Inspection Reports for
Matelyn Retirement Community
602 O STREET, ST PAUL, NE, 68873
Back to Facility ProfileInspection Report — Mar 28, 2025
Renewal
Capacity: 66
Deficiencies: 0
Date: Mar 28, 2025
Visit Reason
The document is a renewal application and license verification for Matelyn Retirement Community, an assisted-living facility, to confirm continued licensure through the renewal date.
Findings
The facility meets statutory requirements as an assisted-living facility and has submitted a renewal application for licensure. The occupancy permit confirms a maximum capacity of 66 beds.
Report Facts
Total licensed beds: 66
Renewal application date: Mar 28, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Oliver S. Pahila | Authorized Representative / CEO | Named on renewal application and ownership listing |
| Anna Lee R. Pahila | Authorized Representative | Named on renewal application and ownership listing |
| Paula Bosak | Administrator | Named on renewal application contact information |
| Kyle Woodgate | Deputy State Fire Marshal | Inspected and approved occupancy permit |
Notice — Aug 16, 2017
Capacity: 66
Deficiencies: 0
Date: Aug 16, 2017
Visit Reason
This document acknowledges the increase in the number of licensed beds at the assisted-living facility from 35 to 66 beds, effective August 16, 2017.
Findings
The letter confirms the approval of the increased licensed bed capacity for the facility as requested in a prior letter dated June 2, 2017.
Report Facts
Licensed beds increase: 31
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the notice acknowledging the bed capacity increase |
Inspection Report — Apr 22, 2015
Renewal
Census: 22
Deficiencies: 1
Date: Apr 22, 2015
Visit Reason
The inspection was a licensure compliance inspection conducted to assess adherence to licensure regulations for Assisted-Living Facilities.
Findings
The facility failed to ensure initial orientation was completed for two newly hired direct care staff members, which is a violation of staff training requirements. The violations did not create imminent danger or immediate adverse effects on residents.
Deficiencies (1)
Failure to ensure initial orientation was completed for two newly hired direct care staff members (Personal Care Assistant A and Medication Aide B).
Report Facts
Facility census: 22
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christine Hale | Registered Nurse | Surveyor who conducted the inspection |
| Daniel Woodward | Registered Nurse | Surveyor who conducted the inspection |
| Melissa Miller | Administrator | Facility administrator interviewed regarding orientation compliance |
Notice — APP2018
Capacity: 66
Deficiencies: 0
Date: APP2018
Visit Reason
The document serves as a licensure renewal application and verification for Matelyn Retirement Community LLC as an assisted-living facility.
Findings
The documents confirm that Matelyn Retirement Community LLC meets statutory requirements for licensure as an assisted-living facility with a total licensed capacity of 66 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 66
Renewal fees: 950
Renewal fees: 1450
Renewal fees: 1650
Renewal fees: 1950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris | Administrator | Named as administrator on the renewal application |
| Keith Harris | Authorized Representative | Signed the renewal application as authorized representative |
| Ramona Harris | Authorized Representative | Signed the renewal application as authorized representative |
| Brandon Lubke | Deputy State Fire Marshal | Inspected the facility for the occupancy permit |
Document — CHOW2025
Capacity: 66
Deficiencies: 0
Date: CHOW2025
Visit Reason
The documents relate to the issuance of a new assisted living facility license due to a change of ownership, renewal of the license, and the purchase agreement and closing for the sale of the facility.
Findings
No inspection findings or deficiencies are reported. The documents focus on licensing, ownership transfer, and administrative compliance with regulatory requirements.
Report Facts
Total licensed capacity: 66
License effective date: Feb 1, 2025
License expiration date: Apr 30, 2025
Fire marshal occupancy permit date: Dec 4, 2024
Purchase price: 5100000
Closing date: Feb 1, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris | Administrator | Named as administrator of Matelyn Retirement Community in licensing letter (page 1). |
| Keith Harris | Chairman | Chairman of Matelyn Retirement Community, signed purchase agreement and closing statement (pages 21, 27, 29). |
| Oliver Pahila | CEO | CEO of RenVibe LLC, buyer in purchase agreement and closing documents (pages 9, 21, 27). |
| Anna Lee Pahila | Manager | Manager of Matelyn Retirement Community, named in renewal application and signature page (pages 4, 21). |
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