Below average — CMS composite of the measures below.
The next survey window likely opens around January 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Accura Healthcare Of Tekamah during CMS and state inspections, most recent first.
Failure to provide required RN coverage. Review of PBJ staffing data showed no RN hours on multiple dates, and the Administrator confirmed that no RN was scheduled on several of those dates. The facility census was 33.
The facility failed to ensure 2 NAs completed the required 12 hours of annual training. One NA had only 7.1 hours documented, including dementia training but no abuse training, and the other NA had no yearly training information available. The Administrator confirmed both NAs did not complete the required training.
Surveyors found that bathroom ventilation systems were not functioning properly in 12 of 27 occupied resident rooms when vents in those bathrooms failed to draw a 1‑ply piece of toilet paper to the vent surface during testing with the MD and Administrator. Facility records showed that monthly exhaust fan checks had been documented as completed, but the log did not identify which rooms were tested or how many rooms were actually checked, and the last recorded check lacked room-specific detail despite multiple rooms having inadequate ventilation.
Failure to Monitor Psychotropic Medication Side Effects: The facility did not document side effect monitoring for three residents receiving psychotropic meds. One resident with dementia and anxiety received lorazepam and mirtazapine, another with anxiety, panic disorder, OCD, and schizophrenia received fluvoxamine, and a third with delusional disorder, mood disorder, dementia, anxiety, and OCD received quetiapine. Although care plans directed staff to observe for side effects and report adverse reactions, the MAR/TAR and chart lacked documentation, and the Administrator and an LPN confirmed the monitoring was not being done.
A facility failed to include measurable, resident-specific care plan details for ADLs and respiratory equipment needs for three residents. One resident with severe cognitive impairment and extensive ADL dependence had no ADL care plan, another resident with severe cognitive impairment and transfer/toileting needs had no care plan focus for transfers, positioning, or ADLs, and a third resident with respiratory failure and OSA had a BiPAP order but the care plan did not address the PAP machine specifics.
The facility failed to obtain valid orders for PAP device modes and settings for three residents receiving CPAP/BiPAP therapy. One resident had OSA and daytime O2, another had OSA with nightly BiPAP and O2, and a third had respiratory failure with hypoxia, OSA, and pulmonary hypertension; in each case, the chart lacked the specific PAP settings, and staff confirmed the orders were incomplete. Observations also showed one resident without the ordered oxygen in place while the concentrator was running.
Infection control failures occurred during wound care, insulin administration, and PAP mask care. An OT and an LPN did not consistently perform hand hygiene or glove changes during wound care for a resident on EBP, and staff clothing contacted the floor during care. During insulin administration, an LPN used gloves taken from a scrub pocket and then gave insulin to a resident with DM and diabetic polyneuropathy. PAP masks for two residents were also found dirty and not cleaned as ordered, with visible facial oils and residue on the mask seal.
A resident with severe cognitive impairment, dementia, and total-to-substantial ADL dependence developed multiple unexplained abrasions and scabbed areas on both shins. Family did not know the cause, an LPN said the cause was unknown, and the Administrator confirmed no investigation was completed and no report was made to APS or DHHS as required.
A resident with severe cognitive impairment, dementia, immobility, and total dependence for many ADLs developed multiple abrasion and scabbed areas on both shins. Although the CCP identified risk for skin breakdown and included general measures, it did not include the specific interventions used for the shin wounds, such as Betadine treatment and sheepskin pads/wraps during transfers, and the RN and administrator confirmed the CCP lacked specific wound-related interventions.
A facility failed to include a suprapubic catheter in a resident's care plan, despite physician's orders detailing specific care instructions. The resident, diagnosed with Neuromuscular Dysfunction of Bladder, had a catheter noted in the Minimum Data Set. The omission was confirmed by the MDS coordinator, contradicting the facility's policy for comprehensive care plans.
A facility failed to monitor a resident's behavioral symptoms to ensure the continued need for antipsychotic medication, despite documented diagnoses and target behaviors. Additionally, another resident's PRN antianxiety medication lacked a stop date, contrary to facility policy. These deficiencies were confirmed through interviews with the MDS Coordinator and DON, highlighting non-compliance with psychotropic drug use policies.
A facility failed to perform adequate hand hygiene during wound care for a resident with chronic ulcers, with hand washing lasting only 9-12 seconds instead of the required 15-20 seconds. Additionally, a resident's suprapubic catheter bag was improperly placed on the floor without a protective covering, violating infection control protocols.
The facility failed to provide a nursing assistant/medication aide with the required 12 hours of ongoing inservice training over the past year. A review of the aide's training transcript showed zero hours of training in the last 12 months, confirmed by the DON. This deficiency had the potential to affect all 28 residents in the facility.
Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to ensure RN coverage was provided at least 8 consecutive hours a day for 7 days a week. Review of the PBJ Staffing Data Report dated 2/5/26 showed the metric "No RN Hours" was triggered for no RN hours on 7/6/25, 7/19/25, 8/2/25, and 8/16/25. During an interview with the Administrator on 2/11/26 at 10:35 AM, the Administrator confirmed there was no RN scheduled on 7/6/25, 7/19/25, and 8/2/25. The facility census was 33.
Failure to Complete Required Annual NA Training
Penalty
Summary
The facility failed to ensure that 2 Nursing Assistants completed the required 12 hours of yearly training. Record review showed NA F was hired on 7/14/2020 and had completed 6.1 hours of annual training on a form dated 2/11/26; an inservice record dated 1/20/26 showed attendance at a Dementia and Behaviors session, bringing the total yearly inservice hours to 7.1, including 2.5 hours of dementia training, with no abuse training documented. Record review also showed NA D was hired on 8/14/2023, and the facility was unable to provide information showing that NA D had completed any yearly training. In an interview on 2/11/26 at 10:35 AM, the Administrator confirmed that NA D and NA F did not complete the required yearly training and should have.
Failure to Maintain Operational Bathroom Ventilation Systems in Multiple Resident Rooms
Penalty
Summary
The deficiency involves the facility’s failure to ensure that resident bathroom ventilation systems were operational as required by licensure regulation 175 NAC 12-007.04D. Facility documentation titled “Exhaust Fans” dated as completed on 1/28/26 instructed staff to check all exhaust fans in bathrooms and other specified areas and to verify that airflow was sufficient to hold a piece of paper to the vent when operating. However, during an observation conducted with the Maintenance Director (MD) and the Administrator, the ventilation systems in resident bathrooms in rooms 1, 5, 10, 11, 15, 16, 17, and 18 on the East hall and rooms 1, 2, 3, and 4 on the South hall did not draw a 1‑ply square of toilet paper to the surface of the ventilation cover, indicating that the systems were not working properly at that time. During interview, the MD confirmed that the ventilation systems in these 12 resident bathrooms were not functioning properly, as evidenced by the failure to draw the toilet paper to the vent surface. The MD also confirmed that monthly checks of the ventilation system had been marked as completed in the electronic Exhaust Fan documentation on 1/28/26, but there was no record specifying which rooms had been tested or how many rooms had been completed. The MD acknowledged that the last documented check of the ventilation systems was on 1/28/26 and that the documentation did not identify the specific rooms where exhaust fans had been checked. The facility census at the time was 33, and 12 of 27 occupied resident rooms were found to have non-functioning or insufficient bathroom ventilation.
Failure to Monitor and Document Psychotropic Medication Side Effects
Penalty
Summary
The facility failed to monitor and document side effects related to psychotropic medication use for three sampled residents. The deficiency was cited under 175 NAC 12-006.05(G) after record review and staff interview showed that side effect monitoring was expected to be documented in the medical record, but was not completed for the residents reviewed. Resident 33 had diagnoses of unspecified dementia and generalized anxiety disorder, a BIMS score of 11 indicating moderate cognitive impairment, and required varying levels of assistance with eating, oral hygiene, toileting, footwear, dressing, and personal hygiene. The resident had orders for lorazepam twice daily and PRN and mirtazapine at bedtime. Although the care plan directed staff to give antidepressant medications as ordered and monitor/document side effects and effectiveness, the MAR/TAR, documentation survey report, and electronic/paper chart did not show side effect monitoring for the psychotropic medications. The Administrator confirmed on interview that staff should have been monitoring and documenting side effects on the MAR/TAR and were not. Resident 6 had diagnoses including anxiety disorder, panic disorder, obsessive compulsive disorder, and schizophrenia, with a BIMS score of 15 and substantial to maximum assistance needed for multiple ADLs. The resident received fluvoxamine ER 150 mg at bedtime for schizophrenia, and the care plan included interventions to observe for side effects and effectiveness and to record/report adverse reactions to psychoactive medications. The record review found no specific side effects identified and no monitoring documented in the EMR or paper chart. Resident 4 had diagnoses including delusional disorders, persistent mood disorder, unspecified dementia with behavioral disturbance, anxiety disorder, and other obsessive-compulsive disorder, with a BIMS score of 14/15 and significant assistance needs for ADLs. The resident received quetiapine 75 mg four times daily, and the care plan included monitoring and reporting adverse reactions to psychotropic medications, but the MAR/TAR and chart did not show side effect monitoring. An LPN confirmed that side effect monitoring was not being monitored and should have been.
Incomplete Care Plans for ADLs and BiPAP Needs
Penalty
Summary
The facility failed to develop comprehensive care plans that included measurable objectives and timetables for resident needs identified in assessment for three residents. The cited deficiency involved missing care plan details for activities of daily living needs for two residents and missing BiPAP/PAP machine specifics for one resident. The facility policy stated that the comprehensive care plan should describe services to be furnished, be reviewed and revised after comprehensive and quarterly MDS assessments, and include measurable objectives and timeframes. Resident 21 had diagnoses including late-onset Alzheimer's disease, non-Alzheimer's dementia, anxiety, and depression, with a BIMS score of 1 indicating severely impaired cognition. The quarterly MDS showed the resident needed substantial to maximum assistance to total dependence with toileting hygiene, bathing, dressing, personal hygiene, footwear, and bed-to-chair and toilet transfers, and the resident used a manual wheelchair with frequent bladder incontinence and occasional bowel incontinence. Observations showed the resident being assisted with eating and toileting, but the care plan contained no specific information about the level of assistance needed with ADLs. The Administrator reviewed the care plan and confirmed there was no ADL care plan and that one should have been developed. Resident 28 had diagnoses including congestive heart failure, gout, osteoarthritis, muscle weakness, obesity, unsteadiness on feet, Down syndrome, and need for assistance with personal care, with a BIMS score of 1 indicating severe cognitive impairment. The MDS showed the resident needed setup or clean-up assistance with eating, partial/moderate assistance with oral hygiene and transfers, and dependence for toileting, bathing, and tub transfers. The care plan did not include focus areas for transfers, positioning, or ADLs, and staff interviews showed they relied on floor knowledge, the huddle book, or the resident self-transferring rather than a documented care plan. Resident 3 was admitted with acute and chronic respiratory failure with hypoxia, obstructive sleep apnea, pulmonary hypertension, and a left tibia fracture, and the MDS identified a non-invasive mechanical ventilator. A physician order directed BiPAP use at night with 4L O2, but the care plan only addressed potential respiratory abnormalities and did not mention the specifics of the PAP machine; an LPN confirmed the PAP machine had not been care planned.
Missing PAP Orders and Settings
Penalty
Summary
The facility failed to obtain valid orders for Positive Airway Pressure (PAP) device use and settings for three sampled residents. The facility’s CPAP and BiPAP policy dated 11/18/2025 stated the facility would obtain an order for the device and settings from the practitioner. For Resident 11, the care plan identified CPAP/BiPAP therapy at night related to obstructive sleep apnea and continuous oxygen during waking hours, but did not list PAP settings. The physician order dated 02/11/2026 ordered CPAP at current with oxygen, apply at night, and oxygen at 1-4 liters per minute continuously, but did not identify the mode or settings for the PAP device. The MAR and TAR showed the resident wore the PAP and oxygen every night. During observations, the resident was awake with the oxygen concentrator running at 3 liters per minute, but the nasal cannula was tucked into the concentrator and the resident was not wearing oxygen. For Resident 28, the care plan identified CPAP/BiPAP therapy for obstructive sleep apnea but did not include the specific mode or settings. The physician order dated 02/11/2026 ordered oxygen 2-3 liters per minute with BiPAP every night at bedtime, but did not include PAP settings. The MAR and TAR showed the resident wore the PAP and oxygen every night. Observations found a ResMed Aircurve 10 VAuto on the bedside table and an oxygen concentrator in the room, and later the resident was awake in the dining room. For Resident 3, the admission MDS showed severe problems with thinking or memory and diagnoses included acute and chronic respiratory failure with hypoxia, obstructive sleep apnea, pulmonary hypertension, and a nondisplaced fracture of the medial malleolus of the left tibia. The physician order dated 2/6/26 ordered BiPAP at preset settings with 4L oxygen, but did not include the settings. An LPN confirmed the order did not include the BiPAP settings and should have.
Infection Control Failures During Wound Care, Insulin Administration, and PAP Mask Cleaning
Penalty
Summary
The facility failed to ensure staff performed hand hygiene and glove changes during wound care for a resident with Enhanced Barrier Precautions (EBP) related to chronic non-healing wounds of the left lower extremity. The resident had physician orders for EBP care during dressing changes, bathing, transferring, hygiene care, changing bed linens, toileting, device care, and wound care, along with wound care orders for lymphedema wraps. During observation, a medication aide assisted the resident from the toilet to the wheelchair without wearing personal protective equipment. Later, during lymphedema wrap changes and assessment, an OT washed hands three times for less than 20 seconds before applying a gown and gloves, removed and re-gloved four times without hand hygiene, and sat on the floor in the resident’s room without a barrier. An LPN also allowed knees to contact the floor and performed the wound care process on the resident’s left lower extremity without changing gloves or performing hand hygiene when moving from cleansing the wound to applying the dressings. The facility also failed to ensure proper infection control during insulin administration for a resident with type 2 diabetes mellitus and diabetic polyneuropathy. The resident had an order for Novolog sliding scale insulin twice daily. During a medication pass, an LPN removed the insulin pen from the medication cart, cleaned the tip with an alcohol wipe, applied the needle, and prepared the dose. The LPN then pulled gloves from the left front pocket of scrub pants, donned them, entered the resident’s room, administered the insulin, removed the gloves, and returned to the medication cart to discard the needle. The LPN confirmed in interview that the gloves taken from the scrub pocket were contaminated. The facility further failed to keep PAP masks clean for two residents who used CPAP/BiPAP equipment. One resident had an order to wash the CPAP or BiPAP mask with soap and water, rinse tubing, and allow it to air dry every morning, and the resident wore PAP and oxygen every night. Observations showed the resident’s nasal mask on the bedside table with facial oils on the seal and a white crusty substance. The facility’s PAP hygiene guide stated the mask seal should be cleaned daily. A medication aide confirmed the masks were supposed to be cleaned in the morning after use, and the Administrator confirmed staff should have cleaned the PAP masks after the resident used them.
Failure to Investigate and Report Injury of Unknown Origin
Penalty
Summary
The facility failed to thoroughly investigate and report an injury of unknown origin for one resident to APS and DHHS. The cited policy required mandated reporters to immediately report unexplained injuries, and required the Administrator or DON to determine whether an incident was reportable, complete an internal investigation, and submit reports to APS or DHHS as required by state law. The report also stated that alleged violations involving injuries of unknown source must be reported immediately and thoroughly investigated while further potential abuse is prevented during the investigation. Resident 16 had an annual MDS showing severe cognitive impairment with a BIMS score of 3, diagnoses including weakness, difficulty walking, cognitive communication deficit, dementia, and mood disorder, and required substantial to total assistance with ADLs. The resident also had physical behavioral symptoms directed toward others, daily antianxiety medication use, and hospice care. The resident’s family reported several abrasion injuries to both shins extending from the knees to the ankles and did not know how they occurred. Treatment records showed bilateral shin wound care beginning with cleansing and Betadine application, and an LPN later observed multiple scabbed and abraded areas up and down both shins. An LPN stated the cause of the leg abrasions was unknown and only had ideas about how they may have happened. The Administrator confirmed that no investigation had been completed to determine the cause of the injuries and no report had been made to APS or DHHS. The Administrator also confirmed the injuries met the criteria for an injury of unknown origin and should have been investigated and reported. The facility’s skin PIP was reviewed, but it did not identify the resident’s bilateral lower leg wounds.
Care Plan Missing Specific Interventions for Shin Wounds
Penalty
Summary
The facility failed to review and revise the Comprehensive Care Plan to include specific interventions related to skin breakdown for one resident. The resident had an annual MDS dated 11/20/25 showing an admission date of 12/25/22, diagnoses including weakness, difficulty walking, cognitive communication deficit, dementia, and mood disorder, and a BIMS score of 3 indicating severe cognitive impairment. The MDS also showed substantial to maximum assistance to total dependence for ADLs, daily antianxiety medication use, hospice care, and no skin conditions at that time. The facility policy stated the CCP should include measurable objectives, timeframes, and resident-specific interventions and be reviewed and revised by the interdisciplinary team after comprehensive and quarterly MDS assessments. The resident’s CCP dated 12/29/25 identified risk for skin breakdown related to immobility and included general interventions such as peri care, observation for red or open areas, pressure-relieving mattress and wheelchair cushion, weekly skin assessment, and dietician consultation as needed. However, the resident later developed several abrasion injuries to both shins extending from the knees to the ankles, and the family member was unaware of how the injuries occurred. Nursing staff observed scabbed and abraded areas on both legs and applied Betadine treatment, while a progress note directed washing the bilateral lower extremities and applying Betadine twice daily to scabbed areas. The regional clinical specialist and administrator confirmed that the interventions tried, including sheepskin pads/wraps on the shins during transfers, were not included on the CCP, and the plan did not address specific interventions for the shin wounds to prevent further breakdown and promote healing.
Failure to Include Suprapubic Catheter in Care Plan
Penalty
Summary
The facility failed to develop and implement a Comprehensive Care Plan (CCP) for a resident with a suprapubic catheter. The resident, admitted on 8/27/24, had a diagnosis of Neuromuscular Dysfunction of Bladder, unspecified, and was noted to have a catheter according to the Minimum Data Set dated 9/3/24. Physician's orders indicated specific care instructions for the catheter, including changing the dry dressing daily, ensuring catheter care during shifts, and irrigating the catheter with normal saline if clogged. Additionally, the orders specified changing the suprapubic catheter monthly or as needed based on clinical indications. Despite these detailed physician's orders, a review of the resident's care plan on 10/29/24 revealed that the suprapubic catheter was not included in the care plan. An interview with the MDS coordinator confirmed that the catheter should have been part of the care plan but was omitted. The facility's policy, revised in November 2023, mandates the development of a comprehensive, individualized care plan for each resident, addressing various needs and conditions. However, this policy was not adhered to in the case of the resident with the suprapubic catheter.
Failure to Monitor Behavioral Symptoms and PRN Medication Management
Penalty
Summary
The facility failed to monitor the behavioral symptoms of a resident to ensure the effectiveness or continued need for antipsychotic medication. The resident, who was admitted with diagnoses including paranoid schizophrenia, anxiety disorder, major depressive disorder, insomnia, unspecified dementia, and cognitive communication deficit, had a comprehensive care plan that identified target behaviors such as paranoia, delusional thinking, hallucinations, and aggression. Despite these documented behaviors, there was no specific behavior charting for the months of October, November, and December 2023, and the last gradual dose reduction was noted in January 2024. Interviews with the MDS Coordinator and the Director of Nursing confirmed the lack of behavior charting and the need for physician awareness. Additionally, the facility failed to include a stop date on a PRN antianxiety medication for another resident. This resident, who was admitted with diagnoses of unspecified dementia, depressive disorder, vascular dementia, and anxiety disorder, had a BIMS score indicating moderate cognitive impairment. The resident's care plan included focus, goals, and interventions for PRN depression medication. However, a physician's order for Xanax, prescribed for irritability, lacked a stop date, which was confirmed by the Director of Nursing during an interview. These deficiencies highlight the facility's failure to adhere to its policy on the use of psychotropic drugs, which requires monitoring and documentation of residents' responses to medications and the inclusion of stop dates for PRN orders. The lack of behavior monitoring and documentation, as well as the absence of a stop date for PRN medication, indicate non-compliance with regulatory requirements designed to ensure the safe and effective use of psychotropic medications.
Inadequate Hand Hygiene and Improper Catheter Bag Placement
Penalty
Summary
The facility staff failed to perform adequate hand hygiene during wound care for a resident with chronic venous hypertension and multiple ulcers. The resident, who had a BIMS score of 15 indicating high cognitive function, refused certain aspects of the wound care treatment. During an observation, a registered nurse washed hands for only 12 seconds before donning protective gear and performing wound care. The nurse continued to perform hand hygiene inadequately, washing hands for only 9 seconds at different stages of the procedure, contrary to the facility's hand hygiene policy which requires at least 15 seconds of hand washing. Another deficiency was observed with a resident who had a suprapubic catheter due to neuromuscular dysfunction of the bladder. The catheter bag was improperly placed, being hooked onto a trash can and resting on the floor without a protective covering. This was observed on two separate occasions, indicating a failure to adhere to proper catheter bag placement protocols to prevent potential contamination. Interviews with the RN and the Director of Nursing confirmed the hand hygiene practices were not in compliance with the facility's policy, which mandates hand washing for at least 15-20 seconds. The Director of Nursing also confirmed that the facility's expectation is not to have catheter bags resting on the floor, highlighting a lapse in maintaining infection control standards.
Deficiency in Ongoing Inservice Training for Medication Aide
Penalty
Summary
The facility failed to ensure that a nursing assistant/medication aide received the required 12 hours of ongoing inservice training over the past year. This deficiency was identified through interviews and record reviews conducted by surveyors. The medication aide in question was hired on August 16, 2021, and a review of their training transcript from Relias, dated October 31, 2024, showed zero hours of training in the last 12 months. An interview with the Director of Nursing on October 31, 2024, confirmed that the medication aide had not participated in any ongoing inservice training since July 9, 2023. This lack of training had the potential to affect all 28 residents residing in the facility, as the facility census was 28.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Tekamah
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Oakland Heights | 13.2 mi | ★★★★★ | 0 | 0 |
| Good Shepherd Lutheran Home | 16.1 mi | ★★★★★ | 11 | 0 |
| Crowell Memorial Home | 16.6 mi | ★★★★★ | 3 | 0 |
| Accura Healthcare Of Onawa | 18.7 mi | ★★★★★ | 0 | 0 |
| Azria Health Longview | 22.4 mi | ★★★★★ | 3 | 0 |
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