Inspection Reports for Country Lane Retirement Village
1203 EAST HYNES AVE, NEILL, NE, 68763
Back to Facility ProfileDeficiencies (last 2 years)
Deficiencies (over 2 years)
0 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
Same as Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Jul 13, 2020
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to protect residents from infection.
Complaint Details
The complaint alleged the facility failed to protect residents from infection. The investigation found the allegation unsubstantiated as the facility was in compliance with infection prevention regulations.
Findings
The facility was found to have protected residents from infections through completed screening logs, updated infection prevention policies, knowledgeable staff, and implemented infection control interventions. The facility was in compliance with relevant regulations.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Original Licensing
Capacity: 30
Deficiencies: 0
Date: Nov 8, 2017
Visit Reason
The document is related to the original licensing and issuance of an Assisted Living Facility license for Country Lane Retirement Village, including Alzheimer's Memory Care endorsement.
Findings
The facility was inspected and found to be in compliance with applicable regulations, including Life Safety Code compliance. The license was issued for 30 beds with an Alzheimer's Memory Care endorsement for 18 beds.
Report Facts
Licensed beds: 30
Memory care beds: 18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alisha Schroeder | Administrator | Named as facility administrator and contact for licensing and memory care endorsement. |
| Thomas L. Williams | Chief Medical Officer, Director, Division of Public Health | Signed licensing documents and letters. |
| Dan Taylor | RN | Contact person for licensing questions. |
| Sarah Sidak | Zoning Administrator | Provided zoning confirmation letter. |
| Jeff Edgar | Deputy State Fire Marshal | Conducted life safety inspection. |
Inspection Report
Routine
Deficiencies: 0
Date: Nov 8, 2017
Visit Reason
The inspection was conducted as a Compliance Inspection to assess the facility's adherence to the Regulations Governing Licensure of Assisted-Living Facilities.
Findings
The facility was found in compliance with the applicable regulations, and the results of the Compliance Inspection were commendable.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | Training Coordinator | Signed the letter acknowledging the results of the Compliance Inspection. |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2018
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Country Lane Retirement Village, confirming the facility meets statutory requirements and is licensed through the indicated renewal date.
Findings
The documents confirm the facility's licensure renewal status, ownership information, total licensed bed capacity of 30, and include an occupancy permit issued by the Nebraska State Fire Marshal with a maximum occupancy of 30 beds.
Report Facts
Total licensed beds: 30
Special care unit beds: 18
Maximum occupancy: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Scheffler | Administrator | Named as the facility administrator on the renewal application. |
| Jill Switzer | Authorized representative who signed the renewal application. | |
| Kathy Bartak | Authorized representative who signed the renewal application and listed as a person in control of the facility. |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Country Lane Retirement Village, including related certifications and disclosures.
Findings
The facility is licensed as an assisted-living facility with a total capacity of 30 beds and is found to be in compliance with applicable regulations, including Life Safety Code compliance as of the latest inspections. The Alzheimer's Memory Care Endorsement renewal is included with detailed disclosures about care philosophy, staffing, environment, and fees.
Report Facts
Total licensed beds: 30
Alzheimer's beds capacity: 12
Fee range: 3800
Fee range: 5900
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Diane Ross | Administrator | Named as facility administrator in the renewal application. |
| Mark Holtkamp | Sole Owner | Named as sole owner of the facility. |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility for Life Safety Code compliance. |
| Chelsi McLain | Contact Person | Contact person for the facility during Life Safety Code inspection. |
| Stacy Hejda | Interim Administrator | Named as interim administrator and authorized representative on Alzheimer's Memory Care Endorsement application. |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves as a renewal application and licensure verification for the assisted-living facility Country Lane Retirement Village, including occupancy permits and Alzheimer's Memory Care endorsement.
Findings
The documents confirm the facility's licensure renewal, maximum licensed capacity of 30 beds, including 12 beds designated for Alzheimer's Memory Care, and approval of occupancy by the State Fire Marshal.
Report Facts
Total licensed beds: 30
Alzheimer's beds capacity: 12
Maximum occupancy: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Presley Whitaker | Administrator | Named as administrator on renewal application and Alzheimer's Memory Care endorsement application (pages 2 and 10). |
| Mark Holtkamp | Owner | Named as owner of Country Lane Retirement Village (page 3). |
Document
Capacity: 30
Deficiencies: 0
Date: APP2021
Visit Reason
The documents serve to verify and renew the assisted-living facility license for Country Lane Retirement Village, including endorsement for Alzheimer's memory care, and to provide occupancy permits and facility layout information.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensing status, renewal application details, and occupancy approval for 30 beds, including 12 beds designated for Alzheimer's special care.
Report Facts
Total licensed beds: 30
Alzheimer's special care beds: 12
Renewal license expiration date: Apr 30, 2022
Renewal license fee: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Presley Whitaker | Administrator | Named as facility administrator and authorized representative on renewal and endorsement applications |
| Mark Holtkamp | Owner | Named as owner of Country Lane Retirement Village |
| Gary J. Anthone, MD | Chief Medical Officer, Director, Division of Public Health | Named on renewal license verification card |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2022
Visit Reason
This document serves to verify that the assisted-living facility, Country Lane Retirement Village, is licensed through the date indicated on the renewal card and includes renewal application and occupancy permit information.
Findings
The documents confirm the facility's licensure status, renewal application details, and occupancy permit with a maximum capacity of 30 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 30
Number of Alzheimer's beds: 12
Renewal license expiration date: 2023
Renewal license fee: 1650
Memory care unit monthly price: 5300
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Jackson | Administrator | Named as administrator and authorized representative on renewal application and Alzheimer's Special Care Unit Disclosure |
| Mark Holtkamp | Owner | Named as owner and authorized representative on renewal application |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2023
Visit Reason
The documents pertain to the renewal of the assisted-living facility license for Country Lane Retirement Village, including verification of licensure, renewal application, and occupancy permit.
Findings
The facility meets statutory requirements for assisted-living licensure with a licensed capacity of 30 beds and a special population designation for Alzheimer's/Special Care Unit with 12 beds. The occupancy permit was issued on 2023-02-17. No deficiencies or inspection findings are reported.
Report Facts
Licensed capacity: 30
Special care unit beds: 12
Occupancy permit date: Feb 17, 2023
Renewal license fees: 950
Renewal license fees: 1450
Renewal license fees: 1650
Renewal license fees: 1950
Monthly private MC suite price: 5725
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Barbara Jackson | Administrator | Named as administrator and authorized representative on renewal application and Alzheimer's special care unit endorsement application |
| Mark Holtkamp | Owner | Named as owner of Country Lane Retirement Village |
| Robert Folck | Deputy State Fire Marshal | Inspected facility and approved occupancy permit |
Notice
Capacity: 30
Deficiencies: 0
Date: APP2024
Visit Reason
The document serves to verify that Country Lane Retirement Village is licensed as an assisted-living facility and includes a renewal application and related licensing information.
Findings
The documents confirm the facility's licensure status, renewal application details, and occupancy permit with a maximum capacity of 30 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 30
Alzheimer's special care beds: 12
Renewal license fees: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elise Reese | Administrator | Named as administrator and authorized representative on renewal application. |
| Mark Holtkamp | Owner | Named as owner of Country Lane Retirement Village. |
Document
Capacity: 30
Deficiencies: 0
Date: APP2025
Visit Reason
The documents serve to verify and renew the assisted-living facility license for Country Lane Retirement Village, including renewal of Alzheimer's Memory Care Endorsement and occupancy permit validation.
Findings
No inspection findings or deficiencies are reported; the documents confirm licensure status, renewal application details, ownership, occupancy permit, and Alzheimer's special care unit endorsement.
Report Facts
Total licensed beds: 30
Alzheimer's beds capacity: 18
Occupancy permit date issued: Feb 7, 2025
Renewal license expiration date: Apr 30, 2026
Unit rate: 6155
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kylie Debus | Administrator | Named on renewal application and Alzheimer's endorsement application. |
| Mark Holtkamp | Owner | Named on renewal application and ownership list. |
| Nicholas Lensch | Regional Operations Director | Named on Alzheimer's endorsement application and ownership list. |
| Samantha Greene | Senior Living Solutions | Named as authorized representative signing Alzheimer's endorsement application. |
| Allison Law | Asset Manager | Named on ownership list. |
| Carol Gasper | Named as representative of Senior Living Solutions on ownership list. | |
| Morgan Brunscheen | Named as representative of Senior Living Solutions on ownership list. |
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