Inspection Reports for Imperial Manor Nursing Home
933 Grant Street, NE, 69033
Back to Facility ProfileDeficiencies per Year
16
12
8
4
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Renewal
Capacity: 58
Deficiencies: 0
Feb 21, 2022
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related renewal certification for Imperial Manor Nursing Home, verifying the facility's license renewal and compliance with statutory requirements.
Findings
The documents confirm that Imperial Manor Nursing Home meets statutory requirements for licensure renewal as a Skilled Nursing Facility with various therapy services. No deficiencies or violations are noted in the provided materials.
Report Facts
Licensed beds: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Doug Gaswick | Authorized Representative | Signed the Nursing Home Licensure Renewal Application |
| Gary J. Anthone, MD | Chief Medical Officer, Director, Division of Public Health | Signed the renewal certification card |
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 1
Mar 11, 2019
Visit Reason
An unannounced visit was conducted to investigate an annual survey at Imperial Manor Nursing Home on March 11, 2019, focusing on allegations that the facility failed to report change in condition to the care provider and failed to treat resident's complaints of pain.
Findings
The facility failed to report changes in condition to the care provider for one sampled resident, specifically after a fall and changes in condition, resulting in a deficiency citation. The facility was found to be in compliance regarding treatment of the resident's complaints of pain.
Complaint Details
The complaint investigation focused on allegations that the facility failed to report changes in condition to the care provider and failed to treat resident's complaints of pain. The failure to report changes was substantiated, while the pain management was found compliant.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure that the physician was notified to determine the need for further medical care after a fall, elevated blood pressure, and changes in speech for one resident. | SS=D |
Report Facts
Facility census: 38
Deficiency citation: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager-Office of LTC Facilities-Licensure Unit-Div. of Public Health-DHHS | Signed the complaint investigation letter |
| Eric Haider | Administrator | Facility administrator addressed in the letter |
| Director of Nursing | Interviewed confirming the nurse should have called the resident's provider rather than sending a facsimile |
Inspection Report
Complaint Investigation
Census: 36
Deficiencies: 1
Dec 18, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at Imperial Manor Nursing Home regarding failure to protect residents from injury and failure to submit investigations within 5 working days.
Findings
The facility failed to implement interventions to prevent falls with injuries for three sampled residents, resulting in multiple falls and injuries. However, the facility was found to be in compliance with submitting investigations within 5 working days.
Complaint Details
The complaint alleged the facility failed to protect residents from injury and failed to submit investigations within 5 working days. The allegation of failure to protect residents from injury was substantiated with deficiencies cited. The allegation regarding submission of investigations was found to be in compliance.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to implement interventions to prevent falls with injuries for three sampled residents. | SS=E |
Report Facts
Facility census: 36
Number of sampled residents with recent falls: 3
Number of falls for Resident 3 in December 2018: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed letter regarding complaint investigation |
| Director of Nurses (DON) | Interviewed and confirmed residents were at risk for falls and care plan interventions were ineffective |
Inspection Report
Annual Inspection
Census: 26
Capacity: 58
Deficiencies: 10
Aug 12, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Imperial Manor Nursing Home from August 12 to August 15, 2018.
Findings
The facility was found to have multiple deficiencies including privacy violations during medication administration, stained flooring needing replacement, incomplete care plans for depression, failure to monitor behavioral health symptoms, medication errors exceeding 5%, lack of qualified dietary staff, food safety violations, sprinkler system obstructions, and improper use of power strips.
Complaint Details
The visit was complaint-related due to an allegation that the facility failed to notify the department of adverse events. The allegation was investigated and found to be unsubstantiated with no violation cited.
Severity Breakdown
SS=D: 5
SS=E: 3
SS=F: 2
Deficiencies (10)
| Description | Severity |
|---|---|
| Injections were administered in public areas, violating resident privacy. | SS=D |
| Tile flooring stained beyond cleaning was not replaced in resident rooms. | SS=D |
| Care plan failed to address depression for a resident on antidepressants. | SS=D |
| Facility failed to identify and routinely monitor symptoms of depression for a resident on antidepressants. | SS=D |
| Facility failed to routinely monitor individualized symptoms or behaviors related to psychotropic medication use for four residents. | SS=E |
| Medication error rate was 13.4%, exceeding the 5% threshold. | SS=D |
| Dietary manager lacked required credentialing and continuing education. | SS=F |
| Food safety violations including ice buildup in freezer, improper hand hygiene, cross contamination risk from thawing meat over other foods, and chipped ceiling paint in kitchen. | SS=F |
| Items stored within 18 inches of fire sprinkler deflector in kitchen freezer. | SS=E |
| Power strip used improperly in resident room for non-medical equipment. | SS=E |
Report Facts
Facility census: 26
Total licensed capacity: 58
Medication error rate: 13.4
Residents sampled for medication administration observations: 7
Residents sampled for medication review: 15
Residents sampled for observations: 15
Residents sampled for medication review (depression care plan): 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator, Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter |
| Eric Haider | Administrator | Facility administrator named in complaint letter and facility documents |
| LPN A | Licensed Practical Nurse | Administered insulin injection in public area; medication administration observations; confirmed loose halo grab bar |
| LPN B | Licensed Practical Nurse, MDS Coordinator | Confirmed care plan deficiencies and behavioral health monitoring issues |
| Dietary Manager | Dietary Manager | Lacked required credentialing; involved in food safety and sprinkler system deficiencies |
| Maintenance Supervisor | Maintenance Supervisor | Verified stained floor tiles and loose halo grab bar; unaware of sprinkler obstruction |
| Director of Nursing | Director of Nursing | Confirmed medication administration errors and behavioral health monitoring deficiencies |
| Maintenance Director | Maintenance Director | Verified loose halo grab bar |
| Social Service Director | Social Service Director | Reeducated family on power cord regulations |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 1
Jun 4, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to provide and maintain a safe environment for residents identified as at risk to elope.
Findings
The investigation found that interventions in place were not effective to prevent an elopement for one sampled resident with a history of elopement and exit seeking behaviors. The resident left the facility unattended multiple times, including one incident where the alarm did not sound and staff were unaware.
Complaint Details
The complaint alleged that the facility failed to provide and maintain a safe environment when residents are identified as a risk to elope. The allegation was substantiated based on observations, record reviews, and staff interviews confirming ineffective interventions and multiple elopement incidents.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure that interventions were in place to prevent an elopement from the facility for one current sampled resident with a history of elopement and exit seeking behaviors. | SS=D |
Report Facts
Facility census: 33
Sampled residents: 3
Elopement duration: 42
Corrective action completion date: Jul 19, 2018
New alarm system installation date: Jul 27, 2018
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the complaint investigation letter |
| Eric Haider | Administrator | Facility administrator addressed in the report |
Inspection Report
Renewal
Capacity: 58
Deficiencies: 0
Mar 7, 2018
Visit Reason
The document is a Nursing Home Licensure Renewal Application and certification verifying that Imperial Manor Nursing Home's SNF/NF Dual Certification is licensed through the indicated renewal date.
Findings
The documents confirm the renewal of the facility's license for 58 beds and include ownership information, current services provided, and an occupancy permit indicating compliance with fire safety codes.
Report Facts
Number of beds to be relicensed: 58
Maximum Occupancy: 58
Renewal Fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eric Haider | Administrator | Named in Nursing Home Licensure Renewal Application |
| Marjorie Haider | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 2
Mar 6, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to use fall interventions to prevent injuries.
Findings
The facility failed to develop and implement fall interventions on Resident #3's initial care plan despite a history of falls, resulting in a resident fall with injury. The facility subsequently implemented corrective actions including updating care plans, staff in-services, and ongoing monitoring.
Complaint Details
The complaint alleged the facility failed to use fall interventions to prevent injuries. The investigation included interviews, record reviews, and observations. The deficiency was substantiated with findings related to Resident #3's care plan and fall interventions.
Severity Breakdown
SS=D: 1
S-S=G: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to develop and implement fall interventions on Resident #3's initial care plan related to history of falls. | SS=D |
| Failure to identify and develop methods to prevent falls and/or injuries for Resident #3 with history of falls. | S-S=G |
Report Facts
Sample size: 5
Census: 33
Fall risk assessment score: 26
Completion date: Mar 30, 2018
Audit frequency: 4
Audit frequency: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eric Haider | Administrator | Named as facility administrator in multiple documents |
| Dan Taylor | RN, Training Coordinator | Author of inspection report and correspondence |
| Kimberly A. Divis | RN, NSSC | Conducted Informal Dispute Resolution and authored related report |
| Marjorie Haider | Director of Nursing | Participant in Informal Dispute Resolution and interviewee confirming care plan deficiencies |
Inspection Report
Complaint Investigation
Deficiencies: 0
Jan 10, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to provide appropriate positioning of residents.
Findings
The complaint was investigated through review of nursing notes, assessments, observations, interviews, and incident reports. No concerns were identified with staff transferring and repositioning residents, and the facility was found to be in compliance with applicable regulations.
Complaint Details
The complaint alleged failure to provide appropriate positioning. The investigation found no violation and the facility was in compliance.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report and is identified as the Training Coordinator for the Office of LTC Facilities - Licensure Unit. |
Inspection Report
Census: 35
Capacity: 58
Deficiencies: 14
May 11, 2017
Visit Reason
The survey was conducted to assess compliance with federal regulations governing skilled nursing facilities, including privacy, housekeeping, assessments, care planning, medication administration, infection control, and life safety.
Findings
The facility had multiple deficiencies including failure to protect resident privacy with medication administration records, housekeeping and maintenance issues, incomplete resident assessments, delayed admission assessments, incomplete care plans, medication administration errors, infection control lapses, emergency lighting concerns, sprinkler system obstructions, electrical panel clearance issues, and use of electrical multi-plug adapters.
Severity Breakdown
SS=D: 8
SS=E: 5
SS=F: 1
Deficiencies (14)
| Description | Severity |
|---|---|
| Failed to ensure MAR screen was closed on unattended medication cart to protect resident privacy. | SS=D |
| Failed to maintain sanitary housekeeping and maintenance services including bathroom vent cleanliness and repair of wall damage. | SS=E |
| Failed to complete comprehensive assessments including dental status and cognitive testing for sampled residents. | SS=E |
| Failed to complete admission MDS within required 14-day timeframe for one resident. | SS=D |
| Failed to develop comprehensive care plan addressing nutritional weight loss for one resident. | SS=D |
| Failed to obtain physician order for bedside medication and educate resident on medication self-administration. | SS=D |
| Failed to ensure dietary staff hair restraints fully covered hair during kitchen procedures. | SS=D |
| Failed to ensure medication administration followed proper procedures including three label checks and immediate documentation. | SS=D |
| Failed to ensure prescription label matched current physician orders for medication. | SS=D |
| Failed to follow infection control practices including glove use for injections, proper storage of vinegar container, cleaning and covering respiratory mask, covered bedpan storage, and basin storage off floor. | SS=E |
| Failed to provide minimum 5 foot candles of emergency lighting at floor level in dining room. | SS=F |
| Failed to maintain required minimum 18 inch clearance around sprinkler heads in storage closets. | SS=E |
| Failed to maintain required 36 inch clearance in front of electrical panels in mechanical room. | SS=E |
| Failed to prevent use of electrical multi-plug adapters in resident room. | SS=E |
Report Facts
Facility census: 35
Total capacity: 58
Deficiency counts: 14
Weight loss: 16
Weight loss percentage: 9
Emergency lighting: 5
Sprinkler clearance: 18
Electrical panel clearance: 36
Sample size: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eric Haider | Administrator | Named in informal dispute resolution request and correspondence |
| Doug Hohbein | Chief Plans Examiner | Conducted informal dispute resolution conference |
| Billie Hayes | Environmental Supervisor | Provided information on emergency lighting during survey |
| LPN A | Licensed Practical Nurse | Named in medication administration and glove use deficiency |
| RN C | Registered Nurse, MDS Coordinator | Named in assessment and care plan deficiencies |
| Medication Aide B | Medication Aide | Named in medication administration deficiency |
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 22, 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 found no evidence of abuse through observation and interviews. Staff were knowledgeable about abuse reporting, and the facility was in compliance with related regulatory requirements.
Complaint Details
The allegation that the facility failed to ensure residents were free from abuse was investigated and found to be unsubstantiated.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Complaint Investigation
Census: 36
Deficiencies: 1
Feb 15, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to follow the plan of care when residents have been identified at risk for falls.
Findings
The investigation found that care plan interventions to prevent falls were in place for 3 sampled residents but were not implemented by staff. Observations and interviews confirmed failure to follow care plans, resulting in violations of federal and state regulations.
Complaint Details
The complaint alleged the facility failed to follow the plan of care for residents identified at risk for falls. The allegation was substantiated based on record review, observation, and interviews.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility staff failed to follow care plan interventions to prevent falls and potential injury for 3 of 3 sampled residents. | SS=E |
Report Facts
Residents sampled: 3
Facility census: 36
Fall incidents: 1
Fall incidents: 1
Fall incidents: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager | Signed the complaint investigation letter. |
| Nolan Gurnsey | Administrator | Facility administrator addressed in the letter. |
| Director of Nursing | Director of Nursing | Interviewed regarding fall mat placement and staff compliance with care plans. |
Notice
Capacity: 58
Deficiencies: 0
Jun 23, 2016
Visit Reason
The letter acknowledges the increase in the number of licensed beds at the Skilled Nursing Facility and amends the Health Insurance Benefits Agreement to reflect changes in certified bed counts and room assignments.
Findings
The facility's licensed beds increased from 53 to 58 effective July 1, 2016, and the certified bed assignments in various rooms were updated accordingly.
Report Facts
Licensed beds increase: 5
Certified beds: 53
Certified beds: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager | Author of the letter acknowledging bed increase and agreement amendment |
Inspection Report
Complaint Investigation
Census: 37
Capacity: 53
Deficiencies: 8
May 23, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Imperial Manor Nursing Home on May 16, 2016-May 23, 2016, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The complaint investigation found multiple deficiencies including failure to notify family of resident condition changes, inaccurate resident assessments, incomplete care plans for insomnia, failure to identify all skin abnormalities and pressure sore risks, incomplete accident investigations, unsecured grab bars on beds, and unsanitary food handling practices. The facility was cited for these deficiencies and required to submit plans of correction.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure residents are discharged to a safe environment, failed to notify appropriate agencies when residents discharged against medical advice, failed to follow plan of care for transfers, failed to prevent pressure sores, failed to provide copies of medical records, failed to provide essential equipment, and failed to ensure resident records are accurate and complete. The investigation found some allegations unsubstantiated but cited related deficiencies.
Severity Breakdown
SS=D: 5
SS=E: 2
SS=F: 1
Deficiencies (8)
| Description | Severity |
|---|---|
| Facility failed to notify family of changes in Resident 40's condition regarding elevated blood sugars, insulin administration, and pain medication orders. | SS=D |
| Facility failed to accurately record presence of fracture and degree of incontinence for residents on MDS assessments. | SS=D |
| Facility failed to develop care plans addressing insomnia for three residents. | SS=E |
| Facility failed to identify all skin abnormalities and determine skin breakdown risk for Resident 40. | SS=D |
| Facility failed to include key components in accident investigation for Resident 40 and failed to ensure grab bars were secured on beds for two residents. | SS=E |
| Facility failed to ensure sanitary conditions in food procurement, storage, preparation, and serving. | SS=F |
| Facility failed to maintain complete, accurate, and accessible resident records including documentation of family concerns at care conference. | SS=D |
| Facility failed to provide a 1/2-hour fire resistance rating for one smoke barrier due to unsealed penetration. | SS=E |
Report Facts
Facility census: 37
Facility capacity: 53
Deficiency severity SS=D: 5
Deficiency severity SS=E: 2
Deficiency severity SS=F: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nolan Gurnsey | Administrator | Named in multiple findings and correspondence |
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit | Signed correspondence related to the inspection |
| LPN-E | Licensed Practical Nurse | Witness and participant in Resident 40 incident investigation |
| RA-D | Restorative Aide | Witness and participant in Resident 40 incident investigation |
| SSD | Social Services Director | Witness and participant in Resident 40 incident investigation and care conference |
| LPN-B | Licensed Practical Nurse | Attended care conference and involved in Resident 40 care |
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 28, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to provide service for appropriate positioning transfer.
Findings
The investigation found that the facility was in compliance with the issue. Observations, record reviews, and interviews showed no unsafe conditions, and interventions were in place to reduce the risk of falls and accidents.
Complaint Details
The complaint alleged failure to provide service for appropriate positioning transfer. The investigation included review of resident records, observations, and interviews. The facility was found to be in compliance with this issue.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Complaint Investigation
Census: 31
Deficiencies: 0
Feb 17, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to ensure residents are free from misappropriation.
Findings
The investigation included interviews with residents and staff, and review of records. No concerns of misappropriation were found and no violation was written.
Complaint Details
The complaint alleged failure to ensure residents are free from misappropriation. The allegation was not substantiated as no violations were found.
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: 25
Deficiencies: 0
Aug 26, 2015
Visit Reason
An unannounced visit was conducted to investigate complaints regarding the facility's failure to change fall interventions after residents were identified at risk for falls and failure to revise the plan of care to address identified needs.
Findings
The investigation found no issues with changing fall interventions or revising care plans to address identified needs. Observations, record reviews, and interviews revealed no violations or deficiencies.
Complaint Details
The complaint alleged the facility failed to change fall interventions after residents were identified at risk for falls and failed to revise the plan of care to address identified needs. Both allegations were investigated with no violations cited.
Report Facts
Facility census: 25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keeli Klein | Registered Nurse | Conducted the complaint investigation visit |
| Eve Lewis | Program Manager | Signed the inspection report |
| Nolan Gurnsey | Administrator | Facility administrator named in the report |
Inspection Report
Annual Inspection
Census: 32
Deficiencies: 5
Jun 3, 2015
Visit Reason
Annual inspection survey of Imperial Manor Nursing Home to assess compliance with state and federal regulations including licensure, resident care, and safety standards.
Findings
The facility was found deficient in several areas including the qualifications of the Dietary Manager, accuracy of resident assessments particularly behavioral symptoms, development and revision of comprehensive care plans, and medication order clarifications. The facility was in compliance with life safety code requirements.
Severity Breakdown
SS=D: 4
Deficiencies (5)
| Description | Severity |
|---|---|
| Dietary Manager did not meet regulatory qualifications for the position. | — |
| Resident admission MDS assessment failed to capture behavioral symptoms accurately. | SS=D |
| Facility failed to develop individualized interventions in care plan to address resident's activity preferences. | SS=D |
| Facility failed to update resident care plan to reflect physician's order for catheter care frequency. | SS=D |
| Contradictory medication order for Felodipine resulted in medication error. | SS=D |
Report Facts
Facility census: 32
Deficiency count: 5
Inspection Report
Complaint Investigation
Census: 38
Deficiencies: 0
Sep 23, 2014
Visit Reason
An unannounced visit was conducted to investigate complaints regarding medication administration, revision of interventions for ongoing behaviors, and protection from resident to resident abuse at Imperial Manor Nursing Home.
Findings
The facility was found to be in compliance with no violations cited regarding medication administration, revision of interventions for behaviors, and protection from resident to resident abuse after thorough record reviews, observations, and interviews.
Complaint Details
The investigation addressed three allegations: failure to administer medications according to practitioner's orders, failure to revise interventions to prevent ongoing behaviors, and failure to protect residents from resident to resident abuse. All allegations were found to be unsubstantiated with no deficiencies cited.
Report Facts
Facility census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keeli Klein | Registered Nurse | Conducted the complaint investigation |
| Kaylene Straetker | Registered Nurse | Conducted the complaint investigation |
| Mike Harris | Provisional Administrator | Interviewed during the investigation |
| Eve Lewis | Program Manager | Signed the report |
Inspection Report
Annual Inspection
Census: 38
Capacity: 53
Deficiencies: 8
Apr 22, 2014
Visit Reason
Annual inspection of Imperial Manor Nursing Home to assess compliance with federal and state regulations including resident care, safety, and facility conditions.
Findings
The inspection identified multiple deficiencies including failure to maintain resident privacy during medication administration, incomplete care plans for residents' dental and transfer needs, unsecured hazardous chemicals, improper food preparation and storage, medication management issues, and fire safety code violations related to smoke barrier doors.
Severity Breakdown
SS=D: 6
SS=F: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Resident received insulin injection in public view in dining room, violating privacy expectations. | SS=D |
| Care plans failed to include dental status and chewing problems for one resident and safe transfer instructions for another. | SS=D |
| Care plan did not reflect safe ambulation needs for one resident requiring two-person assistance. | SS=D |
| Potentially hazardous chemicals (Swiffer WetJet Multipurpose Cleaner) were unsecured in an unlocked utility room accessible to confused wandering residents. | SS=D |
| Resident with chewing difficulties was not consistently provided ground meat diet as ordered. | SS=D |
| Boxes of chicken breasts were stored on the floor in the freezer, risking contamination. | SS=F |
| Routine medication (Daliresp) was not obtained from pharmacy and missed for two days for one resident. | SS=D |
| Smoke barrier doors failed to close completely, compromising fire safety in four of six smoke compartments. | SS=F |
Report Facts
Facility census: 38
Facility total capacity: 53
Missed medication doses: 2
Number of smoke compartments affected: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN-A | Licensed Practical Nurse | Administered insulin injection in public view; omitted medication due to pharmacy delay |
| LPN-B | Licensed Practical Nurse | Confirmed missed medication doses and medication reconciliation process |
| Director of Nursing | Director of Nursing | Provided interview on privacy expectations and medication reconciliation process |
| Maintenance Supervisor | Maintenance Supervisor | Confirmed smoke door deficiencies and chemical storage issues |
| Administrator | Administrator | Confirmed care plan deficiencies and diet order issues |
Inspection Report
Annual Inspection
Census: 39
Deficiencies: 2
Nov 13, 2013
Visit Reason
The inspection was conducted to assess compliance with Nebraska regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities, focusing on deficient practices identified during the survey.
Findings
The facility failed to revise a resident's care plan following a fall and did not implement new interventions to reduce the risk of further falls. Additionally, the facility failed to ensure that fall alarms were in place for the resident as required by the care plan.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to review and revise a resident's care plan following a fall and implement new interventions to reduce the risk of further falls. | SS=D |
| Failed to ensure the resident environment remained free of accident hazards and failed to provide adequate supervision and assistance devices to prevent accidents, specifically fall alarms were not in place as required. | SS=D |
Report Facts
Facility census: 39
Date survey completed: Nov 13, 2013
Completion date for plan of correction: Dec 20, 2013
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed regarding care plan revisions and fall alarm interventions for Resident 1 |
Inspection Report
Routine
Census: 37
Capacity: 53
Deficiencies: 9
Mar 21, 2013
Visit Reason
Routine inspection survey conducted to assess compliance with federal and state regulations including licensure, life safety code, and resident care standards.
Findings
The facility was found deficient in multiple areas including failure to post survey results accessibly, inaccurate resident assessments, incomplete care plans, environmental safety hazards such as damaged handrails, unreadable nurse staffing postings, lack of water availability protocol, blocked fire doors, and sprinkler head obstructions.
Severity Breakdown
SS=C: 2
SS=D: 1
SS=E: 4
SS=F: 2
Deficiencies (9)
| Description | Severity |
|---|---|
| Facility failed to post signage identifying location of survey results and directing residents/families to them. | SS=C |
| Facility failed to code MDS assessment to reflect monthly weight loss of 5% or more for a resident. | SS=D |
| Facility failed to develop comprehensive care plans reflecting residents' diagnoses, treatments, and medications for multiple residents. | SS=E |
| Facility failed to update resident care plans timely to reflect nutritional interventions, catheter care, weights, and discharge planning. | SS=E |
| Facility failed to repair and refinish handrail scrapes and gouges in corridor exposing rough edges. | SS=E |
| Facility failed to post nurse staffing information in a clear, readable format accessible to residents and visitors. | SS=C |
| Facility failed to establish procedures to ensure water availability during loss of normal water supply. | SS=F |
| Facility failed to provide corridor door without impediments to closing, blocking smoke barrier function. | SS=F |
| Facility failed to maintain acceptable clearance to prevent obstructions to fire sprinkler spray patterns. | SS=E |
Report Facts
Facility census: 37
Facility capacity: 53
Deficiency count: 9
Residents affected by door impediment: 37
Residents affected by sprinkler obstruction: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Palmer | Administrator | Signed initial comments and plan of correction |
| Don Fritz | Approved plan of correction | |
| MDS Coordinator | Interviewed regarding MDS assessments and care plans | |
| Dietary Manager | Interviewed regarding nutritional assessments and care plans | |
| Registered Nurse - A | RN | Interviewed regarding care plans and resident care |
| Social Services Director | Interviewed regarding survey results posting and discharge planning | |
| Maintenance Supervisor | Interviewed regarding fire door and sprinkler system deficiencies | |
| Environmental Manager | Responsible for monitoring handrail repairs and fire door clearance |
Inspection Report
Routine
Census: 34
Deficiencies: 12
Mar 5, 2012
Visit Reason
The facility was surveyed for compliance with Nebraska Administrative Code Title 175, Chapter 12, governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities.
Findings
The survey identified multiple deficiencies including failure to notify residents of Medicare Part A benefit discontinuance, failure to notify physicians of resident condition changes, improper use and assessment of physical restraints, failure to update care plans, inadequate monitoring of wanderguard bracelets, failure to provide adequate meal assistance, failure to cover food during transport, and failure to maintain resident dignity during meal service.
Severity Breakdown
SS=D: 8
SS=E: 4
Deficiencies (12)
| Description | Severity |
|---|---|
| Failure to notify residents or responsible parties of discontinuance of Medicare Part A benefits and right to appeal for 2 residents. | SS=D |
| Failure to notify physician of significant change in condition for 1 resident. | SS=D |
| Failure to assess tilt-in-space wheelchair and wheelchair seat belt for safety and possible restraint for 2 residents. | SS=D |
| Failure to notify Adult Protective Services timely for an incident resulting in hospitalization. | SS=D |
| Failure to maintain resident dignity during meal service for 3 residents. | SS=E |
| Failure to accurately assess anti-anxiety medication use and falls in Minimum Data Set assessments for 3 residents. | SS=E |
| Failure to update care plans to reflect current conditions, invite residents or representatives to care plan meetings, and reflect hospice initiation for 4 residents. | SS=E |
| Failure to verify routine testing of wanderguard bracelets for 1 resident. | SS=D |
| Failure to provide assistance with meals for 1 resident. | SS=D |
| Failure to identify causal factors and restore bladder function for 1 resident. | SS=D |
| Failure to determine continued need and safe use of bed cane devices for 11 residents and failure to address fall prevention for 2 residents. | SS=E |
| Failure to cover food during transport from kitchen to dining room to prevent contamination. | SS=E |
Report Facts
Facility census: 34
Sample size: 15
Sample size: 6
Number of falls: 9
Fall risk assessment score: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Palmer | Administrator | Signed inspection report pages and involved in interviews |
| LPN-A | Licensed Practical Nurse | Interviewed regarding wanderguard bracelet checks and wheelchair seat belt |
| NA-E | Nurse Aide | Interviewed regarding meal assistance and wheelchair seat belt |
| MDS Coordinator | Interviewed regarding MDS assessments, care plans, and documentation | |
| Social Service Director | Interviewed regarding notification of Medicare benefit discontinuance and Adult Protective Services reporting | |
| Director of Nursing | DON | Interviewed regarding wheelchair assessments, wanderguard bracelet monitoring, and bed cane safety |
| Occupational Therapist | Interviewed regarding wheelchair assessments | |
| Business Office Manager | Interviewed regarding Medicare benefit notification documentation |
Inspection Report
Annual Inspection
Census: 33
Deficiencies: 3
Mar 22, 2011
Visit Reason
The inspection was conducted as part of the annual survey to assess compliance with state licensure regulations and federal requirements including food service qualifications, medication administration, and life safety code standards.
Findings
The facility was found deficient in ensuring the Dietary Manager met educational qualifications, proper medication administration practices including observation of residents swallowing medications, and maintaining sprinkler head clearance per life safety code. The facility submitted a plan of correction addressing these issues with staff education, recruitment efforts, and monitoring processes.
Severity Breakdown
SS=E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Dietary Manager did not meet educational qualifications required by state licensure regulations. | — |
| Licensed nurse failed to observe residents swallow medications during morning medication pass for two residents. | — |
| Sprinkler heads in multiple closets had obstructions affecting spray patterns, violating life safety code. | SS=E |
Report Facts
Facility census: 33
Number of residents with medication observation deficiencies: 2
Number of sprinkler heads obstructed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Darin Severson | Administrator | Provided statements regarding recruitment of qualified Dietary Manager and facility operations |
| LPN E | Licensed Practical Nurse | Observed leaving residents unattended during medication administration |
| Director of Nursing | Director of Nursing (DON) | Confirmed medication administration standards and facility corrective actions |
| Maintenance Staff A | Confirmed sprinkler head obstructions during survey |
Notice
Capacity: 58
Deficiencies: 0
APP2020
Visit Reason
The document serves as a renewal application for the nursing home license of Imperial Manor Nursing Home and includes certification of licensure and occupancy permit information.
Findings
The documents certify that Imperial Manor Nursing Home meets statutory requirements for licensure renewal and holds an occupancy permit for 58 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 58
Occupancy permit beds: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marjorie Haider | Director of Nursing | Named in the licensure renewal application on page 2. |
| Eric Haider | Administrator | Named in the licensure renewal application on page 2. |
Document
Capacity: 58
Deficiencies: 0
APP2021
Visit Reason
The documents serve to verify and renew the licensure of Imperial Manor Nursing Home, including submission of a renewal application and confirmation of licensed capacity.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure status, renewal application details, and fire marshal occupancy approval.
Report Facts
Total licensed beds: 58
Renewal license expiration date: Expires 03/31/2022 as shown on the renewal card
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eric Haider | Administrator | Named on the renewal application |
| Marjorie Haider | Director of Nursing | Named on the renewal application |
| Douglas Gaswick | Authorized Representative | Signed renewal application |
| David Kahle | Authorized Representative | Signed renewal application |
Document
Capacity: 58
Deficiencies: 0
APP2023
Visit Reason
The document set serves to renew the nursing home license for Imperial Manor Nursing Home and includes verification of licensure, renewal fees, and occupancy permit details.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure renewal, facility capacity, and occupancy permit status.
Report Facts
Total licensed beds: 58
Renewal licensure fee: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lynne West | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Ciana Diane Smith | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 58
Deficiencies: 0
APP2024
Visit Reason
This document serves as a renewal application for the nursing home license of Imperial Manor Nursing Home and includes related licensing and occupancy permits.
Findings
The documents certify that Imperial Manor Nursing Home meets statutory requirements for licensure renewal and occupancy, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Heather Salmon | Administrator | Named on the renewal application and board of directors list |
| Gail Dinnell | Director of Nursing | Named on the renewal application |
Notice
Capacity: 58
Deficiencies: 0
APP2025
Visit Reason
The document serves as a nursing home licensure renewal application and verification of license renewal for Imperial Manor Nursing Home, including an occupancy permit.
Findings
The documents confirm that Imperial Manor Nursing Home meets statutory requirements for licensure renewal and has a maximum occupancy of 58 beds as per the occupancy permit.
Report Facts
Total licensed beds: 58
Renewal Licensure Fees: 1550
Renewal Licensure Fees: 1750
Renewal Licensure Fees: 1950
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Heather Salmon | Administrator | Named as Administrator on the renewal application and Nursing Home Administrator on Board of Directors list |
| Yves Montina | Director of Nursing | Named as Director of Nursing on the renewal application |
| Craig Loeffler | Ex-officio member | Named on Board of Directors list |
Notice
Capacity: 53
Deficiencies: 0
APP2016
Visit Reason
The document serves as a licensure renewal application and verification for Imperial Manor Nursing Home, including renewal of SNF/NF dual certification and occupancy permit.
Findings
The documents confirm the facility's licensure renewal status, bed capacity, and certification for physical, occupational, and speech therapy services. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 53
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nolan Gurnsey | Administrator | Named as administrator on the licensure renewal application and ownership roster. |
| Tammi Simpson | Director of Nursing | Named as Director of Nursing on the licensure renewal application. |
| Eve Lewis | Administrator | Signed letter amending Health Insurance Benefits Agreement. |
Notice
Capacity: 58
Deficiencies: 0
APP2017
Visit Reason
The document serves as a nursing home licensure renewal application and certification for Imperial Manor Nursing Home, verifying the facility's license renewal and occupancy permit status.
Findings
The documents confirm that Imperial Manor Nursing Home meets statutory requirements for licensure renewal and holds an occupancy permit for 58 beds. No inspection findings or deficiencies are reported.
Report Facts
Number of beds to be relicensed: 58
Maximum occupancy: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nolan Gurnsey | Administrator | Named in licensure renewal application and organizational chart |
| Ashley Ambrosek | Director of Nursing | Named in licensure renewal application |
| Dwight Coleman | City Mayor | Listed in ownership/control roster |
| Doug Gaswick | Senior Service Board | Listed in ownership/control roster |
Notice
Capacity: 58
Deficiencies: 0
APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Imperial Manor Nursing Home through the date indicated on the renewal card and includes related licensing and occupancy information.
Findings
The document confirms that Imperial Manor Nursing Home meets statutory requirements for licensure and provides details on the number of licensed beds, ownership, and accreditation status. It also includes an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Licensed beds: 58
Renewal fee: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eric Haider | Administrator | Named as facility administrator in renewal application |
| Marjorie Haider | Director of Nursing | Named as Director of Nursing in renewal application |
| Eve Lewis | Program Manager | Office of LTC Facilities, Licensure Unit, signed letter regarding bed certification changes |
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