Life Care Center Of Elkhorn
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.04(F)(i)(5) Based on interview and record review the facility failed to update the medical practitioner of changes in daily weights for 1 (Resident 1) of 3 resident sampled. The facility census was 83. The findings are:Record review of the Facility Policy titled Changes in Resident's Condition or Status dated 08-29-2025 revealed the facility will notify, his/her primary care provider, and resident/resident representative of changes in the resident's condition or status. The facility must immediately inform the resident and consult the resident's physician when there is a need to alter treatment significantly (That is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment.Record review of Resident 1's Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) dated 09-19-2025 revealed the facility staff assessed
the following about the resident:-date of admission [DATE REDACTED].-Brief Interview of Mental Status (BIMS) was scored as a 15. According to the MDS Manual a score of 13-15 indicates a person is cognitively intact.-required extensive assistance with dressing, hygiene and bed mobility.-required total assistance with transfers, toileting and bathing.-had a diagnosis of Heart Failure. Record review of Resident 1's Order Summary (OS) printed on 11-06-2025 revealed an order for 08-28-2025 for a daily weight call for any weight increase of 1-5 lbs. Record review of Resident 1's MAR for September 2025 revealed an order dated 08-28-2025 for daily weights, call the physician for any weight increases of 1- 5 lbs. The September MAR also revealed the following weights:09-03-2025-weight 171.4 pounds (lbs.).09-04-2025-weight 180 lbs. (a gain of 8.6 lbs. in one day).09-11-2025 hospitalized .Review of the residents medical record that included Progress notes, Faxes, Practitioners orders revealed there was no indication the facility staff had notified
the practitioner of Resident 1's weight gain. Record review of Resident 1's OS printed on 11-06-2025 revealed an order dated 9-18-2025 for daily weights, call the physician for any weight increase of 1 to 5 lbs.Record review of Resident 1's MAR for September revealed an order dated 09-17-2025 for daily weights, call for any weight increase of 1 to 5 lbs. Further review revealed the following dates and weights:09-18-2025-weight 164.1 lbs.09-19-2025-weight 170.8 lbs. (a gain of 6.7 lbs.)09-22-2025-weight 166.8 lbs.09-23-2025-weight 170.7 lbs. (a gain of 3.9 lbs.)09-25-2025-weight 166.7 lbs.09-26-2025-weight 170.5 lbs. (a gain of 3.8 lbs.)09-28-2025-no weight listed09-30-2025-weight NA An interview conducted with the Director of Nursing (DON) on 11-06-2025 at 1:15 PM confirmed Resident 1 had an order to call the physician with any weight increase of 1 to 5 lbs., and the physician was not updated on the weight increase from 09-03-2025 and 09-04-2025 of 8.6 lbs. and should have been.An interview with the DON on 11-06-2025 at 1:10 PM confirmed Resident 1's practitioner had not been notified of the 6.7 lbs. weight increase between 09-18-2025 and 9-19-2025, the 3.9 lbs. weight increase between 9-22-2025 and 09-23-2025 and the 3.8 lbs. increase between 09-25-2025 and 09-26-2025 and should have been.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
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
11/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Life Care Center of Elkhorn
20275 Hopper Street Elkhorn, NE 68022
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 F0684
F 0684 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
observation on 11-05-2025 at 12:50 PM revealed Resident 1 was in the dining room for lunch and was served a Styrofoam cup filled with water. An observation on 11-06-2025 at 3:50 AM revealed Resident 1 was in bed with eyes closed and there was a large blue cup with a white lid that was about half full of liquid,
on the bedside table in Resident 1's reach. Resident 1 woke up during this observation and revealed the blue cup with a white lid was water that was brought to him in the night. An interview conducted with the Medication Aid (MA) D on 11-06-2025 at 4:05 AM revealed Resident 1 gets one of the blue cups with a white lid of water for the whole night shift every night. An interview conducted on 11-06-2025 at 4:10 AM with Registered Nurse (RN) B revealed RN B had not received report for Resident 1, was unaware of the fluid restriction for Resident 1, or how much fluid Resident 1 had received for the night shift. RN B also revealed (gender) was unaware of being assigned to the hall Resident 1 resided on until a couple hours prior to being interviewed. An interview conducted on 11-06-2025 at 9:10 AM with Licensed Practical Nurse (LPN) A revealed the amount of fluids documented on the MAR for November 2025 is the amount nursing provided to Resident 1 and dietary staff write down what their department provides. An interview conducted with the Dietary Aid (DA) E on 11-06-2025 at 9:15 AM revealed Resident 1 gets a white Styrofoam cup of fluids with each meal. When asked how much the Styrofoam cup holds, she replied 12 ounces (360 ml's).
When asked how much the blue cup with the white lid holds DA E said it holds 12 ounces (360 ml's). DA-E also revealed the dietary staff do not record what fluids are provided by the dietary department. An
interview with [NAME] F on 11-06-2025 at 9:20 AM revealed the dietary staff do not record or write down what fluids are provided from the dietary department. Record review of Resident 1's dietary meal ticket dated 11-6-2025 revealed Resident 1 was on a 1400 ml fluid restriction and was to receive 1 beverage only per meal for fluid restriction and heart failure. The ticket did not indicate the amount of fluids to be provided with each meal. Record review of Resident 1's MAR for November 2025 revealed Resident 1's practitioner had ordered on 10-03-2025 a 1440 ml's fluid restriction per day. The dietary staff was to provide 320 ml's for breakfast, lunch and dinner and nursing was to provide 200 ml's on day and evening shift and 80 ml's on night shift. An interview conducted on 11-06-2025 at 10:00 AM with the DON confirmed Resident 1's fluid restriction was not consistently monitored and should have been. An interview conducted on 11-06-2025 at 11:30 AM with RN G revealed the facility process was to record on the MAR what the resident received from dietary and nursing for the shift and then the total fluids are calculated for the entire 24-hour period, to ensure the fluid restriction was followed. An interview conducted with the DON on 11-06-2025 at 12:10 PM revealed the DON was not aware of how the IV fluids were included in the daily total fluid intake for Resident 1. The DON also confirmed the maroon-colored coffee cups hold 8 ounces (240 ml's) and the cup of coffee provided to Resident 1 on 11-05-2025 at 11:25 AM was not recorded and should have been. The DON reported (gender) would have to inform the activity staff not to provide fluids to Resident 1 during activities. An interview conducted with the DON on 11-06-2025 at 1:10 PM revealed the facility did not have
a policy for the implementation of a fluid restriction. The facility was unable to provide additional information relative to the fluid restriction for Resident 1 prior to exit.
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
11/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Life Care Center of Elkhorn
20275 Hopper Street Elkhorn, NE 68022
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 F0695
Federal health inspectors cited Life Care Center of Elkhorn in Elkhorn, NE for a deficiency under regulatory tag F-F0695 during a complaint investigation conducted on 2025-11-06.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide safe and appropriate respiratory care for a resident when needed.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 3 deficiencies cited during this inspection of Life Care Center of Elkhorn.
Correction Status: Deficient, Provider has no plan of correction.
Life Care Center of Elkhorn in Elkhorn, 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 Elkhorn, 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 Life Care Center of Elkhorn or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.