Douglas County Health Center

Also known publicly as Douglas County Community Mental Health Center

Omaha, NE

CMS provider ID 285019CMS source updated July 29, 2026

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CMS overview

CMS overall

Health inspection

Staffing

Quality-measure

No proprietary TrustHub score. These ratings are published separately by CMS.

How CMS describes these ratings

CMS overall rating: The CMS overall rating summarizes health inspections, staffing, and quality measures within Medicare's Five-Star system.
Health inspection rating: The CMS health inspection rating reflects findings from standard and complaint inspections used in Medicare's Five-Star system.
Staffing rating: The CMS staffing rating reflects staffing levels and related measures used in Medicare's Five-Star system.
Quality-measure rating: The CMS quality-measure rating summarizes selected resident assessment and claims-based measures used in Medicare's Five-Star system.

CMS certified beds: 254
Ownership descriptor: Government - City/county
Medicare participation: Yes
Medicaid participation: Yes

Facility information

Contact

CMS remains the primary federal record. Public website and additional contact details appear only when independently verified.

Phone: 4024447041CMS Provider Information
Also known publicly as: Douglas County Community Mental Health CenterVerified public information · checked Aug 2026

Decision guide

What to review

Factual evidence to examine before you decide. These summaries are not a score or recommendation.

Staffing

CMS publishes a 5-star staffing rating for this facility.

RN staffing was 1.01 hours per resident day in 2026Q1, calculated from CMS PBJ records.

View staffing evidence

Inspections

The latest standard inspection on May 13, 2025 cited 11 deficiencies.

View inspection evidence

Ownership

CMS-published records list 21 ownership or control parties.

View ownership evidence

Enforcement record

CMS records show a 8-day payment denial in the loaded enforcement dataset.

View enforcement evidence →

Ownership & operation

Ownership & Operation

Operator, licensee, owner, manager, and chain stay separate. A connected organization is not automatically the party that runs daily operations.

Ownership type: Government - City/countyCMS

Who is behind this facility?

SeniorTrustHub found evidence connecting this facility to:

CMS reports 20 individual ownership interests

Ownership

Who CMS records show is connected to this facility

These are CMS-published ownership disclosures. Medicare enrollment ownership and managerial-control information is reported by enrolled providers through CMS forms; it is not an independent determination of beneficial ownership.

Reported party records: 21
Organizations shown: 1
Individuals shown: 20
Latest ownership source update: Jul 27, 2026

CMS-published ownership and control parties

NELSON, ERIN
Individual · CORPORATE DIRECTOR
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
BORGESON, MARY ANN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 1995
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
BOYLE-MANGANARO, MAUREEN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
CAVANAUGH, JAMES
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 2015
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
FRIEND, MIKE
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
GARCIA, ROGER
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Oct 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
MORGAN, PJ
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 2010
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
NELSON, ERIN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
ROGERS, CHRIS
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 1, 2005
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
NELSON, ERIN
Individual · W-2 MANAGING EMPLOYEE
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Ownership
CMS dataset identifier
y2hd-n93e
Source updated
Jul 1, 2026
Retrieved
Aug 15, 2026
View official CMS source
NELSON, ERIN
Individual · CORPORATE DIRECTOR
Published ownership percentage: 100%
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
BORGESON, MARY ANN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 1995
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
BOYLE-MANGANARO, MAUREEN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
CAVANAUGH, JAMES
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 2015
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
FRIEND, MIKE
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
GARCIA, ROGER
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Oct 1, 2021
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
MORGAN, PJ
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 2010
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
NELSON, ERIN
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
ROGERS, CHRIS
Individual · OPERATIONAL/MANAGERIAL CONTROL
Published ownership percentage: 100%
Association date reported to CMS: Jan 1, 2005
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
NELSON, ERIN
Individual · W-2 MANAGING EMPLOYEE
Published ownership percentage: 100%
Association date reported to CMS: Jul 1, 2019
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility All Owners
CMS dataset identifier
afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source
DOUGLAS COUNTY NEBRASKA
Organization · Medicare-enrolled legal organization
Other facilities connected through this exact CMS organization identity: 0 across NE.
View ownership source details
Source organization
Centers for Medicare & Medicaid Services (CMS)
Dataset
Skilled Nursing Facility Enrollments
CMS dataset identifier
5f2c306f-3b1c-42cd-b037-187b2ce22126
Source updated
Jul 27, 2026
Retrieved
Aug 15, 2026
View official CMS source

What this means

Roles are shown as CMS publishes them. Different CMS sources can describe different enrollment, ownership, and control concepts, so TrustHub keeps each source-specific disclosure distinct.

Inspections & deficiencies

What CMS inspection records show

Scope and severity terms below are CMS classifications. They are not a TrustHub score.

Latest recorded inspection

Date: Oct 30, 2025
Survey type: Health Complaint
Linked findings: 2
Highest linked CMS classification: G — Isolated; Actual harm that is not immediate jeopardy

View source details

Dataset: Inspection Dates
CMS dataset ID: svdt-c123
CMS source updated: Jul 1, 2026
CMS provider ID: 285019
Source record locator: csv-row:75550:ccn:285019

View official CMS source

Oct 30, 2025 — Health Complaint — 2 linked findings

F0697 — Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Dec 12, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213948:ccn:285019
View official CMS source
F0760 — Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
CMS scope/severity G: Isolated; Actual harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Dec 12, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213947:ccn:285019
View official CMS source

May 13, 2025 — Fire Safety Standard — 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

May 13, 2025 — Health Complaint — 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

May 13, 2025 — Health Standard — 11 linked findings

F0605 — Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213950:ccn:285019
View official CMS source
F0636 — Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213953:ccn:285019
View official CMS source
F0656 — Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213954:ccn:285019
View official CMS source
F0684 — Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213955:ccn:285019
View official CMS source
F0686 — Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213956:ccn:285019
View official CMS source
F0688 — Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213957:ccn:285019
View official CMS source
F0695 — Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213958:ccn:285019
View official CMS source
F0697 — Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213959:ccn:285019
View official CMS source
F0699 — Quality of Life and Care Deficiencies
Provide care or services that was trauma informed and/or culturally competent.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213960:ccn:285019
View official CMS source
F0812 — Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213949:ccn:285019
View official CMS source
F0880 — Infection Control Deficiencies
Provide and implement an infection prevention and control program.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 27, 2025)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213962:ccn:285019
View official CMS source

Jul 18, 2024 — Health Complaint — 1 linked finding

F0580 — Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jul 31, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213963:ccn:285019
View official CMS source

May 16, 2024 — Health Complaint — 1 linked finding

F0656 — Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 14, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213972:ccn:285019
View official CMS source

Apr 26, 2024 — Fire Safety Standard — 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Apr 26, 2024 — Health Standard — 8 linked findings

F0553 — Resident Rights Deficiencies
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213965:ccn:285019
View official CMS source
F0577 — Resident Rights Deficiencies
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
CMS scope/severity C: Widespread; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213971:ccn:285019
View official CMS source
F0580 — Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213966:ccn:285019
View official CMS source
F0585 — Resident Rights Deficiencies
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213967:ccn:285019
View official CMS source
F0644 — Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213968:ccn:285019
View official CMS source
F0689 — Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213969:ccn:285019
View official CMS source
F0812 — Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213964:ccn:285019
View official CMS source
F0880 — Infection Control Deficiencies
Provide and implement an infection prevention and control program.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 9, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213970:ccn:285019
View official CMS source

Mar 5, 2024 — Health Complaint — 1 linked finding

F0609 — Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Mar 22, 2024)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213973:ccn:285019
View official CMS source

May 16, 2023 — Fire Safety Standard — 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

May 16, 2023 — Health Standard — 6 linked findings

F0580 — Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213975:ccn:285019
View official CMS source
F0584 — Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213976:ccn:285019
View official CMS source
F0626 — Resident Rights Deficiencies
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213977:ccn:285019
View official CMS source
F0791 — Quality of Life and Care Deficiencies
Provide or obtain dental services for each resident.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213978:ccn:285019
View official CMS source
F0812 — Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213974:ccn:285019
View official CMS source
F0880 — Infection Control Deficiencies
Provide and implement an infection prevention and control program.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 29, 2023)
View source details
Dataset
Health Deficiencies
CMS dataset ID
r5ix-sfxw
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:213979:ccn:285019
View official CMS source

Tags appearing across inspections

F0580 appears in 3 linked inspections.
F0812 appears in 3 linked inspections.
F0880 appears in 3 linked inspections.
F0656 appears in 2 linked inspections.
F0697 appears in 2 linked inspections.

Penalties & enforcement

CMS penalty records in the loaded three-year dataset

Payment Denial — Oct 30, 2025
Payment denial length: 8 days
View source details
Dataset
Penalties
CMS dataset ID
g6vv-u9sr
CMS source updated
Jul 1, 2026
CMS provider ID
285019
Source record locator
csv-row:8347:ccn:285019
View official CMS source

Questions to ask

Questions generated from the evidence above

CMS records show F0580 in 3 inspections in the available record. What changes has the facility made to address this issue?
CMS records show F0812 in 3 inspections in the available record. What changes has the facility made to address this issue?
CMS records show F0880 in 3 inspections in the available record. What changes has the facility made to address this issue?
CMS records show F0656 in 2 inspections in the available record. What changes has the facility made to address this issue?
CMS records show F0697 in 2 inspections in the available record. What changes has the facility made to address this issue?

Facility history

Facility History

11 historical events available. Dates and values come from published CMS and official state regulator evidence, not a score.

What changed recently?

RN staffing increasedRN staffing increased from 0.89 to 1.01 hours per resident day between 2025Q4 and 2026Q1. Staffing improved across those reported periods.
Medicare payment denial recordedCMS recorded a Medicare payment denial lasting 8 days.
Complaint inspection recorded2 deficiencies were recorded. That includes 1 higher-severity deficiency.

2026

Mar 2026
RN staffing increased
RN staffing increased from 0.89 to 1.01 hours per resident day between 2025Q4 and 2026Q1. Staffing improved across those reported periods.
0.89 → 1.01
CMS · Reported in a source release · View related evidence

2025

Oct 30
Medicare payment denial recorded
CMS recorded a Medicare payment denial lasting 8 days.
CMS · Recorded event date · View related evidence
Oct 30
Complaint inspection recorded
2 deficiencies were recorded. That includes 1 higher-severity deficiency.
CMS · Recorded event date · View related evidence
Sep 2025
Total nurse staffing increased
Total nurse staffing increased from 4.65 to 4.96 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.
4.65 → 4.96
CMS · Reported in a source release · View related evidence
May 13
Health inspection completed
11 deficiencies were recorded.
CMS · Recorded event date · View related evidence
May 13
Complaint inspection recorded
No linked health-deficiency findings were recorded for this survey.
CMS · Recorded event date · View related evidence

2024

Jul 18
Complaint inspection recorded
1 deficiency was recorded.
CMS · Recorded event date · View related evidence
May 16
Complaint inspection recorded
1 deficiency was recorded.
CMS · Recorded event date · View related evidence
Apr 26
Health inspection completed
8 deficiencies were recorded.
CMS · Recorded event date · View related evidence
Mar 5
Complaint inspection recorded
1 deficiency was recorded.
CMS · Recorded event date · View related evidence

2023

May 16
Health inspection completed
6 deficiencies were recorded.
CMS · Recorded event date · View related evidence

Staffing

Reported nursing staffing at a glance

CMS staffing rating: 5 of 5 stars. CMS calculates that rating separately using its published methodology. The values below are calculations from daily PBJ records for 2026Q1 (current source quarter).

Inspect a PBJ quarter

Total nursing: 4.781
RN categories: 1.01
LPN/LVN categories: 0.516
CNA: 2.395

Weekday and weekend calculations

2026Q1 reported hours per resident day
Measure	Monday–Friday	Saturday–Sunday
Total nursing	4.938	4.392
RN categories	1.14	0.686

Contract staff accounted for 5.4% of reported nursing hours included in this quarter calculation.

Reported RN-category hours per resident day were 0.118 higher than the prior loaded quarter.

Staffing over time

Solid bar: Total nursing · Outlined bar: RN categories

Calculated reported hours per resident day by PBJ quarter
Quarter	Total nursing	RN categories	LPN/LVN	CNA	Contract share	Days
2025Q2	4.653	0.957	0.514	2.291	4.1%	91
2025Q3	4.965	0.938	0.583	2.487	5.1%	92
2025Q4	4.771	0.892	0.593	2.345	4.5%	92
2026Q1	4.781	1.01	0.516	2.395	5.4%	90

Questions to ask

PBJ records show lower calculated RN-category hours per resident day on weekends this quarter. How does the facility plan RN coverage on Saturdays and Sundays?
PBJ records show that some reported nursing hours were contract hours. How does the facility orient and integrate contract staff?

Staffing source and calculation details

Source: Centers for Medicare & Medicaid Services (CMS)
Dataset: Payroll Based Journal Daily Nurse Staffing
CMS dataset ID: 7e0d53ba-8f02-4c66-98a5-14a1c997c50d
Quarter: 2026Q1
Coverage: Jan 1, 2026–Mar 31, 2026
Days represented: 90 (90 with positive MDS census)
CMS source updated: Jul 29, 2026
Calculation version: pbj-quarter-ratio-of-sums-v1

Hours-per-resident-day values are calculated by this platform from CMS-published daily PBJ hours and MDS census. For each displayed period, included hours are summed and divided by the summed census for days with a positive census. They are not CMS case-mix-adjusted staffing measures or a staffing rating.

View official CMS PBJ source

What we can verify today

Current Provider Information facts

These measures come from the current successfully ingested CMS Nursing Home Provider Information release.

CMS reports a 3-star overall rating.
CMS reports a 2-star health inspection rating.
CMS reports a 5-star staffing rating.
CMS reports a 4-star quality-measure rating.

Planned evidence layers

Additional public-source research

These areas require separate authoritative CMS datasets. No findings are shown until those sources are ingested and reviewed.

Chain / portfolio intelligence

Trust participation

See something that needs correction?

Claims, corrections, and factual context are free. Submissions never replace CMS evidence or affect ranking.

Suggest a correction Report a source-data concern Represent this facility? Submit a profile claim

How corrections work

Source register

See where this record came from

Provider Information

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: 4pq5-n9py
Source updated: Jul 29, 2026
Retrieved: Aug 14, 2026
Supports: Overview, facility facts, and CMS ratings

View official CMS source

Inspection Dates

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: svdt-c123
Source updated: Jul 1, 2026
Retrieved: Aug 14, 2026
Supports: Inspections and facility history

View official CMS source

Health Deficiencies

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: r5ix-sfxw
Source updated: Jul 1, 2026
Retrieved: Aug 14, 2026
Supports: Health deficiencies and facility history

View official CMS source

Penalties

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: g6vv-u9sr
Source updated: Jul 1, 2026
Retrieved: Aug 14, 2026
Supports: Penalties, enforcement, and facility history

View official CMS source

Payroll Based Journal Daily Nurse Staffing

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: 7e0d53ba-8f02-4c66-98a5-14a1c997c50d
Coverage: Apr 1, 2025–Mar 31, 2026
Source updated: Jul 29, 2026
Retrieved: Aug 15, 2026
Supports: PBJ staffing cards, history, and transparent calculations

View official CMS source

Ownership

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: y2hd-n93e
Source updated: Jul 1, 2026
Retrieved: Aug 15, 2026
Supports: Ownership parties, organization connections, and ownership history

View official CMS source

Skilled Nursing Facility All Owners

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: afe44b85-cc6d-40d7-b5df-00ae8910d1d2
Source updated: Jul 27, 2026
Retrieved: Aug 15, 2026
Supports: Ownership parties, organization connections, and ownership history

View official CMS source

Skilled Nursing Facility Enrollments

Source organization: Centers for Medicare & Medicaid Services (CMS)
Dataset identifier: 5f2c306f-3b1c-42cd-b037-187b2ce22126
Source updated: Jul 27, 2026
Retrieved: Aug 15, 2026
Supports: Ownership parties, organization connections, and ownership history

View official CMS source

Verified public facility information

Source organization: Public facility listing
Dataset identifier: commercial-corroboration:public-listing
Source updated: Aug 18, 2026
Retrieved: Aug 18, 2026
Supports: Independently verified public website, phone, or publicly used name. Not a CMS rating or regulatory status.

How sources work

No paid placements. Facilities cannot pay to rank higher. We cite. You decide.

CMS rating overview

CMS overall

Health inspection

Staffing

Quality-measure

Contact

What to review

Staffing

Inspections

Ownership

Ownership & Operation

Who is behind this facility?

Who CMS records show is connected to this facility

CMS-published ownership and control parties

NELSON, ERIN

BORGESON, MARY ANN

BOYLE-MANGANARO, MAUREEN

CAVANAUGH, JAMES

FRIEND, MIKE

GARCIA, ROGER

MORGAN, PJ

NELSON, ERIN

ROGERS, CHRIS

NELSON, ERIN

NELSON, ERIN

BORGESON, MARY ANN

BOYLE-MANGANARO, MAUREEN

CAVANAUGH, JAMES

FRIEND, MIKE

GARCIA, ROGER

MORGAN, PJ

NELSON, ERIN

ROGERS, CHRIS

NELSON, ERIN

DOUGLAS COUNTY NEBRASKA

What this means

What CMS inspection records show

Latest recorded inspection

F0697 — Quality of Life and Care Deficiencies

F0760 — Pharmacy Service Deficiencies

F0605 — Freedom from Abuse, Neglect, and Exploitation Deficiencies

F0636 — Resident Assessment and Care Planning Deficiencies

F0656 — Resident Assessment and Care Planning Deficiencies

F0684 — Quality of Life and Care Deficiencies

F0686 — Quality of Life and Care Deficiencies

F0688 — Quality of Life and Care Deficiencies

F0695 — Quality of Life and Care Deficiencies

F0697 — Quality of Life and Care Deficiencies

F0699 — Quality of Life and Care Deficiencies

F0812 — Nutrition and Dietary Deficiencies

F0880 — Infection Control Deficiencies

F0580 — Resident Rights Deficiencies

F0656 — Resident Assessment and Care Planning Deficiencies

F0553 — Resident Rights Deficiencies

F0577 — Resident Rights Deficiencies

F0580 — Resident Rights Deficiencies

F0585 — Resident Rights Deficiencies

F0644 — Resident Assessment and Care Planning Deficiencies

F0689 — Quality of Life and Care Deficiencies

F0812 — Nutrition and Dietary Deficiencies

F0880 — Infection Control Deficiencies

F0609 — Freedom from Abuse, Neglect, and Exploitation Deficiencies

F0580 — Resident Rights Deficiencies

F0584 — Resident Rights Deficiencies

F0626 — Resident Rights Deficiencies

F0791 — Quality of Life and Care Deficiencies

F0812 — Nutrition and Dietary Deficiencies

F0880 — Infection Control Deficiencies

Tags appearing across inspections

CMS penalty records in the loaded three-year dataset

Payment Denial — Oct 30, 2025

Questions generated from the evidence above

Facility History

What changed recently?

2026

2025

2024

2023

Reported nursing staffing at a glance

Weekday and weekend calculations