Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Renewal
Capacity: 25
Deficiencies: 0
Mar 20, 2025
Visit Reason
The document is a renewal application and license verification for Havelock Manor, an assisted-living facility, to renew its licensure with the Nebraska Department of Health and Human Services.
Findings
The documents confirm that Havelock Manor meets statutory requirements for licensure as an assisted-living facility. The renewal application was signed and submitted on March 20, 2025, and the facility holds a fire prevention operational permit valid through December 31, 2025.
Report Facts
Total licensed beds: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frank Haverkamp | Authorized Representative | Signed the renewal application on March 20, 2025 |
| Mary Haverkamp | Authorized Representative | Signed the renewal application on March 20, 2025 |
Inspection Report
Renewal
Capacity: 25
Deficiencies: 0
Mar 21, 2023
Visit Reason
The document is a renewal application and certification for the assisted-living facility license of Havelock Manor, verifying the facility's licensed status through the renewal date.
Findings
The documents confirm that Havelock Manor meets statutory requirements as an assisted-living facility and is licensed for 25 beds. Ownership and business organization details are provided, along with a fire prevention operational permit valid through 12/31/2023.
Report Facts
Total licensed beds: 25
Renewal application date: Mar 21, 2023
Fire permit issue date: Dec 8, 2022
Fire permit expiration date: Dec 31, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Petracek | Administrator | Named as facility administrator in renewal application |
| Frank Haverkamp | Authorized Representative | Signed renewal application and listed as member of ownership LLC |
| Mary Haverkamp | Authorized Representative | Signed renewal application and listed as member of ownership LLC |
Inspection Report
Renewal
Capacity: 25
Deficiencies: 0
Mar 15, 2021
Visit Reason
The document is a renewal application and certification for the assisted-living facility Havelock Manor, verifying licensure through the renewal date and requesting renewal of the facility license.
Findings
The document certifies that Havelock Manor meets statutory requirements as an assisted-living facility and includes ownership information, licensing details, and a fire department operational permit with a maximum occupancy of 25.
Report Facts
Total licensed beds: 25
Maximum occupancy: 25
Inspection Report
Complaint Investigation
Deficiencies: 0
Oct 17, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to ensure residents are free from abuse.
Findings
The investigation included observations, interviews, and record reviews which found no concerns of abuse and determined the facility was in compliance with regulatory requirements with no violations.
Complaint Details
The complaint alleged the facility failed to ensure residents were free from abuse. The investigation found no substantiated concerns or violations.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit |
Inspection Report
Complaint Investigation
Census: 16
Deficiencies: 1
Oct 3, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Havelock Manor on October 3, 2017, regarding allegations that the facility failed to maintain an effective pest control program, maintain essential equipment, and protect residents from abuse.
Findings
The facility was found to be in compliance with pest control, equipment maintenance, and abuse protection regulations; however, a deficiency was cited for failure to treat residents with dignity. Interviews and record reviews revealed that two residents were not treated with dignity, including threats of discharge and inappropriate communication by the Administrator.
Complaint Details
The complaint investigation was substantiated with findings that two residents were not treated with dignity. Confidential interviews revealed that residents were threatened with discharge and told they had no place to go. The Administrator acknowledged stress and prior incidents of being short with residents. The Notice of Disciplinary Action was affirmed after an Informal Conference.
Deficiencies (1)
| Description |
|---|
| Failure to treat residents with dignity |
Report Facts
Census: 16
Hours worked: 19
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Stearns - Petracek | Administrator | Named in findings related to failure to treat residents with dignity and responsible for facility operations |
| Carrie Murphy | MA | Witnessed conversation with resident regarding discharge notice |
| Tamara Schweitzer | Resident Care Supervisor/Med Aide | Provided statement regarding resident behavior and discharge process |
| Matthew Younker-Rowell | Assistant Facility Manager | Provided statement supporting Administrator's advocacy for residents and denial of abusive behavior |
Inspection Report
Complaint Investigation
Deficiencies: 0
Apr 25, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Havelock Manor on April 25, 2017. The investigation focused on allegations including insufficient staffing, lack of dignity and respect, medication errors, abuse, failure to identify changes in condition, and failure to provide prompt emergency care.
Findings
The facility was found to be in compliance with all related regulatory requirements. Staffing was sufficient, residents were treated with dignity and respect, medications were provided as prescribed with less than 5% error rate, residents were protected from abuse, changes in condition were identified and communicated, and prompt emergency care was provided when needed.
Complaint Details
The complaint investigation addressed six allegations: insufficient staffing, lack of dignity and respect, medication errors, abuse, failure to identify changes in condition, and failure to provide prompt emergency care for stroke-like symptoms. All allegations were found to be unsubstantiated with the facility in compliance.
Report Facts
Medication error rate: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Stearns - Petracek | Administrator | Named as facility administrator in the report |
| Eve Lewis | Program Manager | Signed the complaint investigation report |
Inspection Report
Renewal
Capacity: 25
Deficiencies: 0
Mar 7, 2016
Visit Reason
The document is a licensure renewal application and related certification for Havelock Manor, an assisted-living facility, to renew its license and verify compliance with statutory requirements.
Findings
The documents confirm that Havelock Manor meets statutory requirements as an assisted-living facility and is licensed for a maximum occupancy of 25 beds. Ownership and control are verified, and the state fire marshal certificate is enclosed.
Report Facts
Total licensed beds: 25
Maximum occupancy: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Stearns-Petracek | Administrator | Named as the facility administrator on the renewal application and letter (pages 2 and 3). |
| Geanine Bordogna | Owner | Named as the individual owner and authorized representative signing the renewal application (pages 2 and 3). |
Inspection Report
Complaint Investigation
Census: 19
Deficiencies: 2
Dec 8, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Havelock Manor on December 8-9, 2015, by 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 failed to ensure staff used proper food handling techniques in accordance with the Food Code requirements, specifically improper handwashing practices during meal preparation. The facility also failed to have evidence that a Registered Nurse reviewed the medication administration policy annually. Other allegations including food storage, medication administration, resident care, abuse prevention, and cleanliness were found to be in compliance with no violations.
Complaint Details
The complaint investigation focused on allegations related to food handling practices, medication administration credentials, resident care, abuse prevention, and record accuracy. The facility was found deficient in food handling techniques and policy review but compliant in other areas.
Deficiencies (2)
| Description |
|---|
| Failure to ensure staff used proper food handling techniques, including inadequate handwashing and use of designated handwashing sinks, violating State Regulations at 4-006.10 C. |
| Failure to have evidence that a Registered Nurse reviewed the medication administration policy on an annual basis, violating 175 NAC 4-006.03C2. |
Report Facts
Facility census: 19
Estimated time to correct food handling violation: Completion date set for 2016-01-28
Estimated time to correct medication policy review violation: Completion date set for 2016-01-30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation letter |
| Victoria Smith | Registered Nurse | Surveyor involved in the inspection |
| Connie Heavin | Social Worker | Surveyor involved in the inspection |
| Rebecca Young | Registered Nurse | Surveyor involved in the inspection |
Notice
Capacity: 25
Deficiencies: 0
APP2017
Visit Reason
This document serves as the licensure renewal application and verification for the assisted-living facility Havelock Manor, including ownership confirmation and occupancy permits.
Findings
The documents confirm that Havelock Manor meets statutory requirements for licensure renewal as an assisted-living facility with a total licensed capacity of 25 beds. Ownership and control are confirmed to be held by Geanine Bordogna. The facility holds a valid operational permit with a maximum occupancy of 25.
Report Facts
Total licensed beds: 25
Maximum occupancy: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Geanine Bordogna | Owner | Named as the individual owner with 100% control of Havelock Manor LLC. |
| Janine Stearns-Petracek | Administrator | Named as the facility administrator in the renewal application. |
Notice
Capacity: 25
Deficiencies: 0
APP2018
Visit Reason
This document serves as a licensure renewal notification for Havelock Manor Assisted-Living Facility, confirming the license expiration date and providing renewal application details.
Findings
The documents confirm that Havelock Manor meets statutory requirements for licensure renewal as an assisted-living facility with a total licensed capacity of 25 beds. Included are the renewal application, ownership information, fire prevention operational permit, and occupancy certificate.
Report Facts
Total licensed beds: 25
Maximum occupancy: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Stearns Petracek | Administrator | Named as the facility administrator and Director of Operations in the renewal application and correspondence. |
| Dalene DeGeest | Trustee | Named as the Trustee and individual owner of Havelock Manor Trust in the renewal application. |
Notice
Capacity: 25
Deficiencies: 0
APP2019
Visit Reason
This document serves as verification of licensure renewal for the assisted-living facility Havelock Manor, including submission of the renewal application and related ownership and fire safety permit information.
Findings
The documents confirm that Havelock Manor meets statutory requirements for licensure renewal as an assisted-living facility with a maximum occupancy of 25 beds, and include ownership details and a valid fire safety operational permit.
Report Facts
Total licensed beds: 25
Maximum occupancy: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frank Haverkamp | Sole member of Havelock Holdings LLC, the ownership entity of Havelock Manor. | |
| Janine Stearns-Petracek | Administrator | Named as the facility administrator on the licensure renewal application. |
| Bo Botelho | Interim CEO, Interim Director of Public Health | Signed the licensure verification document from the Department of Health and Human Services. |
| Mary Haverkamp | Authorized representative who signed the renewal application. |
Notice
Capacity: 25
Deficiencies: 0
APP2020
Visit Reason
This document serves to verify that Havelock Manor, an assisted-living facility, is licensed through the date indicated on the renewal card and includes the renewal application and ownership information.
Findings
The documents confirm that Havelock Manor meets statutory requirements as an assisted-living facility and is licensed through April 30, 2021. Ownership and licensing details are provided along with a fire prevention operational permit valid through December 31, 2020.
Report Facts
Total licensed beds: 25
License expiration date: Apr 30, 2021
Fire permit expiration date: Dec 31, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frank Haverkamp | Authorized Representative | Named as authorized representative signing the renewal application and sole member of ownership LLC. |
| Mary Haverkamp | Authorized Representative | Named as authorized representative signing the renewal application. |
Notice
Capacity: 25
Deficiencies: 0
APP2022
Visit Reason
The document serves as a renewal application and verification that Havelock Manor is licensed as an assisted-living facility, including instructions for license renewal and notification of any changes in facility information.
Findings
The document confirms that Havelock Manor meets statutory requirements for licensure as an assisted-living facility and provides details about ownership, business organization, and license renewal fees.
Report Facts
Total licensed beds: 25
Renewal license expiration date: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frank Haverkamp | Authorized Representative | Named as authorized representative signing the renewal application |
| Mary Haverkamp | Authorized Representative | Named as authorized representative signing the renewal application |
Notice
Capacity: 25
Deficiencies: 0
APP2024
Visit Reason
This document serves as a renewal application and verification of licensure for the assisted-living facility Havelock Manor, including ownership and operational permit information.
Findings
The documents confirm that Havelock Manor meets statutory requirements as an assisted-living facility, is licensed for 25 beds, and holds a valid operational fire prevention permit with no noted deficiencies or inspection findings.
Report Facts
Total licensed beds: 25
Renewal license expiration date: Expires 4/30/2025 as shown on the renewal card.
Fire permit issue date: Issued 12/06/2023 with expiration 12/31/2024.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Petracek | Administrator | Named as facility administrator on the renewal application. |
| Frank Haverkamp | Authorized Representative | Signed renewal application and listed as member of ownership LLC. |
| Mary Haverkamp | Authorized Representative | Signed renewal application and listed as member of ownership LLC. |
Notice
Capacity: 25
Deficiencies: 0
CHOW2018
Visit Reason
This document set serves to notify and confirm the issuance and renewal of the assisted living facility license for Havelock Manor, including a change of ownership effective May 1, 2018.
Findings
The documents confirm that Havelock Manor is licensed as an assisted living facility with a capacity of 25 beds. Ownership was transferred to Havelock Holdings LLC on May 1, 2018. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 25
License expiration date: Apr 30, 2019
Permit maximum occupancy: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Janine Stearns-Petracek | Administrator | Named as facility administrator on licensure application. |
| Frank X. Haverkamp | President, Owner | Named as sole member/owner of Havelock Holdings LLC and signatory on ownership transfer documents. |
| Mary Haverkamp | Secretary/Director | Named as officer and director of Havelock Holdings LLC. |
| Dalene DeGeest | Trustee | Trustee of Havelock Manor Trust and seller in ownership transfer. |
| Thomas L. Williams | Chief Medical Officer, Director, Division of Public Health | Signed license issuance and renewal letters. |
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