01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-01 | 6 | 2025-05-01 | 5 |
| Cycle 2 | 2024-05-01 | 10 | 2024-05-01 | 2 |
| Cycle 3 | 2023-04-12 | 0 | 2023-04-12 | 0 |
CMS CCN 2853072026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Eventide Prairie Commons Care Center
3490 Ewoldt Street · Grand Island, NE 68803 · Hall County
Certified beds36CMS provider file
Recent citation rows23current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
23 rows in the current release
2 rows carry G–L scope/severity codes; 1 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-03 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2026-06-25 · complaint2025-05-01 · FIREE0041Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-01 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2025-05-272025-05-01 · HEALTHF0678Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Correction field: Deficient, Provider has date of correction · 2025-05-272025-05-01 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-05-272025-05-01 · HEALTHF0759Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2025-05-272025-05-01 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-05-272025-05-01 · FIREK0222Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-01 · FIREK0351Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-01 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-05-232025-05-01 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-05-232024-12-23 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-02-06 · complaint2024-12-23 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-02-06 · complaint2024-05-01 · HEALTHF0561Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0578Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2024-05-01 · complaint2024-05-01 · HEALTHF0658Severity E · pattern; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0803Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-05-012024-05-01 · FIREK0131Severity F · widespread; potential for more than minimal harm
Construction Deficiencies
Meet requirements for sections of health care facilities separated by fire resistive construction.
Correction field: Deficient, Provider has date of correction · 2024-06-032024-05-01 · FIREK0223Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Correction field: Deficient, Provider has date of correction · 2024-06-0303 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-05-01 | Fine | $10,296 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- TABITHA, INC.Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 12/22/2022
- EVENTIDE NEBRASKA SENIOR LIVING LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST100% · since 10/10/2024
- BOCK, JODEEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- BRANDT, TERRYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- BYE, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- FISCHBACH, TYLERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- GULBRANSON, PATRICKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- JOHNSON, VIKKIIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- LARSON-CASSELTON, CINDYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- LEE, JUDITHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- LUNAK, BRANDONIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- SCHAFER, ERICIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- SELJEVOLD, PETERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- SWENSON, KARLAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/10/2024
- BYE, ROBERTIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/10/2024
- JOHNSON, VIKKIIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/10/2024
- LUNAK, BRANDONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2026
- RIEWER, JONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/10/2024
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.41per resident day
RN hours0.86per resident day
Weekend nurse hours4.17per resident day
Staff turnover67.4%CMS reported field
06 / LOCAL RECORDS
Open the Grand Island ledger →Other published facilities nearby
Adept Nursing & Rehab Of Grand Island76 beds · CMS overall 1/554 citation rowsChi Health St. Francis36 beds · CMS overall 3/513 citation rowsEmerald Nursing & Rehab Lakeview95 beds · CMS overall 1/543 citation rowsGood Samaritan Society - Grand Island Village67 beds · CMS overall 1/543 citation rowsTiffany Square103 beds · CMS overall 2/529 citation rows