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St. Luke Lutheran Nursing Home: Assessment Failures - IA
The citation, issued under a federal tag that governs resident assessment accuracy, found that St....
Latest reports, citations, and penalties from CMS data
The citation, issued under a federal tag that governs resident assessment accuracy, found that St....
The citation also covered a related failure: not always having a licensed nurse in charge on each shift....
The failure came to light during a complaint inspection on September 2, 2025....
The resident, identified in inspection records only as Resident #2, was sent out of the facility after the error....
The September 2 inspection, triggered by a complaint, found the violation serious enough to be cited as causing actual harm....
The wounds were stage 3 pressure ulcers, meaning they had already eaten through the full thickness of the skin and into the tissue below....
That's the core of what federal inspectors found at Maple Crest Health Center in Omaha this September....
The resident, identified in inspection records only as Resident 5, had chronic kidney disease and diabetes....
Inspectors from the Centers for Medicare and Medicaid Services visited Colonial Manor Nursing Center on September 4, 2025, responding to a complaint....
When a facility moves someone, the Ombudsman is supposed to know....
The citation fell under the category of quality of life and care deficiencies....
The facility's Safe Resident Handling Program, last reviewed on July 7, 2025, spelled out the requirements in plain terms....
The severity level assigned was a D, meaning inspectors characterized the lapse as isolated and found no documented actual harm....
The resident, identified in inspection records as R7, had been cussing out staff....
The resident developed swelling in the thigh with what staff described as a bruise-type area....
They needed supervision to go from sitting to standing and required partial to moderate assistance with toilet hygiene....
The citation falls under what federal regulators classify as a quality of care deficiency....
That finding came out of a complaint inspection completed September 3, 2025....
Inspectors classified the deficiency as isolated, meaning it didn't touch every resident....
The September 3, 2025 inspection was triggered by a complaint....