Inspection Reports for The Waterford At Williamsburg Assisted Living

3940 Pine Lake Rd, Lincoln, NE 68516, USA, NE, 68516

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Deficiencies per Year

4 3 2 1 0
2015
2016
2017
2018
2019
2024
Severe High Moderate Low Unclassified

Census Over Time

27 30 33 36 39 42 Jan '15 Apr '16
Inspection Report Renewal Capacity: 44 Deficiencies: 0 Mar 25, 2024
Visit Reason
The document is a renewal application and license verification for The Waterford at Williamsburg assisted-living facility, confirming licensure through the renewal date and requesting renewal of the facility license.
Findings
The documents confirm that The Waterford at Williamsburg meets statutory requirements for licensure as an assisted-living facility, with no deficiencies or violations noted in the materials provided.
Report Facts
Total licensed beds: 44 Fire permit beds: 50
Employees Mentioned
NameTitleContext
Jura MichaelAdministratorNamed as administrator on the renewal application
Dan Klein Jr.Authorized RepresentativeSigned the renewal application as authorized representative
Dan Klein Jr.Listed as contact for The Waterford Group, Inc.
Dan A. Klein Sr.Listed as contact for The Waterford Group, Inc.
Notice Capacity: 44 Deficiencies: 0 Apr 8, 2019
Visit Reason
This document serves as the licensure renewal application and verification for The Waterford at Williamsburg Assisted-Living Facility, including related operational permits and ownership information.
Findings
The documents confirm that The Waterford at Williamsburg is licensed as an assisted-living facility with a total licensed capacity of 44 beds, and holds an operational permit for health care with a maximum occupancy of 50. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 44 Maximum occupancy: 50 Renewal fee: 1650
Employees Mentioned
NameTitleContext
Christy MerrittAdministratorNamed as the facility administrator in the licensure renewal application.
Dan Klein Sr.Named as an individual owner managing The Waterford at Williamsburg.
Dan Klein Jr.Named as an individual owner managing The Waterford at Williamsburg.
Inspection Report Complaint Investigation Deficiencies: 0 May 2, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Waterford At Williamsburg on May 2, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The investigation found the facility was in compliance with regulatory requirements regarding pest control, grievance/complaint handling, meal attractiveness and palatability, and nutritional adequacy of foods/meals.
Complaint Details
The complaint alleged failure to ensure an effective pest control program, failure to address grievances/complaints, failure to ensure meals are attractive and palatable, and failure to ensure foods/meals meet nutritional needs. All allegations were found to be unsubstantiated.
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training CoordinatorSigned the report as Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health
Inspection Report Renewal Capacity: 44 Deficiencies: 0 Mar 3, 2017
Visit Reason
This document is a licensure renewal application and certification for The Waterford at Williamsburg assisted-living facility, verifying that the facility is licensed through the date indicated on the renewal card.
Findings
The document certifies that The Waterford at Williamsburg meets statutory requirements as an assisted-living facility and includes ownership information and operational permits related to fire safety.
Report Facts
Total licensed beds: 44 Renewal fee: 1650 Maximum occupancy: 50
Employees Mentioned
NameTitleContext
Christy MerrittAdministratorNamed as administrator on the renewal application
Dan A. KleinAuthorized RepresentativeSigned the renewal application as authorized representative
Dan Klein Jr.Authorized RepresentativeSigned the renewal application as authorized representative
Inspection Report Complaint Investigation Deficiencies: 0 Sep 22, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to protect residents from abuse.
Findings
The facility was found to protect residents from abuse with no violations noted. Reviews of grievances, observations, and interviews revealed no concerns related to abuse.
Complaint Details
The complaint alleged failure to protect residents from abuse. The investigation found no substantiated abuse or violations.
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training Coordinator, Licensure Unit, Division of Public Health-DHHSSigned the report and identified as representative conducting the investigation.
Inspection Report Complaint Investigation Deficiencies: 1 Jul 6, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Waterford At Williamsburg on July 6-7, 2016, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to follow the individual service plan and administer medications as ordered by a medical practitioner. However, the facility failed to follow the Five Rights for medication administration as observed during the inspection.
Complaint Details
The complaint alleged failure to follow the individual service plan, failure to administer medications as ordered, and failure to follow the Five Rights for medication administration. The first two allegations were not substantiated; the third was substantiated.
Deficiencies (1)
Description
Failure to follow the Five Rights for medication administration.
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS
Inspection Report Complaint Investigation Census: 35 Deficiencies: 1 Apr 20, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding staff direction and monitoring for resident care, sufficient staffing, and medication administration at The Waterford At Williamsburg.
Findings
The facility failed to ensure staff had proper direction and monitoring for medication administration due to absence of licensed nurses on staff, which was a violation of state regulations. The facility was found to have sufficient staffing and medications were administered as ordered, with no violations related to these issues.
Complaint Details
The complaint investigation found the facility failed to ensure staff had direction and monitoring for resident care, specifically medication administration, due to no licensed nurses on staff and improper assignment of responsibility to residents or family. The facility was compliant regarding sufficient staffing and medication administration as ordered.
Deficiencies (1)
Description
Failure to ensure staff have direction and monitoring for resident care due to no licensed nurses on staff and improper assignment of responsibility for medication administration.
Report Facts
Facility census: 35 Residents sampled: 5
Employees Mentioned
NameTitleContext
Christy MerrittAdministratorFacility administrator interviewed regarding staffing and medication monitoring
Lori WehrsRegistered NurseSurveyor conducting the complaint investigation
Eve LewisProgram ManagerSigned letter regarding complaint investigation findings
Inspection Report Complaint Investigation Census: 33 Deficiencies: 1 Jan 21, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and perform the annual survey at The Waterford At Williamsburg on January 21-22, 2015.
Findings
The investigation found the facility had sufficient staffing, appropriate pest control, and adequate ventilation. However, the facility failed to ensure dietary supplies were clean to prevent food borne illness, violating regulation 175 NAC 4-006-10C.
Complaint Details
The complaint alleged insufficient staffing, inadequate pest control, inadequate ventilation, unclean dietary supplies, and failure to ensure residents meet retention criteria. Only the dietary supplies allegation was substantiated.
Deficiencies (1)
Description
Failure to ensure dietary supplies are clean to prevent food borne illness, including unsanitary kitchen conditions and improper food handling by staff.
Report Facts
Facility census: 33 Survey dates: January 21-22, 2015
Employees Mentioned
NameTitleContext
Eve LewisProgram Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the inspection report letter
Sherri LovelaceRegistered NurseSurveyor involved in complaint investigation
Victoria SmithRegistered NurseSurveyor involved in complaint investigation
Rebecca YoungRegistered NurseSurveyor involved in complaint investigation
Notice Capacity: 44 Deficiencies: 0 APP2023
Visit Reason
This document serves as a renewal application and verification that The Waterford at Williamsburg assisted-living facility is licensed through the date indicated on the renewal card.
Findings
The document confirms that The Waterford at Williamsburg meets statutory requirements as an assisted-living facility and is licensed through the renewal expiration date.
Report Facts
Total licensed beds: 44 Fire permit number: 1.00254E+23 Number of beds (fire permit): 50
Employees Mentioned
NameTitleContext
Jura MichaelAdministratorNamed as administrator on the renewal application
Dan Klein Jr.Authorized RepresentativeSigned the renewal application as authorized representative
Dan KleinAuthorized RepresentativeSigned the renewal application as authorized representative
Notice Capacity: 50 Deficiencies: 0 APP2025
Visit Reason
This document serves as a renewal application and license verification for The Waterford at Williamsburg assisted-living facility.
Findings
The documents confirm the facility's licensure renewal status, ownership information, and operational permits including fire prevention certification.
Report Facts
Total licensed beds: 50
Employees Mentioned
NameTitleContext
Jura MichaelAdministratorListed on the renewal application form
Dan KleinAuthorized RepresentativeSigned the renewal application
Dan Klein Jr.Named in ownership and correspondence
Dan A. Klein Sr.Named in ownership and correspondence
Notice Capacity: 44 Deficiencies: 0 APP2016
Visit Reason
This document serves as a licensure renewal application and verification for The Waterford at Williamsburg assisted-living facility, confirming its licensed status and providing renewal details.
Findings
The document confirms the facility's licensure renewal status, ownership information, and operational permits including fire prevention occupancy limits. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 44 Maximum occupancy: 50
Employees Mentioned
NameTitleContext
Dan Klein Jr.Authorized RepresentativeSigned the licensure renewal application.
Daniela A. Klein Jr.Listed as an individual owner managing the facility.
Christy MerrittAdministratorNamed as facility administrator in the renewal application.
Notice Capacity: 44 Deficiencies: 0 APP2018
Visit Reason
This document serves as a licensure renewal notification for The Waterford at Williamsburg assisted-living facility and includes an operational permit for fire prevention.
Findings
The facility is licensed as an assisted-living facility with a total licensed capacity of 44 beds. The operational permit issued by the City of Lincoln Bureau of Fire Prevention allows a maximum occupancy of 50.
Report Facts
Total licensed beds: 44 Maximum occupancy: 50
Employees Mentioned
NameTitleContext
Christy MerrittAdministratorNamed as facility administrator in the licensure renewal application
Dan A. Klein, Sr.Named as individual owner managing the facility
Dan Klein, Jr.Named as individual owner managing the facility
Notice Capacity: 44 Deficiencies: 0 APP2020
Visit Reason
This document serves to verify that The Waterford at Williamsburg Assisted-Living Facility is licensed through the indicated renewal date and includes the renewal application and related permits.
Findings
The documents confirm that the facility meets statutory requirements for licensure as an assisted-living facility and includes a renewal application with ownership and capacity details, as well as a fire prevention operational permit.
Report Facts
Total licensed beds: 44 Renewal expiration date: Apr 30, 2021
Notice Capacity: 44 Deficiencies: 0 APP2021
Visit Reason
The document serves as a renewal application and verification of licensure for The Waterford at Williamsburg assisted-living facility.
Findings
The document confirms that The Waterford at Williamsburg meets statutory requirements for licensure as an assisted-living facility and includes ownership and contact information.
Report Facts
Total licensed beds: 44 Maximum occupancy: 50 Renewal licensure fees: 950
Employees Mentioned
NameTitleContext
Dan Klein Jr.Authorized representative signing the renewal application (page 2).
Dan Klein Sr.Named as an individual owner managing the facility (page 3).
Notice Capacity: 44 Deficiencies: 0 APP2022
Visit Reason
This document serves as a renewal application and license verification for The Waterford at Williamsburg assisted-living facility.
Findings
The documents confirm the facility's licensure status and renewal fees, along with a fire prevention operational permit indicating an occupancy limit of 50 beds.
Report Facts
Total licensed beds: 44 Occupancy limit: 50 Renewal license fees: 950 Renewal license fees: 1450 Renewal license fees: 1650 Renewal license fees: 1950

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