OMAHA, NE - The Life Care Center of Omaha was cited for multiple care deficiencies during a July 2024 federal inspection, including failures to complete required care plans, provide adequate activities for residents, and follow feeding tube protocols according to inspection records from the Centers for Medicare & Medicaid Services.
Critical Care Planning Failures Leave Residents Without Proper Treatment Plans
Inspectors found that the 81-bed facility failed to develop baseline and comprehensive care plans for at least one resident, violating federal requirements designed to ensure continuity of care during the critical first days after admission. The violations centered on Resident 79, whose care plans remained incomplete despite federal mandates requiring these documents within specific timeframes.
The baseline care plan, which must be completed within 48 hours of admission, was never developed for the resident. According to inspection records, the facility's Point Click Care system showed blank fields with no information about the resident's physical or medical needs, goals, or interventions. The Assistant Director of Nursing confirmed during the inspection that the baseline care plan contained no information to guide staff in caring for the resident's immediate needs.
Federal regulations require baseline care plans to include minimum healthcare information necessary to properly care for residents immediately upon admission. These plans must contain initial goals, medication summaries, dietary instructions, and treatment protocols. The facility's own policy, dated August 22, 2023, states that each resident must have a person-centered comprehensive care plan addressing medical, physical, mental, and psychosocial needs.
The inspection also revealed that the facility failed to complete a comprehensive care plan after conducting the required federal assessment. Despite completing a Minimum Data Set assessment on June 28, 2024, which identified that the resident used mobility equipment and required assistance with daily activities including oral hygiene, showering, toileting, and dressing, the comprehensive care plan dated June 22, 2024, contained only one focus area related to advance directives.
This represents a critical gap in care coordination. Comprehensive care plans serve as roadmaps for all staff members, ensuring consistent, appropriate care delivery. The federal Minimum Data Set assessment revealed the resident needed substantial assistance with transfers and multiple daily activities, yet this information was not translated into actionable care instructions for nursing staff.
Medication Administration Errors Put Feeding Tube Patient at Risk
The facility violated federal standards for enteral feeding management when nursing staff administered tube feeding at incorrect times and in improper amounts to a resident with swallowing difficulties. Resident 63, who relied on tube feeding for more than 51% of total calories due to dysphagia and anoxic brain damage, received an unscheduled feeding that could have compromised safety protocols.
During the July 18, 2024 inspection, investigators observed a registered nurse administering tube feeding at 9:12 AM when the resident's prescribed schedule called for feedings at midnight, 6 AM, noon, and 6 PM. The nurse gave 150 cubic centimeters of Jevity 1.5 formula with a 50 cc water flush at 9:10 AM, three hours before the scheduled noon feeding.
The timing violation is medically significant because tube feeding schedules are carefully calculated to prevent complications such as aspiration, gastric distention, and metabolic imbalances. When feedings are administered too close together, residents face increased risks of nausea, vomiting, and potential aspiration of stomach contents into the lungs, which can cause pneumonia.
The nurse documented having difficulty administering the feeding and contacted the resident's nurse practitioner about the problems. Progress notes revealed that the Advanced Practice Registered Nurse was notified about the timing error and ordered staff to monitor the resident's bowel sounds before proceeding with the regularly scheduled noon feeding.
Proper tube feeding administration requires strict adherence to physician orders regarding timing, amount, and flushing protocols. The facility's own gastric enteral tube feeding checklist identifies verifying the practitioner's order as the essential first step in the process. The Assistant Director of Nursing confirmed during the inspection that the timing requirements were not followed.
Inadequate Activities and Fall Prevention Measures
The inspection revealed systematic failures in providing required activities for residents with significant care needs. Resident 63, who required bedside activities due to mobility limitations, received minimal programming despite care plan requirements for 1-2 weekly activities.
Documentation showed the resident accepted only one individual visit between July 1-18, 2024, and three visits during June 2024. The resident's care plan specifically called for one-on-one bedside visits when unable to attend group activities, with preferences noted for country music. However, observations on multiple days found the resident in bed with no activities occurring.
The Activity Director acknowledged that more visits may have been provided than documented but confirmed that activities were limited when residents were not out of bed. This approach contradicts the resident's care plan, which specifically addresses the need for bedside activities and recognizes the resident's dependency on staff for meeting emotional, intellectual, physical, and social needs.
Federal regulations require nursing homes to provide activities that meet each resident's interests and functional capacity. The facility had developed a comprehensive list of bedside activity options including music, crafts, correspondence assistance, games, and reality orientation exercises, but failed to implement these interventions consistently.
The facility also failed to implement fall prevention measures outlined in the resident's care plan. Despite having two documented falls since admission and a care plan requiring bed wedges, low bed positioning, and frequent monitoring, inspectors observed the resident with feet hanging off the bed edge and no positioning wedges in place. Staff confirmed that required safety equipment was not being used consistently, creating ongoing fall risks for a vulnerable resident.
Mental Health Screening Requirements Overlooked
The facility violated federal PASARR (Preadmission Screening and Resident Review) requirements by failing to identify a resident's bipolar disorder diagnosis during the initial screening process. The Social Services Director confirmed that the resident had a bipolar disorder diagnosis upon admission but this was not identified during the mandatory Level I screening.
PASARR regulations require nursing facilities to screen all potential residents for mental illness and intellectual disabilities before admission. When mental health conditions are identified, facilities must request Level II evaluations from state authorities to determine appropriate specialized services. The facility acknowledged that a referral for Level II screening should have been made once the omission was discovered.
This screening process is designed to ensure that residents with mental health conditions receive appropriate specialized services and are placed in the most suitable care setting. Failure to properly screen can result in residents not receiving necessary mental health services and supports that could improve their quality of life and prevent behavioral crises.
Additional Issues Identified
The inspection documented several other compliance concerns:
- Environmental safety protocols requiring ongoing monitoring to prevent accidents and injuries - Documentation procedures needing improvement to ensure accurate record-keeping - Staff training requirements related to care plan implementation and federal regulation compliance - Quality assurance processes requiring enhancement to prevent future violations
These violations reflect systemic challenges in care coordination, staff training, and quality oversight that can significantly impact resident safety and wellbeing. The Centers for Medicare & Medicaid Services requires nursing homes to maintain detailed correction plans addressing each identified deficiency and demonstrating how similar problems will be prevented in the future.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Life Care Center of Omaha from 2024-07-23 including all violations, facility responses, and corrective action plans.
💬 Join the Discussion
Comments are moderated. Please keep discussions respectful and relevant to nursing home care quality.