Deficiencies per Year
24
18
12
6
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Notice
Capacity: 77
Deficiencies: 0
Mar 27, 2025
Visit Reason
This document serves as a nursing home licensure renewal application and verification of license renewal for Continental Springs, LLC, including an occupancy permit for the facility.
Findings
The documents confirm the facility's licensure renewal status and maximum occupancy capacity of 77 beds, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 77
Renewal application date: Mar 27, 2025
Occupancy permit date: Oct 29, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clara A Owolabi | Administrator | Named on nursing home licensure renewal application. |
| Kristin Rodriguez | Director of Nursing | Named on nursing home licensure renewal application. |
| Jim Kenney | Deputy State Fire Marshal | Inspected the facility and approved occupancy permit. |
| Matisyohu Herzka | Authorized Representative | Signed the renewal application. |
| Abraham K Schreiber | Authorized Representative | Signed the renewal application. |
Notice
Capacity: 77
Deficiencies: 0
Mar 13, 2024
Visit Reason
This document serves as a renewal application for the nursing home license of Continental Springs, LLC, including verification of licensure and occupancy permit details.
Findings
The documents confirm that Continental Springs, LLC meets statutory requirements for licensure renewal as a skilled nursing facility with a licensed capacity of 77 beds. No inspection findings or deficiencies are reported.
Report Facts
Licensed beds: 77
Renewal application date: Mar 13, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Brewer | Administrator | Named in Nursing Home Licensure Renewal Application |
| Kristen Rodriguez | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
Notice
Capacity: 77
Deficiencies: 0
Apr 1, 2021
Visit Reason
The document serves as a renewal application for the nursing home license of Continental Springs, LLC, verifying licensure and renewal status.
Findings
The documents confirm that Continental Springs, LLC meets statutory requirements for licensure as a skilled nursing facility and includes a temporary occupancy permit with a maximum occupancy of 77 beds.
Report Facts
Total licensed beds: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stacy Wermes | Administrator | Named on the renewal application. |
| Kimberly Kropp | Director of Nursing | Named on the renewal application. |
| Matisyohu Herzka | Authorized Representative | Signed the renewal application. |
| Abraham K. Schreiber | Authorized Representative | Signed the renewal application. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Feb 11, 2020
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to ensure prompt emergency care.
Findings
The facility was found to ensure prompt emergency care based on reviews of medical records, grievance logs, resident council minutes, facility policy, and staff interviews. The facility was determined to be in compliance with relevant regulatory requirements.
Complaint Details
The complaint alleged failure to ensure prompt emergency care. The investigation found the allegation unsubstantiated and the facility compliant.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health |
Notice
Capacity: 77
Deficiencies: 0
Mar 25, 2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Continental Springs, LLC, confirming licensure through the indicated expiration date.
Findings
The document includes the renewal application details, ownership information, occupancy permit with a maximum capacity of 77 beds, and certification of organization for the facility. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 77
License expiration date: Mar 31, 2020
Occupancy permit date: Apr 10, 2018
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teresa Magdanz | Administrator | Named in the nursing home licensure renewal application. |
| Anita Lenzen | Director of Nursing | Named in the nursing home licensure renewal application. |
| Matisyohu Herzka | Authorized Representative | Signed the renewal application and certificate of organization. |
| Moshe Rosenblatt | Listed as a person in control of the facility and member in certificate of organization. | |
| Abraham K. Schreiber | Listed as a person in control of the facility and member in certificate of organization. |
Inspection Report
Renewal
Capacity: 77
Deficiencies: 0
Feb 14, 2019
Visit Reason
The document serves as a licensing renewal and change of ownership notification for Continental Springs, LLC to operate a Skilled Nursing Facility/Nursing Facility Dual Certification at 3200 G Street, South Sioux City, NE.
Findings
The report includes approval of the transfer of operations and ownership from Matney's Colonial Manor to Continental Springs, LLC and Continental Senior Living, LLC, with the termination of the receivership and authorization for the new owners to apply for and receive facility licenses. The transfer is approved as reasonable and in the best interest of residents, ensuring continued operation and compliance with federal and state regulations.
Report Facts
Total licensed beds: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Teri Magdanz | Administrator | Named as Administrator on the licensure application. |
| Anita Lenzen | Director of Nursing | Named as Director of Nursing on the licensure application. |
| Moshe Rosenblatt | Member | Listed as a member of Continental Springs, LLC and signatory on ownership documents. |
| Matisyohu Herzka | Member | Listed as a member of Continental Springs, LLC and signatory on ownership documents. |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 77
Deficiencies: 18
Apr 9, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Matney's Colonial Manor on April 9, 2018-April 12, 2018.
Findings
The facility was found to be in compliance with abuse protection and staff credentialing. However, the plan of care failed to reflect resident needs related to transfers. Multiple deficiencies were cited including resident dignity during dining, environmental cleanliness, ADL care, psychotropic medication use, fire safety, and emergency preparedness.
Complaint Details
The complaint allegations included failure to protect residents from abuse, failure to ensure staff have adequate credentialing, and failure to ensure plan of care reflects resident needs. The investigation found compliance with abuse protection and credentialing but identified deficiencies related to plan of care and other regulatory requirements.
Severity Breakdown
SS=F: 7
SS=D: 9
SS=E: 1
Deficiencies (18)
| Description | Severity |
|---|---|
| Failed to ensure 1 resident was treated with dignity during dining; staff mixed foods together and fed without verbal cueing. | SS=D |
| Failed to ensure cleanliness and condition of ventilation covers, walls, floors, fixtures and ceilings in 11 resident rooms. | SS=E |
| Failed to provide cueing and supervision with eating to maintain ability to eat independently for 1 resident. | SS=D |
| Failed to complete ongoing evaluations of smoking safety and provide equipment to ensure safe smoking practices for 1 resident. | SS=D |
| Failed to develop a facility assessment to ensure services were available to residents. | SS=F |
| Failed to ensure physicians orders for medications were obtained on admission for 1 resident. | SS=D |
| Failed to provide code to unlock magnetically locked doors in a means of egress in 5 of 6 smoke compartments. | SS=F |
| Failed to separate hazardous areas by smoke-resistive partitions and failed to ensure doors serving hazardous areas automatically closed and latched. | SS=D |
| Failed to provide a complete policy regarding procedures when fire alarm system is out of service for more than 4 hours. | SS=F |
| Failed to maintain minimum required clearance for sprinklers, allowed dust accumulation, and failed to provide escutcheon rings for sprinklers. | SS=F |
| Failed to provide a complete policy regarding procedures when sprinkler system is out of service for more than 10 hours. | SS=F |
| Failed to maintain corridor walls to limit transfer of smoke for 2 of 6 smoke barriers. | SS=D |
| Failed to ensure corridor room doors resist passage of smoke in 4 of 6 smoke compartments. | SS=D |
| Failed to monitor and prohibit use of portable space heaters in 1 of 6 smoke compartments. | SS=D |
| Failed to provide approved cover plates for electrical receptacles in the Activity Room. | SS=F |
| Failed to verify transfer time from normal power to emergency power was not more than 10 seconds. | SS=D |
| Allowed use of power strip in lieu of permanent wiring in freezer room. | SS=D |
| Failed to take precautions to prevent creation of oxygen-enriched atmosphere; oxygen concentrator left unattended in dining room. | SS=F |
Report Facts
Facility census: 47
Total capacity: 77
Deficiency count: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed letter regarding complaint and annual survey |
| Edward Matney | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Deficiencies: 0
Dec 6, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that the facility fails to provide care and services according to practitioner's orders.
Findings
The facility was found to provide care and services according to practitioner's orders after reviewing resident council meeting minutes, grievances, resident records, and conducting interviews and observations. The facility was determined to be in compliance with relevant regulatory requirements.
Complaint Details
The complaint alleged failure to provide care and services according to practitioner's orders. The allegation was not substantiated as the facility was found compliant.
Report Facts
Residents reviewed: 4
Treatments observed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report as representative of the Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Complaint Investigation
Census: 53
Deficiencies: 2
Apr 3, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Matney's Colonial Manor on April 3-4, 2017, regarding allegations of failure to provide care to prevent pressure sores, failure to report falls with injury, failure to notify family of changes in condition, failure to use fall prevention interventions, failure to treat residents with dignity and respect, and failure to answer call notification systems promptly.
Findings
The facility was found to have no violation related to pressure sore prevention, family notification, fall prevention interventions, or call system response. However, the facility failed to report falls with injury for two residents and failed to ensure residents were treated with dignity and respect, specifically by not using dignity bags for Foley drainage bags for three residents. The facility was cited for these deficiencies and provided a plan of correction.
Complaint Details
The complaint investigation was triggered by allegations that the facility failed to provide care to prevent pressure sores, failed to report falls with injury, failed to notify family or guardians of changes in condition, failed to use interventions to prevent falls with injury, failed to treat residents with dignity and respect, and failed to answer call notification systems promptly. The investigation included record reviews, observations, and interviews with residents, family, and staff. The facility was substantiated for failure to report falls with injury and failure to treat residents with dignity and respect.
Severity Breakdown
SS=E: 1
SS=D: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to report falls with injury for two of three sampled residents (Residents 2 and 3). | SS=E |
| Failure to ensure residents are treated with dignity and respect; three residents (Residents 6, 7, and 9) had Foley drainage bags not in dignity bags. | SS=D |
Report Facts
Facility census: 53
Residents affected: 2
Residents affected: 3
Deficiency completion date: Apr 24, 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa | Facility Administrator | Interviewed regarding failure to report falls with injury |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| LPN A | Licensed Practical Nurse | Named in abuse allegation related to resident complaints |
| DON | Director of Nursing | Interviewed regarding abuse allegations and dignity bag use |
| Social Services Director | Involved in abuse allegation investigations and reporting |
Inspection Report
Complaint Investigation
Census: 53
Capacity: 77
Deficiencies: 2
Apr 3, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Matney's Colonial Manor on April 3-4, 2017, by representatives of the Department of Health and Human Services Division of Public Health. The investigation included review of resident records, observation of care and services, and interviews with residents, family members, and staff.
Findings
The facility was found to have failed to report falls with injury for two residents and failed to ensure residents were treated with dignity and respect related to Foley drainage bags not being in dignity bags. Other allegations including prevention of pressure sores, reporting changes to family, fall interventions, and call system response were found not to be violations. The facility census was 53 during the investigation.
Complaint Details
The complaint included allegations of failure to prevent pressure sores, failure to report falls with injury, failure to report change of condition to family/guardian, failure to use interventions to prevent falls with injury, failure to treat residents with dignity and respect, and failure to answer call notification systems promptly. The facility was substantiated for failure to report falls with injury and failure to treat residents with dignity and respect.
Deficiencies (2)
| Description |
|---|
| Failure to report falls with injury for two of three sampled residents. |
| Failure to ensure residents are treated with dignity and respect; Foley drainage bags not in dignity bags for three residents. |
Report Facts
Facility census: 53
Residents sampled: 29
Residents affected: 2
Facility census: 54
Licensed beds: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Nicholas Matney | Administrator | Facility administrator named in complaint investigation |
| Josh Myers | Technician | Fire alarm system inspection and testing |
| Rob Lester | Fire Protection | Fire sprinkler service proposal and inspection |
Inspection Report
Plan of Correction
Census: 54
Deficiencies: 4
Mar 21, 2017
Visit Reason
The inspection was conducted to assess the accuracy of Minimum Data Set (MDS) assessments for residents, focusing on issues related to urinary tract infections, antipsychotic medication usage, falls, and pressure sores.
Findings
The facility failed to ensure the accuracy of MDS assessments for 5 of 12 residents reviewed, with inaccuracies related to UTIs, antipsychotic medication use, falls, and pressure ulcers. The facility submitted corrections and implemented a plan to audit and monitor MDS accuracy.
Deficiencies (4)
| Description |
|---|
| Inaccurate coding of urinary tract infections for Residents 3 and 2 in MDS assessments. |
| Inaccurate coding of antipsychotic medication usage for Resident 12 in MDS assessments. |
| Inaccurate coding of falls for Resident 14 in MDS assessments. |
| Inaccurate staging of pressure ulcers for Residents 2 and 4 in MDS assessments. |
Report Facts
Residents reviewed: 12
Residents with inaccurate MDS: 5
Facility census: 54
Plan of correction completion date: May 8, 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed and confirmed inaccuracies in MDS assessments |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 2
Oct 24, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint at Matney's Colonial Manor on October 24, 2016, regarding allegations of failure to provide care and treatment for bladder elimination, notification of practitioner of change in condition, prevention of skin breakdown, and following practitioner orders for treatments.
Findings
The facility was found in compliance with care for bladder elimination and notification of practitioners of changes in condition. However, the facility failed to provide adequate care to prevent skin breakdown and failed to follow practitioner orders for treatments related to skin care. These were violations of Federal tag F 314 and Nebraska licensure regulations.
Complaint Details
The complaint investigation was triggered by allegations that the facility failed to provide care and treatment for bladder elimination, failed to notify practitioners of changes in condition, failed to prevent skin breakdown, and failed to follow practitioner orders for treatments. The facility was found compliant with the first two allegations but deficient in the latter two.
Severity Breakdown
G: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide care and treatment to prevent skin breakdown, including failure to evaluate, obtain treatment orders, and care for pressure sores. | G |
| Failure to follow practitioner orders for treatments, including failure to provide ordered skin treatments. | G |
Report Facts
Resident sample size: 3
Facility census: 56
Medication error rate: 68
Rooms with maintenance issues: 9
Residents affected by maintenance issues: 14
Residents cognitively impaired and self mobile: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed complaint investigation letter and correspondence regarding informal dispute resolution |
| Nicholas Matney | Administrator | Facility administrator named in complaint investigation and informal dispute resolution correspondence |
| Kimberly A. Divis | RN, NSSC | Conducted informal conference/informal dispute resolution |
| Nurse A | Named in medication administration deficiencies and education | |
| Cook C | Named in dietary sanitation deficiencies and education | |
| Director of Nursing | DON | Interviewed regarding multiple deficiencies and corrective actions |
Inspection Report
Complaint Investigation
Census: 31
Deficiencies: 0
Mar 28, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to provide and maintain a safe environment for residents at risk for elopement.
Findings
The facility was found to provide and maintain a safe environment for residents at risk for elopement, with all interventions in place and no residents having eloped. Staff were aware of safety precautions and residents were assessed for elopement risk with appropriate interventions.
Complaint Details
The complaint alleged failure to provide/maintain a safe environment for residents at risk for elopement. The complaint was found to be unsubstantiated as the facility was in compliance.
Report Facts
Facility census: 31
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator, Licensure Unit, Division of Public Health-DHHS | Signed the inspection report |
Inspection Report
Renewal
Capacity: 77
Deficiencies: 0
Feb 29, 2016
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification verifying that Matneys Colonial Manor is licensed through the indicated renewal date.
Findings
The documents confirm the renewal of the facility's license with no deficiencies or violations noted. The facility is licensed for 77 beds and is certified for Medicare and Medicaid.
Report Facts
Number of beds to be relicensed: 77
Renewal fee: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Verschoor Matney | Administrator | Named as the facility administrator on the renewal application |
| Tammy Palmersheim | Director of Nursing | Named as the director of nursing on the renewal application |
| Edward H. Matney | Authorized representative signing the renewal application and listed as owner on ownership disclosure |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 7
Jan 4, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Matney's Colonial Manor from January 4, 2016 to January 7, 2016 by the Department of Health and Human Services Division of Public Health.
Findings
The facility failed to ensure an effective infection control program, maintain an effective housekeeping program, and ensure residents were free from abuse. Additional deficiencies were found related to notification of changes, housekeeping, comprehensive care plans, accident hazards, medication error rates, food sanitation, and infection control practices.
Complaint Details
The complaint investigation included allegations of ineffective infection control, housekeeping, and abuse. The facility was found deficient in infection control and housekeeping but compliant with abuse prevention.
Severity Breakdown
Level D: 3
Level E: 3
Level F: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to notify Resident 32's physician of blood pressure readings outside parameters. | Level D |
| Failed to maintain floors, windows, door frames, walls, resident equipment and call cords in clean condition and good repair in 9 of 45 occupied rooms. | Level E |
| Failed to develop comprehensive care plans related to dialysis and anticoagulant use for residents. | Level D |
| Failed to ensure medication carts were secured, risking access by cognitively impaired residents. | Level E |
| Medication error rate of 68% related to administration of medications to Residents 3 and 10. | Level E |
| Dietary staff failed to wash hands and change gloves after handling meat products, failed to sanitize equipment between uses, and kitchen ventilation hood was unclean. | Level F |
| Failed to ensure handwashing and gloving during medication administration to prevent cross contamination. | Level D |
Report Facts
Facility census: 56
Medication error rate: 68
Rooms with housekeeping deficiencies: 9
Residents affected by housekeeping deficiencies: 14
Residents cognitively impaired and self mobile: 25
Dialysis frequency: 3
Fluid restriction: 1500
Extension cord audit period: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nurse A | Registered Nurse | Named in medication error and infection control findings related to improper medication administration and hand hygiene |
| Cook C | Dietary Staff | Named in food sanitation deficiencies related to improper glove use and equipment sanitation |
| Director of Nursing | Director of Nursing | Interviewed regarding deficiencies in notification of changes, care plans, medication administration, and infection control |
| Administrator A | Facility Administrator | Interviewed regarding fire alarm system deficiencies and electrical wiring issues |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 2
Jan 20, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Matney's Colonial Manor from January 20, 2015 to January 27, 2015. The investigation included review of resident records, observation of care, and interviews with residents, family, and staff.
Findings
The facility failed to have sufficient staff to meet resident needs related to the timeliness of meal service, which was found to be too long (40-50 minutes). The facility ensured equipment met resident needs and meals were palatable. Additionally, the facility failed to maintain the emergency generator by monthly testing at 30% load or conducting an annual load bank test.
Complaint Details
The complaint alleged the facility failed to ensure equipment met residents' needs, failed to have sufficient staff to meet residents' needs, and failed to ensure the palatability of foods. The facility was found compliant with equipment needs and food palatability but deficient in staffing related to meal service timeliness.
Severity Breakdown
SS=E: 1
SS=F: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility staff failed to ensure staff were available to serve meals in a timely manner for 48 residents in the dining room, with meal service taking 40 to 50 minutes instead of the expected 30 minutes. | SS=E |
| Facility was not maintaining the emergency generator by monthly testing to at least 30% of the nameplate rating or conducting an annual load bank test, lacking complete and verifiable documentation. | SS=F |
Report Facts
Facility census: 56
Residents eating in dining room: 48
Meal service duration: 50
Meal service duration: 40
Generator load testing: 30
Generator load measured: 56
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Verschoor-Matney | Administrator | Named in initial comments and signature on deficiency statements |
| Connie Kincaid | Registered Nurse | Investigator conducting complaint and annual survey |
| Lori Frodsham | Registered Nurse | Investigator conducting complaint and annual survey |
| Carol Neneman | Social Worker | Investigator conducting complaint and annual survey |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit | Author of complaint investigation letter |
| Dietary Manager | Interviewed regarding meal service staffing and expectations | |
| Administrative Staff A | Confirmed deficient generator maintenance practice |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 53
Deficiencies: 14
Feb 26, 2014
Visit Reason
An unannounced visit was conducted to investigate multiple complaints regarding care and services at Matney's Colonial Manor.
Findings
The facility was found to be in compliance with all related regulatory requirements for care and treatment to prevent pressure sores, provision of needed services, infection control, supply availability, plan of care implementation, staff sobriety, medication administration, and medication overuse.
Complaint Details
The complaint investigation was triggered by multiple allegations including failure to provide care to prevent pressure sores, failure to provide needed services, lack of infection control program, insufficient supplies, failure to follow plan of care, staff under influence, overmedication, medication administration errors, and other care concerns. The facility was found to be in compliance with all related regulatory requirements.
Severity Breakdown
SS=E: 6
SS=D: 6
SS=F: 2
Deficiencies (14)
| Description | Severity |
|---|---|
| Facility staff failed to maintain wallpaper, carpets, doors and fixtures in good condition in multiple resident rooms and common areas; failed to control odors in several resident rooms and hallways. | SS=E |
| Facility failed to maintain even lighting levels in a portion of the main dining area, affecting 2 residents. | SS=E |
| Facility staff failed to implement assessed interventions to prevent pressure ulcer development and failed to identify the development of a pressure ulcer for one resident. | SS=D |
| Facility failed to transfer a resident in a safe manner and failed to evaluate neurologic status for another resident. | SS=D |
| Facility failed to attempt a dose reduction for one resident on antipsychotic medication and failed to identify rationale for medication use for another resident. | SS=D |
| Facility kitchen staff failed to follow recipes to ensure nutritional value was maintained for pureed foods. | SS=E |
| Facility staff failed to ensure palatability of foods related to consistency, taste, and temperatures. | SS=F |
| Facility kitchen staff failed to maintain food temperatures to prevent potential food borne illness. | SS=F |
| Facility staff failed to utilize handwashing and gloving techniques to prevent cross contamination during a treatment for one resident. | SS=D |
| Facility failed to maintain and effective quality assurance committee as evidenced by repeat and additional deficiencies. | SS=D |
| Facility failed to maintain smoke resistance in hazardous areas and failed to maintain automatic door closure on a storage room door. | SS=E |
| Facility failed to provide complete fire sprinkler system coverage in a storage room. | SS=F |
| Facility failed to post 'oxygen in use' signs on resident rooms where oxygen was in use. | SS=E |
| Facility failed to provide proper electrical wiring; use of relocatable power strips in resident room. | SS=E |
Report Facts
Facility census: 56
Facility total capacity: 53
Number of deficient resident rooms: 9
Number of rooms with odor issues: 5
Number of residents affected by lighting deficiency: 2
Number of residents sampled for pressure sore care: 3
Number of residents sampled for medication administration: 5
Number of room trays served: 7
Temperature of regular textured BBQ beef patty: 118
Temperature of plain beef patty: 120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Verschoor-Matney | Interim Administrator | Named in complaint investigation and plan of correction documents |
| Eve Lewis | Program Manager | Signed correspondence related to complaint investigation and informal dispute resolution |
| Dain M. Weiss | RN, BSN | Reviewer of informal dispute resolution report |
| Registered Nurse B | Registered Nurse | Named in infection control deficiency related to handwashing and glove use |
| Maintenance Man C | Named in housekeeping and lighting deficiencies | |
| Maintenance Man D | Named in housekeeping deficiencies | |
| Cook G | Named in dietary deficiencies related to food preparation and temperature | |
| Director of Nursing | Named in medication and care deficiencies | |
| NA E | Nursing Assistant | Named in transfer and care deficiencies |
| NA F | Nursing Assistant | Named in transfer and care deficiencies |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 0
Feb 26, 2014
Visit Reason
An unannounced visit was conducted to investigate multiple complaints regarding care and services at Matney's Colonial Manor.
Findings
The facility was found to be in compliance with all related regulatory requirements for all allegations investigated, including prevention of pressure sores, provision of needed services, infection control, supply availability, plan of care implementation, staff sobriety, medication management, and administration according to orders.
Complaint Details
The investigation addressed multiple allegations including failure to prevent pressure sores, failure to provide needed services, lack of infection control program, insufficient supplies, failure to follow plan of care, staff under influence while providing care, over medication of residents, and improper medication administration. All allegations were found to be unsubstantiated with the facility in compliance.
Report Facts
Facility census: 56
Employee files reviewed: 5
Residents sampled: 3
Residents medications cross-checked: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Schmidt | Registered Nurse | Conducted the complaint investigation |
| Eve Lewis | Program Manager | Signed the report as representative of the Office of Long Term Care Facilities |
| Lisa Verschoor-Matney | Interim Administrator | Facility administrator addressed in the report |
| Director of Nursing | Interviewed regarding staff education on working under the influence |
Inspection Report
Annual Inspection
Census: 44
Deficiencies: 21
Aug 2, 2012
Visit Reason
Annual survey and inspection of Matney's Colonial Manor nursing facility to assess compliance with state and federal regulations including licensure, safety, and care standards.
Findings
The facility was found deficient in multiple areas including failure to complete nurse aide registry checks, failure to report and investigate allegations of misappropriation, inadequate activity programs and unqualified activity director, incomplete care plans, failure to follow dietitian recommendations for wound care, duplicate drug therapy without clinical rationale, food safety violations, life safety code violations including fire safety and emergency preparedness deficiencies.
Severity Breakdown
SS=E: 16
SS=D: 4
SS=F: 3
Deficiencies (21)
| Description | Severity |
|---|---|
| Failed to complete nurse aide registry checks for 3 of 5 nurse aide personnel files and failed to report and investigate allegations of misappropriation for 2 residents. | SS=E |
| Failed to provide activities that met the assessed needs for 1 of 33 sampled residents. | SS=D |
| Activity program was not directed by a qualified professional. | SS=E |
| Failed to develop comprehensive care plans related to activities and dental needs for 2 of 33 sampled residents. | SS=D |
| Failed to review and revise comprehensive care plans related to behaviors and pressure ulcers for 3 of 33 sampled residents. | SS=D |
| Failed to ensure Registered Dietitian recommendations for wound healing were implemented for 1 of 33 sampled residents. | SS=D |
| Residents received duplicate drug therapy without adequate clinical rationale or physician notification for 3 of 33 sampled residents. | SS=E |
| Failed to provide food storage to prevent cross contamination and maintain hot foods above 135 degrees Fahrenheit. | SS=F |
| Failed to provide documentation from central receiving station to verify fire alarm system operation. | SS=F |
| Failed to ensure smoke compartment doors close properly due to metal astragals impeding door closure. | SS=E |
| Failed to provide one-hour fire rated barrier or automatic sprinkler system in physical therapy basement and positive latching door in soiled utility room. | SS=E |
| Failed to ensure access-controlled egress door releases upon fire alarm activation and courtyard gate did not allow reliable egress. | SS=E |
| Failed to provide illumination for exit discharge in courtyard. | SS=E |
| Failed to provide exit or directional signage in dining room and center hall. | SS=E |
| Failed to provide documentation verifying fire drills and fire alarm system operation. | SS=F |
| Failed to provide complete sprinkler coverage in physical therapy room and basement. | SS=F |
| Failed to maintain automatic sprinkler system in reliable operating condition; foreign material on sprinkler head and inadequate sprinkler coverage noted. | SS=E |
| Fire extinguishers mounted higher than 5 feet from floor in three smoke compartments. | SS=E |
| Range hood suppression system had seams and rivets allowing grease buildup. | SS=E |
| Failed to maintain and test emergency generator as required; missing time of transfer and monthly test documentation. | SS=E |
| Electrical wiring violations including missing GFCI outlet, broken GFCI, improper use of surge protector and extension cord. | SS=E |
Report Facts
Deficiencies cited: 23
Facility census: 44
Fire extinguishers height: 67
Fire extinguishers height: 66
Fire extinguishers height: 66
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Troy Anderson | Provisional Administrator | Named in plan of correction and informal conference |
| Doug Hohbein | Chief Plans Examiner | Conducted Informal Conference and prepared report |
| Alan Viox | Deputy State Fire Marshal | Conducted Life Safety Survey |
| Administrator A | Verified multiple observations during inspection | |
| Activity Director A | Activity Director | Interviewed regarding activity program qualifications and care plans |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple deficiencies including nurse aide registry, care plans, medication irregularities |
| Registered Nurse B | Registered Nurse | Interviewed regarding wound care and supplement trial |
| Consultant Pharmacist | Consultant Pharmacist | Interviewed regarding medication irregularities |
| Dietary Director | Dietary Director | Interviewed regarding qualifications |
| Administrator A | Verified fire safety and life safety code deficiencies |
Inspection Report
Routine
Census: 44
Deficiencies: 1
Jun 23, 2011
Visit Reason
The inspection was conducted to assess compliance with medication administration regulations, specifically to ensure the facility is free of medication error rates of five percent or greater.
Findings
The facility failed to maintain a medication error rate below 5%, with an observed error rate of 10% based on 40 medication administrations for 3 residents. Errors included incorrect dosing and failure to administer medications with food as ordered.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure medication error rate was below 5%, with 4 medication errors observed out of 40 administrations. | SS=E |
Report Facts
Medication administrations observed: 40
Medication errors observed: 4
Facility census: 44
Medication error rate: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Medication Assistant (CMA) A | Prepared incorrect dose of warfarin for Resident 7 | |
| Registered Nurse (RN) B | Administered medication to Resident 6 without food as ordered | |
| Certified Medication Assistant (CMA) C | Administered Potassium Chloride to Resident 5 without food as ordered |
Inspection Report
Annual Inspection
Census: 46
Deficiencies: 19
Apr 6, 2011
Visit Reason
Annual state inspection of Matney's Colonial Manor to assess compliance with health, safety, and regulatory standards.
Findings
The inspection identified multiple deficiencies including improper medication disposal, use of physical restraints, dignity and respect issues, housekeeping and maintenance problems, care plan inaccuracies, restorative services lapses, food safety violations, infection control failures, fire safety code violations, and electrical hazards.
Severity Breakdown
SS=F: 6
SS=E: 5
SS=D: 5
Deficiencies (19)
| Description | Severity |
|---|---|
| Failed to ensure proper disposal of refused medication for Resident 13. | — |
| Failed to assess use of tilt and space wheelchair as a physical restraint for Resident 4. | SS=D |
| Failed to maintain dignity and respect for Residents 1 and 4, including exposure and hygiene issues. | SS=D |
| Failed to provide adequate housekeeping and maintenance services affecting multiple resident rooms, dining and smoking areas. | SS=E |
| Failed to develop and revise comprehensive care plans reflecting current resident status for Residents 2 and 6. | SS=D |
| Failed to provide restorative nursing program to maintain functional abilities for Residents 4 and 6. | SS=D |
| Failed to properly store, refrigerate, and thaw foods and maintain cleanliness in kitchen and storage areas. | SS=F |
| Failed to implement infection control procedures and isolation for Resident 3 with MRSA. | SS=D |
| Failed to ensure corridor doors latch properly, specifically door to room 210. | SS=D |
| Failed to provide readily accessible exits; issues with exit doors and enclosed courtyard exit. | SS=E |
| Exit corridor obstructed by stored lifts and wheelchairs reducing corridor width. | SS=E |
| Patient room door (room 208) lock could not be operated from inside. | SS=D |
| Emergency lighting could be switched off at nurse's station, risking loss of emergency illumination. | SS=F |
| Fire drills not conducted on all shifts every quarter. | SS=F |
| Missing sprinkler head in closet of room 112 and other sprinkler system maintenance issues. | SS=F |
| Heating boiler inspection expired and not renewed. | SS=F |
| Open flame (candle) found in beauty shop. | SS=E |
| No non-smoking or no smoking signs where oxygen is used in resident rooms. | SS=E |
| Improper use of extension cords and power strips; lack of ground fault interruption circuits near sinks. | SS=F |
Report Facts
Facility census: 46
Residents sampled: 12
Residents affected: 1
Residents affected: 2
Residents affected: 2
Residents affected: 2
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 25
Residents affected: 14
Residents affected: 20
Residents affected: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN H | Licensed Practical Nurse | Named in infection control deficiency related to MRSA wound care |
| Cook D | Cook | Named in food safety deficiencies related to thawing and refrigeration |
| Dietary Manager | Dietary Manager | Named in food safety deficiencies and kitchen cleanliness |
| Administrator A | Named in multiple fire safety and facility maintenance interviews | |
| Administrator B | Named in multiple fire safety and facility maintenance interviews | |
| QA LPN B | Quality Assurance Licensed Practical Nurse | Named in infection control deficiency related to MRSA isolation |
| LPN C | Charge Nurse Licensed Practical Nurse | Named in infection control deficiency related to MRSA isolation |
| OTA A | Occupational Therapist Assistant | Named in restraint assessment for wheelchair use |
| PTA F | Physical Therapist Assistant | Named in restorative therapy program discussion |
| Restorative Aide E | Restorative Aide | Named in restorative therapy program discussion |
| Director of Nursing | Named in multiple interviews regarding restorative therapy and restraint use |
Inspection Report
Plan of Correction
Census: 52
Deficiencies: 3
Jan 27, 2011
Visit Reason
The document is a Plan of Correction submitted by Matney's Colonial Manor following a survey conducted on 01/27/2011, addressing deficiencies related to comprehensive care plans and resident participation in care planning.
Findings
The survey identified deficiencies in developing comprehensive care plans for residents, specifically Resident 5 and Resident 1, including failure to revise care plans to promote skin healing and to establish care plans timely. The facility acknowledged these issues and outlined corrective actions including audits and weekly monitoring by the Director of Nursing.
Deficiencies (3)
| Description |
|---|
| Failure to develop a comprehensive care plan for skin care for Resident 5. |
| Failure to revise care plan problems and interventions to promote skin healing for Resident 1. |
| Failure to ensure Resident 1's right to participate in planning care and revise care plan. |
Report Facts
Sample size: 6
Facility census: 52
Norton Plus Pressure Ulcer Scale score: 10
Norton Plus Pressure Ulcer Scale score: 7
Care plan update deadline: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Interviewed regarding care plan deficiencies and monitoring corrective actions. |
| LPN A. | Licensed Practical Nurse | Signed medical record notes related to wound care and treatment. |
Notice
Capacity: 77
Deficiencies: 0
APP2017
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Matneys Colonial Manor and includes the nursing home licensure renewal application and occupancy permit.
Findings
The documents confirm that Matneys Colonial Manor is licensed as a skilled nursing facility with a total licensed capacity of 77 beds. The renewal application was completed and signed, and the occupancy permit was issued by the State Fire Marshal.
Report Facts
Total licensed beds: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Edward H. Matney | Administrator | Named as authorized representative signing the renewal application and ownership disclosure. |
| Lisa Verschoor | Administrator | Signed affidavit certifying information on ownership disclosure. |
Notice
Capacity: 77
Deficiencies: 0
APP2018
Visit Reason
The document serves as a renewal application and certification for the nursing home license of Matneys Colonial Manor, including verification of licensure and occupancy permit.
Findings
The documents confirm that Matneys Colonial Manor is licensed as a Skilled Nursing Facility with a total licensed capacity of 77 beds and holds a valid occupancy permit issued on 2017-02-07.
Report Facts
Total licensed beds: 77
Occupancy permit date: 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Edward Matney | Administrator | Named as Administrator on the renewal application and ownership disclosure |
| Anita Lenzen | Director of Nursing | Named as Director of Nursing on the renewal application |
Document
Capacity: 77
Deficiencies: 0
APP2020
Visit Reason
The documents pertain to the renewal of the nursing home license for Continental Springs, LLC, including submission of the renewal application and verification of licensure status.
Findings
No inspection findings or deficiencies are reported in these documents; they primarily confirm licensure renewal and facility capacity.
Report Facts
Total licensed beds: 77
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dixie Jackson | Administrator | Named in the renewal application on page 2. |
| Anita Lenzen | Director of Nursing | Named in the renewal application on page 2. |
| Moshe Rosenblatt | Authorized Representative | Signed the renewal application on page 2 and listed as owner on page 3. |
| Matisyohu Herzka | Authorized Representative | Signed the renewal application on page 2 and listed as owner on page 3. |
Notice
Capacity: 77
Deficiencies: 0
APP2022
Visit Reason
The documents serve to renew the nursing home license for Continental Springs, LLC, verify licensure status, and provide occupancy permit information.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure renewal, ownership details, and occupancy capacity compliance.
Report Facts
Total licensed beds: 77
Renewal license fees: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Lange | Administrator | Named on the nursing home licensure renewal application |
| Kristin Rodriguez | Director of Nursing | Named on the nursing home licensure renewal application |
| Matisyohu Herzka | Authorized Representative | Signed the renewal application and listed as 33.3% owner |
| Abraham K. Schreiber | Authorized Representative | Signed the renewal application and listed as 33.3% owner |
| Moshe Rosenblatt | Listed as 33.3% owner |
Document
Capacity: 77
Deficiencies: 0
APP2023
Visit Reason
The documents include a nursing home licensure renewal application for Continental Springs, LLC, and an occupancy permit indicating the facility's licensed bed capacity.
Findings
No inspection findings or deficiencies are reported; the documents primarily verify licensure status, ownership information, and occupancy permit details.
Report Facts
Total licensed beds: 77
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