Applications must be signed by:
1. The owner, if the applicant is an individual or partnership,
2. Two of its members, if the applicant is a limited liability company,
3. Two of its officers, if the applicant is a corporation,
4. The head of the governmental unit having jurisdiction over the facility to be licensed, if the applicant is a governmental unit.
List the names and addresses of all persons in control of the facility (do not include social security numbers or date of birth), including:
• individual owners,
• limited liability members,
• parent companies, if any,
• members of boards of directors owning or managing the operations,
• any other persons with financial interests or investments in the facility,
• For publicly held corporations, list the stockholders who own 5% or more of the company’s stock.
The legal name of a business is the name under which the business conducts its operations. The legal name of the individual is the name that identifies a person for legal, administrative and other official purposes. Example: Licensee Name (as listed with the Secretary of State) dba Facility Name.
An Administrator must hold a current Nebraska Nursing Home Administrator license.
A schematic is a simple floor plan showing room numbers and the number of beds in each room and the type of beds in each room (example: Medicare, Medicaid, License-Only).
A bed capacity worksheet needs to be completed for all new facilities and current facilities requesting a bed increase to determine the maximum capacity for the facility based on Physical Plant Standards. The bed capacity is limited by the size of the resident rooms, the number of bathing fixtures, the number of toilet fixtures, the size of the dining room(s) and the size of the activity room(s).
The information disclosed shall explain the additional care provided in each of the following areas:
1. The Alzheimer’s special care unit’s written statement of its overall philosophy and mission which reflects the needs of residents afflicted with Alzheimer’s disease, dementia, or a related disorder;
2. The process and criteria for placement in, transfer to, or discharge from the unit;
3. The process used for assessment and establishment of the plan of care and its implementation, including the method by which the plan of care evolves and is responsive to change in conditions;
4. Staff training and continuing education practices;
5. The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents;
6. The frequency and types of resident activities;
7. The involvement of families and the availability of family support programs; and
8. The costs of care and any additional fees.
A generic email address should:
• Be accessed by more than one person at your facility
• Not change with personnel changes
• NOT use a person’s name in the email address
An example would be Administration@net.com or ABCNursingHome@AOL.com.
The Department may deem a licensee in compliance with 175 NAC 12-006 based on its accreditation as a skilled nursing facility, nursing facility, or intermediate care facility by the:
1. Joint Commission on Accreditation of Health Organizations;
2. Commission on Accreditation of Rehabilitation facilities; or
3. Medicare or Medicaid certification program.
Bed change rules are as follows:
• To change the location of the beds; a 30-day written notification is required.
• To increase or decrease the size of the facility’s certified beds; written notification is required 45 days prior to the first day of a cost-reporting quarter.
• A change in the size of the certified beds can only occur on the first day of a cost reporting quarter; whereas, the change of location of the beds can occur on any day.
• For all changes, submit a cover letter explaining the specific changes and effective date. Also submit a current and a proposed schematic showing room numbers, the number of beds in each room, and the type of beds in each room.