Life Care Center Of Omaha
Inspection Findings
F-Tag F0686
F 0686 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Administration Record (MAR) for October 2025 revealed no order for Prosource 30 mls twice a day. Record
review of Resident 3's WOT dated 10-28-2025 revealed the stage 2 pressure ulcer to the coccyx measured 7.25 cm in length by 7.66 cm in width by 0.0 depth and staged as a 2. The WOT also indicated the wound was declining and the treatment plan was to cleanse the wound with wound cleanser, rinse and pat dry and apply Hydrofera Blue with water resistant Mepilex change daily and as needed for soiling.Record review of Resident 3's Progress Notes (PN) dated 10-31-2025 revealed there was a decline in wounds to coccyx/sacral region and the wound nurse assessed the wounds and new treatment orders were obtained.Record review of Resident 3's Electronic Health Record (EHR) revealed no wound assessment on 10-31-2025.Record review of Resident 3's TAR for October 2025 revealed no new treatment orders for the wounds to the coccyx/sacral region.Record review of Resident 3's OS printed on 11-17-2025 revealed an order dated 11-04-2025 to Cleanse with wound cleanser, rinse, pat dry, and apply Hydrofera Blue, cut to fit wounds and cover with Duoderm (a wound dressing that provides a moist protective environment to promote wound healing) every other day for wound care.Record review of Resident 3's TAR for November 2025 revealed an order dated 11-01-2025 to cleanse with wound cleanser, rinse, pat dry and apply Hydrofera Blue, cut to fit wounds and cover with a water resistant Mepilex. Change daily and as needed for soiling.Record review of Resident 3's Tissue Analytics Wound Assessment ([NAME]) dated 11-11-2024 revealed the wound to the sacral/coccyx was staged as a 3 (a deep wound that has full thickness skin loss) and measured 2.86 cm in length and 2.90 cm in width and 0.0 cm depth. Record review of Resident 3's MAR for November 2025 revealed the absence of an order for Prosource 30 mls twice a day. Record review of Resident 3's TAR for November 2025 revealed an order dated 11-04-2025 to cleanse with wound cleanser, rinse, pat dry and apply Hydrofera Blue, cut to fit wounds and cover with Duoderm every other day.An observation 11-19-2025 at 1:30 PM of Registered Nurse (RN) A providing wound care to Resident 3's sacral/coccyx region revealed an open wound to the coccyx that was tear drop shaped and approximately 1.5 cm in length by 1 cm in width, another wound below the coccyx wound to the sacral area that was approximately 3 cm in length and 4 cm in width, and another wound to the right buttock that was round and approximately 3.5 cm by 3.5 cm. An interview conducted with RN A on 11-19-2025 at 1:40 PM
during wound care revealed the wound to the coccyx and the right buttock were stage 2 pressure ulcers and the sacral wound was a stage 3 pressure ulcer. An interview conducted with RN A on 11-19-2025 at 3:30 PM confirmed a wound treatment was not provided for Resident 3's pressure ulcer to the coccyx until 10-22-2025, 5 days after the pressure ulcer was identified and also confirmed the recommendation for Prosource 30 mls twice a day was not implemented and Resident 3's wounds have increased in number and 1 of the pressure ulcers is now a stage 3.
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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
11/19/2025
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-Tag F0693
F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09(H)(vi)(3) and 12-006.09(J).Based on observation, interview and
record review the facility failed to ensure a tube feeding was running continuously for 1 (Resident 2) of 3 residents sampled and failed to provide treatment to a feeding tube insertion site according to the practitioner's orders for 1 (Resident 7) of 3 residents sampled. The facility census was 94. The findings are:Record review of the facility policy titled Enteral Nutrition Therapy (Continuous) dated 09-05-2025 revealed the facility will provide continuous enteral nutrition therapy in accordance with physician's orders and professional standards of practice. Record review of the facility policy titled Treatment Orders dated 06-12-2025 revealed treatment orders are written per physician's orders. The physician orders are followed as are the manufacturer's instructions for use for each product ordered.A.Record review of Resident 2's Minimum Data Set (MDS: a federally mandated assessment tools used for care planning) revealed the facility staff assessed the following about the resident:-could rarely or never make themselves understood-required total assistance for eating, dressing, grooming, toileting, bathing, bed mobility and transfers.-had a feeding tube. Record review of Resident 2's Order Summary printed on 11-17-2025 revealed an order for Jevity 1.5 (a tube feeding formula) per feeding tube at 40 milliliters (ml) per hour for 24 hours a day. An observation conducted on 11-19-2025 at 2:32 PM revealed Resident 3 was lying in bed and the tube feeding pump was not administering the tube feeding. The pump was beeping and the screen
on the pump said the pump had been idle for 10 minutes. An observation conducted on 11-19-2025 at 3:25 PM revealed Resident 3 was lying in bed, the feeding pump was beeping and not administering the tube feeding and screen on the pump said the pump had been idle for 10 minutes. An interview conducted on 11-19-2025 at 3:30 PM with Licensed Practical Nurse (LPN) B revealed (gender) was the nurse for Resident 2 and confirmed the tube feeding was not running and should have been running at 40 ml per hour and confirmed LPN B had not restarted the tube feeding pump in the last hour. B.Record review of Resident 7's MDS dated [DATE REDACTED] revealed the facility staff assessed the following about the resident:-Brief
Interview of Mental Status (BIMS) was scored as 12. According to the MDS Manual a score of 8 to 12 indicates moderate cognitive impairment. -required total assistance with dressing, grooming, dressing, toileting, bathing, bed mobility and transfers.-had a feeding tube. Record review of Resident 7's Treatment Administration Record (TAR) for November 2025 revealed an order dated 05-19-2025 for feeding tube site care as follows:Cleanse site, apply Vaseline gauze follow by a split gauze two times a day for healing of the site. An observation on 11-18-2025 at 8:10 AM-8:30 AM of LPN C providing feeding tube site care for Resident 7 revealed when the old dressing was removed from the feeding tube site, Resident 7 grimaced.
The observation also revealed the absence of Vaseline gauze on the old dressing and the presence of bright red blood around the feeding tube insertion site. An interview conducted with LPN C at 8:25 AM confirmed the absence of Vaseline gauze on the old dressing and confirmed Vaseline gauze should have been applied to the tube feeding site, and confirmed the old dressing had stuck to Resident 7's skin causing discomfort.
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Life Care Center of Omaha in Omaha, 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 Omaha, 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 Omaha or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.