Douglas County Health Center

Name: Douglas County Health Center
Address: 4102 Woolworth Avenue, Omaha, NE, 68105, US
Telephone: 4024447041

4102 Woolworth Avenue, Omaha, NE 68105 · Douglas County · 254 certified beds · avg 228 residents/day · certified since Mar 24, 1967

2/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

5.89

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 3/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

Most serious findings (actual harm or immediate jeopardy)

▲ Actual harm, one-off · Oct 30, 2025 · F-0760 · triggered by a complaint

The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication.

Why it matters: A serious medication error can cause real harm, hospitalization, or worse.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Dec 12, 2025 (Deficient, Provider has date of correction)

All citations in the current public record (33)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Oct 30, 2025	▲ G · Actual harm, one-off	The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. · from a complaint
Oct 30, 2025	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint
May 13, 2025	F · Potential for harm, facility-wide	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
May 13, 2025	D · Potential for harm, one-off	The facility gave residents unnecessary mind-altering (psychotropic) medications, or used drugs in a way that restrained residents by dulling their ability to think, move, or function.
May 13, 2025	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
May 13, 2025	D · Potential for harm, one-off	The facility did not respond appropriately to alleged violations, such as reports of abuse, neglect, or mistreatment. Facilities must investigate every allegation and protect residents while they do. · from a complaint
May 13, 2025	D · Potential for harm, one-off	The facility did not fully assess residents on time — a complete assessment of health, abilities, and needs is required when a resident is first admitted and at least once every 12 months after that.
May 13, 2025	D · Potential for harm, one-off	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide the care needed to maintain or improve residents' movement and flexibility — such as range-of-motion exercises — leading to avoidable decline.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it.
May 13, 2025	D · Potential for harm, one-off	The facility did not provide care that took into account residents' past trauma or their cultural backgrounds. Care is supposed to be sensitive to what residents have lived through and where they come from.
May 13, 2025	D · Potential for harm, one-off	The facility did not make sure residents actually saw their doctor face-to-face at all required visits. Doctors must examine nursing home residents in person on a regular schedule. · from a complaint
May 13, 2025	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away. · from a complaint
May 16, 2024	D · Potential for harm, one-off	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. · from a complaint
Apr 26, 2024	E · Potential for harm, repeated	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not let a resident help develop and carry out their own plan of care — the written roadmap of the services and support they'll receive, built around their personal goals and preferences.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not coordinate resident assessments with the state's pre-admission screening program for mental illness and intellectual disabilities, or failed to refer residents for the special services they need.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Apr 26, 2024	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Apr 26, 2024	C · Minimal risk, facility-wide	The facility did not make its inspection results easy for residents to see, or made it hard for residents to contact advocacy agencies like the ombudsman.
Mar 5, 2024	D · Potential for harm, one-off	The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
May 16, 2023	F · Potential for harm, facility-wide	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
May 16, 2023	D · Potential for harm, one-off	The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.
May 16, 2023	D · Potential for harm, one-off	The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs.
May 16, 2023	D · Potential for harm, one-off	The facility did not let a resident return after a hospital stay or approved leave that lasted longer than the facility's bed-hold policy allowed. Residents generally have the right to come back to the next available bed.
May 16, 2023	D · Potential for harm, one-off	The facility did not provide or arrange dental services for its residents. Nursing homes are responsible for making sure residents can get dental care.
May 16, 2023	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.

Inspection trend by year

Citations from standard inspections increased between the last two inspection cycles (8 → 14).

Year	Citations	Serious (G–L)	Worst severity that year
2023	6	0	F
2024	11	0	E
2025	16	1	G ▲

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

0 fines totaling $0, plus 1 Medicare payment denial period.

Date	Type	Amount / length
Oct 30, 2025	Payment Denial	8 days from Dec 4, 2025

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Nebraska avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	5.89	4.33	3.95	top 6% in Nebraska; top 5% in the U.S.
Registered Nurse hours	1.24	0.72	0.69	top 7% in Nebraska; top 8% in the U.S.
Weekend total nurse staffing	5.41	3.79	3.50	top 5% in Nebraska; top 4% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.69	0.47	0.48	top 15% in Nebraska; top 17% in the U.S.
Total nursing staff turnover (%)	14.9	48.7	45.8	top 1% in Nebraska; top 1% in the U.S.
RN turnover (%)	12.8	44.1	42.9	top 8% in Nebraska; top 7% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.78, RN 1.01, weekend 4.39. Staffing rating: 5/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 4/5 · long-stay residents: 4/5 · short-stay residents: 4/5

Who owns this facility

Government - City/county

Owner / manager	Type	Role	Stake	Since
Borgeson, Mary Ann	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/1995
Boyle-Manganaro, Maureen	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2021
Cavanaugh, James	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2015
Friend, Mike	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2021
Garcia, Roger	Individual	Operational/Managerial Control	NOT APPLICABLE	10/01/2021
Morgan, PJ	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2010
Nelson, Erin	Individual	W-2 Managing Employee	NOT APPLICABLE	07/01/2019
Nelson, Erin	Individual	Corporate Director	NOT APPLICABLE	07/01/2019
Nelson, Erin	Individual	Operational/Managerial Control	NOT APPLICABLE	07/01/2019
Rogers, Chris	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2005

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"What systems do you use to prevent medication errors, and what happens when one occurs?"
"How do you assess and manage residents' pain, especially for those who have trouble communicating?"
"What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
"What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
"When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
"If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
"How soon after admission is a full assessment completed, and how are the findings shared with the family?"
"Can you show me an example care plan, and how are families included when it's created and updated?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
The Cypress at Midtown	0.4 mi	Omaha, NE	★★★☆☆	3/5
Emerald Nursing & Rehab Omaha	1.8 mi	Omaha, NE	★☆☆☆☆	1/5	SFF
St. Joseph Villa Nursing Center	2.4 mi	Omaha, NE	★☆☆☆☆	1/5
Omaha Nursing and Rehabilitation Center	2.5 mi	Omaha, NE	★☆☆☆☆	1/5
Ambassador Health of Omaha	2.6 mi	Omaha, NE	★★★★★	4/5
Emerald Nursing & Rehabilitation Mercy	2.9 mi	Omaha, NE	★☆☆☆☆	1/5	SFF
Maple Crest Health Center	3.4 mi	Omaha, NE	★★★☆☆	2/5
Keystone Ridge Post Acute Nursing and Rehabilitati	4.7 mi	Omaha, NE	★★☆☆☆	1/5
Life Care Center of Omaha	5.0 mi	Omaha, NE	★☆☆☆☆	1/5
Quality Living, INC.	5.4 mi	Omaha, NE	★★★☆☆	3/5
Emerald Nursing & Rehab Legacy Pointe LLC	5.6 mi	Omaha, NE	★☆☆☆☆	1/5	SFF
Florence Home	6.0 mi	Omaha, NE	★★★★☆	3/5

Compare this facility with the 3 closest →

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Facility data as of CMS processing date 2026-08-01. CCN 285019.

The Care File

Visit checklist — Douglas County Health Center

4102 Woolworth Avenue, Omaha, NE 68105 · 4024447041

Health inspection rating 2/5 · CMS overall 3/5· Fines (3y): $0

Most serious findings on record:

▲ Oct 30, 2025 (F-0760, Actual harm, one-off): The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication.

Questions for the administrator:

☐ "What systems do you use to prevent medication errors, and what happens when one occurs?"
☐ "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
☐ "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
☐ "What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
☐ "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
☐ "If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
☐ "How soon after admission is a full assessment completed, and how are the findings shared with the family?"
☐ "Can you show me an example care plan, and how are families included when it's created and updated?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 285019 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)