Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Life Care Center Of Elkhorn during CMS and state inspections, most recent first.
Three nurse aides did not complete the required 12 hours of annual in-service education, with training hours ranging from 3 to 5 hours. The DON confirmed the deficiency and acknowledged the absence of an effective tracking system for staff education compliance.
Staff failed to follow infection control protocols by carrying soiled linens against their bodies, neglecting to clean nebulizer kits and PAP equipment after use, and not using enhanced barrier precautions during catheter care for a resident with an indwelling device. These actions were observed and confirmed by staff and facility leadership as not meeting established policies.
Surveyors found that ventilation systems in the bathrooms of four resident rooms were not functioning, as evidenced by a lack of airflow during testing with toilet paper. The Maintenance Supervisor confirmed the issue and stated that no routine checks of the ventilation systems had been performed.
A resident with multiple serious medical conditions and moderate cognitive impairment was admitted without receiving or acknowledging the required notice of rights, as documented in facility policy. The admission paperwork was incomplete, and the electronic health record did not contain evidence that the resident or their representative had been informed of their rights at admission.
A resident with multiple complex medical conditions and moderate cognitive impairment was admitted without completion of required admission paperwork, including documentation of privacy practices, resident rights, and other key policies. The Admissions Director confirmed the omission, resulting in an incomplete medical record.
A resident with heart failure did not consistently receive daily weights or have significant weight gains reported to the practitioner as ordered. Fluid restrictions were not properly implemented or monitored, with frequent overages and incomplete documentation. Staff interviews and observations revealed a lack of awareness and communication regarding the resident's fluid management, and the facility did not have a policy in place for fluid restriction implementation.
Facility staff did not notify the practitioner of significant weight increases in a resident with heart failure, despite clear orders and policy requiring notification for weight gains of 1 to 5 lbs. Multiple weight increases exceeding this threshold were not reported, as confirmed by record review and DON interview.
A resident with heart failure did not consistently receive BiPAP therapy as ordered, with multiple missed applications documented over several weeks. Staff interviews revealed poor communication and lack of clarity regarding responsibility for applying the BiPAP mask, and there was no documentation of resident refusal when the therapy was not provided.
A resident experienced significant weight loss due to the facility's failure to implement recommended nutritional interventions. Despite a Registered Dietician's recommendation for a Magic Cup supplement, it was not provided with meals, and staff were unaware of the recommendation. The facility did not adhere to its policy on hydration and nutrition, failing to assess and address the resident's weight loss.
The facility failed to maintain proper food safety and sanitation practices, affecting all 86 residents. Observations revealed unsealed, unlabeled, and undated food items in refrigerators and freezers, improper food handling by Cook-M, and unsanitary kitchen conditions. The DFS and Registered Dietician confirmed these deficiencies, which were not in line with the facility's policies.
The facility failed to update care plans for four residents, leading to deficiencies in their care. A resident's care plan was not updated after a Foley catheter was discontinued. Another resident's care plan did not reflect multiple open wounds. A third resident's care plan was outdated regarding feeding tube orders, and a fourth resident's care plan did not accurately reflect their dental status. These oversights were confirmed by facility staff.
The facility failed to maintain safe water temperatures in resident bathrooms, with readings between 123.4 and 132.4 degrees Fahrenheit, affecting 14 residents. Interviews with the Maintenance Supervisor and DON confirmed awareness of the issue, leading to the water being shut off in the affected area.
The facility failed to maintain flooring in good repair for 12 resident rooms, affecting 13 residents. Observations revealed missing transition strips between hall carpets and room flooring, and cracked or bubbled linoleum in several bathrooms. The Maintenance Supervisor confirmed these issues, indicating a potential safety concern.
The facility staff failed to clean and sanitize respiratory equipment for several residents, leading to potential cross-contamination. Observations showed that equipment was not maintained according to policy, with visible contamination. Additionally, staff did not implement enhanced barrier precautions during care activities for residents with wounds or indwelling devices, and failed to provide necessary signage for a resident with venous stasis ulcers. Interviews confirmed these deficiencies, highlighting lapses in hygiene and precautionary measures.
A resident experienced a significant weight loss of 6.6 pounds, or 5.47%, over a short period, but the facility failed to notify the physician. Despite the resident's awareness of the weight loss and the RD's recommendation for nutritional supplements, the facility did not follow its policy to inform the physician of such concerns.
A resident with dementia and other conditions fell in the bathroom, resulting in a laceration requiring stitches. Despite the facility's policy to report serious injuries within two hours, the incident was not reported to the state agency, leading to a deficiency finding.
A facility failed to accurately document a resident's care needs in the MDS, omitting tube feeding and incorrectly including insulin administration. The resident, with multiple medical conditions, was on enteral feeding via a G-tube, not insulin. Observations and interviews confirmed the MDS inaccuracies, leading to a deficiency finding.
The facility failed to adhere to oxygen orders for two residents, leading to deficiencies in respiratory care. One resident with COPD and Chronic Respiratory Failure was observed without prescribed oxygen therapy multiple times, despite having orders for continuous oxygen. Another resident was using oxygen continuously without a physician's order for such use outside of AVAPS. Interviews confirmed these discrepancies, highlighting the facility's failure to ensure valid and followed oxygen orders.
The facility failed to ensure proper assessment of dialysis shunt sites for two residents before and after their dialysis treatments. The Pre/Post Dialysis Communication forms were frequently incomplete or missing, indicating that the required assessments were not consistently performed. Observations showed that one resident was left unattended in the hallway after dialysis, and the LPN responsible did not know the location of the shunt site or perform the necessary assessments. The DON confirmed that the staff was not completing the communication sheets accurately, and the shunt site assessments were not always conducted.
Failure to Ensure Required Annual In-Service Education for Nurse Aides
Penalty
Summary
The facility failed to ensure that three nurse aides completed the required 12 hours of annual in-service education, as mandated by licensure regulations. Record reviews showed that one nurse aide had completed only 3.5 hours, another 5 hours, and a third 3 hours of training, despite being employed for sufficient time to meet the requirement. The Director of Nursing confirmed during an interview that the 12-hour education training requirement had not been met for these nurse aides and acknowledged that the facility lacked an effective system to track and ensure compliance with the required training hours. This deficiency had the potential to affect all 86 residents in the facility.
Infection Control Failures in Linen Handling, Equipment Cleaning, and Barrier Precautions
Penalty
Summary
Facility staff failed to adhere to infection prevention and control protocols in several instances involving the handling of soiled linens, cleaning of respiratory equipment, and use of enhanced barrier precautions. Observations revealed that nursing assistants carried soiled linens and bedding against their bodies and clothing, contrary to facility policy, which requires soiled linen to be bagged and handled with minimal agitation to prevent contamination. Staff were seen carrying soiled items uncovered through hallways and placing soiled gowns under their arms while assisting residents, actions confirmed by both the staff involved and facility leadership as improper. Additionally, staff did not consistently clean and disinfect non-critical patient care equipment such as nebulizer kits and PAP (Positive Airway Pressure) machines. Multiple observations showed nebulizer kits with residual medication and facial oils left uncleaned on bedside tables after use for two residents. Similarly, a resident's BiPAP machine and mask were found with facial oils, water left in the humidifier, and missing filters over several days, despite orders and manufacturer guidelines requiring daily and weekly cleaning. Interviews with staff and a family member confirmed that cleaning was not performed as required. The facility also failed to implement enhanced barrier precautions during high-contact care activities for a resident with a urinary catheter. During catheter and incontinence care, staff did not wear gowns as mandated by facility policy for residents with indwelling medical devices. Staff interviews confirmed awareness of the requirement but acknowledged that enhanced barrier precautions were not used during the observed care.
Non-Operational Ventilation Systems in Resident Bathrooms
Penalty
Summary
Surveyors observed that the facility failed to ensure operational ventilation systems in resident bathrooms for four rooms (106, 108, 114, and 115) out of fifteen occupied rooms on the 100 hall. During an inspection with the Maintenance Supervisor, it was noted that the ventilation system did not draw a single ply of toilet paper to the surface of the ventilation cover in these bathrooms, indicating the systems were not functioning properly. The Maintenance Supervisor confirmed these findings and also acknowledged that no routine checks had been conducted to verify the operational status of the ventilation systems.
Failure to Provide Notice of Resident Rights on Admission
Penalty
Summary
The facility failed to provide a notice of resident rights upon admission for one resident. According to the facility's own admission policy, residents or their representatives must be informed of their rights and facility policies both orally and in writing, with accommodations for impairments and language needs. The policy also requires written acknowledgment of this explanation to be documented in the admission agreement. Record review showed that for the resident in question, who was admitted with diagnoses including osteomyelitis, intracranial injury with loss of consciousness, quadriplegia, and depression, there was no documentation in the electronic health record indicating that the resident or their representative received or acknowledged the notice of rights at admission. Further review revealed that the resident had a moderate cognitive impairment, as indicated by a BIMS score of 11, and had a designated health care power of attorney. Interviews with the Admissions Director confirmed that the admission paperwork, including the required notice of rights, had not been completed at the time of admission, and the medical record lacked the necessary documentation to show that the resident or their representative had received this information.
Failure to Complete Admission Paperwork for Resident
Penalty
Summary
The facility failed to complete required admission paperwork for one resident upon admission. According to the facility's own admission policy, residents or their legal representatives must be oriented to various policies and receive a copy of the admissions agreement, which is to be signed and filed in the resident's chart. Record review revealed that for this particular resident, who was admitted with diagnoses including osteomyelitis, intracranial injury with loss of consciousness, quadriplegia, and depression, there was no completed admission paperwork in the electronic health record. This included missing documentation on privacy practices, antidiscrimination policy, grievance policy, resident rights, trust fund, financial agreement, smoking policies, resident care policies, and other required documents. Further review showed that the resident had a moderate cognitive impairment, as indicated by a BIMS score of 11, and had a designated health care power of attorney. Interviews with the Admissions Director confirmed that the admission paperwork had not been completed at the time of admission and that the resident's medical record was incomplete due to the absence of these documents.
Failure to Follow Physician Orders for Daily Weights and Fluid Restrictions
Penalty
Summary
Facility staff failed to follow physician's orders for a resident with a diagnosis of heart failure, specifically regarding daily weights and fluid restrictions. The resident had multiple orders for daily weights, with instructions to notify the practitioner of weight increases between 1-5 lbs. However, there were several documented instances where daily weights were not obtained, and significant weight gains were not reported to the practitioner as required. For example, an 8.6 lb. weight gain in one day and other increases of 6.7 lbs., 3.9 lbs., and 3.8 lbs. were not communicated to the practitioner. These omissions were confirmed by the DON during interviews. Additionally, the facility did not consistently implement or monitor the resident's fluid restriction orders. The resident was placed on various fluid restrictions, including 1000 ml and later 1440 ml per day, with specific allocations for dietary and nursing staff. Despite these orders, the resident's fluid intake regularly exceeded the prescribed limits, and there were days when fluid intake was not recorded at all. Observations and interviews revealed that staff were not always aware of the fluid restriction, did not consistently document fluids provided, and dietary staff did not record the amount of fluids given. The DON confirmed that the facility lacked a policy for implementing fluid restrictions and was unaware of how IV fluids were included in the daily total. The resident experienced multiple hospitalizations for conditions related to heart failure, fluid overload, and other complications during the period in question. Observations showed the resident receiving unmeasured fluids during meals and activities, and staff interviews indicated a lack of communication and understanding regarding the resident's fluid management needs. The facility was unable to provide additional information or documentation regarding the implementation of fluid restrictions prior to the survey exit.
Failure to Notify Practitioner of Significant Weight Changes
Penalty
Summary
Facility staff failed to notify the medical practitioner of significant changes in a resident's daily weights, as required by both facility policy and physician orders. The resident, who was cognitively intact and had a diagnosis of heart failure, had orders in place for daily weights with instructions to call the physician for any weight increase of 1 to 5 pounds. Despite this, the medical record review showed multiple instances where the resident experienced weight gains exceeding the notification threshold, including an 8.6-pound increase in one day and other increases of 6.7, 3.9, and 3.8 pounds on separate occasions. There was no documentation that the practitioner was informed of these changes. Interviews with the Director of Nursing confirmed that the practitioner was not notified of the significant weight increases, despite the clear orders and facility policy requiring such communication. The lack of notification was corroborated by the absence of related documentation in the resident's progress notes, faxes, and practitioner orders. The deficiency was identified through record review and staff interviews, which established that the required notifications did not occur as specified.
Failure to Provide Ordered BiPAP Respiratory Care
Penalty
Summary
Facility staff failed to ensure that a resident with a diagnosis of heart failure received appropriate respiratory care as ordered. The resident required BiPAP therapy while sleeping or napping, as documented in physician orders and the treatment administration record (TAR). Multiple instances were identified where the BiPAP was not applied during various shifts across September and October, despite clear orders. The resident was cognitively intact and required extensive to total assistance with activities of daily living. Documentation showed that the BiPAP was not used on several occasions, and there was no record of resident refusal or staff documentation of such refusals. Interviews with staff revealed confusion and lack of communication regarding responsibility for applying the BiPAP mask. Medication aides indicated that only nurses could apply the mask, but nurses interviewed were either unaware of the resident's needs or had not been informed of the mask not being in use. Observations confirmed the resident was not wearing the BiPAP mask when required, and the resident reported discomfort from air blowing in the eyes when the mask was applied. The Director of Nursing confirmed that the nurse assigned to the resident should have ensured the BiPAP was applied and documented any refusals, which did not occur.
Failure to Implement Nutritional Interventions for Resident
Penalty
Summary
The facility failed to evaluate and implement interventions to prevent significant weight loss for a resident, identified as Resident 37. The resident was admitted following surgery for a diaphragmatic hernia with obstruction and had other diagnoses including GERD, Barrett's Esophagus with dysphagia. The resident's Minimum Data Set (MDS) indicated a weight of 120 pounds and required assistance with various activities of daily living. Despite the resident's awareness of weight loss, the facility did not take appropriate action to address the issue. The resident's weight was recorded multiple times, showing a decrease from 120.6 pounds to 114.0 pounds over a period of less than a month, indicating a significant weight loss of 5.47%. The facility's Registered Dietician (RD) had recommended nutritional supplements, specifically a Magic Cup, to be added to the resident's meals to address the low BMI and potential weight loss. However, this recommendation was not implemented, as evidenced by the absence of the Magic Cup on the resident's meal trays during observations. Interviews with facility staff, including the RD, Director of Food Service (DFS), and nursing staff, revealed a lack of communication and follow-through on the dietary recommendations. The RD was not informed of the resident's weight loss, and the DFS was unaware of the recommendation for the Magic Cup. Additionally, the facility's policy on hydration and nutrition, which requires ongoing assessment and physician notification of concerns, was not adhered to, as there was no documentation of further nutritional evaluation or physician notification regarding the resident's significant weight loss.
Food Safety and Sanitation Deficiencies
Penalty
Summary
The facility failed to ensure proper food safety and sanitation practices in the kitchen, which had the potential to affect all 86 residents consuming food from the kitchen. Observations revealed multiple food items in the kitchen's refrigerators and freezers were not sealed, labeled, or dated, contrary to the facility's Food Safety policy. Items such as an open bag of shredded purple substance, a zip lock bag of white chunks, and an open package of bologna were found without proper labeling or sealing. Additionally, the dry storage contained unsealed bags of macaroni and overripe bananas, while the walk-in refrigerator and freezer had unlabeled and undated food items. The Director of Food Services (DFS) confirmed these observations and acknowledged the failure to adhere to food safety protocols. Further deficiencies were noted in food preparation and kitchen cleanliness. Cook-M was observed handling beef packages in a manner that allowed the outside of the packaging to contact the food product, and did not follow the recipe or measure ingredients during food preparation. The DFS and Registered Dietician confirmed these practices were inappropriate. Additionally, the facility's cleaning logs did not show evidence of regular cleaning of floors, vents, and fans, leading to unsanitary conditions such as crumbs on the kitchen floor, brown drippings on the freezer vent, and a gray fuzzy substance on HVAC vents. The DFS and Maintenance Supervisor confirmed these areas were not cleaned as required, posing a risk of contamination to food and eating surfaces.
Failure to Update and Revise Care Plans for Residents
Penalty
Summary
The facility failed to update and revise care plans for four residents, leading to deficiencies in their care. Resident 6, who was admitted with an indwelling Foley catheter, had the catheter discontinued, but the care plan was not updated to reflect this change. The care plan continued to include interventions related to the catheter, which was no longer in use. This oversight was confirmed by the Minimum Data Set Nurse during an interview. Resident 68 had multiple open wounds on their legs, which were not documented in the care plan. Despite ongoing wound assessments indicating the presence of these wounds, the care plan remained focused on skin integrity related to urinary incontinence and xerosis cutis, without addressing the actual wounds. The Wound Nurse acknowledged that the care plan had not been updated to include the open wounds. Resident 34's care plan was outdated and did not reflect the current orders for bolus feedings via a feeding tube. The care plan incorrectly indicated continuous feeding, while the actual orders specified bolus feedings four times a day. This discrepancy was confirmed by the facility's Registered Dietician and the MDS Nurse. Additionally, Resident 14's care plan was not accurate, as it did not reflect the resident's current dental status, including the absence of teeth and the fact that dentures were at home. The Social Service Assistant confirmed the care plan was outdated.
Unsafe Water Temperatures in Resident Bathrooms
Penalty
Summary
The facility failed to ensure safe water temperatures in resident bathrooms, which posed a potential risk to 14 residents. During an observation on August 7, 2024, it was found that water temperatures in several resident rooms were above the recommended safe level of 120 degrees Fahrenheit, with temperatures ranging from 123.4 to 132.4 degrees Fahrenheit. This issue was identified in rooms 101, 102, 109, 113, 114, 117, 118, 120, 122, and 123. The facility census at the time was 86 residents. Interviews conducted with the Maintenance Supervisor and the Director of Nursing revealed awareness of the elevated water temperatures. The Maintenance Supervisor confirmed taking a water temperature reading above 124 degrees Fahrenheit in one of the rooms. The Director of Nursing acknowledged that the water temperatures in the bathrooms on the 100 Hall were too high, leading to the water being shut off. A review of the facility's Direct Supply TELS logbook indicated that water temperatures should be maintained below 120 degrees Fahrenheit for burn prevention, as per federal guidelines.
Deficiency in Flooring Maintenance
Penalty
Summary
The facility failed to maintain flooring in good repair for 12 resident rooms, which had the potential to affect 13 residents. During a tour with the Maintenance Supervisor, it was observed that rooms 104, 105, 106, 108, 109, 111, 113, 114, 121, and 122 did not have a transition strip between the hall carpet and the flooring in the resident's room. Additionally, rooms 104, 113, 114, 122, 123, and 207 had cracked or bubbled linoleum in the resident's bathroom. An interview with the Maintenance Supervisor confirmed that the resident room floors were not maintained and could potentially be a safety concern.
Infection Control and Precaution Failures in LTC Facility
Penalty
Summary
The facility staff failed to ensure proper cleaning and sanitization of respiratory equipment and supplies for several residents, leading to potential cross-contamination. Observations revealed that the BiPAP/CPAP masks, nebulizer kits, and oxygen concentrators for Residents 26, 38, and 42 were not cleaned according to the facility's policies. The equipment was found with facial oils, residual medication, and a gray fuzzy substance, indicating neglect in maintaining hygiene standards. Interviews with staff confirmed the equipment was not cleaned as required. Additionally, the facility staff did not implement enhanced barrier precautions during activities of daily living (ADL) care for Resident 14 and catheter care for Resident 37. Observations showed that staff did not wear gowns during high-contact care activities, despite the presence of enhanced barrier precaution signage. Interviews with staff confirmed the failure to adhere to the precautionary measures outlined in the facility's policy, which mandates gown and glove use during specific care activities for residents with wounds or indwelling medical devices. Furthermore, the facility failed to provide enhanced barrier signage for Resident 68, who had venous stasis ulcer wounds. Observations over several days revealed the absence of signage on the resident's door, which is necessary to alert staff of the need for precautions. The Infection Preventionist was unaware of the resident's condition, indicating a lapse in communication and policy implementation. The facility's policy requires signage to communicate the need for enhanced barrier precautions for residents with chronic wounds or indwelling medical devices.
Failure to Notify Physician of Significant Weight Loss
Penalty
Summary
The facility failed to notify a resident's physician of a significant weight loss, which was identified during a survey. The resident, who had a history of diaphragmatic hernia surgery, GERD, BPH, and Barrett's Esophagus with dysphagia, experienced a weight loss of 6.6 pounds, or 5.47%, over a period of less than a month. Despite the resident's awareness of weight loss, the facility did not inform the physician of this clinically significant change. The resident's Minimum Data Set indicated a BIMS score of 15, suggesting cognitive intactness, and required varying levels of assistance for daily activities. The facility's Registered Dietician (RD) had noted the resident's low BMI and recommended nutritional supplements, but the weight loss was not communicated to the physician. The facility's policy on Hydration and Nutrition mandates physician notification of any concerns, including weight loss, but this protocol was not followed. The RD confirmed that the weight loss was significant and that the physician had not been updated, highlighting a lapse in the facility's communication and monitoring processes.
Failure to Report Resident Fall with Serious Injury
Penalty
Summary
The facility failed to report a fall resulting in serious bodily injury to the state agency for a resident. The resident, who had diagnoses of dementia, COPD, anxiety, and depression, was found on the bathroom floor by staff after their roommate called for help. The resident was crying and had bleeding from the right cheek, which required transfer to the hospital. At the hospital, the resident received three stitches for the laceration on the right cheek. Despite the facility's policy requiring immediate reporting of serious bodily injuries to the state agency, the incident was not reported. Interviews with the RN and the DON confirmed the fall and the subsequent hospital visit for sutures. The facility's policy mandates reporting such incidents within two hours, but this protocol was not followed, resulting in a deficiency finding during the survey.
Inaccurate MDS Documentation for Resident's Care Needs
Penalty
Summary
The facility failed to ensure an accurate assessment for a resident, as evidenced by discrepancies in the Minimum Data Set (MDS) documentation. The MDS dated 07/12/2024 did not include the resident's tube feeding requirement, and incorrectly documented the resident as receiving insulin and insulin injections, which were not part of the resident's care plan. The resident, who had multiple medical diagnoses including hemiplegia, chronic respiratory failure, and required G-tube feeding, was not accurately represented in the MDS, leading to a deficiency in the resident's comprehensive assessment. Observations and interviews confirmed the inaccuracies in the resident's MDS. The resident's Medication Administration Record and Treatment Administration Record from April to August 2024 showed the resident was on enteral feeding via a G-tube, with no record of insulin administration. Interviews with the resident's Power of Attorney and the facility's MDS Nurse corroborated that the resident was not on insulin or insulin injections, highlighting the error in the MDS documentation. This failure to accurately assess and document the resident's needs and treatments resulted in a deficiency finding during the survey.
Failure to Follow Oxygen Orders for Residents
Penalty
Summary
The facility failed to ensure proper adherence to oxygen orders for two residents, leading to deficiencies in respiratory care. Resident 26, who had multiple diagnoses including Chronic Obstructive Pulmonary Disease (COPD) and Chronic Respiratory Failure with Hypoxia, was observed multiple times without the prescribed oxygen therapy. Despite having a physician's order for continuous oxygen at 1 liter per minute via nasal cannula and oxygen with CPAP, the resident was found without oxygen on several occasions, both while sleeping and during activities. Interviews confirmed that the resident did not refuse oxygen, and the charge nurse acknowledged the resident's order for continuous oxygen was not being followed. Similarly, Resident 42, diagnosed with Chronic Respiratory Failure with Hypoxia and Obstructive Sleep Apnea, was observed using oxygen continuously, although there was no physician's order for oxygen use outside of the AVAPS setting. The resident confirmed continuous oxygen use, and the charge nurse verified the absence of an order for oxygen when not on AVAPS. These observations and interviews highlight the facility's failure to ensure valid and followed oxygen orders for the residents, resulting in a deficiency in providing safe and appropriate respiratory care.
Failure to Assess Dialysis Shunt Sites
Penalty
Summary
The facility failed to ensure proper assessment of dialysis shunt sites for two residents, Resident 26 and Resident 57, before and after their dialysis treatments. The facility's Hemodialysis Offsite Policy mandates ongoing assessment of residents' conditions and monitoring for complications related to dialysis. However, record reviews revealed that the Pre/Post Dialysis Communication forms for both residents were frequently incomplete or missing, indicating that the required assessments were not consistently performed. Resident 57, who has multiple complex medical conditions including End Stage Renal Disease and dependence on renal dialysis, was not assessed for shunt site bruit, thrill, or bleeding as required. Observations showed that upon returning from dialysis, the resident was left unattended in the hallway, and the LPN responsible for the resident's care did not know the location of the shunt site or perform the necessary assessments. The Director of Nursing confirmed that the staff was not completing the Pre/Post Dialysis Communication sheets accurately, and the shunt site assessments were not always conducted. Similarly, Resident 26, who also has End Stage Renal Disease and is dependent on dialysis, did not receive the required shunt site assessments. The resident's Pre/Post Dialysis Communication forms were often incomplete, and the Medication Administration Record and Treatment Administration Record indicated that the shunt site was not assessed every shift as ordered. The Director of Nursing acknowledged the deficiencies in completing the communication sheets and the failure to perform the necessary shunt site assessments.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Elkhorn
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Brookestone Meadows Rehabilitation And Care Center | 2.5 mi | — | 0 | 0 |
| The Lighthouse At Lakeside Village | 4.3 mi | — | 0 | 0 |
| Rose Blumkin Jewish Home | 6.2 mi | — | 1 | 0 |
| Arbor Care Center-valhaven, Llc | 6.4 mi | — | 0 | 0 |
| The Banyan At Montclair | 6.6 mi | — | 15 | 0 |
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