Mid-nebraska Lutheran Home
Inspection Findings
F-Tag F0610
F 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.02(H)Based on observation, record review and interview; the facility failed to complete an investigation and report the results of the investigation to the State Agency for an injury of unknown origin for 1 (Resident 8) of 2 sampled residents. The facility census was 30.Findings are:A. Review of the facility policy Reporting Abuse to State Agencies and other Entities/Individuals dated 12/1/2017 revealed all suspected violations and all substantiated incidents of mistreatment, neglect, injuries of an unknown source or abuse were to be reported to the Administrator or their designee. In addition, the following agencies or persons were to be notified of the incident:-the State licensing/certification agency.-the ombudsman.-the resident's representative.-Adult Protective Services (APS). -the resident's physician. Notices to the agencies were to be made as soon as possible with the maximum notification within 24 hours and if actual harm, APS was to be notified within 2 hours. The Administrator or designee were to then complete an investigation and then send the results of the investigation to the appropriate agencies within 5 working days. B. Review of Resident 8's Minimum Data Set (MDS-federally mandated comprehensive assessment used to develop resident care plans) dated 6/27/25 revealed the resident was admitted on [DATE REDACTED]; had severe cognitive impairment; was dependent on staff for toileting cares, bathing cares, upper and lower extremity dressing, repositioning in bed, moving from bed to chair and from chair to bed and all wheel chair mobility; had physical behaviors and other behavioral symptoms not directed at others (hitting or scratching self); had diagnosis of Non-Alzheimer Dementia (a progressive decline in cognition ability that is not caused by Alzheimer's Disease) and Psychotic Disorder. Review of a Nursing Progress Note dated 9/16/25 at 4:01 PM revealed the physician was notified of yellow bruising to the top of
the right foot that measured 15 centimeters (cm) by 13 cm with minimal swelling and purple and yellow bruising to the bottom of the right foot that measured 9 cm by 7 cm with minimal swelling noted. Review of
the investigation completed by the facility on 9/17/25 revealed the staff determined the resident's foot had potentially bumped into the mechanical lift during a transfer. Further review revealed no staff were interviewed regarding the use of the mechanical lift for the resident or an evaluation was not completed to ensure the staff were transferring the resident safely. An observation on 9/18/25 at 10:35 AM revealed that
the resident had yellow bruising to the top of the right foot and the bottom of the foot had yellow/purple bruising with minimal swelling to foot. Resident had no response when asked if the right foot hurt. An
interview on 9/22/25 at 1:00 PM with the Director of Nursing and Administrator confirmed that the bruising and swelling to Resident 8's right foot was an injury of unknown origin and that staff failed to complete a thorough investigation to determine the cause of the resident's bruising and swelling to the right foot and no investigation was sent to the Agency.
Residents Affected - Few
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:
Mid-Nebraska Lutheran Home in Newman Grove, 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 Newman Grove, 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 Mid-Nebraska Lutheran Home or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.