Inspection Reports for The Ambassador Nebraska City, Inc
1800 14th Avenue, NEBRASKA CITY, NE, 68410
Back to Facility ProfileDeficiencies (last 9 years)
Deficiencies (over 9 years)
8.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
100% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
61% occupied
Based on a July 2019 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Capacity: 71
Deficiencies: 0
Date: Feb 14, 2023
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification materials for The Ambassador Nebraska City, Inc., indicating the facility is applying to renew its license to operate as a Skilled Nursing Facility.
Findings
The documents certify that The Ambassador Nebraska City, Inc. meets statutory requirements for licensure renewal and includes ownership disclosures, occupancy permit, and licensing fees information. No inspection findings or deficiencies are reported.
Report Facts
Number of beds to be relicensed: 71
Renewal Licensure Fee: 1750
Maximum Occupancy: 71
Occupancy Permit Date Issued: Jul 21, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loretta Paul-Allen | Administrator | Named on Nursing Home Licensure Renewal Application |
| Tamela Osborn | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
| Timothy J Juiffs | Authorized Representative / Board of Director/Owner | Signed ownership disclosure and renewal application |
| Sally M. Juiffs | Board of Director/Owner | Named in ownership disclosure |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 71
Deficiencies: 9
Date: Jul 22, 2019
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at The Ambassador Nebraska City on July 22, 2019-July 25, 2019, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged the facility failed to provide service for appropriate transfers. The investigation found the facility was in compliance with relevant regulatory requirements regarding transfers.
Findings
The complaint investigation found the facility provided services for appropriate transfers and was in compliance with relevant regulatory requirements. However, the annual survey identified multiple deficiencies including failure to evaluate and implement a toileting program for a resident, fire safety code violations related to hazardous area door closures, fire alarm system circuit breaker labeling and lockout, sprinkler obstruction, corridor door smoke resistance, incomplete fire evacuation plan, lack of annual fire door inspections, failure to test non-hospital grade electrical receptacles at patient bed locations, and improper use of electrical adapters.
Deficiencies (9)
Failed to evaluate and implement a toileting program for a resident with incontinence.
Doors to hazardous areas failed to close and latch properly, were held open with unapproved means, and resident rooms were used as storage.
Fire alarm system circuit breaker lacked lock out device and labeling.
Fire sprinkler was obstructed by office supplies.
Corridor door to kitchen failed to resist passage of smoke and lacked proper latching hardware.
Fire plan was incomplete, lacking evacuation details for smoke compartments and staff instructions.
Failed to conduct annual inspections and testing of all fire rated doors.
Failed to conduct individualized assessment and testing of non-hospital grade electrical receptacles at patient bed locations.
Allowed use of a lamp as an electrical adapter in a resident room.
Report Facts
Deficiencies cited: 9
Facility census: 43
Facility capacity: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Staff A | Confirmed multiple deficiencies including door closures, fire alarm circuit breaker issues, sprinkler obstruction, corridor door latching, and electrical receptacle testing. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 26, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding misappropriation and failure to submit investigations within 5 working days at The Ambassador Nebraska City.
Complaint Details
The complaint alleged failure to protect residents from misappropriation and failure to submit investigations within 5 working days. The investigation found misappropriation occurred but was properly reported, and the investigation was submitted timely; therefore, no deficiencies were cited.
Findings
The facility failed to protect residents from misappropriations but reported the occurrences to the state agency, law enforcement, and individual licensure, and implemented policy changes; no deficiency was written. The facility submitted the required investigation within 5 working days and was found in compliance with regulatory requirements.
Report Facts
Working days for investigation submission: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and contact person for questions. |
Inspection Report
Routine
Census: 50
Capacity: 71
Deficiencies: 8
Date: May 7, 2018
Visit Reason
Routine inspection to assess compliance with federal regulations including emergency preparedness, comprehensive care planning, infection control, and life safety code.
Findings
The facility was found not in compliance with emergency preparedness communication plan requirements, comprehensive care planning for oxygen therapy, infection prevention and control practices, and life safety code requirements including fire door latching, smoke resistant enclosures, sprinkler system maintenance, and corridor door smoke resistance.
Deficiencies (8)
Emergency Operations Communication Plan did not include names and contact information for volunteers.
Emergency Operations Plan did not include contact information for the State Licensing and Certification agency and the office of the State Long Term Care Ombudsman.
Failed to develop a comprehensive care plan related to oxygen therapy for one resident.
Failed to cleanse scissors properly and perform hand hygiene between glove changes during wound care for one resident.
Failed to maintain a 2-hour fire separation between Nursing Home and Assisted Living occupancies due to a fire door that failed to latch.
Failed to provide smoke resistant enclosure for hazardous areas due to gap between door and frame.
Fire sprinkler missing escutcheon ring, risking sprinkler operability.
Doors opening onto corridors failed to resist passage of smoke due to gaps between door and frame.
Report Facts
Facility census: 50
Total licensed capacity: 71
Deficiency count: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Staff A | Confirmed fire door failed to latch and verified gaps in hazardous area door and corridor doors | |
| Licensed Practical Nurse B | LPN | Observed failing to cleanse scissors and perform hand hygiene during wound care |
| Director of Nursing | DON | Confirmed oxygen therapy should be addressed in care plan and staff expected to wash hands between glove changes |
Inspection Report
Renewal
Capacity: 71
Deficiencies: 0
Date: Feb 28, 2018
Visit Reason
This document is related to the renewal of the nursing home license for The Ambassador Nebraska City, Inc., verifying that the SNF/NF dual certification is licensed through the indicated renewal date.
Findings
The documents confirm the facility's licensure renewal, ownership information, bed capacity, and occupancy permit compliance with state requirements. No deficiencies or inspection findings are noted.
Report Facts
Licensed beds: 71
Renewal expiration date: Mar 31, 2019
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shannon Borer | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Tamela Osborn | Director of Nursing, R.N. | Named in the Nursing Home Licensure Renewal Application. |
| Timothy J. Juilfs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Juilfs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 71
Deficiencies: 13
Date: Mar 2, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding medication administration, assistance with eating, weight loss, nutritional needs, staffing sufficiency, and plan of care adherence at The Ambassador Nebraska City.
Complaint Details
The complaint alleged failure to administer medications as ordered, failure to assist residents with eating, failure to address weight loss, failure to ensure foods meet nutritional needs, failure to ensure sufficient staffing, and failure to follow the plan of care. The investigation found the facility in compliance with all allegations except for failure to follow the plan of care for some residents.
Findings
The facility was found to be in compliance with medication administration, assistance with eating, weight loss management, nutritional needs, and staffing sufficiency. However, the facility failed to follow the plan of care for four residents related to end of life care, behaviors, or skin breakdown, constituting a violation.
Deficiencies (13)
Failed to ensure equipment and surfaces in resident rooms were cleanable for 3 of 7 resident rooms reviewed.
Failed to ensure the Minimum Data Set (MDS) was coded to reflect terminal illness for 2 sampled residents.
Failed to develop and implement a comprehensive care plan related to hospice care, behaviors, and skin breakdown for sampled residents.
Failed to provide care and services to attain or maintain the highest practicable well-being; specifically failed to monitor and ensure interventions for non-pressure skin breakdown.
Failed to evaluate and implement fall interventions for one resident and failed to evaluate and implement safe use of call bell for another resident.
Failed to ensure spices were dated and not expired in the kitchen.
Failed to ensure the glucometer was sanitized between resident use and failed to follow recommended disinfectant contact time.
Allowed the egress side of interior courtyard doors to be locked with a sliding surface bolt, preventing exit in an emergency.
Failed to provide a smoke resistant enclosure for hazardous areas, allowing fire and smoke to migrate into exit corridor.
Failed to ensure all fire alarm initiating devices would cause the fire alarm system to sound an alarm when activated.
Failed to ensure corridor doors resist passage of smoke; door did not latch and could be opened without using the handle.
Failed to ensure staff had knowledge to operate Class K fire extinguishing equipment in the event of a fire.
Failed to hold fire drills under varied conditions for 2 of 3 quarters reviewed.
Report Facts
Deficiencies cited: 13
Facility census: 50
Total licensed capacity: 71
Residents affected by plan of care deficiency: 4
Residents affected by hazardous area deficiency: 11
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation letter. |
| Shannon Borer | Administrator | Named in the report as facility administrator. |
| Maintenance Director | Interviewed and acknowledged facility deficiencies related to courtyard doors and smoke barriers. | |
| LPN E | Licensed Practical Nurse | Observed and interviewed regarding wound care and glucometer sanitization. |
| LPN C | Licensed Practical Nurse | Observed and interviewed regarding glucometer sanitization. |
| NA G | Nursing Assistant | Witnessed fall incident and interviewed. |
| NA I | Nursing Assistant | Interviewed regarding bed alarm functionality. |
| RN B | Registered Nurse | Interviewed regarding care plan for anxiety. |
| DON | Director of Nursing | Interviewed regarding multiple deficiencies including MDS coding, care plans, and call light safety. |
| Dietary Manager | Interviewed regarding expired spices and fire extinguisher training. |
Inspection Report
Complaint Investigation
Census: 55
Deficiencies: 3
Date: Jul 11, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to put interventions in place to prevent injuries and failure to submit investigations within 5 working days.
Complaint Details
The complaint alleged the facility failed to put interventions in place to prevent injuries and failed to submit investigations within 5 working days. The investigation found the facility compliant with injury prevention but deficient in timely submission of investigations and registry checks.
Findings
The facility was found compliant with injury prevention interventions but failed to submit an investigation within 5 working days for one resident. Additionally, the facility failed to have evidence of a completed Nurse Aide Registry check for one nurse aide hired within the last 4 months.
Deficiencies (3)
Failure to submit investigation of potential neglect within 5 working days.
Failure to have evidence of a completed Nurse Aide Registry check for one nurse aide hired in the last 4 months.
Failure to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.
Report Facts
Total nursing staff: 57
Resident census: 55
Investigation date: Jun 12, 2016
Investigation submission deadline: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mikeal Pickrell | Administrator | Facility administrator addressed in the report |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Author of the complaint investigation letter |
| Nurse Aide A | Nurse aide hired on 5/16/16 without evidence of completed nurse aide registry check | |
| Director of Nursing | Reported being unaware that fax of investigation was not sent | |
| Business Office Manager | Reported nurse aide registry check was completed but file deleted | |
| Human Resources Manager | Educated on regulations and conducted audits related to nurse aide registry checks |
Notice
Capacity: 71
Deficiencies: 0
Date: Jun 30, 2016
Visit Reason
The letter acknowledges the increase in the number of licensed beds at the Skilled Nursing Facility and amends the Health Insurance Benefits Agreement to reflect changes in certified beds.
Findings
The facility's licensed beds increased from 55 to 71 effective July 1, 2016, including the transfer of 10 beds from another facility and an additional 6 beds allowed by state statute. Certified beds are detailed for specific rooms before and after the increase.
Report Facts
Licensed bed increase: 16
Bed transfer: 10
Additional beds allowed: 6
Certified beds: 55
Certified beds: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed letter as Program Manager, Office of LTC Facilities - Licensure Unit |
Inspection Report
Annual Inspection
Census: 47
Deficiencies: 15
Date: Jan 28, 2016
Visit Reason
Annual inspection survey conducted to assess compliance with state and federal regulations governing skilled nursing facilities.
Findings
The facility was found deficient in multiple areas including failure to inform residents of medication changes, failure to notify physicians of medication refusals, inadequate resident choice evaluations, failure to monitor resident bruising, unsecured medication carts, lack of target behaviors for antipsychotic medication use, medication administration errors, improper glove use in dietary services, life safety code violations including obstructed egress, missing fire alarm notifications, improperly installed fire extinguishers, unsealed kitchen hood joints, improper oxygen cylinder storage, non-functioning generator annunciator and emergency lighting, and unsafe electrical surge protector use.
Deficiencies (15)
Failed to notify and inform one resident of medication change and reason for blood draw.
Failed to notify physician of resident's refusal of medication.
Failed to evaluate bathing choices for two residents.
Failed to identify and monitor bruising for one resident.
Failed to ensure medication/treatment carts were secured when unattended.
Failed to identify specific target behaviors for antipsychotic medication use for two residents.
Medication error rate exceeded 5% due to incorrect administration timing of medications for two residents.
Dietary staff failed to change gloves to prevent potential cross contamination of ready to eat foods.
Means of egress was obstructed and incorrect keypad code posted on controlled exit door.
Failed to install audible/visual notification devices for automatic fire alarm system in courtyard.
Fire extinguishers installed more than 5 feet above finished floor.
Internal seams and joints of kitchen hood and exhaust system were not sealed and grease tight.
Failed to segregate empty oxygen cylinders from full ones in storage area.
Generator annunciator failed to operate and no emergency lighting installed at generator.
Electrical surge protectors were daisy chained creating fire and shock hazard.
Report Facts
Facility census: 47
Medication error rate: 6.06
Number of medication errors observed: 2
Number of residents affected by medication errors: 2
Number of residents affected by fire extinguisher height issue: 12
Number of residents affected by courtyard fire alarm notification issue: 38
Facility census: 48
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse E | Registered Nurse | Named in findings related to medication notification and bruising monitoring |
| Registered Nurse D | Registered Nurse | Named in findings related to medication refusal notification |
| Director of Nursing | Director of Nursing | Provided expectations on physician notification and confirmed findings |
| Social Services Director | Social Services Director | Interviewed regarding antipsychotic medication target behaviors |
| Maintenance A | Maintenance Staff | Verified life safety code deficiencies and fire safety system issues |
| Dietary Director | Dietary Director | Interviewed regarding glove use and kitchen hood maintenance |
| Licensed Practical Nurse A | Licensed Practical Nurse | Observed administering medications incorrectly |
Inspection Report
Complaint Investigation
Census: 48
Deficiencies: 10
Date: Feb 5, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at The Ambassador Nebraska City on February 5, 2015-February 12, 2015, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint allegations included failure to protect residents from abuse, failure to report and investigate abuse allegations, failure to answer call lights promptly, insufficient staffing, misuse of residents' personal belongings, unsafe resident transport, inappropriate resident dressing, and failure to respond to complaints. The facility was found to be in compliance with all these allegations after interviews, observations, and record reviews.
Findings
The facility was found to be in compliance with abuse-related allegations, call light response, staffing, personal belongings, resident transport safety, appropriate dressing, and complaint response. Deficiencies were identified related to notification of changes, weight loss reporting, decline in activities of daily living, free of accident hazards, food safety, ventilation, life safety code violations including missing exit signs, smoke door gaps, emergency lighting, smoke detector maintenance, and electrical safety.
Deficiencies (10)
Failed to notify resident's physician of significant weight loss for Resident 17.
Failed to provide restorative services to prevent decline in activities of daily living for Resident 31.
Failed to ensure resident environment free of accident hazards affecting Residents 31 and 56.
Failed to maintain adequate food temperatures affecting 47 residents.
Failed to provide adequate outside ventilation for three resident rooms (502, 509, 510).
Failed to provide approved No Exit signs at doors that could be mistaken for exits affecting 40 residents.
Smoke separation door next to Resident Room 214 had a gap greater than 1/8 inch allowing smoke passage affecting 28 residents.
Failed to provide emergency illumination in Arbor Room and Fireside Room affecting 130 occupants.
Failed to maintain single station smoke detectors within resident rooms and manual pull fire alarm was obstructed.
Electrical cord run through door opening in Resident Room 424 increasing fire risk.
Report Facts
Facility census: 48
Weight loss: 7.5
Weight loss: 11.6
Residents affected: 40
Residents affected: 28
Residents affected: 130
Residents affected: 47
Rooms affected: 3
Residents affected: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Juilfs | Administrator | Named as facility administrator in multiple documents and correspondence. |
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed letter regarding inspection findings and regulatory authority. |
| George Voigtlander | Physician Reviewer/Medical Director, CIMRO of Nebraska | Signed informal dispute resolution report. |
| Becky Wisell | Administrator, Licensure Unit | Signed notification of department decision following informal conference. |
Inspection Report
Life Safety
Census: 51
Deficiencies: 4
Date: Nov 13, 2013
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code and related fire protection regulations for a skilled nursing facility.
Findings
The facility was found to have multiple deficiencies related to fire safety, including unsealed holes in corridor doors, smoke barrier doors failing to close and latch, lack of oxygen in use signage, and improper use of power strips in resident rooms.
Deficiencies (4)
Corridor door next to the Fireside Room had six unsealed holes allowing smoke to spread, affecting 32 residents.
Smoke door next to the Director of Nursing office failed to close and latch, allowing smoke and gases to spread affecting 22 residents.
Oxygen in use signage was not posted on Resident Room 202, increasing fire potential for 29 residents.
Use of power strips as permanent wiring in Resident Room 511, increasing potential for electrical fire affecting 13 residents.
Report Facts
Residents affected: 32
Residents affected: 22
Residents affected: 29
Residents affected: 13
Facility census: 51
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Confirmed unsealed holes in door, smoke door failure, lack of oxygen signage, and power strip use during interviews |
Inspection Report
Annual Inspection
Census: 50
Deficiencies: 3
Date: Jul 18, 2012
Visit Reason
The inspection was conducted as an annual survey to assess compliance with licensure regulations and the Life Safety Code for the skilled nursing facility.
Findings
The facility was found deficient in revising care plans for residents receiving psychotropic medications, obstructing a fire door with a trash can, and improper electrical wiring of a ceiling light fixture. These deficiencies affected resident care planning and fire safety compliance.
Deficiencies (3)
Failure to review and revise care plans for residents receiving psychotropic medications.
Trash can obstructing the Employee Break Room door, preventing proper door closure and fire/smoke containment.
Ceiling light fixture in Therapy Room not hard wired, using an extension cord instead.
Report Facts
Facility census: 50
Sample size: 30
Residents affected: 2
Residents affected: 20
Residents affected: 22
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nurses | Interviewed and verified care plan deficiencies for Residents 9 and 32 | |
| Administrator | Confirmed trash can obstructing break room door and ceiling light wiring issue |
Inspection Report
Routine
Census: 39
Deficiencies: 11
Date: Jun 8, 2011
Visit Reason
Routine inspection of The Ambassador Nebraska City nursing facility to assess compliance with regulatory requirements including resident safety, medication management, food safety, and life safety code standards.
Findings
The facility was found deficient in fall prevention interventions for a resident, medication order parameters, food equipment sanitation, fire safety door integrity, hazardous area separation, exit door egress, sprinkler maintenance, kitchen fire suppression knowledge, flame retardant decorations, soiled linen receptacle storage, and emergency generator gas supply security.
Deficiencies (11)
Failed to have fall interventions in place as indicated in 1 resident's care plan (Resident 72).
Failed to establish medication frequency parameters for 3 medications and failed indications for use for 2 medications for 1 resident (Resident 76).
Failed to maintain food equipment in a safe operational manner; oven dial temperature controls were illegible due to heavy food soil/grease accumulation.
Doors protecting corridor openings were not smoke tight; double glass doors to kitchen had a gap greater than 1/8 inch.
Failed to provide separation of hazardous areas from other compartments; door to water heater room failed to close and latch; double doors to trash room had a gap greater than 1/8 inch.
Exit door in Bistro Dining area equipped with magnetic locking device but lacked posted code for egress.
Failed to maintain sprinkler head in Resident Room 512 closet; sprinkler head appeared pushed up within fitting.
Kitchen staff failed to know procedure for fire under kitchen hood suppression system.
Facility failed to maintain all decorations as flame retardant throughout the facility corridors.
Soiled linen collection receptacles exceeding 32 gallons stored unattended outside soiled linen room.
Failed to verify natural gas supply piping for emergency generator had shutoff valve ahead of main shutoff and proper labeling; valve not secured to prevent inadvertent shutoff.
Report Facts
Resident sample size: 26
Facility census: 39
Occupant load: 69
Residents affected: 40
Residents affected: 27
Residents affected: 35
Residents affected: 14
Soiled linen receptacle capacity: 44
Soiled linen receptacle capacity: 32
Notice
Capacity: 71
Deficiencies: 0
Date: APP2021
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for The Ambassador Nebraska City, Inc nursing home facility and includes related ownership and occupancy permit information.
Findings
The documents confirm the facility's license renewal status, ownership details, and occupancy permit with a maximum capacity of 71 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 71
Renewal license fee: 1550
Expiration date: Mar 31, 2021
Date issued: Mar 3, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Crunk | Administrator | Named on the renewal application. |
| Tamela Osborn | Director of Nursing | Named on the renewal application. |
| Timothy J. Juilfs | Authorized Representative / Board of Director/Owner | Signed renewal application and ownership disclosure. |
| Sally M. Juilfs | Board of Director/Owner | Listed in ownership disclosure. |
Document
Capacity: 71
Deficiencies: 0
Date: APP2022
Visit Reason
The document serves as a renewal application for the nursing home license of The Ambassador Nebraska City, Inc., including ownership disclosure and occupancy permit information.
Findings
No inspection findings or deficiencies are reported; the document primarily certifies licensure renewal and ownership information.
Report Facts
Total licensed beds: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Crunk | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Tamela Osborn | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
| Timothy J. Julifs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Julifs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
Notice
Capacity: 71
Deficiencies: 0
Date: APP2024
Visit Reason
This document serves as a renewal application for the nursing home license of The Ambassador Nebraska City, Inc., including certification of ownership and occupancy permit details.
Findings
The documents confirm the facility's licensure renewal status, ownership information, and occupancy permit with a maximum capacity of 71 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loretta Paul-Allen | Administrator | Named on the renewal application form |
| Tamela Osborn | Director of Nursing, RN | Named on the renewal application form |
| Timothy J. Juilfs | Board of Director/Owner | Listed in ownership disclosure and affidavit |
| Sally M. Juilfs | Board of Director/Owner | Listed in ownership disclosure |
Inspection Report
Renewal
Capacity: 71
Deficiencies: 0
Date: APP2025
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification materials for The Ambassador Nebraska City, Inc., indicating the purpose is to renew the facility's license.
Findings
The documents confirm that The Ambassador Nebraska City, Inc. meets statutory requirements for licensure renewal as a Skilled Nursing Facility with specified services including occupational therapy, physical therapy, and speech therapy.
Report Facts
Total licensed beds: 71
Renewal license fees: 1750
Occupancy permit maximum occupancy: 71
Occupancy permit issue date: Oct 30, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loretta Paul-Allen | Administrator | Named as the facility administrator on the renewal application |
| Tamela Osborn | Director of Nursing | Named as the director of nursing on the renewal application |
| Timothy J. Juilfs | Board of Director/Owner | Named as board of director/owner in the ownership disclosure statement |
| Sally M. Juilfs | Board of Director/Owner | Named as board of director/owner in the ownership disclosure statement |
Notice
Capacity: 55
Deficiencies: 0
Date: APP2016
Visit Reason
This document serves as a licensure renewal application and verification for The Ambassador Nebraska City, Inc., confirming the facility's license status and renewal through the indicated date.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal, including occupancy permit approval and ownership disclosures. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Juilfs | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Wendy Hays | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Timothy J. Juilfs | Owner/CEO | Signed the Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Juilfs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
Document
Capacity: 71
Deficiencies: 0
Date: APP2017
Visit Reason
The document serves as a renewal application for the nursing home license of The Ambassador Nebraska City, Inc., including certification of statutory requirements and occupancy permit details.
Findings
The document confirms that The Ambassador Nebraska City, Inc. meets statutory requirements for SNF/NF dual certification and holds an occupancy permit for 71 licensed beds.
Report Facts
Licensed beds: 71
Renewal fees: 1750
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shannon Borer | Administrator | Named as the facility administrator in the renewal application. |
| Tamela Osborn | Director of Nursing | Named as the director of nursing in the renewal application. |
| Timothy J. Juilfs | Board of Director/Owner | Listed as a board member and owner with financial interest in the facility. |
| Sally M. Juilfs | Board of Director/Owner | Listed as a board member and owner with financial interest in the facility. |
Notice
Capacity: 71
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for The Ambassador Nebraska City, Inc, confirming licensure through the indicated expiration date and providing related ownership and occupancy information.
Findings
The document includes the license renewal application, ownership disclosure, occupancy permit with maximum licensed beds, and bed configuration details. No inspection findings or deficiencies are reported.
Report Facts
Licensed beds: 71
Renewal expiration date: License renewal expiration date is March 31, 2020.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shannon Buckminster | Administrator | Named in the renewal application. |
| Tamela Osborn | Director of Nursing | Named in the renewal application. |
| Timothy J. Juilfs | Board of Director/Owner and Owner/CEO | Named in ownership disclosure and affidavit. |
| Sally M. Juilfs | Board of Director/Owner | Named in ownership disclosure. |
Notice
Capacity: 71
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves as the Nursing Home Licensure Renewal Application and certification for The Ambassador Nebraska City, Inc, verifying licensure renewal through March 31, 2021, and includes ownership disclosure and occupancy permit information.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies reported. The occupancy permit certifies a maximum capacity of 71 beds.
Report Facts
Total licensed beds: 71
Renewal expiration date: 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shannon Buckminster | Administrator | Named on the renewal application. |
| Tamela Osborn | Director of Nursing | Named on the renewal application. |
| Timothy J. Juilfs | Board of Director/Owner | Listed in ownership disclosure and signed affidavit. |
| Sally M. Juilfs | Board of Director/Owner | Listed in ownership disclosure. |
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