Inspection Reports for Park View Haven Nursing Home
309 North Madison Street, COLERIDGE, NE, 68727
Back to Facility ProfileDeficiencies (last 10 years)
Deficiencies (over 10 years)
8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
90% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
30 residents
Based on a March 2019 inspection.
Census over time
Notice
Deficiencies: 0
Date: Jan 28, 2025
Visit Reason
The notice serves to inform the facility of disciplinary action due to failure to develop and implement interventions for fall prevention, based on findings from a survey dated January 28, 2025.
Findings
The facility was found to have violated licensure regulations related to accidents and fall prevention, resulting in probation for 90 days starting February 21, 2025, with requirements to submit plans of correction and ongoing reports.
Report Facts
Probation period length: 90
First report due date: 2025
Survey exit date: 2025
Scheduled expiration date: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Timothy Tesmer | Chief Medical Officer | Signed the Notice of Disciplinary Action |
| Dan Taylor | Administrator | Named as Health Facilities Licensure Unit Administrator |
| Kolby Venger | Administrative Specialist | Signed Certificate of Service for the Notice |
| Randa Napier | Registered Nurse | Listed on page 4 |
| Brenda Orlowski | Registered Nurse | Listed on page 4 |
Inspection Report
Complaint Investigation
Census: 30
Deficiencies: 1
Date: Mar 18, 2019
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to protect residents from injury.
Complaint Details
The complaint alleged the facility failed to protect residents from injury. The investigation substantiated this allegation with findings related to Resident 1's fall in the shower and inadequate preventive measures.
Findings
The facility failed to protect a resident from injury related to falls. Resident 1 fell in the shower alone, resulting in a right humerus fracture. The facility did not fully assess causal factors or implement staff education to prevent recurrence.
Deficiencies (1)
Failed to assess causal factors and develop/implement interventions to prevent potential injuries related to falls for Resident 1.
Report Facts
Sample size: 3
Facility census: 30
Incident date: Feb 28, 2019
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation letter |
| Leigh Bloomquist | Administrator | Facility administrator named in the letter |
| Nursing Assistant-C | Knew Resident 1 went into the shower alone on 2/28/19 | |
| Director of Nursing | DON | Interviewed regarding Resident 1's fall and supervision |
Inspection Report
Renewal
Capacity: 34
Deficiencies: 0
Date: Mar 4, 2019
Visit Reason
The document is a renewal license application and certification for Park View Haven Nursing Home, verifying that the facility's SNF/NF dual certification is licensed through the indicated renewal date.
Findings
The documents confirm the facility's licensure renewal, ownership information, accreditation status, and occupancy permit with a maximum capacity of 34 beds. No deficiencies or inspection findings are reported.
Report Facts
Total licensed beds: 34
Renewal expiration date: Mar 31, 2020
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leigh Bloomquist | Administrator | Named as Administrator on renewal application |
| Maureen Burton | Director of Nursing | Named as Director of Nursing on renewal application |
| George R. Hefner | Authorized Representative | Signed renewal application and listed as Village Board of Trustees member |
Inspection Report
Annual Inspection
Census: 30
Capacity: 34
Deficiencies: 16
Date: Nov 19, 2018
Visit Reason
Annual inspection of Park View Haven Nursing Home to assess compliance with federal and state regulations including resident care, safety, and facility maintenance.
Findings
The facility was found to have multiple deficiencies including failure to notify physicians of resident condition changes, failure to protect residents from abuse, inaccurate resident assessments, inadequate ADL care, infection control lapses, insufficient nursing staff, and fire safety violations.
Deficiencies (16)
Failed to notify attending physician of changes in condition for 2 residents related to low blood sugar and medication initiation.
Failed to protect 4 residents from verbal and physical abuse by another resident.
Failed to report incidents of abuse to the State Agency in a timely manner.
Failed to accurately code resident assessment related to anticoagulant use.
Failed to provide toileting assistance/incontinence management and repositioning for 2 residents requiring assistance.
Failed to provide appropriate care and services to prevent urinary tract infections for a resident with an indwelling urinary catheter.
Failed to develop nutritional interventions for a resident with weight loss and nutritional needs.
Failed to coordinate care and services for dialysis treatments and monitor resident related to dialysis.
Failed to provide sufficient nursing staff to answer call lights timely and assist with activities of daily living.
Failed to prevent potential cross contamination during indwelling urinary catheter care and failed to complete monthly infection control surveillance.
Allowed dust and lint to accumulate on fire sprinklers, potentially causing failure to operate.
Failed to install portable fire extinguishers so the bottom was at least 4 inches above the floor.
Failed to hold fire drills under varied conditions at least one hour apart on each shift.
Failed to implement testing and inspection program for fire rated doors to ensure proper operation.
Failed to install ground-fault circuit interrupter outlets at sink locations in resident restrooms.
Failed to secure shut-off valves in the open position for the gas supply to the emergency generator.
Report Facts
Facility census: 30
Total licensed capacity: 34
Deficiency count: 15
Call light response time: 21
Resident 10 weight loss: 8
Resident 10 weight loss: 4
Resident 10 weight: 162
Resident 27 blood sugar: 44
Resident 27 blood sugar: 49
Resident 27 blood sugar: 62
Resident 27 blood sugar: 77
Resident 32 medication delay: 32
Resident 10 catheter output documentation missing: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leigh Bloomquist | Administrator | Confirmed fire drill and fire safety deficiencies |
| NA-B | Nurse Aide | Observed providing catheter care with improper hand hygiene |
| NA-E | Nurse Aide | Observed providing catheter care with improper hand hygiene and toileting Resident 4 |
| Director of Nursing | Director of Nursing | Confirmed multiple deficiencies including notification failures, infection control, staffing, and dialysis care |
| Administrator | Administrator | Confirmed abuse incidents not reported to State Agency and fire drill deficiencies |
| Maintenance Staff A | Maintenance Staff | Confirmed dust on sprinklers, fire extinguisher placement, fire drill and fire door inspection deficiencies |
| Administrative Staff A | Administrative Staff | Confirmed dust on sprinklers, fire extinguisher placement, fire drill and fire door inspection deficiencies |
| LPN-A | Licensed Practical Nurse | Interviewed about dialysis care and AV fistula monitoring |
Notice
Deficiencies: 0
Date: Oct 27, 2017
Visit Reason
The facility's license was placed on probation for 90 days beginning October 27, 2017, due to violations related to unplanned weight loss and failure to revise or develop interventions to prevent significant weight loss.
Findings
The facility failed to revise interventions or develop new interventions to prevent significant weight loss, violating multiple licensure regulations including resident rights, care plans, medication errors, and sanitary conditions.
Report Facts
Probation period: 90
Report submission frequency: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Thomas L. Williams | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Becky Wisell | Administrator, Licensure Unit | Mentioned in relation to the Notice of Disciplinary Action |
| Dan Taylor | RN, Training Coordinator | Signed letter terminating probation on January 29, 2018 |
Inspection Report
Complaint Investigation
Census: 27
Capacity: 34
Deficiencies: 19
Date: Sep 25, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Park View Haven Nursing Home on September 25-28, 2017.
Complaint Details
The complaint allegations included failure to ensure residents are not restrained, failure to provide appropriate supervision to prevent falls, and failure to submit investigations within 5 working days. The facility was found non-compliant with restraint and supervision allegations but compliant with timely submission of investigations.
Findings
The facility was found non-compliant for failure to ensure residents were not restrained, failure to provide appropriate supervision to prevent falls, failure to ensure dietary supervisor qualifications, failure to develop comprehensive care plans, failure to prevent weight loss, failure to ensure safe medication administration, failure to prevent medication errors, failure to maintain sanitary food preparation, failure to maintain pharmaceutical services, failure to maintain fire safety and smoke barriers, failure to conduct fire drills properly, and failure to maintain electrical safety.
Deficiencies (19)
Facility failed to identify geri-chair as a physical restraint, did not evaluate appropriateness, obtain physician's order, or monitor use for Resident 43.
Facility failed to provide appropriate supervision to prevent falls for Resident 43 and failed to develop appropriate interventions.
Dietary Supervisor was not qualified as Director of Food Services due to incomplete educational requirements.
Facility failed to develop comprehensive care plans for use of geri-chair for Resident 43, safe smoking plan for Resident 26, and supervision for Resident 11 outside the facility.
Facility failed to review and revise care plans for Resident 43 related to fall interventions and Resident 13 regarding significant weight loss.
Facility failed to ensure Resident 13 was transferred safely using appropriate equipment and techniques.
Facility failed to secure hazardous chemicals from residents at risk for wandering.
Facility failed to assess Resident 11's safety to be outside without staff supervision.
Facility failed to assess Resident 26's safety to self-administer bedside medications and failed to obtain physician's orders for bedside medications.
Facility failed to ensure Resident 17's bedside medications were labeled according to pharmaceutical standards and stored securely.
Facility failed to ensure Resident 11 was free from unnecessary antipsychotic medications and failed to attempt gradual dose reduction.
Facility failed to ensure Resident 29 was free from a significant medication error related to Hydralazine dosage.
Dietary staff failed to wash hands at appropriate intervals and used potentially contaminated gloves when handling ready to eat foods.
Facility failed to maintain acceptable nutritional status for Resident 13, failed to implement nutritional interventions, and failed to monitor supplement intake.
Facility failed to ensure corridor doors sealed properly to prevent passage of smoke for rooms 201 and 203.
Facility failed to provide smoke barriers with ½ hour fire resistance rating for two of four smoke barriers.
Facility failed to conduct fire drills quarterly under varying conditions on all shifts.
Facility failed to provide approved cover plates for electrical receptacles.
Facility failed to take precautions to prevent creation of oxygen enriched atmosphere in one smoke compartment.
Report Facts
Facility census: 27
Total licensed capacity: 34
Deficiency counts: 19
Weight loss: 9
Weight loss: 13
Weight loss: 17
Hydralazine dosage: 100
Hydralazine dosage: 50
Fire drills missed: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Named as facility administrator |
| Eve Lewis | Program Manager | Signed complaint investigation letter |
| RN-I | Registered Nurse | Administered incorrect Hydralazine dose to Resident 29 |
| RN-E | Registered Nurse | Verified Resident 17's pain and medication monitoring |
| DC-F | Dietary Cook | Observed failing hand hygiene and glove use |
| DON | Director of Nursing | Verified multiple findings and facility non-compliance |
| Administrator | Interviewed regarding multiple findings and QA committee | |
| Maintenance Staff A | Interviewed regarding fire safety and smoke barrier findings |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 24, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's pest control program at Park View Haven Nursing Home.
Complaint Details
The complaint alleged that the facility failed to ensure an effective pest control program. The investigation found the allegation unsubstantiated.
Findings
The facility was found to have an effective pest control program with no pests observed in resident rooms, prompt treatment of infestations, and no evidence of pest-related symptoms among residents. The facility was in compliance with regulatory guidelines.
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: 11
Date: Jul 7, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Park View Haven Nursing Home from July 7, 2016 to July 13, 2016 by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint investigation included allegations that the facility failed to notify healthcare practitioners of changes in condition, failed to monitor bedside medications, failed to provide appropriate discharge notice, failed to assess residents after elopement, and failed to change interventions for exit-seeking residents. The investigation confirmed violations related to notification of change, medication monitoring, elopement assessment and interventions.
Findings
The facility was found to have multiple deficiencies including failure to notify healthcare practitioners of changes in condition, failure to monitor bedside medications, failure to assess residents after elopement, failure to change interventions for exit-seeking residents, failure to develop care plans to prevent elopement, failure to maintain nutrition and hydration status, failure to ensure drug regimens were free from unnecessary drugs, failure to provide pharmaceutical services with accurate procedures, and failure to properly store medications.
Deficiencies (11)
Failed to notify healthcare practitioner of change in condition for residents.
Failed to ensure usage of bedside medications were monitored.
Failed to assess residents after they eloped.
Failed to change interventions after residents identified as exit seeking.
Failed to develop care plan with interventions to prevent elopement.
Failed to ensure resident environment free of accident hazards and provide adequate supervision to prevent accidents.
Failed to maintain acceptable nutritional status and provide therapeutic diets as needed.
Failed to provide sufficient fluid intake to maintain hydration and health.
Failed to ensure drug regimen free from unnecessary drugs including lack of gradual dose reduction and monitoring.
Failed to provide pharmaceutical services with accurate procedures and consultation.
Failed to ensure drug records, labeling, and storage of drugs and biologicals met requirements including expired medications and secure storage.
Report Facts
Facility census: 31
Weight loss: 6
Medication administration opportunities: 26
Residents reviewed for notification of change: 3
Residents reviewed for unnecessary medications: 6
Residents reviewed for accidents: 4
Weight: 112
Weight: 106
Weight: 107
Weight loss: 5
Fluid intake: 720
Fluid intake: 1290
Fluid intake: 1380
Fluid intake: 1340
Fluid intake: 1520
Fluid intake: 1000
Fluid intake: 1260
Fluid intake: 1360
Fluid intake: 1500
Fluid intake: 1320
Fluid intake: 900
Medication dosage: 25
Blood pressure: 76
Blood pressure: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Sheryl Kalin | Administrator | Facility administrator named in report |
| Director of Nursing | Director of Nursing (DON) | Named in multiple interviews and findings related to notification, elopement, medication monitoring, and care plans |
| RN-F | Registered Nurse | Interviewed regarding fall and notification procedures |
| NA-B | Nursing Assistant | Interviewed regarding hydration and thickened liquids |
| Dietary Manager | Dietary Manager | Interviewed regarding nutritional interventions and hydration |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 5
Date: Jul 15, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Park View Haven Nursing Home on July 14, 2015-July 21, 2015. The complaint involved ensuring residents are safe from residents with behaviors and protection from abuse.
Complaint Details
The complaint alleged the facility failed to ensure residents are safe from residents with behaviors and failed to protect residents from abuse. The investigation found the facility was in compliance with these allegations.
Findings
The facility was found to be in compliance with regulatory requirements regarding resident safety from adverse behaviors and protection from abuse. However, deficiencies were found related to care plan revisions, fall prevention interventions, nutritional status maintenance, pharmaceutical services, and life safety code compliance.
Deficiencies (5)
Failed to revise Resident 15's Care Plan to address fall prevention interventions after falls on 3/17/15 and 5/1/15.
Failed to assess causal factors and develop/revise and implement interventions for prevention of ongoing falls for Residents 15 and 47.
Failed to assure interventions for prevention of weight loss were implemented for Resident 15.
Failed to administer Resident 43's sliding scale insulin in accordance with physician's orders.
Failed to provide separation of hazardous areas from other areas in the facility as required by NFPA 101 Life Safety Code Standard.
Report Facts
Facility census: 33
Resident 15 weight loss: 6
Missed supplement administrations: 14
Missed supplement administrations: 40
Missed supplement administrations: 52
Missed sliding scale insulin administrations: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Named in complaint letter and facility correspondence |
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter |
| Brenda Orlowski | Registered Nurse | Surveyor involved in complaint and annual survey investigation |
| Patricia Wolfe | Registered Nurse | Surveyor involved in complaint and annual survey investigation |
| Janice Hake | Registered Nurse | Surveyor involved in complaint and annual survey investigation |
| Don Fritz | ASFM | Approved plan of correction for Life Safety Code deficiency |
Inspection Report
Complaint Investigation
Census: 32
Deficiencies: 2
Date: Feb 23, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint survey at Park View Haven Nursing Home from February 19, 2015 to February 23, 2015. The investigation included review of resident records, observation of care, and interviews with residents, family, and staff.
Complaint Details
The complaint alleged failure to transfer residents safely, failure to notify healthcare practitioners of changes in condition, and failure to ensure resident safety from residents with behaviors. The facility was found in violation for unsafe transfers and failure to protect residents from abuse and unsafe behaviors, but was compliant regarding notification of healthcare practitioners.
Findings
The facility failed to transfer residents safely, failed to protect a resident from abuse, and failed to ensure residents were safe from residents with behaviors. Staff did not follow manufacturer's recommendations for lift use, and interventions to prevent resident altercations were not implemented.
Deficiencies (2)
Facility failed to protect 1 resident from abuse, evidenced by resident altercations without interventions to prevent recurrence.
Facility failed to transfer residents in a safe manner, not using required lower straps on mechanical lifts during transfers.
Report Facts
Facility census: 32
Residents observed for unsafe transfer: 2
Residents involved in abuse incidents: 2
Inspection Report
Annual Inspection
Census: 25
Deficiencies: 12
Date: Jun 17, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Park View Haven Nursing Home from June 11, 2014 to June 17, 2014.
Complaint Details
The complaint allegation was that the facility failed to ensure equipment was sanitized between uses. The investigation found the facility was in compliance with infection control policies and practices.
Findings
The facility was found to be in compliance with infection control practices. Deficiencies were identified related to failure to notify physicians of significant resident condition changes, dignity and respect issues including failure to knock and long wait times for meal assistance, inadequate activities program for resident interests, failure to provide care to prevent pressure sores, failure to protect a resident from falls, insufficient fluid intake for residents at risk of dehydration, unnecessary drug use without proper monitoring or gradual dose reduction, medication administration errors related to enteral feeding tube procedures, inadequate RN coverage, failure to maintain smoke resistance in hazardous areas, inadequate fire drill documentation, and failure to maintain emergency generator testing.
Deficiencies (12)
Failure to notify physicians of significant changes in resident conditions including pressure ulcers, weight loss, and edema.
Failure to treat residents with dignity and respect including failure to knock before entering rooms, long wait times for meal assistance, and grooming in dining room.
Failure to provide an ongoing program of activities meeting resident interests and needs.
Failure to provide care and services to prevent and heal pressure sores.
Failure to ensure resident environment is free of accident hazards and provide adequate supervision to prevent falls.
Failure to provide sufficient fluid intake to maintain proper hydration and health.
Failure to ensure drug regimen is free from unnecessary drugs including lack of monitoring, rationale, and gradual dose reduction for psychotropic medications.
Failure to administer enteral medications according to facility policy including failure to check tube placement and administer medications separately with water flushes.
Failure to provide Registered Nurse coverage at least 8 consecutive hours a day, 7 days a week for two days in May 2014.
Failure to maintain smoke resistance in hazardous areas allowing smoke to spread to main lobby and other zones.
Failure to adequately document and hold fire drills under varied conditions at different times of day for all shifts.
Failure to maintain emergency generator by testing monthly to at least 30% of nameplate rating and conduct annual load bank test.
Report Facts
Resident census: 25
Pressure ulcer size: 4
Pressure ulcer size: 4.3
Pressure ulcer size: 4.4
Weight loss percentage: 6
Medication administration error rate: 8
RN coverage hours: 6.5
RN coverage days missed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Named in complaint investigation letter |
| Eve Lewis | Program Manager | Signed complaint investigation letter |
| Krista Roeber | Social Worker | Complaint investigation team member |
| Brenda Orlowski | Registered Nurse | Complaint investigation team member |
| Patricia Wolfe | Registered Nurse | Complaint investigation team member |
| Janice Hake | Registered Nurse | Complaint investigation team member |
| Sheryl Kalin | Administrator | Signed statement of deficiencies |
Inspection Report
Annual Inspection
Census: 28
Deficiencies: 6
Date: Apr 15, 2013
Visit Reason
The inspection was conducted as an annual survey to assess compliance with state and federal regulations governing skilled nursing facilities, including care planning, professional standards, medication management, infection control, and life safety code compliance.
Findings
The facility was found deficient in revising care plans following changes in resident conditions, meeting professional standards of care, providing necessary care and services, securing medications, maintaining infection control practices, and maintaining smoke resistance in hazardous areas.
Deficiencies (6)
Failed to revise care plans following changes in fall interventions and medication regimen for multiple residents.
Failed to meet professional standards of care as TED hose were not applied according to physician's orders.
Failed to provide necessary care and services to attain or maintain highest practicable well-being, including lack of admission physician orders and assessments, and failure to reassess after falls and changes in condition.
Failed to assure medications were stored and secured at all times and to prevent access from unauthorized persons; medications left unsecured during administration.
Failed to maintain an infection control program including proper handling of urinary catheter drainage bags, hand hygiene, and sanitizing mechanical lifts after use.
Failed to maintain smoke resistance in hazardous areas due to lack of automatic door closures and faulty door closures.
Report Facts
Resident census: 28
Deficiency count: 6
Inspection Report
Annual Inspection
Census: 26
Deficiencies: 7
Date: Jan 11, 2012
Visit Reason
The inspection was conducted as an annual survey to assess compliance with federal and state regulations including licensure, life safety code, infection control, medication administration, and food safety.
Findings
The facility was found deficient in multiple areas including failure to notify family of resident injury, improper food handling practices, failure to observe medication administration, inadequate infection control practices related to blood glucose meter sanitation, and life safety code violations such as lack of documentation for flame spread rating of interior finishes, improper installation of alcohol-based hand rub dispensers, and lack of remote audible annunciator for emergency generator.
Deficiencies (7)
Failure to notify resident's family of injury from hot coffee dispenser spill resulting in bruise.
Food handlers observed using bare hands to handle food items, risking contamination.
Staff failed to observe residents swallowing medications to ensure safe delivery.
Blood glucose meter was not cleaned between residents, risking infection transmission.
Failed to provide documentation verifying interior finishes have flame spread rating of Class A or B.
Alcohol-based hand rub dispensers installed over light fixtures, violating minimum distance from ignition source.
Emergency generator lacked remote audible annunciator at a continuously occupied staff location.
Report Facts
Facility census: 26
Bruise size: 3.8
Bruise size: 1
Medications observed: 5
Pill count: 5
Generator test duration: 30
Minimum distance: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Signed waiver request and plan of correction |
| Joan Davis | Registered Dietician | Conducted in-service on safe food handling and distribution |
| RN-E | Registered Nurse | Observed failing to stay with residents during medication administration and blood glucose testing |
| RN-C | Registered Nurse | Observed failing to clean blood glucose meter between residents |
| Director of Nursing | Interviewed regarding deficiencies and monitoring plans | |
| Maintenance Supervisor | Responsible for correcting hand rub dispenser installation and monitoring generator annunciator | |
| Maintenance A | Confirmed deficient installation of hand rub dispensers and lack of audible annunciator |
Inspection Report
Complaint Investigation
Census: 33
Deficiencies: 1
Date: Oct 21, 2010
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to report an allegation of staff to resident abuse involving Resident 10 to the State Agency as required by law.
Complaint Details
The complaint investigation was substantiated as the facility failed to report an allegation of staff to resident abuse involving Resident 10 within the required timeframe. The allegation was reported 11 days late to the State Agency.
Findings
The facility failed to report an allegation of staff to resident abuse within the required 24 hours, reporting it 11 days late. The investigation confirmed the allegation was not reported timely, violating state law. The facility developed a Plan of Correction including staff training, suspension of involved staff pending investigation, and re-education on abuse reporting policies.
Deficiencies (1)
Failure to report an allegation of staff to resident abuse to the State Agency within 24 hours as required.
Report Facts
Facility census: 33
Sample size: 10
Days late reporting: 11
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Named in Plan of Correction letter and signature |
Inspection Report
Renewal
Capacity: 34
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves to verify that Park View Haven Nursing Home's SNF/NF dual certification license is renewed and valid through the date indicated on the renewal card.
Findings
The document certifies that Park View Haven Nursing Home meets statutory requirements for SNF/NF dual certification and includes licensing and occupancy information.
Report Facts
Licensed beds: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leigh Bloomquist | Administrator | Named as the facility administrator on the renewal application. |
| Lindsay Tramp | Director of Nursing | Named as the Director of Nursing on the renewal application. |
| Gary J. Anthone | Chief Medical Officer, Director, Division of Public Health | Signed the certification of licensure renewal. |
Notice
Capacity: 51
Deficiencies: 0
Date: APP2021
Visit Reason
This document set serves to verify the renewal of the SNF/NF dual certification license for Park View Haven Nursing Home and includes the renewal application, ownership details, and occupancy permit.
Findings
The documents confirm that Park View Haven Nursing Home meets statutory requirements for licensure renewal, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 51
Maximum occupancy: 34
Renewal license expiration date: Mar 31, 2022
Document
Capacity: 34
Deficiencies: 0
Date: APP2022
Visit Reason
The documents pertain to the renewal of the nursing home license for Park View Haven Nursing Home, including verification of licensure, renewal application, and occupancy permit.
Findings
No inspection findings or deficiencies are reported. The documents confirm the facility's licensure renewal and occupancy status with no noted compliance issues.
Report Facts
Total licensed beds: 34
Renewal license expiration date: 2023
Renewal license expiration month and day: 03-31
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Mosel | Administrator | Named as administrator on the renewal application |
| Lindsay Tramp | Director of Nursing | Named as director of nursing on the renewal application |
| Gary J. Amihone, MD | Chief Medical Officer, Director, Division of Public Health | Named on the license renewal verification card |
| George Hefner | Chairman | Named as chairman of the Village Board and authorized representative on renewal application |
Notice
Capacity: 34
Deficiencies: 0
Date: APP2023
Visit Reason
The document set serves to verify the licensure renewal of Park View Haven Nursing Home and includes the renewal application, occupancy permit, and related administrative information.
Findings
The documents confirm that Park View Haven Nursing Home meets statutory requirements for licensure renewal, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 34
Renewal license fee: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy J. Mosel | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Lindsay Tramp | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Jeremy Bruning | Chairman | Chairman of the Board of Directors listed in the administrative documents. |
| George R. Hefner | Trustee | Trustee of the Board of Directors listed in the administrative documents. |
| Chad Frerichs | Trustee | Trustee of the Board of Directors listed in the administrative documents. |
| Leroy Cautrell | Trustee | Trustee of the Board of Directors listed in the administrative documents. |
| Roger Anderson | Trustee | Trustee of the Board of Directors listed in the administrative documents. |
Notice
Capacity: 34
Deficiencies: 0
Date: APP2024
Visit Reason
The documents serve to verify and renew the license for Park View Haven Nursing Home and to provide occupancy permit information.
Findings
The documents confirm that Park View Haven Nursing Home meets statutory requirements for licensure and holds an occupancy permit for 34 beds.
Report Facts
Total licensed beds: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy J Mosel | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Kandice Rahn | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Jeremy C. Bruning | Authorized Representative | Signed the Nursing Home Licensure Renewal Application and listed as Chairman of the Board of Directors. |
Notice
Capacity: 34
Deficiencies: 0
Date: APP2025
Visit Reason
This document package includes a Nursing Home Licensure Renewal Application for Park View Haven Nursing Home, renewal of the facility's license, and related occupancy permit documentation.
Findings
The documents verify the facility's licensure renewal status, confirm the licensed bed capacity, and include the occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Licensed beds: 34
Renewal expiration date: 2025
Renewal expiration date: 2026
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nancy Mosel | Administrator | Named as Administrator on the renewal application and authorized representative |
| Heather Persinger | Director of Nursing | Named as Director of Nursing on the renewal application |
| Brenda Lage | Authorized Representative | Signed renewal application as authorized representative |
Notice
Capacity: 35
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as verification of the renewal of the SNF/NF dual certification license for Park View Haven Nursing Home and includes the occupancy permit indicating the maximum occupancy allowed.
Findings
The documents confirm that Park View Haven Nursing Home is licensed through the renewal date and has an approved occupancy permit for 35 beds. No inspection findings or deficiencies are reported.
Report Facts
Number of beds to be relicensed: 34
Maximum occupancy: 35
Renewal fee: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sheryl Kalin | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Kristine Karnes-Snyder | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
| Don Fast | Deputy State Fire Marshal | Inspected the facility for occupancy permit |
Notice
Capacity: 34
Deficiencies: 0
Date: APP2018
Visit Reason
The documents serve to verify the license renewal for Park View Haven Nursing Home and provide the occupancy permit and related administrative information.
Findings
The documents confirm that Park View Haven Nursing Home meets statutory requirements for licensure and holds an occupancy permit for 34 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Leigh Bloomquist | Administrator | Named on renewal application as administrator |
| Kristine Karnes-Snyder | Director of Nursing | Named on renewal application as director of nursing |
| George R. Hefner | Authorized Representative | Signed renewal application and listed as Village Board Trustee |
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