Inspection Reports for
Cottonwood Villa
450 SOUTH MAIN STREET, AINSWORTH, NE, 69210
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
0.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
88% better than Nebraska average
Nebraska average: 4.2 deficiencies/year
Deficiencies per year
4
3
2
1
0
Inspection Report
Renewal
Capacity: 36
Deficiencies: 0
Date: Mar 20, 2025
Visit Reason
The document is a renewal application and license verification for Cottonwood Villa, an assisted-living facility, confirming licensure through the renewal date.
Findings
The documents certify that Cottonwood Villa meets statutory requirements as an assisted-living facility and includes ownership information, licensing renewal details, and occupancy permit with a maximum capacity of 36 beds.
Report Facts
Total licensed beds: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named in renewal application form |
| Todd Mundhenke | Board Chair | Listed in ownership/control list and signed renewal application |
| David Spann | Listed in ownership/control list and signed renewal application | |
| Sheryl Graff | Listed in ownership/control list | |
| Jim Hoch | Listed in ownership/control list | |
| Robert Miles | Listed in ownership/control list | |
| Linda O'Hare | Listed in ownership/control list | |
| Robert Folck | Deputy State Fire Marshal | Inspected and approved occupancy permit |
Inspection Report
Renewal
Capacity: 36
Deficiencies: 0
Date: Apr 10, 2023
Visit Reason
The document is a renewal application and license verification for Cottonwood Villa, an assisted-living facility, confirming licensure through the indicated renewal date.
Findings
The documents confirm that Cottonwood Villa meets statutory requirements as an assisted-living facility and is licensed for 36 beds. The renewal application was completed and signed on April 10, 2023.
Report Facts
Renewal Licensure Fees: 950
Renewal Licensure Fees: 1450
Renewal Licensure Fees: 1650
Renewal Licensure Fees: 1950
Total Licensed Beds: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named on renewal application |
| David Spann | Authorized representative signing renewal application | |
| Larry Rice | Authorized representative signing renewal application |
Notice
Capacity: 36
Deficiencies: 0
Date: Mar 18, 2016
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Cottonwood Villa, confirming its licensed status and renewal expiration date.
Findings
The documents confirm that Cottonwood Villa meets statutory requirements as an assisted-living facility with a licensed capacity of 36 beds. The Nebraska State Fire Marshal issued an occupancy permit for 36 beds on 2015-02-24.
Report Facts
Total licensed beds: 36
Renewal expiration date: Apr 30, 2016
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named as administrator on the licensure renewal application |
Inspection Report
Complaint Investigation
Census: 26
Deficiencies: 2
Date: Aug 13, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Cottonwood Villa on August 13-14, 2014. The investigation included review of resident records, observation of care and services, and interviews with residents, family members, and staff.
Complaint Details
Complaint investigation was conducted regarding failure to provide therapeutic meals as agreed and failure to ensure food safety. The allegation that therapeutic meals were not provided was not substantiated. The allegation that foods were not handled correctly to prevent foodborne illness was substantiated.
Findings
The facility was found compliant with providing therapeutic meals as agreed upon in service agreements. However, the facility failed to ensure foods were handled correctly to prevent foodborne illness, including failure of staff to wash hands and change gloves during meal preparation. Additionally, the facility failed to assure safe self-administration of medication for two residents.
Deficiencies (2)
Facility failed to ensure foods were handled correctly to prevent foodborne illness; staff failed to wash hands and change gloves during meal preparation.
Facility failed to assure 2 of 2 sampled residents were evaluated for safety to self-administer medications.
Report Facts
Facility census: 26
Residents sampled for medication self-administration: 2
Residents interviewed for therapeutic meals: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Krista Roeber | Social Worker | Surveyor conducting the complaint investigation and annual survey |
| Ann Fiala | Administrator | Named in interview verifying medication self-administration and response letter |
| Eve Lewis | Program Manager | Office of Long Term Care Facilities, signed letters related to inspection and complaint investigation |
Notice
Capacity: 36
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as verification and renewal of the assisted-living facility license for Cottonwood Villa, confirming licensure through the indicated expiration date.
Findings
The documents confirm the facility meets statutory requirements for licensure as an assisted-living facility, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 36
Expiration date: Apr 30, 2018
Occupancy maximum: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named as administrator in the licensure renewal application on page 2. |
Notice
Capacity: 36
Deficiencies: 0
Date: APP2018
Visit Reason
This document serves to verify that Cottonwood Villa is licensed as an assisted-living facility through the indicated renewal date and includes the occupancy permit specifying the maximum occupancy.
Findings
The facility is licensed through 4/30/2019 with a total licensed capacity of 36 beds. The Nebraska State Fire Marshal issued an occupancy permit on 4/11/2017 confirming the maximum occupancy of 36 beds.
Report Facts
Total licensed beds: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named as facility administrator on renewal application |
| Robert Folck | Deputy State Fire Marshal | Inspected and approved occupancy permit |
Notice
Capacity: 36
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves as a licensure renewal application and renewal notice for the assisted-living facility Cottonwood Villa, verifying that the facility is licensed through the indicated expiration date.
Findings
The document confirms that Cottonwood Villa meets statutory requirements as an assisted-living facility and is licensed through the renewal date. It includes ownership information, total licensed bed capacity, and certification of compliance with state regulations.
Report Facts
Total licensed beds: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann Fiala | Administrator | Named as administrator in the licensure renewal application |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility for occupancy permit |
Document
Capacity: 36
Deficiencies: 0
Date: APP2020
Visit Reason
The documents pertain to the renewal of the assisted-living facility license for Cottonwood Villa, including verification of licensure, submission of renewal application, and occupancy permit.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure status, ownership information, and facility capacity.
Report Facts
Total licensed beds: 36
Renewal license fees: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann F. Fiala | Administrator | Named in the renewal application. |
Notice
Capacity: 36
Deficiencies: 0
Date: APP2021
Visit Reason
This document serves to verify that the assisted-living facility Cottonwood Villa is licensed through the date indicated on the renewal card and includes the renewal application for the facility's license.
Findings
The document confirms the renewal of the assisted-living facility license for Cottonwood Villa with a total licensed capacity of 36 beds. It includes ownership information and a fire marshal occupancy permit.
Report Facts
Total licensed beds: 36
Renewal license fees: 950
Renewal license fees: 1450
Renewal license fees: 1650
Renewal license fees: 1950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann F. Fiala | Administrator | Named as facility administrator on the renewal application |
| Todd Mundhenke | Board Chair | Listed in ownership/control list |
| David Spann | Listed in ownership/control list | |
| Larry Rice | Listed in ownership/control list | |
| Sheryl Graff | Listed in ownership/control list | |
| Jim Hoch | Listed in ownership/control list | |
| Patricia Daugherty | Listed in ownership/control list |
Notice
Capacity: 36
Deficiencies: 0
Date: APP2022
Visit Reason
The documents serve to verify and renew the assisted-living facility license for Cottonwood Villa, including ownership information and occupancy permit details.
Findings
The documents confirm that Cottonwood Villa meets statutory requirements as an assisted-living facility, with a licensed capacity of 36 beds and an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Licensed capacity: 36
Renewal license fees: 950
Notice
Capacity: 36
Deficiencies: 0
Date: APP2024
Visit Reason
The document serves to verify that Cottonwood Villa, an assisted-living facility, is licensed through the date indicated on the renewal card and includes the renewal application and related licensure information.
Findings
The documents confirm the facility's licensure status, ownership information, bed capacity, and occupancy permit without reporting any inspection findings or deficiencies.
Report Facts
Total licensed beds: 36
Renewal license fees: 950
Renewal license fees: 1450
Renewal license fees: 1650
Renewal license fees: 1950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ann F. Fiala | Administrator | Named as facility administrator on the renewal application. |
| James H. Hoch | Authorized Representative | Signed the renewal application as an authorized representative. |
| David S. Spann | Authorized Representative | Signed the renewal application as an authorized representative and listed on ownership/control list. |
| Todd Mundhenke | Board Chair | Listed on ownership/control list. |
| Larry Rice | Listed on ownership/control list. | |
| Sheryl Graff | Listed on ownership/control list. | |
| Jim Hoch | Listed on ownership/control list. | |
| Patricia Daugherty | Listed on ownership/control list. |
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