Provider Name: CLOVERLODGE CARE CENTER
Address: 301 NORTH 13TH STREET, ST EDWARD, NE 68660
Phone: (402) 678-2294
County: Boone (050)
Ownership Type: Non profit - Corporation
Certified Beds: 47
Average Residents Per Day: 33.9 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: VSL ST EDWARD LLC
First Approved Date: October 1, 1996
Affiliated Entity: VETTER SENIOR LIVING (547)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 3 ()
Long Stay QM Rating: 3 ()
Short Stay QM Rating: (2)
Staffing Rating: 3 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 1.58758, LPN Staff Hours Per Day: 0.7922, RN Staff Hours Per Day: 0.6522, Licensed Staff Hours Per Day: 1.4445
Total Nurse Staff Hours Per Day, per resident: 3.03213
Weekend Nurse Staff Hours: 2.49715, Weekend RN Staff Hours: 0.4318
PT Staff Hours Per Day, per resident: 0.0772
Nurse Staff Turnover: 30.4, Nurse Turnover Note:
RN Turnover: 40.0, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 1.9211, Case Mix LPN Hours Per Day: 0.6314, Case Mix RN Hours Per Day: 0.2879
Adjusted Nurse Aide Hours Per Day, per resident: 1.68354, Adjusted LPN Hours Per Day: 0.9259, Adjusted RN Hours Per Day: 0.8535
Total Adjusted Nurse Hours Per Day, per resident: 3.36467
Adjusted Weekend Nurse Hours Per Day, per resident: 2.77102
Health Survey Dates and Scores: Cycle 1: 2023-05-02 (Score: 4), Cycle 2: 2022-02-23 (Score: 36), Cycle 3: 2021-02-01 (Score: 0)
Total Weighted Health Score: 14.000
Reported Incidents: 1, Substantiated Complaints: 0
Infection Control Citations: 0
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 301 NORTH 13TH STREET,ST EDWARD,NE,68660 (41.5710, -97.853)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-06-03
Type: Health, Deficiency: Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-03-31
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-03-31
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-03-31
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0363, Version: New
Description: Install corridor and hallway doors that block smoke.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-05-25
Type: Fire Safety, Tag: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-03-22
Type: Fire Safety, Tag: 0351, Version: New
Description: Install an approved automatic sprinkler system.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-03-17
Type: Fire Safety, Tag: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-02-18
Type: Fire Safety, Tag: 0920, Version: New
Description: Ensure proper usage of power strips and extension cords.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-02-18