Inspection Reports for Plainview Manor
Plainview Manor, PLAINVIEW, NE, 68769
Back to Facility ProfileDeficiencies (last 10 years)
Deficiencies (over 10 years)
4.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
2% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
85% occupied
Based on a May 2019 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Capacity: 39
Deficiencies: 0
Date: Mar 27, 2023
Visit Reason
This document is a Nursing Home Licensure Renewal Application for Plainview Manor to renew its license for 39 beds.
Findings
The document certifies that Plainview Manor meets statutory requirements for SNF/NF dual certification and includes licensing renewal details, ownership information, and occupancy permit data.
Report Facts
Number of beds to be relicensed: 39
Maximum Occupancy: 39
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named in Nursing Home Licensure Renewal Application |
| Tami Anderson | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Robert Smith | Authorized Representative | Signed the Nursing Home Licensure Renewal Application |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility and approved the Occupancy Permit |
Inspection Report
Renewal
Capacity: 39
Deficiencies: 0
Date: Feb 10, 2020
Visit Reason
The document is a Nursing Home Licensure Renewal Application for Plainview Manor to renew its license for 39 beds.
Findings
The documents certify that Plainview Manor meets statutory requirements for SNF/NF dual certification and includes an occupancy permit for 39 beds issued on 2019-07-03 by the Nebraska State Fire Marshal.
Report Facts
Number of beds to be relicensed: 39
Maximum Occupancy: 39
Renewal License Expiration Date: Expires 3/31/2021 as per license card
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named on Nursing Home Licensure Renewal Application |
| Tami Anderson | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
| Brian Schlote | Mayor | Authorized Representative signing renewal application |
Inspection Report
Annual Inspection
Census: 33
Capacity: 39
Deficiencies: 5
Date: May 21, 2019
Visit Reason
Annual inspection survey conducted to assess compliance with federal Medicare and Medicaid requirements, including emergency preparedness, nursing care, pain management, food safety, and life safety code compliance.
Findings
The facility was found to be generally compliant with emergency preparedness regulations but had deficiencies in nursing restorative care, pain management, food safety (dishwasher temperature), fire alarm system installation, and smoke barrier maintenance. Plans of correction were provided for each deficiency with specific corrective actions and monitoring.
Deficiencies (5)
Failed to implement a specific nursing restorative program for a resident to prevent decrease in range of motion and mobility.
Failed to make adjustments in treatments to manage a resident's chronic pain effectively.
Dishwashing machine failed to maintain wash and/or rinse cycle temperature of at least 120 degrees Fahrenheit to sanitize dishes.
Fire alarm system circuit breaker was not equipped with a lock out device, risking inadvertent disconnection.
Failed to maintain smoke barriers in corridor ceilings to resist passage of smoke, allowing potential smoke migration.
Report Facts
Facility census: 33
Total licensed capacity: 39
Deficiencies cited: 5
Dishwasher wash temperature: 98
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ryan Gallagher | Physical Therapist | Oversees the facility restorative program; involved in plan of correction for restorative nursing program deficiency |
| Juleen Johnson | Administrator | Signed facility compliance and staffing forms |
| LPN-G | Restorative Licensed Practical Nurse | Confirmed resident was not started on individualized restorative nursing program after PT discharge |
| LPN-F | Licensed Practical Nurse | Verified resident pain complaints and medication use |
| LPN-C | Licensed Practical Nurse | Verified resident pain complaints and medication use |
| Director of Nursing | Responsible for monitoring pain assessments, provider visit forms, and restorative nursing program documentation | |
| Dietary Manager | Responsible for monitoring dishwasher temperature logs and compliance with food safety requirements | |
| Maintenance Staff A | Confirmed lack of lock out device on fire alarm circuit breaker and assisted with smoke barrier repairs | |
| Maintenance Supervisor | Responsible for monitoring fire alarm circuit breaker lock and smoke barrier maintenance | |
| Administrative Staff A | Confirmed fire alarm circuit breaker issue and smoke barrier deficiencies |
Inspection Report
Complaint Investigation
Census: 32
Capacity: 39
Deficiencies: 7
Date: Mar 25, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Plainview Manor on March 25-28, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged the facility failed to follow the plan of care when residents were identified at risk for falls. The investigation confirmed care plan interventions were not implemented to ensure resident safety and/or prevent falls for two residents.
Findings
The facility failed to follow the plan of care when residents were identified at risk for falls, failed to implement interventions to prevent ongoing weight loss for three residents, and failed to maintain infection prevention and control practices including transmission-based precautions and hand hygiene. Life safety code deficiencies were also noted including sprinkler clearance, corridor door sealing, and combustible decorations.
Deficiencies (7)
Failed to develop and implement care plan interventions for prevention of hot liquid spills, prevention of falls, and individualized medical needs for residents.
Failed to ensure resident environment remains free of accident hazards and provide adequate supervision and assistance devices to prevent accidents.
Failed to implement interventions to prevent ongoing weight loss for 3 residents.
Failed to establish and maintain an infection prevention and control program including transmission-based precautions and hand hygiene.
Failed to maintain required minimum clearance around fire sprinklers in closets.
Failed to ensure corridor doors resist passage of smoke; door to Director of Nursing office had over a half inch gap at top.
Failed to use non-combustible or flame-retardant decorations in the Activities room.
Report Facts
Deficiency sample size: 20
Facility census: 32
Total licensed capacity: 39
Weight loss percentage: 7
Weight loss percentage: 5
Temperature of hot water: 167
Temperature of hot coffee: 168
Clearance around sprinkler: 18
Gap in door seal: 0.5
Number of combustible decorations: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed complaint investigation letter |
| Juleen Johnson | Administrator | Facility administrator named in report |
| LPN-C | Observed failing hand hygiene during medication administration and blood glucose testing | |
| LPN-E | Observed failing hand hygiene and resident handwashing during care | |
| NA-G | Observed failing hand hygiene and resident handwashing during care | |
| Director of Nursing | Interviewed regarding care plan and infection control deficiencies | |
| Administrative Staff A | Interviewed regarding sprinkler clearance and combustible decorations | |
| Maintenance Staff A | Interviewed regarding sprinkler clearance and combustible decorations |
Inspection Report
Annual Inspection
Census: 31
Capacity: 39
Deficiencies: 16
Date: Jan 18, 2017
Visit Reason
Annual inspection of Plainview Manor to assess compliance with federal Medicare and Medicaid requirements, including life safety, infection control, medication management, and food safety.
Findings
The inspection identified multiple deficiencies including failure to properly assess and document skin conditions, improper medication administration, inadequate food handling and hand hygiene practices, life safety code violations related to door locking mechanisms, corridor obstructions, emergency lighting, fire door maintenance, hazardous area enclosures, cooking facility safety, fire alarm system installation and testing, sprinkler system maintenance, electrical safety, fire extinguisher signage, smoke barrier integrity, and oxygen cylinder storage.
Deficiencies (16)
Facility failed to assess and monitor skin conditions for residents, including bruising and skin tears, with no weekly documentation.
Facility failed to ensure Resident 13 was free from unnecessary medications related to antihypertensive use.
Dietary staff failed to wash hands during food preparation and service, risking food contamination.
Facility staff failed to wash hands between resident contacts while assisting residents to eat.
Facility used a door lock system on egress doors requiring more than one releasing motion, delaying evacuation.
Furniture placed in exit corridors reduced corridor width and was not secured, obstructing egress.
Facility failed to conduct annual 90-minute test of battery powered emergency lights.
Facility failed to have a preventative maintenance plan to inspect and test fire doors annually.
Facility failed to separate hazardous areas by smoke resistive partitions; doors did not self-close.
Facility failed to conduct monthly visual inspections of kitchen range hood suppression system.
Facility failed to install smoke detectors so air movement from supply vents would not delay activation.
Facility failed to have smoke detector sensitivity test conducted every other year.
Electrical conduit was attached to and supported by sprinkler pipe, risking damage to sprinkler system.
Facility failed to post placard near Class K fire extinguisher describing operating procedures.
Oxygen cylinder was not restrained from tipping over in storage room.
Facility failed to prohibit use of extension cords and daisy-chained power strips in basement leased area.
Report Facts
Facility census: 31
Total licensed capacity: 39
Sample size: 27
Number of residents affected by door lock deficiency: 31
Corridor width: 7
Corridor clearance: 6
Kitchen dry food storage room size: 63
Medication room size: 56
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN-D | Registered Nurse | Confirmed bruising monitoring and documentation requirements |
| Director of Nurses | Director of Nursing | Confirmed skin assessment documentation and medication administration policies |
| LPN-G | Licensed Practical Nurse | Verified wound assessment documentation procedures |
| DC-J | Dietary Cook | Observed failing to wash hands during food preparation and service |
| NA-B | Nursing Assistant | Observed failing to wash hands between resident feeding |
| LPN-F | Licensed Practical Nurse | Observed failing to wash hands between resident feeding |
| Maintenance A | Acknowledged sprinkler pipe conduit attachment, smoke detector placement, fire door issues, and fire extinguisher placard absence | |
| Administration A | Confirmed door lock system, fire door maintenance, smoke barrier issues, emergency lighting testing, fire alarm sensitivity testing, and oxygen cylinder storage |
Inspection Report
Routine
Census: 27
Deficiencies: 1
Date: Dec 29, 2015
Visit Reason
The inspection was conducted to assess compliance with regulations governing licensure of skilled nursing facilities, focusing on treatment and services to prevent and heal pressure sores, and compliance with the Life Safety Code.
Findings
The facility failed to properly assess, stage, and document pressure ulcers for Residents 39 and 9, including weekly wound measurements and staging, which is required to promote healing and prevent new sores. The facility was found to be in compliance with the Life Safety Code.
Deficiencies (1)
Failure to assess and monitor pressure ulcers for Residents 39 and 9, including lack of staging and incomplete documentation of wound characteristics.
Report Facts
Facility census: 27
Pressure ulcer measurements: 3
Pressure ulcer measurements: 4
Pressure ulcer measurements: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse B | Registered Nurse | Assessed Resident 39's buttocks and encouraged pressure relief |
| Director of Nursing | Director of Nursing | Verified pressure ulcer on Resident 39 and confirmed weekly wound assessment and documentation |
| Licensed Practical Nurse I | Licensed Practical Nurse | Interviewed regarding Resident 9's pressure ulcer care and documentation |
Inspection Report
Renewal
Capacity: 39
Deficiencies: 0
Date: Dec 29, 2015
Visit Reason
This document is related to the renewal of the nursing home license for Plainview Manor, verifying that the SNF/NF Dual Certification is licensed through the indicated renewal date.
Findings
The documents confirm the renewal of the facility's license with no noted deficiencies or violations. The Nebraska State Fire Marshal issued an occupancy permit for 39 beds, and the facility is certified for physical, occupational, and speech therapy services.
Report Facts
Total licensed beds: 39
Renewal fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Tami Anderson | Director of Nursing, R.N. | Named on the Nursing Home Licensure Renewal Application |
| Darren Scjpe | Mayor | Signed as authorized representative on the renewal application |
| Don Fast | Deputy State Fire Marshal | Inspected the facility and issued the occupancy permit |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Sep 15, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint at Plainview Manor regarding the facility's failure to evaluate causal factors for falls and failure to submit investigations within 5 working days.
Complaint Details
The complaint alleged that the facility failed to evaluate causal factors for falls and failed to submit investigations within 5 working days. Both allegations were found to be unsubstantiated as the facility complied with regulations.
Findings
The facility was found to be in compliance with relevant regulatory requirements for both allegations. The facility evaluated causal factors for falls and submitted investigations within 5 working days as required.
Report Facts
Residents reviewed: 3
Reported incidents reviewed: 4
Working days for investigation submission: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Annual Inspection
Census: 35
Deficiencies: 5
Date: Oct 2, 2014
Visit Reason
The inspection was conducted as an annual survey to assess compliance with federal regulations governing skilled nursing facilities, including care plan implementation, fall prevention, medication management, infection control, and life safety code adherence.
Findings
The facility failed to implement care plan interventions for fall prevention for two residents, failed to ensure call lights and alarms were properly used, administered unnecessary psychoactive medications without appropriate diagnosis or dose reduction attempts for two residents, and did not sanitize mechanical sit/stand lifts between resident uses, risking cross-contamination. Additionally, the facility lacked proper smoke tight separation in a hazard area due to a missing automatic door closing device.
Deficiencies (5)
Failed to implement care plan interventions for fall prevention for Residents 5 and 29.
Failed to protect residents from falls by not ensuring call lights and alarms were properly used for Residents 5 and 29.
Medication regimens included unnecessary psychoactive drugs without appropriate diagnosis or gradual dose reduction for Residents 7 and 21.
Failed to sanitize mechanical sit/stand lift between resident uses, risking cross contamination among 13 residents.
Failed to provide proper smoke tight separation for a hazard area due to missing automatic door closing device on linen room door.
Report Facts
Facility census: 35
Residents at risk of falls: 2
Residents receiving unnecessary psychoactive drugs: 2
Residents using mechanical sit/stand lift: 13
Residents at risk in smoke zones: 13
Inspection Report
Complaint Investigation
Census: 30
Deficiencies: 1
Date: May 21, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Plainview Manor on May 21-22, 2014, including review of resident records, observations, and interviews with residents, family, and staff.
Complaint Details
The complaint alleged failure to protect residents from abuse, failure to investigate allegations of abuse, failure to submit investigations within 5 working days, failure to treat residents with dignity and respect, failure to answer call notification systems promptly, failure to allow residents to participate in planning of care, and failure to ensure residents are not retaliated against when making complaints. The facility was found compliant with all except dignity and respect, which was substantiated.
Findings
The facility was found compliant with abuse protection, investigation, timely submission of investigations, call system response, resident care planning, and protection from retaliation. However, the facility failed to treat residents with dignity and respect as staff failed to knock and announce themselves prior to entering resident rooms on multiple occasions.
Deficiencies (1)
Facility failed to knock and announce themselves prior to entering resident rooms ten times for Rooms 306, 311, 210, 306, 301, 304, and 205.
Report Facts
Facility census: 30
Number of times staff failed to knock and announce: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named as recipient of report and responsible party |
| Dan Taylor | RN, Training Coordinator | Signed report letter |
| Krista Roeber | Social Worker | Surveyor conducting investigation |
Inspection Report
Annual Inspection
Census: 32
Deficiencies: 4
Date: Nov 21, 2013
Visit Reason
The inspection was conducted as an annual survey to assess compliance with federal regulations governing skilled nursing facilities, including resident care, safety, medication management, infection control, and life safety code compliance.
Findings
The facility was found to have deficiencies related to failure to revise care plans and interventions for a resident with wandering risk, inadequate supervision to prevent accidents, failure of the pharmacist to identify drug irregularities related to psychoactive medications, and inadequate infection control practices related to cleaning of glucometers. The facility was in compliance with life safety code provisions.
Deficiencies (4)
Failure to revise interventions for Resident 30's comprehensive care plan related to desire to leave the facility.
Failure to ensure resident environment was free of accident hazards and provide adequate supervision to prevent accidents for Resident 30.
Failure of consultant pharmacist to identify potential drug irregularities related to psychoactive drugs for Residents 21 and 3.
Failure to maintain infection control by not cleaning glucometers after use, risking cross contamination.
Report Facts
Facility census: 32
Resident 30 BIMS score: 15
Resident 30 BIMS score: 8
Seroquel dosage: 50
Abilify dosage: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Verified no new interventions were initiated after Resident 30's incident and participated in plan of correction | |
| Director of Nursing (DON) | Verified monitoring and documentation issues related to Resident 30 and infection control practices | |
| Bill Michael | Pharmacist | Participated in state survey exit and consultant pharmacist activities |
| Licensed Practical Nurse (LPN)-F | Observed not cleaning glucometer after use | |
| Licensed Practical Nurse (LPN)-G | Interviewed about glucometer cleaning procedures |
Inspection Report
Complaint Investigation
Census: 34
Deficiencies: 4
Date: Jul 24, 2012
Visit Reason
The inspection was conducted due to complaint-related concerns regarding failure to notify physicians of residents' conditions, failure to revise care plans, inadequate pain management, and failure to properly treat and prevent pressure sores.
Complaint Details
The visit was complaint-related, focusing on failure to notify physicians of residents' diarrhea and condition changes, failure to revise care plans, inadequate pain management, and failure to properly treat pressure sores.
Findings
The facility failed to notify physicians timely about residents' diarrhea, failed to revise care plans to address pain and diarrhea, did not adequately manage pain for a resident with shingles, and failed to monitor and treat pressure ulcers properly, including failure to float heels as prescribed.
Deficiencies (4)
Failure to notify physicians regarding residents' diarrhea and condition changes.
Failure to revise care plan to address resident's pain and diarrhea problems.
Failure to provide adequate pain management for a resident with shingles and pain complaints.
Failure to monitor and treat pressure ulcers properly, including failure to float heels.
Report Facts
Facility census: 34
Resident 28 left heel pressure ulcer size: 0.2
Resident 28 right heel pressure ulcer size: 1
Days delay in notifying physician for Resident 35's loose stools: 6
Days delay in notifying physician for Resident 43's diarrhea: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse H | Licensed Nurse | Administered Tylenol to Resident 43 during observed care |
| Director of Nursing | Director of Nursing | Interviewed regarding notification policies and care plan revisions |
| Nursing Assistant C | Nursing Assistant | Observed assisting Resident 43 and reporting pain complaints |
| Nursing Assistant E | Nursing Assistant | Observed assisting Resident 43 and reporting diarrhea complaints |
Inspection Report
Deficiencies: 0
Date: Jul 5, 2011
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements for long term care facilities, skilled nursing facilities, and life safety code provisions.
Findings
The facility was found to be in compliance with applicable regulations under 42 CFR Part 483 Subpart B, Title 175 Chapter 12, and the 2000 Edition of the Life Safety Code of the National Fire Protection Association, with no deficiencies cited.
Notice
Capacity: 39
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as a licensure renewal application for Plainview Manor, verifying the facility's SNF/NF dual certification and renewal of its nursing home license.
Findings
The documents confirm the facility's licensure status, renewal fees, ownership information, and occupancy permit with a maximum capacity of 39 beds. No inspection findings or deficiencies are reported.
Report Facts
Number of beds to be relicensed: 39
Maximum occupancy: 39
Renewal fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named on Nursing Home Licensure Renewal Application |
| Tami Anderson | Director of Nursing, R.N. | Named on Nursing Home Licensure Renewal Application |
Notice
Capacity: 39
Deficiencies: 0
Date: APP2018
Visit Reason
The document serves as a licensure renewal application and verification for Plainview Manor's Skilled Nursing Facility license, confirming the facility's licensed status and capacity.
Findings
The documents confirm that Plainview Manor meets statutory requirements for licensure renewal as a Skilled Nursing Facility with a licensed capacity of 39 beds. An occupancy permit issued by the Nebraska State Fire Marshal also confirms the maximum occupancy of 39 beds.
Report Facts
Licensed beds: 39
Renewal fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named on the licensure renewal application |
| Tami Anderson | Director of Nursing, R.N. | Named on the licensure renewal application |
| Darren Seip | Mayor | Authorized representative signing the renewal application |
| Mark Manchester | Deputy State Fire Marshal | Inspected the facility for occupancy permit |
Notice
Capacity: 39
Deficiencies: 0
Date: APP2021
Visit Reason
This document serves as a Nursing Home Licensure Renewal Application for Plainview Manor, including verification of licensure status and occupancy permit details.
Findings
The documents confirm that Plainview Manor meets statutory requirements for SNF/NF dual certification and holds a valid occupancy permit for 39 beds.
Report Facts
Total licensed beds: 39
Renewal license fee: 1550
Occupancy permit date issued: Jan 27, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Tami Anderson | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Brian Schlote | Mayor | Authorized representative who signed the renewal application. |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility and approved the occupancy permit. |
Notice
Capacity: 39
Deficiencies: 0
Date: APP2022
Visit Reason
This document serves as a licensure renewal application and verification for Plainview Manor's SNF/NF dual certification, including renewal of license and occupancy permit.
Findings
The documents confirm that Plainview Manor meets statutory requirements for licensure renewal as a skilled nursing facility with 39 beds and includes an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 39
Renewal license fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Tami Anderson | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
| Brian Schlote | Authorized Representative | Signed the Nursing Home Licensure Renewal Application. |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility and approved the occupancy permit. |
Notice
Capacity: 39
Deficiencies: 0
Date: APP2024
Visit Reason
This document serves as a licensure renewal application and certification for Plainview Manor nursing home, verifying the facility's license and renewal status.
Findings
The documents confirm that Plainview Manor meets statutory requirements for licensure renewal and includes an occupancy permit issued by the Nebraska State Fire Marshal with a maximum occupancy of 39 beds.
Report Facts
Number of beds to be relicensed: 39
Maximum occupancy: 39
Renewal Licensure Fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Juleen Johnson | Administrator | Named in Nursing Home Licensure Renewal Application |
| Pamela Albin | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Robert Smith | Mayor | Authorized representative signing the renewal application |
| Robert Folck | Deputy State Fire Marshal | Inspected and approved the occupancy permit |
Document
Capacity: 39
Deficiencies: 0
Date: APP2025
Visit Reason
The document is a licensure renewal application and verification for Plainview Manor, a skilled nursing facility, to maintain its license and certification status.
Findings
No inspection findings or deficiencies are reported. The documents confirm the facility's licensure renewal status and occupancy permit with a maximum capacity of 39 beds.
Report Facts
Total licensed beds: 39
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Judeen Johnson | Administrator | Named in Nursing Home Licensure Renewal Application |
| Pamela Albin | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Robert Smith | Mayor | Authorized representative signing the licensure renewal application |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility for occupancy permit |
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