Inspection Reports for Ambassador Health of Omaha
1540 North 72ndStreet, NE, 68114
Back to Facility ProfileDeficiencies (last 9 years)
Deficiencies (over 9 years)
10.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
152% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
58% occupied
Based on a November 2024 inspection.
Census over time
Inspection Report
Renewal
Census: 85
Capacity: 146
Deficiencies: 0
Date: Nov 18, 2024
Visit Reason
This document is a hospital license renewal application and related documentation for The Ambassador Omaha, Inc. DBA Ambassador Health Omaha, verifying the facility's license renewal for the period 1/1/2025 to 12/31/2025.
Findings
The documents confirm the facility meets statutory requirements for a long term care hospital license renewal. The occupancy permit issued by the Nebraska State Fire Marshal shows compliance with fire safety codes. The bed count forms indicate 85 beds occupied out of 146 licensed beds as of 11/18/2024.
Report Facts
Total licensed beds: 146
Beds occupied: 85
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named as facility administrator and contact person in renewal application |
| Tyler Juulfs | Corporate Treasurer | Named corporate officer in ownership information section |
| Timothy Juulfs | Corporate President | Named corporate officer and signed renewal application |
| Sally Juulfs | Corporate Vice President and Secretary | Named corporate officer and signed renewal application |
| Ty Hernes | Deputy State Fire Marshal | Inspected facility and issued occupancy permit |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 20, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha on November 20, 2018, regarding allegations that the facility failed to protect residents from injury and failed to answer call notification systems promptly.
Complaint Details
The complaint alleged failure to protect residents from injury and failure to answer call notification systems promptly. Both allegations were found to be unsubstantiated with no violations.
Findings
The facility was found to be in compliance with relevant regulatory requirements for both allegations: residents were protected from injury and call notification systems were answered promptly.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 92
Capacity: 146
Deficiencies: 6
Date: Nov 20, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha on November 20, 2018, by representatives of the Department of Health and Human Services Division of Public Health. The investigation included review of resident records, observation of care and services, and interviews with residents, family members, and staff.
Complaint Details
The complaint alleged that the facility failed to protect residents from injury and failed to answer call notification systems promptly. The investigation found no violations related to these allegations.
Findings
The facility was found to be in compliance with regulations regarding protection from injury and prompt response to call notification systems. However, deficiencies were identified related to environmental cleanliness, food safety practices, fire safety, and equipment storage.
Deficiencies (6)
Failed to ensure that light fixtures in the second floor dining room were free of dead insects.
Failed to ensure kitchen staff wore hair nets properly to cover all hair while preparing food.
Failed to separate hazardous areas by smoke resistive partitions in 2 of 6 smoke compartments, allowing smoke migration into exit corridors.
Failed to ensure corridor room doors resist passage of smoke in 6 of 6 smoke compartments.
Failed to conduct fire drills on each shift for all four quarters of the 12 months reviewed on 2 of 2 shifts.
Failed to segregate full and empty oxygen cylinders in the 2nd floor oxygen storage closet.
Report Facts
Facility census: 92
Total licensed capacity: 146
Deficiency count: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named as facility administrator in complaint investigation letter and survey documents |
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 108
Deficiencies: 12
Date: Nov 13, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Ridgecrest Rehabilitation Center on November 13-15, 2018, including review of resident records, observation of care and services, and interviews with residents, family, and staff.
Complaint Details
The complaint investigation included allegations that the facility failed to protect residents from adverse behaviors, complete and submit investigations timely, ensure sufficient staffing, meet food code standards, prevent staff under influence, and report adverse events. Findings confirmed violations related to investigation submission, food preparation hygiene, reporting adverse events, and abuse reporting.
Findings
The facility was found compliant with protecting residents from adverse behaviors, sufficient staffing, and staff not under influence. Deficiencies were found in timely submission of investigations, food preparation hygiene, reporting adverse events, medication self-administration assessments, abuse reporting and investigation, bed hold policy notification, expired medication storage, food safety hand hygiene, fire sprinkler maintenance, fire drills, and oxygen cylinder labeling.
Deficiencies (12)
Failed to submit investigations within 5 working days.
Failed to ensure foods served met food code standards due to inadequate hand hygiene and gloving.
Failed to report adverse events to the appropriate agency within required timeframe.
Failed to assess residents for self-administration of medications.
Failed to ensure abuse allegations were reported within 2 hours and investigations submitted within 5 working days.
Failed to suspend or remove employee accused of abuse pending investigation.
Failed to provide written notice of bed hold policy upon resident transfer to hospital for 5 residents.
Failed to ensure expired medications were removed from medication carts, treatment carts, and medication rooms.
Failed to perform proper hand hygiene during food preparation to prevent food borne illness.
Allowed dust and dirt to accumulate on fire sprinklers, potentially obstructing water spray.
Failed to conduct fire drills under varied conditions and times on 2 of 3 shifts.
Failed to label oxygen cylinders as empty or full in oxygen storage room.
Report Facts
Residents reviewed: 6
Facility census: 66
Facility capacity: 108
Deficiency counts: 12
Fire drills on 2nd shift: 4
Fire drills on 3rd shift: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Robinson | Administrator | Named as facility administrator in report |
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter |
| Cook B | Cook | Named in food preparation hand hygiene deficiency |
| Maintenance Staff A | Confirmed fire sprinkler dust accumulation and fire drill findings | |
| Administrator | Confirmed late abuse reporting and oxygen cylinder labeling deficiency | |
| Director of Nursing (DON) | Director of Nursing | Confirmed expired medications and food preparation deficiencies |
| Licensed Practical Nurse (LPN) E | Licensed Practical Nurse | Interviewed regarding medication self-administration deficiency |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 31, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that the facility fails to ensure residents are free from restraints.
Complaint Details
The allegation that the facility fails to ensure residents are free from restraints was investigated and found to be unsubstantiated.
Findings
The facility was found to be in compliance with relevant regulatory requirements, with no restraints observed or reported in use on residents, and no related grievances.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation report |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Aug 22, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha on August 22-23, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged failure to protect residents from abuse, failure to address grievances/complaints, failure to ensure residents are treated with respect and dignity, and failure to immediately report allegations of abuse. All allegations were found unsubstantiated.
Findings
The investigation found no violations related to abuse, grievance handling, respect and dignity of residents, or timely reporting of abuse. Interviews, observations, and record reviews confirmed compliance with regulatory requirements.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report as Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Apr 9, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha on April 9, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged that the facility failed to notify the responsible party of changes in condition and failed to provide care and treatment for tracheas. Both allegations were found to be unsubstantiated.
Findings
The investigation found no violations related to the allegations. The facility staff did notify responsible parties of changes in condition and provided care and treatment for residents with tracheas.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed as Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Mar 13, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to ensure staff are trained to meet residents' needs.
Complaint Details
The complaint alleged that the facility failed to ensure staff were trained to meet residents' needs. The allegation was found to be unsubstantiated as the facility was in compliance.
Findings
The facility was found to have ensured staff were trained to meet residents' needs through observations, interviews, and record reviews. Staff received education and ongoing competency testing, and residents' needs were observed to be met, resulting in compliance with regulations.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report and identified as Training Coordinator for the Office of LTC Facilities - Licensure Unit. |
Inspection Report
Renewal
Capacity: 146
Deficiencies: 0
Date: Jan 16, 2018
Visit Reason
This document is a Nursing Home Licensure Renewal Application for The Ambassador Omaha, verifying the facility's license renewal and compliance with statutory requirements.
Findings
The document confirms that The Ambassador Omaha meets statutory requirements for licensure renewal as a skilled nursing facility with various therapy services. It includes ownership information, certification, and occupancy permits.
Report Facts
Total Licensed Beds: 146
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tyler Julifs | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Polly Stern | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
| Timothy J. Julifs | Board of Director/Owner | Listed in Disclosure of Ownership and Controlling Interest Statement |
| Sally M. Julifs | Board of Director/Owner | Listed in Disclosure of Ownership and Controlling Interest Statement |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 146
Deficiencies: 12
Date: Sep 11, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at The Ambassador Omaha on September 11-13, 2017, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint allegations were that the facility failed to provide care and assistance for bladder elimination and failed to follow practitioner's orders regarding physical therapy. The investigation found the facility was in compliance with these allegations.
Findings
The facility was found to be in compliance with the allegations related to bladder elimination care and following practitioner orders for physical therapy. However, deficiencies were found related to medication administration errors, food safety, medication storage, expired medications, fire safety code violations, and quality assurance processes.
Deficiencies (12)
Failed to maintain a medication error rate under 5%, with 17 errors of 29 medications observed due to leaving a resident unattended during medication administration.
Failed to ensure food stored in refrigerators was dated when opened and food was maintained at safe temperatures, risking outdated and unsafe food for residents.
Failed to safely store medications by not discarding expired medications and supplies in 2 of 10 medication storage areas and leaving a respiratory cart unlocked and unattended.
Failed to maintain correction for previously cited deficient practice related to assuring storage areas were free from expired medication and supplies.
Failed to ensure the delayed egress release on the south exit would activate when not more than 15 pounds of pressure was applied to the release device.
Failed to provide a smoke resistant enclosure for hazardous areas to separate them from the rest of the facility, allowing fire and smoke to migrate into exit corridors.
Failed to ensure smoke separation doors were capable of resisting the passage of smoke in 1 of 3 smoke compartments (Cedar Ridge).
Failed to ensure all staff knew the procedure for relocation of wheeled equipment located in corridors in the event of an emergency.
Failed to post the code required to unlock the exit doors on 2 of 3 floors (2nd and 3rd floors).
Failed to maintain the one-hour fire resistance rating for the South stair enclosure due to a 1" hole in the wall.
Failed to provide all required appurtenances for sprinkler heads on 1 of 3 floors (1st floor), risking sprinkler heads not operating as designed.
Failed to provide an exit sign in the 2nd and 3rd floor Elevator Lobby to direct occupants to an alternate exit.
Report Facts
Medication errors: 17
Residents receiving meals: 42
Residents affected by fire safety deficiencies: 28
Residents affected by smoke separation door deficiency: 10
Residents affected by stair enclosure deficiency: 25
Facility census: 91
Facility total capacity: 146
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Williamson | Administrator | Named as facility administrator in complaint letter. |
| Eve Lewis | RNC, Program Manager - Office of LTC Facilities - Licensure Unit | Signed complaint investigation letter. |
| LPN A | Licensed Practical Nurse | Involved in medication administration observation with errors. |
| LPN B | Charge Nurse | Interviewed regarding medication administration policy. |
| Director of Nursing | DON | Interviewed regarding medication administration and storage policies. |
| Dietary Manager | DM | Interviewed and observed regarding food storage and temperature issues. |
| Dietary Aide | DA | Observed taking food temperatures incorrectly. |
| Registered Dietitian | RD | Provided dietary policies and temperature logs. |
| Licensed Practical Nurse C | LPN | Observed respiratory cart unlocked and unattended. |
| Respiratory Therapist | RT | Confirmed respiratory cart should not be unlocked. |
| Registered Nurse B | RN | Removed expired medication from storage. |
| Nursing Staff A | Interviewed regarding relocation of wheeled equipment during fire alarm. | |
| Facility Staff A | Verified fire safety deficiencies and observations. | |
| Maintenance Supervisor | Responsible for corrective actions and monitoring fire safety compliance. |
Inspection Report
Renewal
Census: 94
Capacity: 146
Deficiencies: 0
Date: Mar 3, 2017
Visit Reason
The document is related to the renewal of the skilled nursing facility license for The Ambassador Omaha, including updates on bed certifications and occupancy changes.
Findings
The report includes updates on Medicaid-certified bed designations, relocation of beds between units, and confirmation of compliance with licensing and occupancy requirements. The facility's licensed capacity is 146 beds, with detailed bed counts per unit and room.
Report Facts
Licensed beds: 146
Medicaid certified ventilator beds: 34
Medicaid certified pediatric beds: 38
Medicaid certified ventilator beds: 36
Medicaid certified long-term care beds: 35
Medicaid certified pediatric beds: 36
Medicaid certified ventilator beds: 26
Licensed beds: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marcia Schroeder | CEO | Named in letters regarding bed certification changes and facility operations |
| Danny Vanourney | MDS/OASIS Automation Coordinator | Named in letters regarding Medicaid bed certifications and facility correspondence |
| Timothy J. Juilfs | Board of Director/Owner | Named in ownership disclosure and certification |
| Sally M. Juilfs | Board of Director/Owner | Named in ownership disclosure and certification |
| David Williamson | Administrator | Named in facility licensing application |
| Polly Stern | Director of Nursing | Named in facility licensing application |
| Alan Viox | Deputy State Fire Marshal | Inspected and approved occupancy permit |
Inspection Report
Annual Inspection
Census: 92
Capacity: 146
Deficiencies: 13
Date: Dec 5, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at The Ambassador Omaha on December 5, 2016-December 13, 2016, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint investigation included allegations of failure to protect residents from misappropriation, abuse, failure to notify family of change in condition, failure to submit investigations timely, failure to have signed physician orders, failure to develop plans of care, failure to have physician orders for therapy, failure to ensure medical records completeness, failure to maintain essential equipment, failure to ensure call lights within reach, failure to follow infection control guidelines, failure to provide care to prevent skin breakdown, failure to provide care for g-button feedings, failure to transfer residents safely, failure to evaluate causal factors for falls, failure to change fall interventions, failure to evaluate use of physical restraints, failure to follow practitioner orders, failure to ensure appropriate discharge planning, and failure to provide wound treatment as ordered. The facility was found in compliance with most allegations except for physical restraint evaluation and discharge planning.
Findings
The facility was found to be in compliance with many regulatory requirements including protection from misappropriation, abuse, notification of family of change in condition, signed physician orders, plans of care, therapy orders, medical record completeness, equipment maintenance, call light accessibility, infection control, skin breakdown prevention, g-button feeding care, resident transfer safety, fall intervention changes, and wound treatment. However, deficiencies were found related to failure to evaluate physical restraint use, inappropriate discharge planning, failure to provide correct advance beneficiary non-coverage notice, medication cart security, lab monitoring for anticoagulant therapy, dishwasher sanitizer concentration, food temperature maintenance, expired medications and supplies, fire safety issues including delayed egress door pressure, hazardous area enclosure, sprinkler head cleanliness, fire extinguisher mounting, and emergency generator labeling.
Deficiencies (13)
Failure to evaluate use of physical restraints including side rails for one resident.
Involuntary discharge of one resident without medical necessity.
Failure to provide correct advance beneficiary non-coverage notice to one resident.
Medication carts left unsecured on pulmonary unit.
Failure to ensure lab monitoring for anticoagulant therapy for one resident.
Failure to ensure correct dishwasher sanitizer concentration and food temperature maintenance.
Failure to ensure expired pediatric AED pads, expired inhaler, undated insulin vials, and expired aspirin were removed.
Delayed egress door on 2nd floor East Stairs required excessive force to open.
Failure to maintain hazardous area enclosure allowing smoke migration on 2nd floor.
Accumulation of lint on two fire sprinkler heads in resident room #C232.
Fire extinguisher resting on floor in laundry room.
Failure to label remote manual stop switch for Level 2 emergency generator.
Excessive combustible decorations in resident room #2121 and therapy room #1112.
Report Facts
Deficiencies cited: 12
Census: 92
Total licensed capacity: 146
Force to release door: 35
Fire sprinkler heads observed: 2
Fire extinguisher weight limit: 40
Employees mentioned
| Name | Title | Context |
|---|---|---|
| David Williamson | Administrator | Named as facility administrator in the report. |
| Dan Taylor | RN, Training Coordinator - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the complaint investigation letter. |
Inspection Report
Complaint Investigation
Census: 101
Deficiencies: 0
Date: Mar 2, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to maintain and/or monitor equipment for resident safety.
Complaint Details
The complaint alleged failure to maintain and/or monitor equipment for resident safety. The allegation was not substantiated.
Findings
The facility did not fail to maintain and/or monitor equipment for resident safety; no violation was found related to the allegation after review of resident records, observations, and staff interviews.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and responsible for the investigation |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 1, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha from December 1, 2015 to December 3, 2015, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint allegations included failure to provide care and treatment for bladder elimination, failure to ensure residents are treated with respect and dignity, failure to ensure a clean environment, failure to provide care and treatment according to standards for feeding tubes, failure to identify a change in condition, failure to follow the plan of care, and failure to protect residents from misappropriation. All allegations were found to have no violations.
Findings
The investigation found no violations related to the allegations. The facility provided appropriate care and treatment for bladder elimination, respect and dignity to residents, a clean environment, proper care for feeding tubes, identification of changes in condition, adherence to the plan of care, and protection of residents from misappropriation.
Report Facts
Resident records reviewed: 4
Residents observed: 3
Resident rooms observed: 4
Residents with feeding tubes observed: 3
Records reviewed for misappropriation protection: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator, Licensure Unit, Division of Public Health-DHHS | Signed the report and is the contact for questions. |
Inspection Report
Complaint Investigation
Census: 95
Deficiencies: 0
Date: May 27, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to protect residents from physical and verbal abuse.
Complaint Details
The complaint alleged failure to protect residents from physical and verbal abuse. The investigation found no violations related to these allegations.
Findings
The facility was found to have protected residents from both physical and verbal abuse. Interviews, observations, and record reviews revealed no concerns or violations related to abuse, and staff were knowledgeable about abuse prevention policies.
Report Facts
Census: 95
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Khristy Sweeney | Registered Nurse | Investigator conducting the complaint investigation |
| Ron Chase | Registered Nurse | Investigator conducting the complaint investigation |
| Kay Reeves | Nutrition/dietitian | Investigator conducting the complaint investigation |
Inspection Report
Complaint Investigation
Census: 89
Deficiencies: 0
Date: Sep 22, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha on September 22-23, 2014, regarding allegations of inappropriate involuntary discharge, failure to prevent pressure sores, and failure to promote wound healing.
Complaint Details
The investigation addressed allegations that the facility failed to ensure appropriate reasons for involuntary discharge, failed to provide care to prevent pressure sores, and failed to provide care to promote wound healing. All allegations were found to be unsubstantiated with the facility in compliance.
Findings
The facility was found to be in compliance with all related regulatory requirements for the allegations investigated. Reviews of resident records, observations, and staff and resident interviews confirmed appropriate discharge reasons, care to prevent pressure sores, and care to promote wound healing.
Report Facts
Residents sampled for discharge review: 3
Residents sampled for pressure sore prevention: 4
Residents sampled for wound healing: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Schmidt | Registered Nurse | Conducted the complaint investigation visit. |
| Eve Lewis | Program Manager | Signed the report as Program Manager, Office of Long Term Care Facilities. |
Inspection Report
Complaint Investigation
Census: 96
Deficiencies: 13
Date: Aug 28, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at The Ambassador Omaha on August 25-28, 2014. The investigation included review of resident records, observation of care and services, and interviews with residents, family members, and staff.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure proper notice for involuntary discharge, resident privacy and confidentiality, interventions to protect residents from misappropriation, reporting and investigating abuse incidents. The allegation of failure to report abuse was substantiated but self-corrected by the facility.
Findings
The facility was found compliant with proper notice for involuntary discharge, resident privacy and confidentiality, and investigation of abuse allegations. However, the facility failed to report incidents of abuse to the correct state agency, which was substantiated but self-corrected. The census was 96.
Deficiencies (13)
Facility failed to maintain written justification for hire of an employee with a positive criminal background check.
Facility failed to ensure resident dignity by not knocking or closing doors prior to care for multiple residents.
Facility failed to provide bathing choices for Resident 230.
Facility failed to monitor dialysis access site for Resident 110.
Facility failed to maintain proper food temperatures and cleanliness of electrical cords in kitchen.
Facility failed to maintain corridor doors with proper latching and fire resistance.
Facility failed to maintain hazard room doors and seal penetrations in walls and ceilings.
Facility failed to conduct fire drills at random times on each shift.
Facility failed to maintain smoke detector in Central Supply.
Facility failed to maintain sprinkler head assembly in employee break room.
Facility failed to have kitchen hood suppression system tested bi-annually.
Facility failed to post 'oxygen in use' signs on resident rooms C200 and C227.
Facility used non-hospital grade power strip on TV cart and had an open breaker in electrical panel.
Report Facts
Facility census: 96
Facility census: 90
Facility census: 99
Deficiency count: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mitch Jevne | Administrator | Named in complaint investigation letter |
| Eve Lewis | Program Manager | Signed complaint investigation letter |
| Khristy Long | Registered Nurse | Surveyor in complaint investigation |
| Connie Kincaid | Registered Nurse | Surveyor in complaint investigation |
| Kelly Schmidt | Registered Nurse | Surveyor in complaint investigation |
| Carol Neneman | Social Worker | Surveyor in complaint investigation |
| Kay Reeves | Nutrition/dietitian | Surveyor in complaint investigation |
| Mitch Jevne | Administrator | Signed statement of deficiencies |
| Environmental Service Coordinator | Confirmed multiple life safety deficiencies | |
| Director of Nursing | Interviewed regarding privacy and dignity education | |
| Director of Clinical Services | Responsible for staff education on dignity and respect | |
| Director of Nursing | Interviewed regarding bathing preferences | |
| Registered Nurse A | Observed not knocking before entering resident rooms | |
| Registered Nurse B | Observed not knocking before entering resident rooms | |
| Unit Manager B | Observed pushing door shut with foot during medication administration | |
| Registered Dietitian F | Reported food temperature requirements and cleaning schedule | |
| Director of Nursing | Interviewed regarding dialysis assessment documentation | |
| Environmental Service Director | Confirmed fire safety and electrical deficiencies |
Inspection Report
Complaint Investigation
Census: 100
Deficiencies: 0
Date: Jan 29, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint at The Ambassador Omaha regarding allegations of inadequate resident supervision and medical equipment maintenance.
Complaint Details
The complaint alleged the facility failed to ensure residents had adequate supervision and that medical equipment was working and maintained. Both allegations were found to be unsubstantiated.
Findings
The facility was found to provide adequate supervision according to residents' plans of care and ensured medical equipment was properly maintained and functioning, with no concerns reported by residents or staff.
Report Facts
Facility census: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Schmidt | Registered Nurse | Representative conducting the complaint investigation |
| Carol Neneman | Social Worker | Representative conducting the complaint investigation |
| Eve Lewis | Program Manager | Signed the correspondence regarding the investigation |
Inspection Report
Complaint Investigation
Census: 93
Deficiencies: 2
Date: Jul 23, 2013
Visit Reason
The inspection was conducted based on a complaint investigation regarding failure to notify the physician and responsible party of poor fluid and food intake for Resident 11.
Complaint Details
The complaint investigation found that Resident 11's family and physician were not notified within the required 72 hours of the resident's decline in food and fluid intake. Resident 11 was hospitalized with severe sepsis and dehydration. The facility failed to evaluate fluid intake and implement interventions to prevent dehydration.
Findings
The facility failed to notify the physician and responsible party timely about Resident 11's significant decline in food and fluid intake, resulting in severe dehydration and sepsis. The facility also failed to evaluate fluid intake and implement interventions to prevent dehydration.
Deficiencies (2)
Failure to notify physician and responsible party of significant change in resident's condition related to poor fluid and food intake.
Failure to provide sufficient fluid intake to maintain proper hydration and health.
Report Facts
Resident census: 93
Fluid intake: 120
Fluid intake: 480
Fluid intake: 240
Fluid intake: 360
Fluid intake: 120
Fluid intake: 240
Inspection Report
Annual Inspection
Census: 94
Deficiencies: 18
Date: May 13, 2013
Visit Reason
Annual survey inspection of The Ambassador Omaha nursing facility to assess compliance with state and federal regulations including licensure and life safety code.
Findings
The facility was found deficient in multiple areas including failure to notify family of hospital discharge, inadequate ADL care, improper catheter evaluation, infection control breaches, and multiple life safety code violations such as fire door deficiencies, emergency lighting failures, sprinkler system issues, blocked egress, oxygen storage violations, and electrical hazards.
Deficiencies (18)
Failure to notify family of hospital discharge for Resident 41.
Failure to provide incontinence care as directed by plan of care for Resident 111.
Failure to evaluate clinical indications for indwelling catheter for Resident 23.
Failure to utilize proper handwashing and gloving techniques during personal care for Resident 111.
Wooden storage shelves and kitchen handwashing sink faucet not maintained in cleanable and good operating condition.
3rd floor Shower Room 3111 door blocked open by EZ Lift, not resisting passage of smoke.
1st floor Activity Storage room doors not smoke-tight.
Doors protecting corridor openings failed to resist fire and lacked positive latching on resident rooms C314 and C215.
Newly installed three story dumb waiter doors failed to provide fire rated listing.
Air transfer grilles in equipment storage room door, kitchen door obstructed, lack of self-closing devices on storage rooms, and drug specimen box blocking door.
Means of egress obstructed by furniture, carts, and boxes in corridors and resident areas.
Oxygen storage rooms had air transfer grilles, unsealed penetrations, oxygen stored in resident room C204 with unrestrained tanks.
Boiler inspection certificate expired.
Electrical panels obstructed by storage and open panel box space.
Alcohol based hand rub dispenser installed adjacent to electrical outlet in corridor.
Kitchen hood welds and paint not maintained; wheeled appliance under hood not properly positioned.
Fire extinguishers in kitchen pantry blocked by boxes.
Emergency lighting failed to operate or provide required illumination in dining rooms and corridors.
Report Facts
Facility census: 94
Facility census: 97
Residents affected: 8
Residents affected: 9
Residents affected: 11
Residents affected: 86
Residents affected: 28
Residents affected: 24
Residents affected: 52
Inspection Report
Annual Inspection
Census: 87
Capacity: 95
Deficiencies: 18
Date: Jan 23, 2012
Visit Reason
The inspection was conducted as an annual survey to assess compliance with state and federal regulations including licensure and life safety codes.
Findings
The facility was found deficient in multiple areas including medication self-administration evaluation, failure to report abuse investigations, nutritional needs not met due to improper food preparation, unsanitary kitchen conditions, medication labeling errors, expired laboratory supplies, infection control breaches, and multiple life safety code violations including fire safety and emergency lighting.
Deficiencies (18)
Facility staff failed to evaluate medication self administration capability for one resident.
Facility failed to report two investigation reports related to misappropriation of resident property to the required state agency.
Facility staff failed to ensure nutritional needs were met for three residents due to improper preparation and portioning of pureed diets.
Facility staff failed to maintain kitchen equipment in a clean manner to prevent potential food borne illness.
Facility failed to ensure correct medication labeling for two residents and failed to remove outdated biologicals.
Facility failed to utilize proper hand-washing techniques and failed to clean glucometers after resident use to prevent cross contamination.
Facility failed to provide a safe, functional, sanitary, and comfortable environment by not maintaining kitchen floors and ceiling in clean condition and good repair.
Nurse Charting Room 3115 door was not capable of resisting the passage of smoke.
Access-controlled egress doors at the front exit were turned off and locked, preventing proper egress.
Open electrical junction box above water heater in Mechanical Room.
Non-flame retardant carpet installed on front of nurse's station on second floor.
Smoke separation doors failed to close and would not prevent spread of smoke on third floor.
Hazardous areas not separated from other compartments; doors failed to close and latch; yellow foam around ductwork in bio-hazard area.
Emergency lighting failed to operate and facility failed to document testing of emergency lights.
No ABC type fire extinguisher provided in kitchen.
Kitchen staff not trained on use of kitchen hood suppression system and fire procedure.
No 'oxygen in use' signage posted on resident room where oxygen was used.
Refrigerator plugged into power strip in Administrator's office.
Report Facts
Facility census: 87
Facility census: 89
Occupant load: 95
Residents affected: 7
Residents affected: 6
Residents affected: 5
Residents affected: 3
Residents affected: 3
Residents affected: 2
Expired laboratory tubes: 376
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael Jones | Administrator | Signed inspection and plan of correction documents |
| Jim Heine | Assistant State Fire Marshal | Signed fire safety plan of correction and waiver documents |
| RN C | Registered Nurse | Observed medication self-administration and interview regarding medication evaluation |
| Director of Nursing | Interviewed regarding medication self-administration evaluation and expired laboratory tubes | |
| Cook D | Observed preparing pureed diets and meal service | |
| Dietary Supervisor | Interviewed regarding kitchen cleanliness and food preparation | |
| Registered Dietician | Provided nutritional calculations for pureed diets | |
| RN E | Registered Nurse | Observed medication administration and labeling discrepancy |
| Nurse Consultant F | Interviewed regarding medication labeling and pharmacy orders | |
| RN H | Registered Nurse | Observed blood glucose testing and infection control breaches |
| Unit Manager I | Interviewed regarding infection control and blood glucose testing procedures | |
| LPN B | Licensed Practical Nurse | Observed repositioning resident without proper hand hygiene |
| RN A | Registered Nurse | Observed repositioning resident without proper hand hygiene |
| Maintenance A | Interviewed and observed regarding fire safety, electrical, and maintenance deficiencies | |
| Staff A | Interviewed regarding access-controlled doors | |
| Kitchen Staff | Interviewed regarding kitchen hood fire suppression system |
Inspection Report
Routine
Census: 102
Deficiencies: 1
Date: Jun 7, 2011
Visit Reason
The inspection was conducted to evaluate compliance with regulations governing licensure of skilled nursing facilities, focusing on accident hazards, supervision, and devices to prevent accidents.
Findings
The facility failed to evaluate changes in blood pressure related to fall risk and implement interventions to decrease falls for one resident. The resident experienced multiple falls and injuries, including a laceration requiring emergency room transfer. The facility did not document changes in interventions or identify the resident as a falling star, contrary to their fall prevention program.
Deficiencies (1)
Facility failed to evaluate changes in blood pressure related to risk for falls and implement interventions to decrease risk for falls for one resident.
Report Facts
Census: 102
Blood pressure readings: 79
Blood pressure readings: 51
Blood pressure readings: 75
Blood pressure readings: 48
Blood pressure readings: 76
Blood pressure readings: 50
Blood pressure readings: 85
Blood pressure readings: 49
Blood pressure readings: 80
Blood pressure readings: 51
Blood pressure readings: 93
Blood pressure readings: 50
Blood pressure readings: 89
Blood pressure readings: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Nurse Aide A | Reported stepping on Resident 1's foot while preventing fall | |
| Nurse Aide B | Reported assisting Resident 1 during transfer and lowering resident to floor | |
| Nurse Aide C | Reported finding Resident 1 on floor after fall and not being informed resident could not be left alone | |
| Registered Nurse D | Reported Resident 1 had not been identified as a falling star | |
| DON | Director of Nursing | Confirmed orthostatic blood pressure should have been evaluated and interventions documented |
Notice
Capacity: 146
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves as a licensure renewal application and verification for The Ambassador Omaha skilled nursing facility, confirming its license status and renewal through the indicated expiration date.
Findings
The documents confirm the facility's licensure renewal status, ownership information, accreditation, and occupancy permit with a maximum capacity of 146 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 146
Renewal fees: 1750
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Polly Stern | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Timothy J. Juilfs | Owner/CEO | Signed the Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Juilfs | Board of Director/Owner | Listed in the Disclosure of Ownership and Controlling Interest Statement. |
Document
Capacity: 156
Deficiencies: 0
Date: APP2016
Visit Reason
The documents pertain to licensure renewal, ownership disclosure, occupancy permit issuance, Medicaid bed certification updates, and facility floor plans for The Ambassador Omaha nursing home.
Findings
No inspection findings or deficiencies are reported. The documents verify licensure renewal, ownership information, occupancy permit with a maximum capacity of 156 beds, and Medicaid bed certifications.
Report Facts
Total licensed beds: 156
Renewal fees: 1750
Medicaid certified beds: 67
Medicaid only certified beds: 48
Medicaid pulmonary unit beds: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mitch Jevne | Administrator | Named on licensure renewal application and Medicaid correspondence. |
| Polly Stern | Director of Nursing | Named on licensure renewal application. |
| Timothy J. Juilfs | Board of Director/Owner and Owner/CEO | Named on ownership disclosure and affidavit. |
| Sally M. Juilfs | Board of Director/Owner | Named on ownership disclosure. |
| Joette Novak | Interim Unit Manager, MDS/OASIS Automation Coordinator | Signed Medicaid bed certification letter dated May 8, 2014. |
Document
Capacity: 146
Deficiencies: 0
Date: APP2020
Visit Reason
The document set includes a nursing home licensure renewal application and related certifications for The Ambassador Omaha skilled nursing facility, verifying licensure status and ownership information.
Findings
The documents confirm the facility's licensure renewal status, ownership details, and maximum licensed bed capacity. There are no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 146
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named in Nursing Home Licensure Renewal Application. |
| Polly Stern | Director of Nursing | Named in Nursing Home Licensure Renewal Application. |
| Timothy J. Julifs | Board of Director/Owner | Named in Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Julifs | Board of Director/Owner | Named in Disclosure of Ownership and Controlling Interest Statement. |
Notice
Capacity: 146
Deficiencies: 0
Date: APP2021
Visit Reason
The documents serve to verify the renewal of the nursing home license for The Ambassador Omaha and to provide official occupancy permit information.
Findings
The documents confirm that The Ambassador Omaha meets statutory requirements for skilled nursing facility licensing and has an approved occupancy permit for 146 beds issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 146
Renewal license expiration date: 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named as administrator on the Nursing Home Licensure Renewal Application. |
| Polly Stern | Director of Nursing | Named as director of nursing on the Nursing Home Licensure Renewal Application. |
| Timothy J. Juilfs | Board of Director/Owner | Listed as Board of Director/Owner in the Disclosure of Ownership and Controlling Interest Statement. |
| Sally M. Juilfs | Board of Director/Owner | Listed as Board of Director/Owner in the Disclosure of Ownership and Controlling Interest Statement. |
Document
Capacity: 146
Deficiencies: 0
Date: APP2022
Visit Reason
The documents pertain to the renewal of the nursing home license for The Ambassador Omaha and include verification of licensure, renewal application, ownership disclosure, and occupancy permit issuance.
Findings
No inspection findings or deficiencies are reported. The documents certify licensure renewal, ownership information, and occupancy permit compliance.
Report Facts
Total licensed beds: 146
Renewal license fees: 1950
Occupancy permit date: Jan 19, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Polly Stern | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
| Timothy J. Juilfs | Board of Director/Owner | Named on the Disclosure of Ownership and Controlling Interest Statement and signed affidavit |
| Sally M. Juilfs | Board of Director/Owner | Named on the Disclosure of Ownership and Controlling Interest Statement |
| Gary J. Amihone, MD | Chief Medical Officer, Director, Division of Public Health | Named on the licensure verification card |
| Susen Lindner | Deputy State Fire Marshal | Inspected and approved the occupancy permit |
Notice
Capacity: 146
Deficiencies: 0
Date: APP2023
Visit Reason
This document serves as a hospital license renewal application and confirmation for The Ambassador Omaha, Inc. DBA Ambassador Health Of Omaha for the renewal period 1/1/2023 - 12/31/2023, including verification of licensed capacity and occupancy permit.
Findings
The documents confirm that the facility meets statutory requirements for licensure as a Long Term Care Hospital/Dual, with a licensed bed capacity of 146. The Nebraska State Fire Marshal issued an occupancy permit for 146 beds on 11/9/2022. Key facility personnel and corporate officers are listed.
Report Facts
Licensed beds: 146
Renewal period: License renewal period from 1/1/2023 to 12/31/2023.
Renewal fee: 1950
Occupancy permit date: Occupancy permit issued on 11/9/2022 by Nebraska State Fire Marshal.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator/CEO | Named as facility administrator and contact person for renewal application. |
| Timothy Julifs | President | Corporate President listed in ownership information and key personnel. |
| Sally Julifs | Vice President | Corporate Vice President listed in ownership information and key personnel. |
| Tom Wood | Director of Maintenance | Listed under key facility personnel. |
| Polly Stern | Director of Clinical Services | Listed under key facility personnel. |
| Shauna Stradling | Pediatric Unit Manager | Listed under key facility personnel. |
| Michelle Baker | Rehabilitation Unit Manager | Listed under key facility personnel. |
| Delores Williams | Pulmonary Unit Manager | Listed under key facility personnel. |
| Steve Johnson | Respiratory Therapy Director | Listed under key facility personnel. |
| Kim Eby | Social Services Director | Listed under key facility personnel. |
| Trisha Burke | Pulmonary Social Services | Listed under key facility personnel. |
| Maddie Quinonez | Pediatric Social Services | Listed under key facility personnel. |
| Jerry Kraft | Director of Human Resources | Listed under key facility personnel. |
| Tammy Flegenschuh | Business Office Director | Listed under key facility personnel. |
| Angela Jones | Dietary Manager | Listed under key facility personnel. |
| Laura Honcik | Registered Dietician | Listed under key facility personnel. |
| Emily George | Housekeeping/Laundry Manager | Listed under key facility personnel. |
| Tanya Forbush | Admissions Coordinator | Listed under key facility personnel. |
| Larry Cornelius | Director of Recreational Therapy | Listed under key facility personnel. |
Notice
Capacity: 146
Deficiencies: 0
Date: APP2024
Visit Reason
This document serves as the hospital license renewal application for the period 1/1/2024 to 12/31/2024 and includes the occupancy permit issued by the Nebraska State Fire Marshal.
Findings
The facility is licensed as a Long Term Care Hospital with a total licensed bed capacity of 146. The occupancy permit confirms the maximum occupancy of 146 beds as of 6/8/2023. No inspection findings or deficiencies are reported in this document.
Report Facts
Licensed beds: 146
Maximum occupancy: 146
Renewal period: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named as administrator and contact person for the facility in the renewal application |
| Tim Julifs | Corporate President | Named as corporate president and signatory on the renewal application |
| Sally Julifs | Corporate Vice President and Secretary | Named as corporate vice president and secretary and signatory on the renewal application |
| Tyler Julifs | Corporate Treasurer | Named as corporate treasurer in the renewal application |
| Ty Hernes | Deputy State Fire Marshal | Inspected the facility and issued the occupancy permit |
Document
Census: 80
Capacity: 146
Deficiencies: 0
Date: APP2026
Visit Reason
This document set serves as the hospital license renewal application for the period 1/1/2026 to 12/31/2026 for The Ambassador Omaha, Inc. DBA Ambassador Health Omaha, including verification of licensed beds and occupancy permit.
Findings
The documents confirm the facility meets statutory requirements for licensing as a Long Term Care Hospital (LTCH) with a total licensed bed capacity of 146 and current occupancy of 80 beds. The Nebraska State Fire Marshal issued an occupancy permit on 7/9/2025.
Report Facts
Total licensed beds: 146
Beds occupied: 80
Beds set up: 99
Renewal period: 2026
License expiration date: 2026
Occupancy permit issue date: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jake Bleach | Administrator | Named as facility administrator and contact person in renewal application. |
| Timothy Juilfs | Corporate President | Named as corporate president and authorized signatory on renewal application. |
| Sally Juilfs | Corporate Vice President and Secretary | Named as corporate vice president, secretary, and authorized signatory on renewal application. |
| Ty Hernes | Deputy State Fire Marshal | Inspected facility and approved occupancy permit. |
Document
Deficiencies: 0
Date: BEDS
Visit Reason
The documents notify the facility about certification of Medicaid beds effective July 1, 2017, and amendments to the record of Medicaid and Medicare certified beds, as well as a decrease in licensed beds effective July 1, 2016.
Findings
The letters confirm the certification of 63 Medicaid certified beds effective July 1, 2017, and document changes in the number of licensed beds and Medicare certified beds at the facility, including a decrease from 156 to 146 licensed beds effective July 1, 2016.
Report Facts
Medicaid certified beds: 63
Licensed beds decrease: 10
Medicare certified beds: 108
Medicare certified beds: 98
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joette Novak | Program Manager | Named as contact for Medicaid certified beds certification letter. |
| Eve Lewis | Program Manager | Named as contact for licensed beds decrease and Medicare certified beds letters. |
Notice
Deficiencies: 0
Date: DAN060711
Visit Reason
This Notice of Disciplinary Action was issued to The Ambassador Omaha Skilled Nursing Facility due to failure to evaluate changes in blood pressure related to risk for falls and failure to implement interventions to decrease risk for falls.
Findings
The Department of Health and Human Services determined that the facility violated licensure regulations related to accident prevention and placed the license on probation for 90 days starting July 7, 2011. The facility must submit a Plan of Correction and weekly reports documenting implementation of corrective processes.
Report Facts
Probation period length: 90
Probation start date: Jul 7, 2011
Notice date: Jun 22, 2011
Response deadline days: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joann Schaefer | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action dated June 22, 2011 |
| Helen L. Meeks | Administrator, Licensure Unit | Signed the Notice of Disciplinary Action |
| Linda Stenvers | Staff Assistant II, Office of Long Term Care Facilities | Certified mailing of the Notice of Disciplinary Action |
| Eve Lewis | Administrator, Office of Long Term Care Facilities | Recipient of required reports and signed letter terminating probation on November 4, 2011 |
| Mitch Jevne | Administrator | Administrator of The Ambassador Omaha, recipient of the Notice and probation termination letter |
Notice
Deficiencies: 0
Date: DAN072313
Visit Reason
This Notice of Disciplinary Action was issued to The Ambassador Omaha Skilled Nursing Facility due to violations related to failure to evaluate fluid intake and implement interventions to prevent dehydration.
Findings
The Department of Health and Human Services determined that the facility violated licensure regulations concerning hydration, resulting in probation for 90 days starting August 20, 2013, with requirements to submit plans of correction and ongoing reports on residents with dehydration signs.
Report Facts
Probation period length: 90
Report due date: Aug 30, 2013
Notice mailing date: Aug 5, 2013
Notice final effective date: Aug 20, 2013
Notice mailing date: Aug 5, 2013
Response period: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Joseph M. Acierno | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Helen L. Meeks | Administrator, Licensure Unit | Signed the Notice of Disciplinary Action |
| Linda Stenvers | Staff Assistant II, Office of Long Term Care Facilities | Certified mailing of the Notice |
| Eve Lewis | RNC, Program Manager, Office of Long Term Care Facilities | Addressee for reports and correspondence related to the Notice |
| Mitch Jevne | Administrator | Facility administrator addressed in the December 9, 2013 letter |
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