Life Care Center Of Omaha

Federal health inspectors cited Life Care Center of Omaha in Omaha, NE for a deficiency under regulatory tag F-F0605 during a standard health inspection conducted on 2025-09-15.

Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies

The facility was found deficient in the following area: Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Scope/Severity Level E: pattern, 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 10 deficiencies cited during this inspection of Life Care Center of Omaha.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-20.

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for

a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09(G) Based on interview and record review, the facility failed to complete a discharge plan for 1 (Resident 102) of 2 sampled residents. The facility census was 98. Findings are:A record review of Resident 102's Progress Notes dated 09/11/2025 revealed the resident was discharged to home on [DATE REDACTED]. A record review of Resident 102's Notice Of Resident Transfer Or Discharge dated 08/18/2025 revealed the resident discharged to home and the box was marked that the resident's health had improved sufficiently and no longer needed the services provided by the facility. A

record review of Resident 102's Discharge Summary Information dated 08/18/2025 revealed the resident was discharged to home. The reason for discharge was patient request. The resident was educated on the discharge process and was not expected to return. A record review of Resident 102's Care Plan with an admission date of 08/08/2025 did not reveal a Focus area or interventions for the discharge plan. A record

review of Resident 102's Baseline Care Plan dated 08/08/2025 revealed the box for Discharge Plan was not checked. In an interview on 09/10/2025 at 11:50 AM, the facility's Regional Nurse Consultant (RNC)-A confirmed there was not a discharge plan done for Resident 102 and it should have been done.

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

09/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Omaha

6032 Ville DE Sante Drive Omaha, NE 68104

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)

Federal health inspectors cited Life Care Center of Omaha in Omaha, NE for a deficiency under regulatory tag F-F0628 during a standard health inspection conducted on 2025-09-15.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

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 10 deficiencies cited during this inspection of Life Care Center of Omaha.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-20.

F 0641

Ensure each resident receives an accurate assessment.

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 12-006.09 Based on observation, interview and record review the facility failed to accurately code the Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) for 1 (Resident 13) of 1 residents sampled. The facility census was 98. The findings are:Record

review of Resident 13's MDS dated [DATE REDACTED] revealed the facility staff assessed the following about the resident:-Brief Interview of Mental Status (BIMS) was scored as a 15. According to the MDS Manual a score of 15 indicates a person is cognitively intact.-required limited assistance with upper body dressing.-required extensive assistance with bed mobility and lower body dressing.-required total assistance with toileting, bathing, and transfers-oral and dental status including edentulous and loosely fitting dentures were not present. An observation on 09-08-2025 at 10:36 AM revealed Resident 13 was edentulous. During the observation a interview conducted with Resident 13 with Resident 13 reporting the dentures were to big. An interview conducted on 09-15-2025 at 10:15 AM with the Regional Director of Clinical Reimbursement confirmed the MDS was coded incorrectly for Resident 13's oral status.

Residents Affected - Few

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

09/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Omaha

6032 Ville DE Sante Drive Omaha, NE 68104

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)

Federal health inspectors cited Life Care Center of Omaha in Omaha, NE for a deficiency under regulatory tag F-F0657 during a standard health inspection conducted on 2025-09-15.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

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 10 deficiencies cited during this inspection of Life Care Center of Omaha.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-20.

Federal health inspectors cited Life Care Center of Omaha in Omaha, NE for a deficiency under regulatory tag F-F0684 during a standard health inspection conducted on 2025-09-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide appropriate treatment and care according to orders, resident’s preferences and goals.

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 10 deficiencies cited during this inspection of Life Care Center of Omaha.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-20.

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

According to the MDS manual, a score of 13 indicated the resident was cognitively intact. Further review of

the MDS identified Resident 9 required supervision while eating and was dependent upon staff for all other activities of daily living including transfers and mobility.

Record review of Resident 9's “Progress Notes” printed 9/9/2025 revealed: -7/8/2025: “Bath aide called nurse to show purple bruise to left front shoulder. Resident not sure how she got this, denies pain to area. Message left with family to return call to facility. NP [nurse practitioner], DON notified.”

Record review of a facility provided document “Skin Related Injury” dated 7/8/2025 involving Resident 9 revealed after facility investigation, the determined cause of the bruise to the shoulder was related to wheelchair positioning. Further review of the document showed a note dated 7/9/2025 “therapy applied a wedge in between knees to assist with positioning.”

Record review of Resident 9's CCP revealed interventions to place an abductor wedge between the knees and make sure wedge is in place between resident and armrest on right side while in wheelchair dated revised 5/8/2025.

An observation on 9/11/2025 at 10:34 AM revealed a standard foam cushion in the seat of Resident 9's wheelchair. Nurse Aide (NA)-B utilized a gait belt, performed a stand pivot transfer with Resident 9, and seated Resident 9 in the wheelchair. No wedge was placed between the resident and the armrest of the wheelchair, nor was an abductor wedge placed between Resident 9's knees.

An observation on 9/15/2025 at 11:45 AM revealed Resident 9 seated in the wheelchair in the main dining room. A standard foam cushion was in the seat of the wheelchair. No further positioning devices were present.

An interview on 9/11/2025 at 10:34 AM with NA-B revealed [gender] works with Resident 9 approximately half of NA-B's scheduled shifts. NA-B further revealed that [gender] was never made aware that Resident 9 required positioning devices to prevent the potential for further injury. NA-B reported that [gender] has never seen cushions or wedges in use with Resident 9.

An interview on 9/15/2025 at 11:50 PM with the Director of Nursing confirmed the resident did not have any wedge or abductor wedge in use for Resident 9.

An interview on 9/15/2025 at 12:20 PM with the Director of Rehabilitation (DOR) confirmed Resident 9 should have an abductor wedge between the knees. The DOR reported that the wedge between the resident and the right side of the wheelchair was no longer an active intervention.

Record review of a facility policy entitled “Incident and Reportable Event Management” dated reviewed 9/25/24 revealed: -The Five “I's” to Event Management: -Intervention -1. The licensed nurse should implement an appropriate immediate intervention, based on the conclusions of the initial investigation. -2. The licensed nurse should update the resident care plan and communicate the intervention to the staff caring for the resident. -3. The IDT will, as part of their review, determine if the initial intervention is sufficient or if a modification is needed. Any changes from the initial intervention will be documented on the resident's care plan and communicated to the staff caring for the resident.

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

09/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Omaha

6032 Ville DE Sante Drive Omaha, NE 68104

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 0732

Post nurse staffing information every day.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to ensure that the posted nurse staffing information contained the required information related to the total number of actual hours worked per discipline. This had the potential to affect all residents that resided in the facility. The facility staff identified a census of 98.Record reviews of 30 days of past posted nurse staffing between 8/10/25 and 9/10/25 revealed the daily posted nurse staffing did not contain the total number of actual hours worked for the different types of staff.An interview on 9/15/25 at 1:02 PM with the facility Administrator confirmed the nurse staff posting information did not contain the total number of actual hours worked per discipline and that the hours had not been calculated or documented on the posted nurse staffing and should have been.

Residents Affected - Many

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

09/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Life Care Center of Omaha

6032 Ville DE Sante Drive Omaha, NE 68104

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)

Federal health inspectors cited Life Care Center of Omaha in Omaha, NE for a deficiency under regulatory tag F-F0757 during a standard health inspection conducted on 2025-09-15.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure each resident’s drug regimen must be free from unnecessary drugs.

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 10 deficiencies cited during this inspection of Life Care Center of Omaha.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-20.

F 0759

Ensure medication error rates are not 5 percent or greater.

Level of Harm - Minimal harm or potential for actual harm

Licensure Reference Number 175 NAC 12-006.10(D) Based on observation, interview and record review

the facility failed to ensure a medication error rate of 5% or less as evidenced by 2 medication administration errors out of 25 opportunities for error, resulting in an error rate of 8%. The facility census was 98. The findings are:Record review of the facility policy titled Medication Administered through an Enteral Tube (feeding tube) dated 11-15-2024 revealed medications are administered by authorized and qualified facility staff, as prescribed, in accordance with standard nursing principles and practices. Insert medication syringe into the appropriate port and pour each medication through the syringe. Medications should be prepared and given separately. Do not mix medications together in a medication syringe. Record

review of Resdient 3's Minimum Data Set (MDS: a federally mandated assessment tool used for care planning) revealed the facility staff assessed the following about the resident:-required total assistance with eating, hygiene, bathing, dressing, toileting, transfers and bed mobility.-had a feeding tube (a tube inserted into the gastrointestinal tract to deliver nutrition, fluids and medications). An observation on 09-15-2025 at 1:37 PM was conducted of Licensed Practical Nurse (LPN) F administering medication to Resident 3 revealed hydralazine 75 milligram (mg) tablet and baclofen 5 mg tablet were to be administered. LPN F removed the tablets from the medication cards and placed both medications in a clear pouch and inserted

the pouch into the pill crusher and crushed the medications together. After the medications were crushed

the medications were poured out of the clear pouch and into a clear medicine cup. Then LPN F along with LPN G went to Resident 3's room to administer the medication. LPN F poured approximately 3 teaspoons of water into the cup with medications and stirred it with a plastic spoon until the medication had dissolved.

Resident 3's tube feeding was placed on hold by LPN F and a feeding syringe was inserted into the resident feeding port and after checking placement, LPN F flushed the feeding tube with water and then administered both medications dissolved in water through the feeding tube followed by a water flush. LPN G was present during the observation and was training LPN F. An interview with LPN G on 09-15-2025 at 1:45 PM reveals Resident 3's physician had given an order for medications to be crushed and administered together through the feeding tube. An interview with the Director of Nursing on 09-15-2025 confirmed Resident 3 did not have an order for medications to be crushed and administered together through the feeding tube and confirmed medications should not have been crushed and administered together for Resident 3.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet