Deficiencies (last 10 years)
Deficiencies (over 10 years)
6.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
52% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
91% occupied
Based on a November 2017 inspection.
Census over time
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Mar 13, 2025
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related renewal certification for Sumner Place, indicating the purpose is to renew the facility's license.
Findings
The documents confirm that Sumner Place meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specialized care units. No deficiencies or inspection findings are reported.
Report Facts
Total licensed beds: 104
Maximum capacity for Alzheimer's beds: 23
Renewal license expiration date: Mar 31, 2026
Inspection date: Jun 25, 2024
Daily room rates: Rates range from $284 to $321 depending on room type
Daily level of care rates: Rates range from $35 (minimum assistance) to $83 (total assistance)
Memory support daily rate: 10
Staffing numbers: CNA and nurse shift breakdowns provided, e.g., 2 CNAs per shift Monday-Friday, 1 nurse per shift
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kaitlin Clegg | Administrator | Named as administrator on renewal application and Alzheimer's unit disclosure |
| Mindy Rueschhoff | Director of Nursing | Named as Director of Nursing on renewal application |
| Brian Stuhr | Authorized Representative | Signed renewal application and Alzheimer's unit disclosure as authorized representative |
| Glenn Van Ekeren | Authorized Representative | Signed renewal application as authorized representative |
| Susen Lindner | Deputy State Fire Marshal | Inspected facility and approved occupancy permit |
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Feb 28, 2024
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related renewal certification for Sumner Place, verifying the facility's license renewal and compliance with statutory requirements.
Findings
The documents confirm that Sumner Place meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specialized care services including Alzheimer's/Special Care Unit, physical, occupational, and speech therapy. The renewal application includes facility capacity, ownership, and service details with no deficiencies or violations noted.
Report Facts
Total licensed beds: 104
Alzheimer's beds capacity: 23
Renewal application date: Feb 28, 2024
Occupancy permit date: Jul 20, 2023
Daily room rates: 284
Daily room rates: 321
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kaitlin Clegg | Administrator | Named as facility administrator on the renewal application and Alzheimer's Special Care Unit Disclosure. |
| Mindy Rueschhoff | Director of Nursing | Named as Director of Nursing on the renewal application. |
| Brian Stuhr | Authorized Representative / Treasurer | Signed renewal application and Alzheimer's Special Care Unit Disclosure as authorized representative and contact person. |
| Glenn Van Ekeren | President | Named as President of the parent entity and Board of Directors. |
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Mar 16, 2020
Visit Reason
This document is a Nursing Home Licensure Renewal Application and related licensing and certification documents for Sumner Place, including Alzheimer's Special Care Unit Disclosure and Memory Care Endorsement Application.
Findings
The documents verify that Sumner Place meets statutory requirements for SNF/NF dual certification and includes detailed information about the Alzheimer's Special Care Unit philosophy, admission and discharge criteria, staffing, training, environment, life enrichment programs, family support, and fees.
Report Facts
Total licensed beds: 104
Alzheimer's Special Care Unit beds: 23
Cost/Fees of care: 245
Cost/Fees of care: 282
Staffing numbers: 4
Staffing numbers: 2
Dementia training hours: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named as facility administrator in renewal application and Alzheimer's Special Care Unit Disclosure. |
| Mindy Rueschhoff | Director of Nursing | Named as Director of Nursing in renewal application. |
| Jack D. Vetter | Authorized Representative | Signed the renewal application and Alzheimer's Special Care Unit Disclosure as authorized representative. |
| Julie Knobbe | Contact | Named as contact person for Alzheimer's Special Care Unit Disclosure. |
Inspection Report
Complaint Investigation
Deficiencies: 0
May 17, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at Sumner Place regarding allegations that the facility fails to protect residents from abuse and fails to immediately report allegations of abuse.
Findings
The investigation found that the facility does protect residents from abuse and immediately reports allegations of abuse, with no violations identified related to these concerns.
Complaint Details
The complaint alleged failure to protect residents from abuse and failure to immediately report allegations of abuse. Both allegations were found to be unsubstantiated with no violations.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report as Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Complaint Investigation
Census: 95
Capacity: 104
Deficiencies: 8
Nov 14, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Sumner Place from November 7, 2017 to November 14, 2017 by the Department of Health and Human Services Division of Public Health.
Findings
The complaint investigation found no violations related to bathing preferences, care and services according to practitioner's orders, staff assistance for food/fluid intake, food temperature, clean/dirty environment, or call notification response. The facility was found in compliance with these allegations. However, the life safety inspection identified multiple deficiencies including obstructed means of egress, storage in exit stairwells, fire door issues, fire alarm system testing deficiencies, sprinkler system issues, electrical panel safety, and improper use of power strips and extension cords.
Complaint Details
The complaint investigation addressed allegations related to failure to follow bathing care plans, provide care according to orders, assist with food/fluid intake, serve food at proper temperatures, maintain clean/dirty environment, and answer call notifications promptly. No violations were found related to these allegations.
Severity Breakdown
E: 2
D: 1
F: 5
Deficiencies (8)
| Description | Severity |
|---|---|
| Lawn chair obstructing exit gate in enclosed courtyard in The Loft corridor. | E |
| Storage of combustible items in basement exit stairwell. | D |
| Doors to hazardous areas failed to automatically close and latch properly, and penetrations around cables were unsealed in multiple locations. | F |
| Fire alarm system failed to have smoke detector sensitivity test conducted every other year and lacked documentation of 100% smoke detector testing. | F |
| Non-sprinkler components attached to sprinkler piping. | F |
| Corridor doors failed to resist passage of smoke due to gaps greater than 1/8 inch and latching hardware failures. | E |
| Missing dead front cover in electrical panel box in kitchen. | F |
| Use of power strips and extension cords in patient care vicinity and offices. | F |
Report Facts
Facility census: 95
Total licensed capacity: 104
Date of inspection: Nov 14, 2017
Number of deficiencies: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Maintenance Staff A | Interviewed regarding life safety deficiencies and maintenance issues | |
| Larry Van Hunnik | Administrator | Facility administrator addressed in complaint letter and plan of correction |
Inspection Report
Complaint Investigation
Deficiencies: 1
Jul 6, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Sumner Place on July 6, 2017, by representatives of the Department of Health and Human Services Division of Public Health. The investigation focused on allegations including misappropriation, failure to evaluate falls, failure to protect residents from abuse, and failure to immediately report allegations of abuse.
Findings
The facility was found compliant with regulations regarding protection from misappropriation, evaluation of falls, and protection from abuse. However, the facility failed to immediately report allegations of abuse in two incidents, though corrective actions and staff education were implemented, and no current violation was found.
Complaint Details
The complaint investigation included allegations of misappropriation, failure to evaluate falls, failure to protect residents from abuse, and failure to immediately report abuse. The facility was found compliant on all but the immediate reporting of abuse, where two incidents were not reported timely. The facility corrected the reporting failures and provided staff education.
Deficiencies (1)
| Description |
|---|
| Failure to immediately report allegations of abuse in two incidents. |
Report Facts
Incidents not immediately reported: 2
Reporting timeframe: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator, Licensure Unit | Signed the report and is the Training Coordinator for the Licensure Unit, Division of Public Health-DHHS. |
| Larry Van Hunnik | Administrator | Administrator of Sumner Place, recipient of the report. |
| Director of Nursing | Interviewed regarding failure to immediately report allegations of abuse. |
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Jul 1, 2017
Visit Reason
The document package relates to the renewal of the Skilled Nursing Facility license for Sumner Place due to a change of ownership effective July 1, 2017.
Findings
The documents include the license issuance, change of ownership paperwork, facility description, memory support unit disclosure, floor plans, room and service charges, and related administrative materials. The facility is licensed for 104 beds and includes a specialized memory support household with detailed policies and staffing.
Report Facts
Total licensed beds: 104
Memory support unit capacity: 23
Daily room rates: 203
Daily room rates: 225
Daily level of care rates: 25
Daily level of care rates: 34
Daily level of care rates: 46
Daily level of care rates: 54
Daily level of care rates: 64
Daily level of care rates: 73
Memory support daily rate: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named as facility administrator in licensure application and memory support unit disclosure. |
| Mindy Zuhairi | Director of Nursing | Named as Director of Nursing in licensure application. |
| Thomas L. Williams | Chief Medical Officer, Director, Division of Public Health | Signed licensing and renewal letters from Nebraska Department of Health and Human Services. |
| Shari Terry | Chief Operations Officer | Signed letter submitting change of ownership packet to Nebraska Department of Health and Human Services. |
| Jack D. Vetter | President | Signed General Assignment and Bill of Sale for change of ownership. |
| Julie Knobbe | Contact for legal owning entity | Named contact for VSL Lincoln Sumner, LLC in licensure application. |
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Mar 23, 2017
Visit Reason
This document is a licensure renewal application and related materials for Sumner Place, a skilled nursing facility, verifying the renewal of the SNF/NF dual certification license and providing detailed information about the facility's services, ownership, memory support household program, policies, and room and care charges.
Findings
The document provides comprehensive information about Sumner Place's licensure renewal, including facility capacity, ownership, memory support household philosophy and operations, staffing, training, safety, family support, and detailed room and care charges. It outlines the facility's commitment to quality care for residents with dementia and other needs, emphasizing individualized care plans and specialized memory support services.
Report Facts
Total licensed capacity: 104
Maximum endorsed capacity: 23
Daily room rates: 203
Daily room rates: 225
Daily room rates: 208
Daily room rates: 240
Level of care rates: 25
Level of care rates: 34
Level of care rates: 46
Level of care rates: 54
Level of care rates: 64
Level of care rates: 73
Memory support daily rate: 10
Specialized care charge: 145
Personal alarms: 30
Walker rental: 10
Air fluidized pressure mattress: 7
Specialty wheelchair rental: 45
Pressure mattress: 3
Standard wheelchair rental: 25
Specialized supplements: 5
Wheelchair pad & cushions: 10
Advanced wound/skin treatments: 10
Blood glucose tests: 2
Nebulizer usage & rental: 40
Oxygen E-tanks: 14
Transportation local area: 11
Transportation attendant fee: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named in licensure renewal application and Alzheimer's Memory Care Endorsement application |
| Mindy Zuhairi | Director of Nursing | Named in licensure renewal application |
| Jack D. Vetter | Chair of the Board & CEO | Named in ownership and corporate officers list and signed Alzheimer's Memory Care Endorsement application |
| Julie A. Knobbe | Contact for legal owning entity | Named in licensure renewal application |
| Shari Terry | Chief Operations Officer | Named in corporate officers list |
| Rhonda Flanigan | Chief People Officer | Named in corporate officers list |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 104
Deficiencies: 8
Sep 11, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Sumner Place from September 11, 2016 to September 15, 2016 by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The investigation found the facility compliant with allegations regarding fall evaluations and protection from residents with adverse behaviors. The facility was found in compliance with regulations related to these complaints. Additionally, the facility had multiple life safety and fire safety deficiencies including issues with smoke barrier doors, emergency lighting, fire drills, generator testing, oxygen signage, and electrical panel access.
Complaint Details
The complaint allegations were that the facility failed to evaluate causal factors for falls and failed to protect residents from residents with adverse behaviors. The investigation found the facility compliant with these allegations.
Deficiencies (8)
| Description |
|---|
| Smoke separation doors were not capable of resisting the passage of smoke due to gaps greater than 1/8 inch. |
| Instructional signage for delayed egress doors was obscured by window coverings. |
| Emergency lighting in the Magnolia Hall Linen Storage room failed to operate. |
| Fire drills were not conducted under varying conditions on each shift and drills were not spaced at least one hour apart. |
| Remote emergency generator shut down switch was located too close to the generator, preventing safe access. |
| Oxygen in use signs were not posted on resident rooms where oxygen was used. |
| Generator was not tested at 30 percent of rated capacity monthly and annual load bank test was not performed. |
| Storage obstructed access to the electrical disconnect box at the Nurses Station in the Loft. |
Report Facts
Facility census: 91
Total licensed capacity: 104
Number of residents affected by electrical panel obstruction: 19
Number of residents affected by oxygen signage deficiency: 38
Number of residents affected by delayed egress signage obstruction: 46
Number of residents affected by smoke door gaps: 91
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named in complaint investigation and interview |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Maintenance Staff A | Interviewed and confirmed multiple deficiencies including smoke door gaps, emergency lighting failure, fire drill issues, generator testing, and electrical panel obstruction | |
| Administration Staff A | Interviewed and confirmed multiple deficiencies including delayed egress signage obstruction, oxygen signage deficiency, generator shutdown switch location, and electrical panel obstruction | |
| Quality Assurance Nurse | Responsible for reviewing oxygen signage and monitoring compliance |
Inspection Report
Renewal
Capacity: 104
Deficiencies: 0
Aug 11, 2016
Visit Reason
This document is related to the renewal of the nursing home license for Sumner Place, verifying that the SNF/NF dual certification is licensed through the indicated renewal date.
Findings
The documents primarily consist of the nursing home licensure renewal application, occupancy permit, and detailed program descriptions for the Memory Support Household at Sumner Place. No specific inspection deficiencies or findings are reported.
Report Facts
Total licensed beds: 104
Memory Support Daily Rate: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Mindy Zuhairi | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Jun 13, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint at Sumner Place on June 13-14, 2016, regarding allegations that the facility failed to protect residents from residents with behaviors, failed to ensure residents are free from abuse, and failed to complete written investigations within five working days.
Findings
The facility was found to be in compliance with regulatory requirements regarding protection from residents with behaviors and abuse. The facility failed to submit one investigative report within five working days, but this was an isolated instance and overall the facility was found to be in compliance.
Complaint Details
The complaint investigation included allegations of failure to protect residents from residents with behaviors, failure to ensure residents are free from abuse, and failure to complete written investigations within five working days. The facility was found compliant except for one isolated instance of delayed submission of an investigative report.
Deficiencies (1)
| Description |
|---|
| Failure to submit an investigative report within five working days. |
Report Facts
Investigations reviewed: 9
Investigation dates: 2
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
Annual Inspection
Census: 90
Deficiencies: 4
Aug 12, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Sumner Place from August 6, 2015 to August 12, 2015.
Findings
The facility was found to have limited infestations of bed bugs which were treated and controlled, and cleaning chemicals were used according to manufacturer recommendations. However, deficiencies were found including medication errors, infection control lapses, and life safety code violations related to smoke door closures and kitchen exhaust hood.
Complaint Details
Complaint investigation included allegations of inadequate pest control and improper use of cleaning chemicals. The pest control allegation was not substantiated as the facility actively treated bed bug infestations. The cleaning chemical use allegation was not substantiated.
Severity Breakdown
SS=D: 1
SS=E: 2
SS=F: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to administer medication according to physician's orders and manufacturer's directions, resulting in an 8% medication error rate. | SS=D |
| Failed to follow infection control practices to prevent cross contamination between residents, affecting two residents. | SS=E |
| Failed to ensure corridors are separated to resist passage of smoke, allowing smoke migration throughout the facility. | SS=E |
| Commercial cooking exhaust hood covered only half of each appliance, not meeting NFPA 96 requirements. | SS=F |
Report Facts
Medication opportunities observed: 25
Facility census: 90
Facility census: 88
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN A | Registered Nurse | Named in medication error finding for improper administration of omeprazole and hand washing observations. |
| LPN F | Licensed Practical Nurse | Named in medication error finding for failure to check g-tube placement before medication administration. |
| Dan Taylor | RN, Training Coordinator - Office of LTC Facilities - Licensure Unit | Signed letter regarding complaint and annual survey findings. |
| Larry Van Hunnik | Administrator | Facility administrator addressed in the report. |
| Don Fritz | Assistant State Fire Marshal | Signed approval of fire safety plan of correction. |
Inspection Report
Complaint Investigation
Census: 91
Deficiencies: 15
Jul 14, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Sumner Place on July 8, 2014-July 14, 2014. The investigation included review of resident records, observation of care and services, and interviews with residents, family members and staff.
Findings
The investigation found the facility was providing medications within the Five Rights with no medication errors observed. Multiple deficiencies related to life safety code violations were identified including blocked corridor doors, roller latches on clean linen closet doors, storage in stair enclosures, gaps in fire rated doors, missing sprinkler escutcheons, unsealed penetrations around sprinkler pipes, flammable wooden room dividers, improperly installed exit doors, inadequate fire drills, untested smoke detectors, unsecured oxygen tanks, lack of remote annunciator panel for generator, and improper use of extension cords.
Complaint Details
The complaint alleged the facility failed to provide medications within the Five Rights. The investigation found no evidence to support this allegation.
Deficiencies (15)
| Description |
|---|
| Therapy Gym door was blocked open with a hand weight. |
| Roller latches installed on the 300 Hall Clean Linen room doors. |
| Storage of paper barrel, resident lifts, and coat rack in stair enclosure. |
| East 1 1/2 hour fire rated doors had a gap greater than 1/8 inch. |
| Ceiling of stair enclosure was a drop in unrated ceiling grid with unsealed penetrations around HVAC, CAT5 wires, and electrical conduits. |
| Wooden folding room dividers in the main dining room were not treated with flame resistant finish. |
| Service exit doors required two motions to open; magnetically locked exit door code not posted; front lobby exit door had a thumb turn lock that prevented operation. |
| Fire drills were not conducted randomly throughout the month and shift. |
| Smoke detectors throughout the facility were not tested for sensitivity since 2011. |
| Sprinkler heads missing escutcheons, obstructed, or with unsealed penetrations around pipes in multiple locations. |
| Newly installed fabric curtains in the front lobby lacked documentation of flame retardant rating. |
| Kitchen staff and maintenance were not trained on the proper use of fire extinguishers for electrical fires. |
| Mobile oxygen tanks were not secured properly. |
| Remote audible annunciator panel for generator was not located in an attended location. |
| Extension cord used as permanent wiring for resident bed in room 401; electrical receptacles not tested for retention. |
Report Facts
Medication occurrences observed: 32
Facility census: 91
Residents affected by stair enclosure door deficiency: 55
Occupants affected by wooden room dividers deficiency: 178
Occupants affected by exit door deficiencies: 172
Occupants affected by unsecured oxygen tanks: 172
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named in complaint investigation letter |
| Eve Lewis | Program Manager, Office of Long Term Care Facilities | Signed complaint investigation letter |
| Jean Obermier | Registered Nurse | Surveyor for complaint and annual survey |
| Frances Prokop | Registered Nurse | Surveyor for complaint and annual survey |
| Susan Griepenstroh | Registered Nurse | Surveyor for complaint and annual survey |
| Nancy Hauschild | Nutrition/dietitian | Surveyor for complaint and annual survey |
Inspection Report
Life Safety
Census: 89
Deficiencies: 8
Jun 27, 2013
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code and other regulatory requirements related to fire safety, construction, and emergency preparedness at Sumner Place.
Findings
The facility failed to meet several Life Safety Code standards including inadequate fire-rated separation walls during construction, malfunctioning fire doors, unsealed hazardous areas, obstructed exit discharges, deficient horizontal exits, incomplete fire drills documentation, sprinkler system maintenance issues, and lack of acceptance testing for a new emergency generator. These deficiencies posed risks to residents, staff, and visitors.
Severity Breakdown
SS=F: 6
SS=E: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Failed to construct one hour fire rated separation walls between occupied areas and construction areas in the 1960's section of the building. | SS=F |
| Failed to maintain doors with automatic flush bolts that stay latched tightly within doorframes, affecting smoke containment. | SS=E |
| Failed to provide separation of hazardous areas from other compartments; unsealed holes in ceilings and doors not closing properly. | SS=F |
| Failed to maintain all exit discharges free of obstructions and construction materials/storage. | SS=F |
| Failed to maintain a horizontal exit with 90 minute fire doors that close and latch, allowing smoke passage between smoke zones. | SS=E |
| Failed to hold fire drills at least quarterly on each shift, missing documentation for night shift drills in Q3 2012. | SS=F |
| Failed to maintain, inspect, and test a complete automatic sprinkler system quarterly; missing escutcheons on sprinkler heads; ceiling removed compromising sprinkler coverage. | SS=F |
| Failed to conduct acceptance testing on newly installed emergency generator supporting life safety features. | SS=F |
Report Facts
Census: 89
Deficiency count: 8
Fire drills missing documentation: 1
Sprinkler inspections: 2
Sprinkler inspection due date: Aug 22, 2013
Fire drill documentation retention date: Aug 1, 2013
Plan of correction completion dates: Aug 22, 2013
Inspection Report
Annual Inspection
Census: 89
Deficiencies: 8
Jun 27, 2013
Visit Reason
The inspection was conducted as an annual survey to assess compliance with federal and state regulations including Life Safety Code standards during ongoing construction and renovation.
Findings
The facility failed to construct one-hour fire rated separation walls in the 1960s section during renovations, maintain proper door latching on fire and corridor doors, ensure hazardous areas were properly separated, keep exit discharges free of obstructions, maintain horizontal exit fire doors, conduct quarterly fire drills on all shifts, maintain and inspect the sprinkler system quarterly, and perform acceptance testing on a new emergency generator.
Severity Breakdown
SS=F: 6
SS=E: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Failed to construct one hour fire rated separation walls between occupied areas and construction areas in the 1960s section of the building. | SS=F |
| Failed to maintain doors with automatic flush bolts that stay latched tightly within doorframes, affecting smoke containment in the Memory Support Household. | SS=E |
| Failed to provide separation of hazardous areas from other compartments; unsealed holes and open conduits found in ceilings. | SS=F |
| Failed to maintain all exit discharges free of obstructions, including construction equipment and trash dumpsters. | SS=F |
| Failed to maintain horizontal exit fire doors that close and latch, allowing smoke passage between smoke zones. | SS=E |
| Failed to hold fire drills at least quarterly on each shift, missing documentation for night shift drills in third quarter 2012. | SS=F |
| Failed to maintain, inspect, and test the sprinkler system quarterly as required; missing escutcheons on sprinkler heads and ceiling removed compromising system activation. | SS=F |
| Failed to perform acceptance testing on newly installed emergency generator supporting life safety features. | SS=F |
Report Facts
Census: 89
Deficiency count: 8
Fire drill missing documentation: 1
Sprinkler inspections: 2
Sprinkler inspection due: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Staff A | Confirmed observations of sprinkler system deficiencies, door latch failures, and construction area occupancy | |
| Maintenance Staff B | Confirmed door latch failures and fire door deficiencies | |
| Project Manager | Confirmed occupancy of construction areas without approval and lack of acceptance testing for generator | |
| Administration A | Expressed concern about construction safety and confirmed storage obstructions at exits | |
| Contractor | Confirmed storage and obstructions blocking exits |
Inspection Report
Life Safety
Census: 95
Deficiencies: 11
May 15, 2012
Visit Reason
The inspection was conducted to assess compliance with the 2000 Edition of the Life Safety Code of the National Fire Protection Association for a skilled nursing facility.
Findings
The facility was found to have multiple life safety deficiencies including obstructed egress routes, improper fire-rated door operation, lack of flame retardant curtains, obstructed sprinkler heads, inadequate emergency lighting testing, improper electrical wiring, lack of kitchen fire suppression training, missing oxygen use signage, and improper placement of alcohol-based hand rub dispensers.
Severity Breakdown
SS=E: 8
SS=F: 3
Deficiencies (11)
| Description | Severity |
|---|---|
| Means of egress in the second floor corridor was obstructed by a floor fan affecting 21 residents. | SS=E |
| Facility failed to maintain flame retardant rating for resident curtains and decorations affecting 34 residents. | SS=E |
| Door to the Dish Room was obstructed with dirty dish carts preventing proper closure affecting 74 residents. | SS=E |
| Incorrect signage posted for delayed egress hardware on north exit door affecting 34 residents. | SS=E |
| Failed to provide illumination of exit discharge so failure of any single lighting fixture would not leave area in darkness affecting 74 residents. | SS=E |
| Failed to test emergency lighting annually for 90 minutes, only tested for 30 minutes affecting all 95 residents. | SS=F |
| Sprinkler heads obstructed by walkers and covered with plastic sleeves in multiple rooms affecting 74 residents. | SS=E |
| Kitchen staff not trained on kitchen hood suppression system and fire procedure affecting 74 residents. | SS=E |
| Missing 'oxygen in use' signage on resident rooms where oxygen was used affecting all 95 residents. | SS=F |
| Electrical wiring not in accordance with NFPA 70; power strips used as permanent wiring in resident rooms affecting 40 residents. | SS=E |
| Alcohol Based Hand Rub dispensers installed adjacent to ignition sources in Therapy Office and Beauty Shop affecting approximately 95 residents. | SS=F |
Report Facts
Facility census: 95
Residents affected by obstructed egress: 21
Residents affected by flame retardant curtain deficiency: 34
Residents affected by dish room door obstruction: 74
Residents affected by delayed egress signage: 34
Residents affected by exit discharge illumination deficiency: 74
Residents affected by emergency lighting testing deficiency: 95
Residents affected by sprinkler head obstruction: 74
Residents affected by kitchen fire suppression training deficiency: 74
Residents affected by missing oxygen signage: 95
Residents affected by improper electrical wiring: 40
Residents affected by improper ABHR dispenser placement: 95
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kitchen Staff A | Named in findings related to dish room door obstruction and lack of kitchen fire suppression training | |
| Environmental Supervisor | Confirmed multiple deficiencies including obstruction removal, signage issues, sprinkler head conditions, emergency lighting testing, and ABHR placement | |
| Director of Maintenance | Responsible for corrective actions and monitoring related to fire safety, lighting, sprinkler heads, electrical wiring, and ABHR dispenser placement | |
| Director of Food Service | Conducted fire safety inservice for kitchen staff | |
| Charge Nurse | Affixed oxygen in use signage on resident room doors |
Notice
Capacity: 104
Deficiencies: 0
APP2018
Visit Reason
This document serves to verify that Sumner Place's SNF/NF dual certification license is renewed and valid through the indicated expiration date. It includes ownership, facility capacity, and service information.
Findings
The document confirms licensure renewal for Sumner Place with a licensed capacity of 104 beds and provides detailed ownership, facility services, and organizational information. It also includes floor plans and memory support household philosophy.
Report Facts
Licensed capacity: 104
Maximum endorsed capacity: 23
Base rate: 223
Staffing numbers: 1
Staffing numbers: 3
Staffing numbers: 1
Staffing numbers: 3
Staffing numbers: 1
Staffing numbers: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named as facility administrator on page 2 and 6. |
| Mindy Zuhairi | Director of Nursing | Named as Director of Nursing on page 2. |
| Jack D. Vetter | CEO | Named as CEO and authorized representative on pages 2, 3, and 10. |
| Glenn Van Ekeren | President | Named as President and authorized representative on pages 2 and 3. |
| Julie Knobbe | Contact | Named as contact for legal owning entity on page 6. |
Notice
Capacity: 104
Deficiencies: 0
APP2019
Visit Reason
This document serves to verify that Sumner Place's SNF/NF dual certification license is renewed and valid through the date indicated on the renewal card. It includes ownership, facility capacity, and service information.
Findings
The document confirms the facility's licensure status, ownership details, bed capacity, and services offered. It includes no inspection findings or deficiencies.
Report Facts
Total licensed beds: 104
Maximum endorsed capacity: 23
Base Rate: 233
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Larry Van Hunnik | Administrator | Named as Administrator on page 2 and 6. |
| Mindy Zuhairt | Director of Nursing | Named as Director of Nursing on page 2. |
| Jack D. Vetter | Chairman of the Board and CEO | Named as Chairman of the Board and CEO on pages 3 and 10. |
| Glenn Van Ekeren | President | Named as President on page 3. |
| Julie Knobbe | Contact Representative | Named as contact for legal owning entity on page 6. |
Notice
Capacity: 104
Deficiencies: 0
APP2021
Visit Reason
The document serves as a licensure renewal application and certification for Sumner Place nursing home, including renewal of the SNF/NF dual certification and Alzheimer's special care unit endorsement.
Findings
The documents confirm licensure renewal, certification of statutory requirements, and provide detailed information about the facility's services, ownership, capacity, and Alzheimer's special care unit philosophy and procedures.
Report Facts
Total licensed beds: 104
Maximum capacity for Alzheimer's beds: 23
Renewal licensure fees: 1950
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Abby Lehr | Administrator | Named as facility administrator on the renewal application and Alzheimer's special care unit disclosure. |
| Mindy Rueschhoff | Director of Nursing | Named as Director of Nursing on the renewal application. |
| Jack D Vetter | Authorized Representative | Signed the renewal application and Alzheimer's special care unit disclosure as authorized representative. |
| Glenn Van Ekeren | Authorized Representative | Named as authorized representative on the renewal application. |
| Julie Knobbe | Contact Name | Named as contact person on the Alzheimer's special care unit disclosure form. |
Notice
Capacity: 104
Deficiencies: 0
APP2022
Visit Reason
The document serves as a renewal application for the nursing home license of Sumner Place, including certification of licensure, occupancy permit, and Alzheimer's special care unit disclosure.
Findings
The documents confirm that Sumner Place meets statutory requirements for licensure renewal as a skilled nursing facility with a total capacity of 104 beds and a maximum of 23 Alzheimer's special care beds. It includes detailed information on facility ownership, staffing, memory support philosophy, and environmental considerations.
Report Facts
Total licensed beds: 104
Maximum Alzheimer's beds: 23
Renewal license fees: 1550
Renewal license fees: 1750
Renewal license fees: 1950
Staffing numbers: 8
Staffing numbers: 12
Cost/Fees of care: 268
Cost/Fees of care: 305
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexander Willford | Administrator | Named as facility administrator on renewal application |
| Mindy Rueschhoff | Director of Nursing | Named as Director of Nursing on renewal application |
| Brian Stuhr | Contact name / Treasurer | Named as contact and Treasurer on ownership and Alzheimer's unit application |
| Glenn Van Ekeren | President | Named as President on ownership documents |
| Jack D. Vetter | Chairman of the Board and CEO | Named as Chairman and CEO on ownership documents and signed application |
| Eldora D. Vetter | Secretary | Named as Secretary on ownership documents |
Notice
Capacity: 104
Deficiencies: 0
APP2023
Visit Reason
This document serves to verify the renewal of the SNF/NF Dual Certification license for Sumner Place and includes the Nursing Home Licensure Renewal Application, ownership and officer information, occupancy permit, and Alzheimer's Special Care Unit Disclosure.
Findings
The documents confirm the facility's licensure renewal status, ownership details, maximum bed capacity, occupancy permit approval, and Alzheimer's special care unit endorsement with related policies and staffing information.
Report Facts
Total licensed beds: 104
Maximum capacity for Alzheimer's beds: 23
Renewal license fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kaitlin Clegg | Administrator | Named in Nursing Home Licensure Renewal Application and Alzheimer's Special Care Unit Disclosure. |
| Mindy Rueschhoff | Director of Nursing | Named in Nursing Home Licensure Renewal Application. |
| Brian Stuhr | Contact and Treasurer | Named as contact in Alzheimer's Special Care Unit Disclosure and Treasurer in ownership documents. |
| Glenn Van Ekeren | President | Named as President in ownership documents. |
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