Inspection Detail

Case Status: CLOSED

Inspection: 1289020.015 - Five Star Quality Care, Inc.

Inspection Information - Office: Omaha Area Office

Inspection Nr: 1289020.015

Report ID: 0728900

Date Opened: 01/22/2018

Site Address:
Five Star Quality Care, Inc.
1100 W 1st Street
Milford, NE 68405

Mailing Address:
1100 W 1st Street, Milford, NE 68405

Union Status: NonUnion

SIC:

NAICS: 623110/Nursing Care Facilities

Inspection Type: Fat/Cat

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 03/12/2018

Emphasis:

Case Closed: 05/09/2018

Related Activity
Type	Activity Nr	Safety	Health
Accident	1302254

Case Status: CLOSED

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				2		2
Current Violations				2		2
Initial Penalty	$0	$0	$0	$9,239	$0	$9,239
Current Penalty	$0	$0	$0	$6,500	$0	$6,500
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Contest	Latest Event	Note
1.	01001	Other	19040039 A01	04/05/2018	04/24/2018	$6,500	$9,239	$0		I - Informal Settlement
2.	01002	Other	19040041 A02	04/05/2018		$0	$0	$0		I - Informal Settlement

Investigation Summary

Investigation Nr: 102384.015

Event: 12/21/2017

Employee falls on slippery surface, fractures skull, and lat

At 5:30 p.m. on December 21, 2017, an employee was carrying an 8 lb bag of personal items to her car when she slipped and fell on an icy sidewalk. The employee was discovered on the sidewalk by coworkers, bleeding from head and vomiting. The employee was transported to hospital where she was treated for a non-displaced skull fracture. The employee was later transferred to a rehab facility where she died 26 days after the initial incident from complications that resulted from a blunt force head injury.

Keywords: Concrete, Fall, Fracture, Head, Skull, Slip, Slippery Surface, Vomit

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	1289020.015	65	F	Fatality

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