The Willows at Gretna
Open-data reference.
The Willows at Gretna is a for profit - limited liability company facility in Gretna, NE with 63 certified beds and a 2-star overall CMS rating. The facility has 20 deficiency records on file.
700 Highway 6, Gretna, NE 68028
Phone: 4023323446
Overall Rating
Health Inspection
Staffing
Quality Measures
Long-Stay Quality
Facility Information
- Provider Number
- 285146
- Ownership
- For profit - Limited Liability company
- Provider Type
- Medicare and Medicaid
- Beds
- 63
- Residents
- 45
- In Hospital
- No
- County
- Sarpy
- Last Inspection
- Oct 16, 2024
Staffing Data
- RN Hours
- 0.50 (nat'l avg: 0.68)
- LPN Hours
- 0.76
- CNA Hours
- 2.67
- Total Nursing Hours
- 3.93 (nat'l avg: 3.89)
- PT Hours
- 0.14
- Nursing Turnover
- 82.0%
- RN Turnover
- 100.0%
What the CMS Record Reveals About The Willows at Gretna
The Willows at Gretna operates 63 certified beds in Gretna, NE with approximately 45 residents currently in care, and carries a CMS overall rating of 2 out of 5 stars. The overall score is a composite of three weighted sub-ratings published by the Centers for Medicare & Medicaid Services: health inspection results (2★), staffing levels (2★), and quality measures (2★). Because CMS caps the overall score at the health-inspection tier and then adjusts up or down based on staffing and quality, the sub-scores often tell a sharper story than the headline star count alone — a 3-star facility with weak inspection history reads differently from one held back by thin staffing.
The inspection file contains 20 deficiency records from recent surveys, of which 1 reached the actual-harm or immediate-jeopardy threshold on the CMS scope-and-severity grid. No fines or payment denials have been assessed against this provider, suggesting issues — if any — did not rise to the enforcement threshold. Staffing is reported at 3.93 total nursing hours per resident day (national average 3.89), with RN coverage at 0.50 per resident day — the single staffing metric most strongly tied to resident outcomes in peer-reviewed literature.
Classified as "For profit - Limited Liability company" ownership and operating as a "Medicare and Medicaid" provider, The Willows at Gretna falls into a category where comparative context matters. National research consistently shows that ownership structure, staffing hours, and turnover are the three operational levers that correlate most strongly with resident outcomes — ratings and fines are lagging indicators of those upstream choices. Reported nursing turnover at this facility is 82.0%, above the level where continuity of care typically begins to suffer. For families evaluating this facility, the CMS record should be read alongside a site visit, direct conversation with current residents and their families, and review of the state health department's most recent inspection report — the star rating is a starting point, not a verdict. All data on this page is sourced from CMS Provider Data and the Nursing Home Compare program; always verify details directly with the facility or your state survey agency before making placement decisions.
Deficiency History (20 most recent)
Provide and implement an infection prevention and control program.
Category: Infection Control Deficiencies
Corrected: Sep 12, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Category: Nutrition and Dietary Deficiencies
Corrected: Sep 12, 2025
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Category: Quality of Life and Care Deficiencies
Corrected: Sep 12, 2025
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Category: Quality of Life and Care Deficiencies
Corrected: Sep 12, 2025
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Category: Quality of Life and Care Deficiencies
Corrected: Jun 13, 2025
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Category: Resident Rights Deficiencies
Corrected: Jun 13, 2025
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Category: Resident Rights Deficiencies
Corrected: Jun 13, 2025
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Category: Resident Rights Deficiencies
Corrected: Nov 30, 2024
Post nurse staffing information every day.
Category: Nursing and Physician Services Deficiencies
Corrected: Nov 30, 2024
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Category: Pharmacy Service Deficiencies
Corrected: May 14, 2024
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Category: Quality of Life and Care Deficiencies
Corrected: May 14, 2024
Provide enough food/fluids to maintain a resident's health.
Category: Quality of Life and Care Deficiencies
Corrected: Feb 16, 2024
Ensure medication error rates are not 5 percent or greater.
Category: Pharmacy Service Deficiencies
Corrected: Sep 28, 2023
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Category: Quality of Life and Care Deficiencies
Corrected: Sep 28, 2023
Provide and implement an infection prevention and control program.
Category: Infection Control Deficiencies
Corrected: Sep 28, 2023
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Category: Resident Rights Deficiencies
Corrected: Sep 28, 2023
Perform COVID19 testing on residents and staff.
Category: Infection Control Deficiencies
Corrected: Jun 26, 2022
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Category: Quality of Life and Care Deficiencies
Corrected: Jun 26, 2022
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Category: Resident Assessment and Care Planning Deficiencies
Corrected: Jun 26, 2022
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Category: Resident Rights Deficiencies
Corrected: Jun 26, 2022
Quality Measures
| Measure | Type | Score | Used in Rating |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 17.6% | Yes |
| Percentage of long-stay residents who lose too much weight | Long Stay | 8.5% | No |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 2.6% | Yes |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 0.0% | Yes |
| Percentage of long-stay residents who have depressive symptoms | Long Stay | 12.4% | No |
| Percentage of long-stay residents who were physically restrained | Long Stay | 1.9% | No |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 0.0% | Yes |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | Long Stay | 79.5% | No |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | Short Stay | 80.8% | No |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 1.6% | Yes |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 16.2% | Yes |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | Long Stay | 15.1% | No |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | Long Stay | 89.8% | No |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | Short Stay | 75.0% | No |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 7.0% | Yes |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | Long Stay | 17.6% | No |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 31.8% | Yes |
Penalty History
| Date | Type | Amount |
|---|---|---|
| May 5, 2025 | Payment Denial | - |
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Understanding Nursing Home Data
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County Health Data
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Frequently Asked Questions
What is the overall CMS rating for The Willows at Gretna?
What are the staffing levels at The Willows at Gretna?
How many beds does The Willows at Gretna have?
Does The Willows at Gretna have any deficiencies on record?
Has The Willows at Gretna received any fines or penalties?
Who owns The Willows at Gretna?
When was The Willows at Gretna last inspected?
What quality measures are tracked for The Willows at Gretna?
Data Sources
Data source: CMS Nursing Home Compare. Ratings, staffing, deficiency, quality measure, and penalty data are from CMS Provider Data. For informational purposes only. Always verify information directly with the facility or your state health department.
Read our methodology — how this data is sourced, computed, and verified.