Inspection Reports for Fairbury Assisted Living Facility DBA Cedarwood
828 22ND STREET, FAIRBURY, NE, 68352
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
0.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
93% better than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
4
3
2
1
0
Notice
Capacity: 65
Deficiencies: 0
Date: Mar 13, 2025
Visit Reason
The document serves as a renewal application and license verification for Fairbury Assisted Living Facility DBA Cedarwood, confirming licensure through the indicated renewal date and providing related facility and ownership information.
Findings
The documents confirm the facility meets statutory requirements for assisted living licensure, with a licensed capacity of 65 beds, and includes an occupancy permit issued by the Nebraska State Fire Marshal. No inspection findings or deficiencies are reported.
Report Facts
Licensed Capacity: 65
Renewal Application Date: Mar 13, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Becky Bruce | Administrator | Named as administrator on renewal application. |
| Chance M. Klasek | Authorized Representative | Signed renewal application. |
| Holly Wolff | Authorized Representative | Signed renewal application and listed as President on Board of Directors. |
Notice
Capacity: 65
Deficiencies: 0
Date: Feb 18, 2016
Visit Reason
The document serves as a licensure renewal application for the Fairbury Assisted Living Facility DBA Cedarwood, verifying the facility's license and providing renewal fee information.
Findings
The documents confirm the facility meets statutory requirements as an assisted-living facility, provide ownership and administrative information, and include occupancy permits indicating a maximum capacity of 65 beds.
Report Facts
Total licensed beds: 65
Renewal fees: 950
Renewal fees: 1450
Renewal fees: 1650
Renewal fees: 1950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Sutton | Administrator | Named as the administrator of the facility in the licensure renewal application. |
Inspection Report
Routine
Census: 43
Deficiencies: 1
Date: Feb 16, 2011
Visit Reason
The inspection was conducted as a compliance inspection of the Fairbury Assisted Living Facility to assess adherence to licensure regulations for assisted-living facilities.
Findings
The facility failed to ensure that 5 out of 5 sampled resident records contained monthly documentation about assistance with activities of daily living, personal care, health maintenance activities, or supervision. Documentation was only done for vital signs monthly, while other activities were documented quarterly.
Deficiencies (1)
Failure to ensure monthly documentation in resident records regarding assistance with activities of daily living, personal care, health maintenance activities, or supervision.
Report Facts
Facility census: 43
Sampled resident records: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Terese Itzen | Registered Nurse | Surveyor conducting the inspection |
| Diana Meyer | Registered Nurse | Surveyor conducting the inspection |
| Debra Sutton | Administrator | Facility administrator named in the report |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Fairbury Assisted Living Facility DBA Cedarwood, confirming its licensed status through the renewal date.
Findings
The documents confirm the facility's licensure renewal status, ownership information, total licensed bed capacity of 65, and include occupancy permits and floor plans for the facility.
Report Facts
Total licensed beds: 65
Occupancy permit beds: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Sutton | Administrator | Named as facility administrator in the licensure renewal application. |
| Pat Merrick | Deputy State Fire Marshal | Signed the occupancy permit for the facility. |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2018
Visit Reason
The document serves as a licensure renewal application and verification of licensure for Fairbury Assisted Living Facility DBA Cedarwood, including renewal fees and occupancy permit information.
Findings
The documents confirm the facility's licensure status, ownership information, total licensed bed capacity of 65, and include an occupancy permit issued by the Nebraska State Fire Marshal with a maximum occupancy of 65 beds.
Report Facts
Total licensed beds: 65
Renewal fee: 1650
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Sutton | Administrator, R.N. | Named as the facility administrator in the renewal application. |
| Pat Merrick | Deputy State Fire Marshal | Inspected the facility for the occupancy permit. |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves as a licensure renewal application and verification that Fairbury Assisted Living Facility DBA Cedarwood is licensed through the indicated expiration date.
Findings
The document confirms the facility's licensure status and includes ownership information, board of directors, and occupancy permit details. No inspection findings or deficiencies are reported.
Report Facts
Total licensed capacity: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Sutton | Administrator, R.N. | Named as facility administrator in the licensure renewal application |
| Chad Jurgens | President | Named as President of Cedarwood Assisted Living Board of Directors and authorized representative on renewal application |
| Bo Botelho | Interim CEO, Interim Director of Public Health | Signed the licensure verification document |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves as a licensure renewal application and verification for Fairbury Assisted Living Facility DBA Cedarwood, confirming the facility's license status and renewal through the indicated expiration date.
Findings
The document certifies that the facility meets statutory requirements as an assisted-living facility and includes ownership, capacity, and licensing information. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 65
Renewal license expiration date: License expires on 2021-04-30 as shown on the renewal card
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Sutton | Administrator | Named as administrator on the renewal application |
| Chance Klasek | Authorized Representative | Signed the renewal application as authorized representative |
| Victor Lee | Authorized Representative | Signed the renewal application as authorized representative and listed as President of the Board of Directors |
Document
Capacity: 65
Deficiencies: 0
Date: APP2021
Visit Reason
The document serves as a renewal application for the assisted-living facility license and includes certification of licensure, ownership information, and occupancy permit details.
Findings
The documents verify that the facility meets statutory requirements for licensure as an assisted-living facility with a maximum occupancy of 65 beds, and includes an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 65
Renewal Licensure Fees: 950
Renewal Licensure Fees: 1450
Renewal Licensure Fees: 1650
Renewal Licensure Fees: 1950
Document
Capacity: 65
Deficiencies: 0
Date: APP2022
Visit Reason
This document set includes a licensure renewal application for Fairbury Assisted Living Facility DBA Cedarwood, renewal verification, and occupancy permit documentation.
Findings
No inspection findings or deficiencies are reported in these documents; they primarily serve to verify licensure renewal and occupancy capacity.
Report Facts
Total licensed beds: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Becky Bruce | Administrator | Named as facility administrator on the renewal application (page 2). |
| Chance M. Klasek | Authorized Representative | Signed the renewal application on 3/15/2022 (page 2). |
| Burke Kline | Authorized Representative | Signed the renewal application on 3/15/2022 (page 2) and listed as President of the Board of Directors (page 3). |
| Brandon Lubke | Deputy State Fire Marshal | Inspected the facility and approved the occupancy permit dated 2/28/2022 (page 4). |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2023
Visit Reason
This document serves to verify the assisted-living facility's license renewal status and includes the renewal application, occupancy permit, and facility floor plans.
Findings
The documents confirm the facility meets statutory requirements for assisted-living licensure, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 65
Renewal application date: 2023
Occupancy permit issue date: 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Becky Bruce | Administrator | Named as facility administrator in the renewal application. |
| Brandon Lubke | Deputy State Fire Marshal | Inspected the facility and approved the occupancy permit. |
Notice
Capacity: 65
Deficiencies: 0
Date: APP2024
Visit Reason
This document serves as a license renewal confirmation for Fairbury Assisted Living Facility DBA Cedarwood, verifying the facility's licensure through the expiration date on the renewal card.
Findings
The documents confirm the facility meets statutory requirements for assisted living licensure, provide the total licensed bed capacity, and include occupancy permits and detailed floor plans.
Report Facts
Total licensed beds: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Becky Bruce | Administrator | Named as administrator on the renewal application. |
| Chance M. Klasek | Authorized Representative | Signed the renewal application as authorized representative. |
| Dr. Burke Kline | Authorized Representative | Signed the renewal application as authorized representative and listed as President of the Board of Directors. |
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