Hillcrest Health & Rehab
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
BM. If there have been no results from the PRN bowel medication by the following day, the nurse should administer further PRN medications as ordered. The provider should be called if no results from the above interventions.
Record review of Resident 2's bowel records revealed Resident 2 did not have BM from 12-10-2025 to 12-17-2025 and no BM from 12-26-2025 to 12-30-2025.
Record review of Resident 2's Medication Administration Record (MAR) for December 2025 revealed no PRN bowel medications were administered between 12-10-2025 and 12-17-2025 or 12-26-2025 and 12-30-2025.
An interview conducted with Licensed Practical Nurse (LPN) I on 12-30-2025 at 6:35 AM revealed the night shift nurse runs a report from the Electronic Health Record and a list of residents that have not had a BM for 3 days are placed on the list. The list is communicated through shift change report and each resident on
the list are given the PRN bowel medication.
An interview conducted with Nurse Tech (NT) H on 12-30-2025 at 7:40 AM revealed when Resident 2 had a BM, the staff document the BM in the Electronic Health Record.
An interview conducted with the Clinical Care Coordinator (CCC) G on 12-30-2025 at 2:30 PM confirmed Resident 2 was not provided with PRN bowel medications between 12-10-2025 and 12-17-2025 or 12-26-2025 and 12-30-2025 and should have been.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hillcrest Health & Rehab
1702 Hillcrest Drive Bellevue, NE 68005
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0686
F 0686
- 12/05/2025
Level of Harm - Actual harm
- 12/12/2025
Residents Affected - Few
- 12/19/2025 - 12/22/2025
A record review of Resident 4's Progress Notes dated 06/05/2025 - 12/28/2025 revealed RN-F completed a skin evaluation on 11/19/2025 and the wound treatment was completed.
In an interview on 12/30/2025 at 9:55 AM, RN-F confirmed if RN-F completed the wound care during a skin evaluation, then RN-F would mark it off as being completed, but failed to mark it off on 11/19/2025.
In an interview on 12/30/2025 at 2:25 AM, RN-F confirmed Resident 4's left medial metatarsal wound care orders were not completed on 9/26/2024, 9/29/2025, 10/6/2025, 10/17/2025, 10/31/2025, 11/17/2025, 12/5/2025, 12/12/2025, 12/19/2025, or 12/22/2025 and should have been.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hillcrest Health & Rehab
1702 Hillcrest Drive Bellevue, NE 68005
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0689
F 0689
-pillows removed from wheelchair and a cushion ordered by hospice. Dated 09-08-2025.
Level of Harm - Minimal harm or potential for actual harm
-if Resident 2 is restless during the day or night, staff were to bring resident out of room and set up a western movie to be watched in the day room dated 09-09-2025
Residents Affected - Few
-keep room clear of any obstacles dated 11-29-2024. -rounds to be increased when resident in the room to prevent resident from getting up without assistance dated 11-10-2025/ -Dycem and cushion placed to the seat of the recliner to prevent sliding out of the chair dated 11-05-2025. -staff to offer toileting frequently during each shift.
An observation conducted on 12-29-2025 at 11:18 AM revealed Resident 2 was sitting in wheelchair in room and Resident 2's bell was sitting on dresser next to the television.
An observation conducted on 12-29-2025 at 2:35 PM revealed Resident 2 was in bed, call light in reach and bell was still on the dresser next to the television out of Resident 2's reach.
An observation conducted on 12-30-2025 at 6:20 AM revealed Resident 2 was lying in bed and unable to observe the location of the call light and the bell was on the dresser next to the television out of Resident 2's reach.
An observation conducted on 12-30-2025 at 7:40 AM revealed Resident 2 was in bed and Nurse Tech (NT) H entered the room to provide assistance. NT H confirmed Resident 2 did not have a call light in reach or
the bell and took the bell off of the dresser next to the television and placed it on Resident 2's bedside table.
An interview conducted with NT H on 12-30-2025 at 11:20 AM revealed Resident 2's call light was broken and a work order had been placed for it to be repaired.
An interview conducted with the Environmental Service Director (EVSD) on 12-30-2025 at 12:30 PM revealed a work order had not been placed for the repair of Resident 2's call light.
An interview conducted with the Assistant Director of Nursing (ADON) on 12-30-2025 at 12:35 PM confirmed that Resident 2 was without a call light and bell for over an hour and should a call light and hand bell in reach.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
12/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hillcrest Health & Rehab
1702 Hillcrest Drive Bellevue, NE 68005
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0880
F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
An observation on 12/29/2025 at 2:24 PM revealed Resident 4's room did not have an EBP sign posted, and no gowns were available. RN-N entered the resident's room and completed wound care orders on the resident's left medial metatarsal pressure ulcer. RN-N did not donn (put on) a gown prior to completing wound care. During the wound care, RN-N removed the right-hand glove and held the dressing against the wound with the ungloved right hand while taping the dressing. RN-N then walked down the Ivy Court hallway to the nurse's station.
An observation on 12/29/2025 at 2:58 AM revealed Resident 4's room did not have an EBP sign posted, and no gowns were available. RN-F, the wound nurse, completed wound care orders on the resident right knee surgical incision without donning a gown. RN-F kneeled on the floor with RN-F's clothing directly touching Resident 4's carpeting. RN-F then exited the resident's room, walked down the Ivy Court hallway to the laundry room on Ivy Lane, then continued down the main hall to the Registered Dietician's office (shared with RN-F) and then down the [NAME] Way hallway.
In an interview on 12/29/2025 at 2:57 PM, RN-F, the wound nurse confirmed that RN-F was unsure why Resident 4 was not in EBP.
In an interview on 12/29/2025 at 3:05 PM, the Assistant Director of Nursing (ADON), Infection Preventionist, confirmed that Resident 4 should have been in EBP and was not. The ADON confirmed staff should have worn a gown and gloves during wound care.
B. Observation on 12/29/2025 at 2:44 PM revealed six recliners in the commons area centered around a television with vinyl that had peeled away from the arm rests and the seats, which prevented the surface from being able to be fully cleaned.
An interview on 12/30/2025 at 7:47 AM with the Environmental Services Director (EVSD) confirmed the chairs were missing vinyl and were unable to be cleaned.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Hillcrest Health & Rehab in Bellevue, NE inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Bellevue, NE, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Hillcrest Health & Rehab or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.