Grand Plains Skilled Nursing by Americare

In the surveyor’s words

From the most serious findings on record at Grand Plains Skilled Nursing by Americare, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Jun 1, 2021

  The facility census totaled 28 residents, with 14 included in the sample with all reviewed for neglect. Based on observation, interview, and record review the facility failed to prevent incidents of neglect of two residents. On [DATE] Certified Nurse Aide (CNA) E left Resident (R)9 and R14 in the whirlpool and shower alone without notifying other staff to ensure the appropriate assistance and a call light in reach for approximately 30 minutes to an hour. This failure placed both residents in immediate jeopardy. […]

• Actual harm, isolatedF600Oct 1, 2025

  The facility reported a census of 51 residents. The sample included six residents who were reviewed for abuse. Based on observation, interview, and record review, the facility failed to ensure residents remained free from resident-to-resident abuse when, on 09/03/25 at approximately 05:00 AM, Resident (R)1 wandered into R2's room and struck R2, a cognitively and physically impaired resident, in the head. Findings included:- R1's Electronic Health Record (EHR) documented diagnoses that included unspecified dementia (a progressive mental disorder characterized by failing memory and confusion).R1's 07/28/25 admission Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of eight, which indicated moderately impaired cognition. […]

• Actual harm, isolatedF686Jun 27, 2023

  The facility had a census of 42 residents. The sample included 12 residents, with two reviewed for pressure ulcers/pressure injury (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observation, record review and interview, the facility failed to implement interventions to prevent the development of a facility-acquired, right heel pressure ulcer for Resident (R)22 and R39 who were at risk for pressure injuries. […]

• Actual harm, isolatedF686Jun 1, 2021

  The facility census totaled 28 residents, with 14 residents included in the sample and three residents reviewed for pressure ulcers. Based on observation, interview, and record review the facility failed to ensure cognitively impaired Resident (R) 2, identified as at risk for developing pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, and/or in combination with shear and/or friction), did not develop pressure ulcers while in the facility with appropriate repositioning, weekly skin assessments lacked the appropriate documentation for all pressure injuries or areas of skin concerns, staff did not follow wound treatment orders, and staff did not place the anti-pressure boots or float the residents heels as ordered. […]

• No harm, potential for more than minimal, patternF610Oct 1, 2025

  The facility reported a census of 51 residents. The sample included six residents who were reviewed for abuse. Based on observation, interview, and record review, the facility failed to initiate protective actions to prevent the opportunity for additional resident-to-resident abuse, as required. On 09/03/25 at approximately 05:00 AM, Resident (R)1 wandered into R2's room and struck R2, a cognitively and physically impaired resident, in the head. R1 was placed on one-on-one observation by facility staff; however, R1 continued to wander into other resident's rooms with the potential to harm other residents on the unit. […]