Deficiencies per Year
16
12
8
4
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Renewal
Capacity: 103
Deficiencies: 0
Feb 28, 2024
Visit Reason
This document is a Nursing Home Licensure Renewal Application for Tiffany Square, indicating the facility is applying to renew its license as a Skilled Nursing Facility.
Findings
The application confirms Tiffany Square's licensure renewal request, specifying the number of beds to be relicensed and the types of special care and treatment services provided. No deficiencies or violations are noted in this document.
Report Facts
Number of beds to be relicensed: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Olson | Administrator | Named in the renewal application |
| Jamie Zapp | Director of Nursing | Named in the renewal application |
Inspection Report
Renewal
Capacity: 103
Deficiencies: 0
Mar 1, 2021
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification and occupancy permit for Tiffany Square, indicating the renewal of the facility's license and certification.
Findings
The documents certify that Tiffany Square meets statutory requirements for SNF/NF dual certification and holds a temporary occupancy permit for 103 beds, valid through 03/31/2022.
Report Facts
Number of beds to be relicensed: 103
Maximum Occupancy: 103
Renewal License Fees: 1950
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mikayla Wengler | Administrator | Named on Nursing Home Licensure Renewal Application |
| Danielle Deaver | Director of Nursing, R.N. | Named on Nursing Home Licensure Renewal Application |
| Jack D Vetter | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
| Glenn Van Ekeren | Authorized Representative | Signed Nursing Home Licensure Renewal Application |
| Mark Manchester | Deputy State Fire Marshal | Inspected facility for Temporary Occupancy Permit |
Notice
Capacity: 103
Deficiencies: 0
Mar 16, 2020
Visit Reason
This document serves to verify the licensure renewal of Tiffany Square skilled nursing facility and includes the renewal application for the nursing home license.
Findings
The document confirms that Tiffany Square meets statutory requirements for licensure renewal through the indicated expiration date and provides ownership and facility information. It also includes a Nebraska State Fire Marshal occupancy permit showing a maximum occupancy of 103 beds.
Report Facts
Licensed capacity: 103
License expiration date: 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mikayla Wengler | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Danielle Deaver | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
| Jack D. Vetter | Chairman of the Board and CEO | Named as authorized representative and in corporate officers listing. |
| Glenn Van Ekeren | President | Named as authorized representative and in corporate officers listing. |
Document
Capacity: 103
Deficiencies: 0
May 25, 2018
Visit Reason
The letter serves to amend the Health Insurance Benefits Agreement to update the certified bed assignments and counts as requested by the facility.
Findings
The letter confirms the certified bed locations and counts effective September 14, 2007, and the updated configuration effective May 27, 2018, both totaling 103 Medicare certified beds.
Report Facts
Certified beds: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed letter from Office of LTC Facilities, Licensure Unit |
Notice
Deficiencies: 0
Apr 4, 2018
Visit Reason
The facility's license was placed on probation for 90 days starting April 4, 2018, due to violations related to failure to implement interventions to promote healing of pressure ulcers and other regulatory infractions.
Findings
The facility was found in violation of multiple licensure regulations, including failure to have interventions in place to promote healing of pressure ulcers, medication errors, resident rights, and other care standards. The probation required submission of a Plan of Correction and biweekly reports on residents with pressure ulcers.
Report Facts
Probation period: 90
Report due date: Apr 15, 2018
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Program Manager | Contact for submission of reports and correspondence related to disciplinary action |
| Thomas L. Williams | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Becky Wisell | Administrator, Licensure Unit | Mentioned in relation to licensure unit |
| Linda Stenvers | Staff Assistant II | Certified mailing of the Notice of Disciplinary Action |
| Dustin Frey | Administrator | Facility administrator addressed in termination of probation letter |
Inspection Report
Annual Inspection
Census: 82
Deficiencies: 16
Mar 7, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Tiffany Square on March 1-7, 2018 by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to have multiple deficiencies including failure to update care plans to reflect residents' current needs, dignity and privacy violations, inaccurate assessments, inadequate pressure ulcer care, unsecured toilet risers, medication administration errors, food safety violations, infection control issues, and environmental sanitation problems. Some deficiencies were affirmed and others modified after informal dispute resolution.
Complaint Details
The visit was complaint-related with allegations that the facility failed to develop care plans addressing identified needs and failed to control offensive odors. The facility was found in violation for failure to update care plans but was in compliance regarding offensive odors.
Severity Breakdown
Level E: 8
Level D: 5
Level G: 1
Level F: 2
Deficiencies (16)
| Description | Severity |
|---|---|
| Failure to update resident care plans to reflect current conditions. | Level D |
| Failure to ensure resident dignity and privacy including improper wheelchair transport, failure to knock before entering rooms, leaving gait belts on residents, and improper dining assistance. | Level E |
| Failure to maintain resident privacy by exposing private medical information and discussing medical information audibly in public areas. | Level E |
| Inaccurate coding of Minimum Data Set (MDS) assessments regarding antipsychotic medication and discharge status. | Level D |
| Failure to revise care plans timely after acute changes including infections, choking episodes, and blood transfusions. | Level D |
| Failure to provide interventions to promote healing of a facility-acquired Stage 2 pressure ulcer which worsened to Stage 3. | Level G |
| Failure to secure toilet risers to toilets and failure to maintain safe hot water temperatures below 110 degrees Fahrenheit. | Level E |
| Medication aides administered PRN medications without licensed nurse assessment prior to administration. | Level D |
| Medication error rate exceeded 5% due to failure to observe medication administration and incorrect medication administration times. | Level D |
| Failure to properly label medications and biologicals according to physician orders and facility procedures. | Level D |
| Failure to ensure meals were served in a sanitary manner including handling crackers and food with bare hands and uncovered food items. | Level F |
| Failure to cover linens during transport to resident care areas. | Level E |
| Failure to maintain overhead light fixtures and kitchen vents free from dead bugs and debris. | Level F |
| Magnetically locked delayed egress exit doors did not open with 15 pounds of force as required. | Level E |
| Failure to maintain sprinkler heads free of paint, corrosion, and grease. | Level E |
| Failure to provide an exhaust inlet within 1 foot of the floor in the oxygen transfilling room. | Level E |
Report Facts
Deficiencies cited: 16
Census: 82
Medication error rate: 7.69
Pressure ulcer size: 2.5
Pressure ulcer size: 1.3
Pressure ulcer size: 1.7
Hot water temperature: 125.1
Hot water temperature: 124.5
Hot water temperature: 123.6
Hot water temperature: 123.3
Hot water temperature: 120.2
Force to open door: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed correspondence and coordinated informal dispute resolution. |
| Dustin Frey | Administrator | Facility administrator named in correspondence and informal dispute resolution. |
| LPN-A | Licensed Practical Nurse | Named in medication administration and care plan findings. |
| MA-K | Medication Aide | Named in medication administration findings. |
| DON | Director of Nursing | Named in multiple findings including care plan, medication, and dignity issues. |
| KM | Kitchen Manager | Named in food service and sanitation findings. |
| MD | Maintenance Director | Named in environmental and safety findings. |
| ADON-F | Assistant Director of Nursing | Named in assessment and care plan findings. |
| OT-D | Occupational Therapist | Named in dignity and care plan findings. |
Inspection Report
Complaint Investigation
Deficiencies: 0
May 10, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to investigate for causative factors in falls.
Findings
The investigation revealed the facility is in compliance with all regulatory regulations regarding investigation of causative factors in falls after review of resident records, observations, and interviews.
Complaint Details
The complaint alleged the facility fails to investigate for causative factors in falls. The investigation found the facility compliant with regulations.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Complaint Investigation
Census: 87
Capacity: 103
Deficiencies: 9
Feb 2, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Tiffany Square Care Center from January 30, 2017 to February 2, 2017. The complaint allegations included concerns about nutritional needs and laboratory testing per physician orders.
Findings
The facility was found to be in compliance with nutritional needs and laboratory testing allegations. However, multiple deficiencies were identified related to medication management, life safety code violations, fire safety, emergency lighting, fire door inspections, cooking facility suppression system, sprinkler system maintenance, corridor door latching, suspended heater safety, and emergency generator gas line labeling.
Complaint Details
The complaint investigation focused on allegations that the facility failed to ensure foods provided met nutritional needs and failed to complete laboratory testing per physician orders. Both allegations were found to be unsubstantiated as the facility was in compliance with nutritional and laboratory testing requirements.
Severity Breakdown
SS=D: 3
SS=E: 1
SS=F: 5
Deficiencies (9)
| Description | Severity |
|---|---|
| Failed to document clinical rationale for continued use of antipsychotic and antidepressant medications for one resident. | SS=D |
| Exit door in 400 Wing required excessive force to release delayed egress lock. | SS=F |
| Battery backup emergency lights in Central Wing and 400 Wing not functioning and no documentation of monthly/annual testing. | SS=F |
| Failed to implement preventative maintenance program to inspect and test fire doors annually. | SS=F |
| Kitchen range hood suppression system missing protective caps, no semiannual inspection, and no monthly visual inspections documented. | SS=F |
| Data cable improperly supported by sprinkler piping in Central Wing. | SS=F |
| Corridor door to therapy gym did not positively latch within door frame. | SS=E |
| Suspended natural gas heater in garage was within reach and lacked verification of failsafe feature. | SS=D |
| Natural gas piping and shutoff valve supplying emergency generator were not labeled. | SS=F |
Report Facts
Facility census: 87
Total licensed capacity: 103
Deficiency count: 9
Force to activate delayed egress lock: 15
Height of suspended heater: 78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dustin Frey | Administrator | Named as facility administrator in complaint investigation letter and facility staffing form |
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter |
| Administration A | Interviewed regarding multiple deficiencies including door issues, emergency lighting, sprinkler pipe support, and heater safety | |
| Consultant Pharmacist | Interviewed regarding medication regimen deficiency for Resident 23 | |
| Director of Nursing | Interviewed regarding failure to document clinical rationale for medication dose reduction |
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 2, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to investigate causative factors in resident falls.
Findings
The investigation found that immediately after a fall, the charge nurse assessed the situation and initiated interventions to prevent further falls. The Interdisciplinary Team reviewed all falls the next business day to ensure appropriate interventions were in place, determining the facility was in compliance with this issue.
Complaint Details
The complaint alleged the facility failed to investigate causative factors in falls. The allegation was investigated and found to be unsubstantiated as the facility had appropriate assessment and intervention processes.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report and identified as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Life Safety
Census: 85
Deficiencies: 5
Nov 16, 2015
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code and related fire safety regulations for the Tiffany Square Care Center.
Findings
The facility was found to have multiple deficiencies related to fire safety, including unsealed penetrations in smoke barriers, failure to provide smoke resistive barriers in storage rooms, inadequate fire drill scheduling, lack of separation of a gas fireplace from resident sleeping areas, and failure to inspect the range hood suppression system every six months.
Severity Breakdown
Level E: 3
Level F: 1
Level D: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to seal penetrations in the 500/600 Smoke Barrier allowing potential smoke migration affecting 8 residents. | Level E |
| Failed to provide smoke resistive barriers for storage rooms in the 600, 500, and 100 Wings allowing smoke migration affecting 36 residents. | Level E |
| Failed to conduct fire drills quarterly for all three shifts with varying times, affecting all residents. | Level F |
| Failed to separate the 600 Wing Gas Fireplace from resident sleeping areas, affecting 8 residents. | Level E |
| Failed to have the range hood suppression system inspected every six months, increasing risk of failure during a cooking fire. | Level D |
Report Facts
Facility census: 85
Residents affected by unsealed smoke barrier: 8
Residents affected by lack of smoke resistive barriers: 36
Residents affected by gas fireplace issue: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Acknowledged holes in smoke barrier and rooms failed to resist smoke passage; confirmed gas fireplace not separated from resident sleeping areas; confirmed inspection interval for range hood suppression system exceeded six months. | |
| Administration A | Acknowledged missing fire drill and that fire drill times were not varied. |
Inspection Report
Complaint Investigation
Census: 87
Deficiencies: 13
Dec 10, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Tiffany Square Care Center from December 3, 2014 to December 10, 2014.
Findings
The facility was found in violation for failure to ensure resident safety and supervision, failure to provide adequate nutritional care and care planning, failure to report and investigate allegations of abuse and misappropriation, failure to ensure staff administering medications were appropriately credentialed, and failure to ensure residents were able to make informed decisions regarding Medicare benefits.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure sufficient discharge planning, hydration, identification of condition changes, medication evaluation, protection from misappropriation, staff credentialing for medication administration, and timely submission of investigations. Violations were substantiated related to supervision to prevent accidents, quality care nutrition, medication administration, and abuse reporting.
Severity Breakdown
SS=E: 6
: 7
Deficiencies (13)
| Description | Severity |
|---|---|
| Facility failed to ensure residents were able to make informed decisions regarding Medicare benefits; Resident 87 signed a Medicare denial letter with no documentation of family notification. | — |
| Facility failed to report allegations of abuse and misappropriation timely and conduct thorough investigations related to missing resident property and money. | — |
| Facility failed to develop and revise comprehensive care plans for residents with nutritional needs and weight loss (Residents 56 and 150). | — |
| Facility failed to ensure staff administering oxygen were appropriately credentialed; unlicensed staff administered oxygen therapy to residents. | — |
| Facility failed to implement interventions for resident with suicidal ideations (Resident 155) and failed to provide adequate supervision. | — |
| Facility failed to ensure residents were free of significant medication errors; Resident 95 was administered rapid-acting insulin without timely food intake. | — |
| Facility failed to properly disinfect reusable equipment (glucometers) to prevent cross contamination. | — |
| Facility failed to seal smoke barrier penetrations allowing potential smoke migration affecting multiple wings. | SS=E |
| Facility failed to separate hazardous areas from exit corridors in multiple smoke compartments, risking smoke and fire spread. | SS=E |
| Facility failed to provide unobstructed sprinkler protection in required areas, including storage blocking sprinkler head and lack of sprinkler under garage doors. | SS=E |
| Facility failed to maintain corridors free of obstructions; furniture obstructed exit corridors. | SS=E |
| Facility failed to maintain emergency generator testing and inspection documentation in accordance with NFPA standards. | SS=E |
| Facility failed to use electrical equipment in accordance with NFPA 70; multiple electrical safety violations observed. | SS=E |
Report Facts
Resident census: 87
Weight loss: 15
Weight loss percentage: 10.7
Blood sugar: 430
Units of insulin: 7
Facility census: 86
Residents affected: 48
Residents affected: 59
Residents affected: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dustin Frey | Administrator | Named in complaint investigation letter and findings |
| Eve Lewis | Program Manager, Office of Long Term Care Facilities | Signed complaint investigation letter |
| Jean Obermier | Registered Nurse | Surveyor for complaint investigation |
| Susan Griepenstroh | Registered Nurse | Surveyor for complaint investigation |
| Nancy Hauschild | Nutrition/dietitian | Surveyor for complaint investigation |
| Maintenance A | Interviewed regarding smoke barrier and fire safety deficiencies | |
| RN J | Registered Nurse | Interviewed regarding resident suicidal ideation and glucometer cleaning |
| RN K | Registered Nurse | Interviewed regarding glucometer cleaning |
| LPN B | Licensed Practical Nurse | Observed administering insulin and glucometer use |
Inspection Report
Life Safety
Census: 79
Deficiencies: 5
Oct 7, 2013
Visit Reason
The inspection was conducted to assess compliance with the 2000 Edition of the Life Safety Code of the National Fire Protection Association, specifically related to fire safety and smoke barriers.
Findings
The facility failed to provide smoke barriers with at least a ½ hour fire resistance rating for 1 of 6 smoke barriers, failed to separate a hazardous area from the exit corridor due to a manual fire shutter not tied to the fire alarm, failed to maintain sprinkler system inspections quarterly, failed to submit plans and have acceptance testing for a newly installed range hood suppression system, and failed to avoid use of highly flammable decorations in certain smoke compartments.
Severity Breakdown
SS=E: 2
SS=F: 2
SS=D: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to provide smoke barriers with at least ½ hour fire resistance rating for 1 of 6 smoke barriers affecting 18 residents in the 100 Wing. | SS=E |
| Failed to separate a hazardous area from the exit corridor due to a manual roll-down fire shutter not tied to the fire alarm system affecting all residents using the Dining Room. | SS=F |
| Failed to maintain sprinkler system inspections quarterly as required, increasing potential for sprinkler failure affecting all residents. | SS=F |
| Failed to submit plans and have acceptance test performed by Authority Having Jurisdiction for newly installed range hood suppression system, risking system failure in staff kitchen. | SS=D |
| Failed to avoid use of decorations of highly flammable character in 2 of 6 smoke compartments, potentially speeding fire progression affecting 29 residents. | SS=E |
Report Facts
Facility census: 79
Smoke barriers affected: 1
Residents affected by smoke barrier deficiency: 18
Smoke compartments with flammable decorations: 2
Residents affected by flammable decorations: 29
Deficiency correction completion date: Jan 7, 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Confirmed findings related to smoke barrier penetrations, fire shutter, sprinkler inspections, and range hood suppression system acceptance test | |
| Administrator A | Administrator | Confirmed flammable decorations were not flame retardant |
| Tami Smith | Administrator | Contact person listed on waiver request |
Inspection Report
Life Safety
Census: 87
Deficiencies: 14
Jul 24, 2012
Visit Reason
The inspection was conducted to assess compliance with the Life Safety Code and related fire safety regulations for Tiffany Square Care Center.
Findings
The facility was found to have multiple life safety deficiencies including obstructed resident doors, lack of self-closing devices on certain doors, non-operational delayed egress hardware, inadequate emergency lighting, missing exit signage, failure to conduct proper fire drills, sprinkler system maintenance issues, unsecured fire extinguisher, improperly aligned hood suppression nozzles, presence of prohibited heat producing devices, obstructed means of egress, combustible decorations without flame retardant treatment, unattended oxygen concentrator, and use of power strips as permanent wiring.
Severity Breakdown
SS=E: 7
SS=F: 7
Deficiencies (14)
| Description | Severity |
|---|---|
| Resident doors 607 and 302A were obstructed from closing, affecting 27 residents. | SS=E |
| Break room door held open with a chair and pantry door lacked self-closing device, affecting 92 residents. | SS=F |
| Delayed egress hardware on service exit door was not operational, affecting 92 residents. | SS=E |
| Emergency lighting not provided in Dining Rooms A and B, affecting 92 residents. | SS=F |
| Exit sign or directional signage missing near 200 and 300 Nurses Station, affecting 41 residents. | SS=E |
| Fire drills not conducted on second shift during 2nd quarter of 2011 and 2012; quizzes given instead, affecting all residents. | SS=F |
| Missing sprinkler head escutcheons in Resident Room 110, Dish Room, and Dryer area, affecting 92 residents. | SS=F |
| Portable fire extinguisher unsecured in Service Corridor, affecting 92 residents. | SS=F |
| Hood suppression nozzles misaligned after cleaning, affecting 92 residents. | SS=F |
| Presence of candle in Resident Room 402 and space heater in Dietary Office, affecting 16 residents. | SS=E |
| Means of egress obstructed by dehumidifier, fans, and trash barrel in corridors and kitchen, affecting 33 residents. | SS=E |
| Flammable fabric horse blanket hanging on corridor wall without flame retardant treatment, affecting 92 residents. | SS=F |
| Unattended oxygen concentrator running in Resident Room 307, affecting 19 residents. | SS=E |
| Use of power strips as permanent wiring in Activity Room, affecting 22 residents. | SS=E |
Report Facts
Facility census: 87
Residents affected: 27
Residents affected: 92
Residents affected: 41
Residents affected: 33
Residents affected: 16
Residents affected: 19
Residents affected: 22
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Confirmed findings related to door obstructions, delayed egress door, hood nozzles, fire extinguisher, space heater, trash barrel, sprinkler escutcheons, oxygen concentrator | |
| Administrator | Confirmed multiple findings including door obstructions, emergency lighting, exit signage, fire drills, oxygen concentrator, power strip use |
Inspection Report
Life Safety
Census: 86
Capacity: 103
Deficiencies: 3
Aug 17, 2011
Visit Reason
The inspection was conducted to assess compliance with the 2000 Edition of the Life Safety Code of the National Fire Protection Association, specifically for health care occupancies.
Findings
The facility failed to maintain positive latching on corridor doors and failed to provide smoke resisting partitions in hazardous areas, potentially allowing smoke and fire to migrate. Additionally, the facility did not identify natural gas shutoff valves properly or provide verification that natural gas is a reliable fuel source for the emergency generator.
Severity Breakdown
SS=E: 2
SS=F: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to maintain positive latching of a corridor door (Clean Side Kitchen Door) which could allow smoke and fire migration affecting 23 residents in the Dining Room. | SS=E |
| Failed to provide smoke resisting partitions for a hazardous area (Ancillary Storage Room Door) which could allow smoke and fire migration affecting 28 residents in the 500 and 100 Wings. | SS=E |
| Failed to identify natural gas shutoff valves and provide verification that natural gas is a reliable fuel source for the emergency generator, affecting the safety of all residents. | SS=F |
Report Facts
Facility census: 86
Total capacity: 103
Number of doors sampled: 88
Number of smoke compartments: 7
Number of residents affected by door latching deficiency: 23
Number of residents affected by smoke partition deficiency: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Acknowledged door latching failures and natural gas shutoff valve identification issues during observations and interviews |
Notice
Capacity: 103
Deficiencies: 0
APP2018
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Tiffany Square and includes the occupancy permit indicating the maximum licensed capacity.
Findings
The document confirms that Tiffany Square meets statutory requirements for SNF/NF dual certification with a license valid through 3/31/2019 and holds an occupancy permit for 103 beds issued on 1/31/2017.
Report Facts
Total licensed beds: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dustin Frey | Administrator | Named on the license renewal application. |
| Kevin Vogt | Director of Nursing | Named on the license renewal application. |
| Jack D. Vetter | CEO | Authorized representative signing the renewal application and Chairman of the Board and CEO of parent corporation. |
| Glenn Van Ekeren | President | Authorized representative signing the renewal application and President of parent corporation. |
Notice
Capacity: 103
Deficiencies: 0
APP2019
Visit Reason
This document serves to verify that Tiffany Square's SNF/NF Dual Certification license is renewed and valid through the date indicated on the renewal card.
Findings
The document confirms that Tiffany Square meets statutory requirements for SNF/NF Dual Certification and is licensed through the renewal expiration date of 2020-03-31.
Report Facts
Total licensed beds: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brenda Ewers-Nordhues | Administrator | Named on the renewal application |
| Kevin Vogt | Director of Nursing | Named on the renewal application |
| Jack D. Vetter | Chairman of the Board and CEO | Listed as officer and director of Vetter Senior Living, parent entity |
| Eldora D. Vetter | Secretary | Listed as officer and director of Vetter Senior Living, parent entity |
| Glenn Van Ekeren | President | Listed as officer and director of Vetter Senior Living, parent entity |
| Brian Stuhr | Treasurer | Listed as officer and director of Vetter Senior Living, parent entity |
Notice
Capacity: 103
Deficiencies: 0
APP2022
Visit Reason
The document serves to verify the renewal of the SNF/NF dual certification license for Tiffany Square and includes the renewal application for the nursing home license.
Findings
The documents confirm that Tiffany Square meets statutory requirements for licensure renewal and provide details on ownership, accreditation, and occupancy permit status.
Report Facts
Number of beds to be relicensed: 103
Renewal License Fees: 1750
Maximum Occupancy: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason Nitz | Administrator | Named in Nursing Home Licensure Renewal Application |
| Jamie Zapp | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Brian Stuhr | Treasurer | Authorized representative signing renewal application and listed as officer of Vetter Senior Living |
| Glenn Van Ekeren | President | Authorized representative signing renewal application and listed as officer of Vetter Senior Living |
| Mark Manchester | Deputy State Fire Marshal | Inspected facility for occupancy permit |
Notice
Capacity: 103
Deficiencies: 0
APP2023
Visit Reason
The documents serve to verify and renew the license for Tiffany Square Skilled Nursing Facility and provide 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 103 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Olson | Administrator | Named in Nursing Home Licensure Renewal Application |
| Jamie Zapp | Director of Nursing | Named in Nursing Home Licensure Renewal Application |
| Brian Stuhr | Authorized Representative and Treasurer | Signed renewal application and listed as Treasurer of Vetter Senior Living |
| Glenn Van Ekeren | Authorized Representative and President | Signed renewal application and listed as President of Vetter Senior Living |
Notice
Capacity: 103
Deficiencies: 0
APP2025
Visit Reason
This document set serves to verify the renewal of the SNF/NF dual certification license for Tiffany Square and includes the renewal application, occupancy permit, and related corporate and ownership information.
Findings
The documents confirm the facility's license renewal status, ownership details, and occupancy permit with a maximum capacity of 103 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 103
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Olson | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Jamie Zapp | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Brian Stuhr | Authorized Representative | Signed the Nursing Home Licensure Renewal Application and listed as Treasurer in corporate documents. |
| Glenn Van Ekeren | Authorized Representative and President | Signed the Nursing Home Licensure Renewal Application and listed as President in corporate documents. |
| Mark Manchester | Deputy State Fire Marshal | Inspected the facility and approved the occupancy permit. |
Document
Capacity: 103
Deficiencies: 0
CHOW2017
Visit Reason
Documents pertain to the issuance of a new Skilled Nursing Facility license due to change of ownership and facility name change, along with related licensing and occupancy permits and a lease agreement.
Findings
The documents confirm the licensing and regulatory compliance of Tiffany Square as a Skilled Nursing Facility with a licensed capacity of 103 beds. They include the license issuance, occupancy permit, ownership information, and a lease agreement outlining terms between the landlord and tenant.
Report Facts
Licensed capacity: 103
License issuance date: Jul 1, 2017
Occupancy permit date: Jan 31, 2017
Lease commencement date: Jul 1, 2017
Lease term length: 10
Lease extension terms: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dustin Frey | Administrator | Named as facility administrator in licensing application. |
| Kevin Vogt | Director of Nursing | Named as director of nursing in licensing application. |
| Thomas L. Williams, MD | Chief Medical Officer, Director, Division of Public Health | Signed licensing and renewal documents for Nebraska Department of Health and Human Services. |
| Eve Lewis, RN-C | Program Manager | Contact person for licensing questions at Nebraska Department of Health and Human Services. |
| Shari Terry | Chief Operations Officer | Signed letter submitting change of ownership documents. |
| Jack D. Vetter | Chairman of the Board and CEO | Board member and officer of Vetter Senior Living and subsidiaries. |
| Glenn Van Ekeren | President | Board member and officer of Vetter Senior Living and subsidiaries. |
Notice
Capacity: 103
Deficiencies: 0
APP2016
Visit Reason
This document serves as a licensure renewal application and verification of the SNF/NF dual certification for Tiffany Square Care Center, including occupancy permit information.
Findings
The documents confirm the facility's licensure renewal status, certification for skilled nursing and nursing facility services, and occupancy permit with a maximum capacity of 103 beds.
Report Facts
Total licensed beds: 103
Renewal fees: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Vogt | Director of Nursing | Named as Director of Nursing on the Nursing Home Licensure Renewal Application (page 2). |
| Dustin Frey | Administrator | Named as Administrator on the Nursing Home Licensure Renewal Application (page 2). |
| Todd D. Vetter | Authorized Representative | Signed the Nursing Home Licensure Renewal Application as authorized representative (page 2). |
Document
Capacity: 103
Deficiencies: 0
APP2017
Visit Reason
The document serves as a licensure renewal application and certification for Tiffany Square Care Center, including verification of licensure, occupancy permit, and ownership information.
Findings
The documents confirm that Tiffany Square Care Center meets statutory requirements for SNF/NF dual certification, has a licensed capacity of 103 beds, and holds an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Licensed capacity: 103
Renewal fees: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dustin Frey | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Kevin Vogt | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
| Jack D. Vetter | President and Chair of the Board & CEO | Listed as officer and director of Vetter Holding, Inc. and Vetter Health Services, Inc. |
| Eldora D. Vetter | Vice President, Treasurer, Secretary | Listed as officer and director of Vetter Holding, Inc. and Vetter Health Services, Inc. |
| Todd D. Vetter | Assistant Secretary and Secretary | Listed as officer and director of Vetter Holding, Inc. and Vetter Health Services, Inc. |
| Glenn Van Ekeren | President | Officer of Vetter Health Services, Inc. |
| Shari Terry | Chief Operations Officer | Officer of Vetter Health Services, Inc. |
| Rhonda Flanigan | Chief People Officer | Officer of Vetter Health Services, Inc. |
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