, inadequate fall prevention interventions, lapses in infection control practices such as improper hand hygiene and equipment disinfection, and life safety code violations related to cooking facility inspections and suspended unit heaters.
Deficiencies (5)
Failure to put interventions in place for Resident 1 to prevent potential choking/aspiration while eating and drinking.
Failure to identify potential causal factors and develop additional interventions for prevention of falls for Resident 79.
Failure to prevent potential cross contamination between residents in provision of cares and treatments including improper hand hygiene, equipment disinfection, and sanitary storage of oxygen cannulas.
Failure to conduct monthly visual inspection of components of the range hood suppression system in the kitchen smoke compartment.
Failure to verify natural gas fueled suspended heater was equipped with failsafe features and installed out of reach in the garage smoke compartment.
Report Facts
Facility census: 32
Sample size: 21
Total licensed capacity: 55
Number of residents affected by glucometer disinfection issue: 9
Number of residents affected by sit-to-stand lift cleaning issue: 9
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 30, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Cloverlodge Care Center on October 30-31, 2017, regarding allegations of failure to provide care for skin breakdown, medication allergies, informed consent, and appropriate transfer services.
Complaint Details
The investigation addressed four allegations: failure to provide care for skin breakdown, failure to prevent administration of medications to which residents were allergic, failure to obtain informed consent for treatment, and failure to provide appropriate transfer services. All allegations were found to be unsubstantiated with the facility compliant in each area.
Findings
The facility was found compliant with relevant regulatory requirements in all areas investigated, including care and treatment for skin breakdown, prevention of medication allergies, informed consent for treatment, and appropriate transfer services.
Report Facts
Residents reviewed: 3
Residents reviewed: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Complaint Investigation
Census: 35
Deficiencies: 1
Date: Feb 15, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to protect residents from injuries.
Complaint Details
The complaint alleged that the facility fails to protect residents from injuries. The investigation confirmed failure to protect 3 residents from injuries due to inadequate documentation and lack of preventive interventions.
Findings
The facility failed to protect residents from injuries for 3 sampled residents by not identifying causal factors for bruising, not implementing interventions to prevent future bruising, and not reevaluating current interventions for effectiveness. Documentation was insufficient to determine root causes or preventive measures.
Deficiencies (1)
Failure to identify causal factors for bruising and implement interventions to prevent future bruising for 3 residents.
Report Facts
Number of residents affected: 3
Census: 35
Incident dates for Resident 1 bruising: 4
Incident dates for Resident 2 bruising: 2
Incident dates for Resident 3 bruising: 3
Inspection Report
Annual Inspection
Census: 34
Capacity: 55
Deficiencies: 9
Date: Dec 6, 2016
Visit Reason
Annual inspection survey conducted to assess compliance with federal and state regulations governing skilled nursing facilities, including investigation of allegations, comprehensive assessments, quality of care, safety, and life safety code compliance.
Findings
The facility was found deficient in multiple areas including failure to report and investigate an incident of potential abuse, incomplete comprehensive assessments, inadequate care planning for skin tears, failure to assess and monitor use of grab bars, inaccurate medication labeling, incomplete fire watch policy, unsealed smoke barrier conduit, lack of remote manual stop for emergency generator, and missing covers on electrical junction boxes.
Deficiencies (9)
Failed to report and investigate an incident of potential abuse/neglect for one resident.
Failed to identify presence of a skin tear on the Minimum Data Set for one resident.
Failed to assess causal factors for skin tears and implement interventions for prevention.
Failed to assess use of grab bars and ensure they did not pose safety hazards for two residents.
Failed to ensure medication labels were accurate for two residents.
Failed to assure a complete fire watch policy was in place regarding sprinkler system impairment.
Failed to provide a smoke barrier that resists passage of smoke due to unsealed conduit.
Failed to provide a remote manual stop for the emergency generator.
Failed to provide covers for electrical junction boxes above suspended ceilings in two smoke compartments.
Report Facts
Facility census: 34
Total licensed capacity: 55
Sample size: 21
Number of residents affected: 1
Number of residents affected: 2
Number of residents affected: 2
Number of residents affected: 1
Number of residents affected: 12
Number of residents affected: 19
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Madison Guthrie | Administrator | Named in plan of correction and interview regarding abuse/neglect reporting and fire watch policy |
| Theresa Naber | Office Manager | Signed facility staffing form |
| Registered Nurse-I | Interviewed regarding medication labeling and skin tear assessment | |
| Director of Nurses (DON) | Interviewed regarding abuse reporting, medication labeling, fire watch policy, and grab bar assessments | |
| Maintenance A | Interviewed regarding smoke barrier sealing, electrical junction box covers, and fire watch policy | |
| Medication Aide-H | Interviewed regarding medication labeling |
Inspection Report
Life Safety
Census: 39
Deficiencies: 9
Date: Nov 24, 2015
Visit Reason
The facility was surveyed for compliance with Title 175, Chapter 12 regulations for Skilled Nursing Facilities and for compliance with the 2000 Edition of the Life Safety Code of the National Fire Protection Association.
Findings
The facility was found to be in compliance with resident rights and notification requirements but had deficiencies related to life safety code including a smoke barrier door that did not fully close, a kitchen fire shutter not tied to the fire alarm, an exterior exit door requiring excessive force to open, fire drills not conducted quarterly on each shift with varying times, lack of fire alarm re-acceptance testing after panel replacement, unsealed range hood penetrations, missing signage for emergency generator gas piping, and improper electrical equipment use in the mechanical room.
Deficiencies (9)
Failed to issue liability notice to resident or responsible party regarding Medicare Part A payment liability and right to appeal.
Dining Room/Life Enrichment Smoke Barrier Door failed to fully close within the doorframe.
Kitchen Serving Window fire shutter did not close automatically upon fire alarm activation.
Dining Room 2 Exterior Exit Door required more than 30 pounds of force to open.
Fire drills were not conducted quarterly on each shift with varying times.
No re-acceptance test performed on fire alarm system after installation of new fire alarm panel.
Range hood penetrations were not sealed, allowing grease accumulation.
Missing signage for natural gas piping indicating emergency generator and separate shutoff valve.
Electrical equipment in mechanical room not used according to listing; surge protector plugged into UPS and exposed wiring not properly managed.
Report Facts
Facility census: 39
Residents affected: 20
Residents affected: 6
Residents affected: 20
Fire drills: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Acknowledged deficiencies related to smoke barrier door, fire shutter, exterior exit door, fire drills, fire alarm re-acceptance test, range hood penetrations, emergency generator signage, and electrical equipment use. | |
| Social Services Director | Communicated with residents' responsible parties regarding Medicare liability notices and appeals. | |
| Office Manager | Verified lack of required Medicare liability notices and appeal options. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 8, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to change fall interventions for residents identified at risk and failure to submit investigations within 5 working days.
Complaint Details
The complaint alleged failure to change fall interventions for residents at risk and failure to submit investigations within 5 working days. Both allegations were found to be unsubstantiated with no violations.
Findings
The investigation found that the facility appropriately changed fall interventions for residents at risk and submitted investigations within 5 working days, resulting in no violations related to the allegations.
Report Facts
Working days for investigation submission: 5
Residents reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Krista Roeber | Social Worker | Conducted the complaint investigation |
| Janice Hake | Registered Nurse | Conducted the complaint investigation |
| Eve Lewis | Program Manager | Signed the report |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 8, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to change fall interventions for residents identified at risk and failure to submit investigations within 5 working days.
Complaint Details
The complaint alleged the facility failed to change fall interventions for residents at risk and failed to submit investigations within 5 working days. Both allegations were found to be unsubstantiated.
Findings
The investigation found that the facility appropriately changed fall interventions for residents at risk and submitted investigations within the required 5 working days. No violations were identified related to these allegations.
Report Facts
Working days for investigation submission: 5
Date of complaint investigation visit: Apr 8, 2015
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Krista Roeber | Social Worker | Conducted complaint investigation |
| Janice Hake | Registered Nurse | Conducted complaint investigation |
| Eve Lewis | Program Manager | Signed report and represents Office of LTC Facilities - Licensure Unit |
Inspection Report
Annual Inspection
Census: 42
Capacity: 55
Deficiencies: 11
Date: Aug 27, 2014
Visit Reason
Annual inspection survey conducted to assess compliance with federal and state regulations including resident care, safety, infection control, and life safety code standards.
Findings
The facility was found deficient in multiple areas including failure to resolve resident grievances, failure to identify and investigate abuse allegations, failure to revise care plans for residents at risk, failure to provide adequate assistance with hand hygiene, potential foodborne illness risk due to improper sanitization of puree equipment, potential waterborne illness risk due to contaminated water supply, ineffective quality assurance committee, and life safety code violations including unsealed smoke barrier penetrations, sprinkler obstructions, and improper electrical wiring.
Deficiencies (11)
Failed to act upon and resolve a grievance for Resident 24 regarding care concerns.
Failed to identify, report, investigate and protect residents from potential abuse including incidents involving Resident 17 and Resident 22.
Failed to revise care plan interventions for residents at risk of bruising and hygiene issues (Residents 3, 24, 33).
Failed to identify and implement interventions to prevent bruising for Residents 3 and 33.
Failed to provide assistance with hand hygiene for Resident 24.
Failed to prevent potential foodborne illness due to improper sanitization and premature reuse of puree food equipment.
Failed to prevent potential waterborne illness related to resident use of tap water from bathroom faucets during oral hygiene after water contamination notification.
Facility administration failed to maintain an effective Quality Assurance committee to address quality deficiencies including abuse, bruising, and infection control.
Failed to maintain smoke barriers due to unsealed penetrations in walls over smoke doors allowing potential smoke communication between compartments.
Failed to maintain automatic sprinkler system by allowing privacy curtains to obstruct sprinkler heads within 6 inches.
Failed to prohibit use of extension cords as substitute for permanent wiring, creating fire hazard.
Report Facts
Facility census: 42
Facility capacity: 55
Number of bruising incidents: 9
Number of smoke compartments: 5
Number of sprinkler obstructions: 41
Inspection Report
Routine
Census: 41
Deficiencies: 3
Date: May 10, 2013
Visit Reason
Routine inspection survey conducted to assess compliance with regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities.
Findings
The facility was found deficient in ensuring residents were free of significant medication errors, specifically related to timely administration of food after rapid acting insulin. Additional deficiencies included improper sanitization of food preparation equipment and cross contamination risks during meal service, as well as inadequate infection control practices related to water pitcher handling and hand hygiene during meal service.
Deficiencies (3)
Facility failed to ensure Resident 40 received something to eat within 10-15 minutes after rapid acting insulin was given, resulting in a medication error.
Facility failed to prevent potential for food borne illness related to sanitization of equipment and cross contamination during meal service.
Facility failed to maintain an infection control program preventing cross contamination while refilling water pitchers affecting residents in 8 rooms.
Report Facts
Facility census: 41
Units of rapid acting insulin administered: 4
Time delay in feeding after insulin: 25
Time delay in feeding after insulin: 38
Number of residents served by Social Worker without hand hygiene: 31
Number of occupied resident rooms affected by water pitcher contamination: 8
Number of occupied resident rooms on 200 hallway: 29
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) A | Administered rapid acting insulin to Resident 40 on 5/6/2013 | |
| Licensed Practical Nurse (LPN) B | Administered rapid acting insulin to Resident 40 on 5/8/2013 and interviewed about feeding delay | |
| Social Worker (SW) | Observed serving meals without hand hygiene on 5/6/2013 | |
| Nursing Assistant (NA) A | Observed refilling water pitchers improperly on 5/8/2013 | |
| Director of Nursing | Interviewed regarding ice scoop contamination and infection control practices | |
| Cook B | Observed improper drying of kitchen equipment |
Inspection Report
Routine
Census: 38
Capacity: 55
Deficiencies: 4
Date: Jan 24, 2012
Visit Reason
Routine inspection of Cloverlodge Care Center to assess compliance with federal and state regulations including comprehensive resident assessments, care planning, and life safety code standards.
Findings
The facility failed to accurately assess and document range of motion and skin lesions for certain residents, and did not develop comprehensive care plans addressing these issues. Additionally, life safety code violations were found including corridor doors not fitting tightly to resist smoke passage and sprinkler system maintenance deficiencies.
Deficiencies (4)
Failed to accurately assess Resident 17 for range of motion and failed to update care plan accordingly.
Failed to develop comprehensive care plans for Residents 12 and 17, including skin lesions and contractures.
Corridor doors did not stay latched tightly and had gaps allowing smoke passage, violating life safety code.
Sprinkler system was not maintained or tested quarterly as required and had sprinkler heads with insufficient clearance.
Report Facts
Facility census: 38
Facility capacity: 55
Sample size: 28
Deficiency count: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Linda Zentner | Administrator | Signed the inspection report and plan of correction |
| Dan Taylor | RN | Accepted the plan of correction on behalf of the facility |
Inspection Report
Routine
Census: 30
Deficiencies: 2
Date: Jan 6, 2011
Visit Reason
The inspection was conducted to assess compliance with regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities, focusing on food safety and infection control.
Findings
The facility failed to properly cool potentially hazardous foods, risking foodborne illness affecting all residents. Additionally, improper wound care techniques were observed that could lead to cross contamination, potentially affecting two residents with MRSA infections.
Deficiencies (2)
Failed to cool potentially hazardous food to temperatures that prevent bacterial growth, risking foodborne illness.
Failed to ensure wound care for a resident with MRSA was completed in a manner to prevent cross contamination.
Report Facts
Census: 30
Sample size: 10
Food temperature: 50
Food temperature: 44
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dietary Manager | Interviewed regarding food temperatures and cooling procedures | |
| Licensed Practical Nurse A | LPN | Observed performing wound care with improper infection control technique |
Notice
Capacity: 55
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as a licensure renewal application and verification of the SNF/NF dual certification for Cloverlodge Care Center, including occupancy permit and ownership information.
Findings
The documents confirm that Cloverlodge Care Center meets statutory requirements for licensure renewal as a skilled nursing facility with a licensed capacity of 55 beds. The occupancy permit was issued on 2016-12-06 by the Nebraska State Fire Marshal.
Report Facts
Licensed capacity: 55
Renewal fees: 1750
Occupancy permit date: Dec 6, 2016
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Madison Guthrie | Administrator | Named as facility administrator on the licensure renewal application. |
| Eydie Schrad | Director of Nursing | Named as director of nursing on the licensure renewal application. |
| Mark Manchester | Deputy State Fire Marshal | Inspected and approved the occupancy permit. |
Notice
Capacity: 55
Deficiencies: 0
Date: APP2018
Visit Reason
This document serves to verify that Cloverlodge Care Center's SNF/NF dual certification license is renewed and valid through the indicated expiration date. It also provides ownership, facility capacity, and certification details.
Findings
The document confirms the facility's licensure status, ownership structure, and certification for Medicare and Medicaid. It includes no inspection findings or deficiencies.
Report Facts
Licensed beds: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Edward Remm | Administrator | Listed as facility administrator on page 2. |
| Eydie Schrad | Director of Nursing | Listed as Director of Nursing on page 2. |
| Jack D. Vetter | CEO and Chairman of the Board | Named as CEO and Chairman of the Board of Vetter Senior Living and related corporations on page 3. |
| Glenn Van Ekeren | President | Named as President of Vetter Senior Living and related corporations on page 3. |
Notice
Capacity: 55
Deficiencies: 0
Date: APP2019
Visit Reason
This document verifies the renewal of the SNF/NF dual certification license for Cloverlodge Care Center and includes the occupancy permit indicating the facility's licensed bed capacity.
Findings
The facility meets statutory requirements for licensure as a skilled nursing facility/nursing facility dual certification. The occupancy permit confirms a licensed capacity of 55 beds.
Report Facts
Licensed bed capacity: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named on relicensing application. |
| Eydie Schrad | Director of Nursing | Named on relicensing application. |
| Bo Botelho | Interim CEO and Interim Director of Public Health | Signed licensure verification. |
Document
Capacity: 47
Deficiencies: 0
Date: APP2021
Visit Reason
The document serves as a renewal application for the nursing home license of Cloverlodge Care Center and includes related licensing and occupancy permit information.
Findings
No inspection findings or deficiencies are reported; the document confirms licensure renewal and occupancy permit status.
Report Facts
Total licensed beds: 47
Renewal application date: Mar 1, 2021
Occupancy permit issue date: Jan 27, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named in the renewal application as the facility administrator. |
| Eydie Schrad | Director of Nursing | Named in the renewal application as the Director of Nursing. |
| Jack D. Vetter | Authorized Representative | Signed the renewal application as an authorized representative. |
| Glenn Van Ekeren | Authorized Representative | Signed the renewal application as an authorized representative. |
Notice
Capacity: 47
Deficiencies: 0
Date: APP2022
Visit Reason
This document set serves as a license renewal application and verification for Cloverdge Care Center, including an occupancy permit and ownership information.
Findings
No inspection findings or deficiencies are reported; the documents confirm licensure renewal and facility capacity.
Report Facts
Total licensed beds: 47
Document
Capacity: 47
Deficiencies: 0
Date: APP2024
Visit Reason
The documents serve to renew the nursing home license for Cloverlodge Care Center and provide official certification and occupancy permits.
Findings
No inspection findings or deficiencies are reported; the documents confirm licensure renewal, facility capacity, and ownership information.
Report Facts
Total licensed beds: 47
Renewal license fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Naber | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Jennifer Nauenburg | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
| Brian Stuhr | Treasurer | Listed as officer of Vetter Senior Living and signer on renewal application |
| Glenn Van Ekeren | President | Listed as officer of Vetter Senior Living and signer on renewal application |
Document
Capacity: 55
Deficiencies: 0
Date: CHOW2017
Visit Reason
The documents relate to the issuance and renewal of the Skilled Nursing Facility license for Cloverlodge Care Center, including a change of ownership effective July 1, 2017.
Findings
No inspection findings are reported. The documents confirm licensure, occupancy permit, and ownership transfer details for the facility.
Report Facts
Total licensed beds: 55
Licensure issuance date: 2017
Occupancy permit date: 2016
Licensure expiration date: 2018
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Madison Guthrie | Administrator | Named as facility administrator in licensure application |
| Eydie Schrad | Director of Nursing | Named as Director of Nursing in licensure application |
| Thomas L. Williams, MD | Chief Medical Officer, Director, Division of Public Health | Signed licensure issuance and renewal letters |
| Jack D. Vetter | President | Named as President of Heritage of Fairbury/St. Edward, Inc. and signer of legal deeds |
| Shari Terry | Chief Operations Officer | Signed letter submitting change of ownership documents |
| Mark Manchester | Deputy State Fire Marshal | Signed occupancy permit |
Notice
Capacity: 55
Deficiencies: 0
Date: APP2016
Visit Reason
The document serves as a licensure renewal application for Cloverlodge Care Center, verifying the facility's SNF/NF dual certification and renewal of its nursing home license.
Findings
The documents confirm the facility's licensure status, renewal fees, ownership information, and fire marshal occupancy permit with a maximum occupancy of 55 beds.
Report Facts
Number of beds to be relicensed: 55
Maximum occupancy: 55
Renewal fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Samantha Tilson | Administrator | Named in Nursing Home Licensure Renewal Application |
| Eydie Schrad | Director of Nursing, R.N. | Named in Nursing Home Licensure Renewal Application |
| Jack D. Vetter | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
| Todd D. Vetter | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
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