Inspection Reports for Country View Assisted Living
811 EAST 14TH STREET, NE, 68787
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Inspection Report
Renewal
Capacity: 32
Deficiencies: 0
Apr 3, 2025
Visit Reason
The document is a renewal application and license verification for Country View Assisted Living facility, confirming the facility's licensure status and renewal of its assisted-living license.
Findings
The facility is licensed as an assisted-living facility with a total capacity of 32 beds. The renewal application was completed and signed by authorized representatives on April 3, 2025. An occupancy permit was issued with a maximum occupancy of 32 beds.
Report Facts
Total licensed beds: 32
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martin Brown | Administrator | Named in renewal application |
| Soon Burnam | Authorized Representative | Signed renewal application |
| Ami Sato | Authorized Representative | Signed renewal application |
| Tara Helenthal | President | Officer of Lindahl Healthcare, Inc., corporate organization chart |
| Soon Burnam | Secretary | Officer of Lindahl Healthcare, Inc., corporate organization chart |
| Ami Sato | Treasurer | Officer of Lindahl Healthcare, Inc., corporate organization chart |
| Dave Jorgensen | Director | Officer of Lindahl Healthcare, Inc., corporate organization chart |
| Barry Port | Manager | Officer of Gateway Healthcare, LLC, corporate organization chart |
| Spencer Burton | President | Officer of The Ensign Group, Inc., corporate organization chart |
| Barry Port | CEO | Officer of The Ensign Group, Inc., corporate organization chart |
Inspection Report
Renewal
Capacity: 32
Deficiencies: 0
Apr 4, 2022
Visit Reason
The document is a renewal application and license verification for Country View Assisted Living facility to continue its operation as an assisted-living facility.
Findings
The documents confirm that Country View Assisted Living meets statutory requirements for licensure renewal. The renewal application includes ownership and corporate organization details, and the occupancy permit confirms a maximum capacity of 32 beds.
Report Facts
Total licensed beds: 32
Renewal license expiration date: Apr 30, 2023
Occupancy permit date issued: Jun 22, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rachael Hurley | Administrator | Named as the facility administrator on the renewal application. |
| Soon Burnam | Authorized Representative | Signed the renewal application as an authorized representative. |
| Craig Fitch | Authorized Representative | Signed the renewal application as an authorized representative and listed as Secretary in corporate organization. |
| Tara Helenthal | President | Listed as President of Lindahl Healthcare, Inc., the ownership corporation. |
| Spencer Burton | Director and President | Listed as Director of Country View Assisted Living and President of Gateway Healthcare, Inc. |
| Barry Port | Director and CEO | Listed as Director of Gateway Healthcare, Inc. and CEO of The Ensign Group, Inc. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Apr 12, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and perform the annual survey at Country View Assisted Living on April 11-12, 2018.
Findings
The facility was found to be in compliance with regulations governing assisted living facilities. Residents were appropriate for the level of care provided, and no complex nursing interventions were observed. Residents reported satisfaction with the assistance provided.
Complaint Details
The complaint alleged that the facility failed to ensure residents were not beyond the level of care provided. The complaint was not substantiated as the facility ensured residents were appropriate for assisted living.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the inspection and complaint investigation report. |
| Kay Reeves | Nutrition/dietitian | Conducted the compliance inspection at the facility. |
Inspection Report
Complaint Investigation
Census: 10
Deficiencies: 2
Aug 7, 2012
Visit Reason
The inspection was conducted following a complaint investigation regarding noncompliance with licensure regulations for Assisted-Living Facilities, specifically related to resident grievances and record confidentiality.
Findings
The facility failed to establish and implement a process to address and resolve resident grievances concerning food temperatures, with multiple meals served below required temperatures. Additionally, resident records were stored in an unlocked cabinet accessible to unauthorized persons, compromising confidentiality.
Complaint Details
The complaint investigation was substantiated based on observations, record review, and staff and resident interviews indicating unresolved grievances about cold food and unsecured resident records.
Deficiencies (2)
| Description |
|---|
| Failure to address and resolve resident grievances related to food temperatures, with multiple hot food items served below 140 degrees Fahrenheit. |
| Failure to store resident records in a manner assuring confidentiality and restricting access to authorized persons only. |
Report Facts
Facility census: 10
Sample size: 4
Breakfast meals recorded: 36
Noon meals recorded: 33
Evening meals recorded: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Patricia Wolfe | Registered Nurse | Surveyor who conducted the inspection |
| Pamela Albin | Administrator | Named in Plan of Correction response |
Notice
Capacity: 32
Deficiencies: 0
APP2016
Visit Reason
The document serves as a licensure renewal application and verification for Country View Assisted Living, confirming the facility's licensed status and capacity.
Findings
The documents confirm the facility meets statutory requirements for assisted living licensure renewal and include ownership information, occupancy permit, and organizational charts.
Report Facts
Total licensed beds: 32
Renewal fees: 950
Renewal fees: 1450
Renewal fees: 1650
Renewal fees: 1950
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Pyper | Administrator | Named as the facility administrator on the renewal application. |
| Soon Burnam | Treasurer | Listed as an officer of Lindahl Healthcare, Inc. and Gateway Healthcare, Inc. |
| Beverly Wittekind | Secretary | Listed as an officer of Lindahl Healthcare, Inc. and Gateway Healthcare, Inc. |
| Michael Clegg | President | Listed as an officer of Lindahl Healthcare, Inc. and Gateway Healthcare, Inc. |
| Christopher Christensen | Director and President and CEO | Listed as an officer of Lindahl Healthcare, Inc., Gateway Healthcare, Inc., and The Ensign Group, Inc. |
| Beverly Wittekind | Authorized Representative | Signed the renewal application. |
| Soon Burnam | Authorized Representative | Signed the renewal application. |
Notice
Capacity: 32
Deficiencies: 0
APP2017
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Country View Assisted Living, confirming the facility's license status and renewal through the indicated expiration date.
Findings
The documents confirm that Country View Assisted Living meets statutory requirements as an assisted-living facility and is licensed through the renewal date. The occupancy permit indicates a maximum capacity of 32 beds.
Report Facts
Total licensed beds: 32
Renewal expiration date: License expiration date is 04/30/2018 as shown on the renewal card.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Pyper | Administrator | Named as the facility administrator on the renewal application. |
| John Albrechtsen | President | Listed as President of Lindahl Healthcare, Inc., the ownership entity. |
| Beverly Wittekind | Secretary | Listed as Secretary of Lindahl Healthcare, Inc., and signed as authorized representative on renewal application. |
| Soon Burnam | Treasurer | Listed as Treasurer of Lindahl Healthcare, Inc. |
| Christopher Christensen | Director | Listed as Director of Lindahl Healthcare, Inc. |
Notice
Capacity: 32
Deficiencies: 0
APP2018
Visit Reason
This document serves as a licensure renewal application and verification that Country View Assisted Living is licensed through the indicated expiration date.
Findings
The documents confirm the facility's licensure status, ownership information, and maximum licensed capacity of 32 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 32
Renewal expiration date: Licensure renewal expiration date is 4/30/2019 as shown on renewal card.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacque Moss | Administrator | Named as facility administrator on renewal application. |
| Jim Guschl | President and Sole Director | Officer of Lindahl Healthcare, Inc., the facility's owner. |
| Derek Bunker | Secretary | Officer of Lindahl Healthcare, Inc., the facility's owner. |
| Soon Burnam | Treasurer | Officer of Lindahl Healthcare, Inc., the facility's owner. |
| Christopher Christensen | President and CEO | Officer of The Ensign Group, Inc., 100% shareholder of Gateway Healthcare, Inc. |
Notice
Capacity: 32
Deficiencies: 0
APP2019
Visit Reason
This document serves as a licensure renewal application and renewal notice for Country View Assisted Living, verifying that the facility is licensed through the expiration date indicated on the renewal card.
Findings
The document confirms that Country View Assisted Living meets statutory requirements as an assisted-living facility and is licensed through the renewal date. It includes ownership information, facility capacity, and certification details.
Report Facts
Total licensed beds: 32
Renewal expiration date: 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tara Helenthal | Administrator | Named as facility administrator in the licensure renewal application. |
| Derek Bunker | Authorized Representative and Secretary | Signed the renewal application and listed as Secretary of Lindahl Healthcare, Inc. |
| Soon Burnam | Authorized Representative and Treasurer | Signed the renewal application and listed as Treasurer of Lindahl Healthcare, Inc. |
| Spencer Bartlett | President | Officer of Lindahl Healthcare, Inc. |
| Jim Guschl | Director | Officer of Lindahl Healthcare, Inc. and President of Gateway Healthcare, Inc. |
| Barry Port | Director | Officer of Gateway Healthcare, Inc. |
| Christopher Christensen | President and CEO | Officer of The Ensign Group, Inc., 100% shareholder of Gateway Healthcare, Inc. |
Notice
Capacity: 32
Deficiencies: 0
APP2020
Visit Reason
This document serves as the renewal application for the assisted-living facility license for Country View Assisted Living, including verification of licensure and occupancy permit details.
Findings
The documents confirm that Country View Assisted Living is licensed as an assisted-living facility with a maximum capacity of 32 beds, and includes an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 32
Renewal expiration date: License expiration date is 04/30/2021 as shown on the renewal card.
Occupancy permit issue date: Occupancy permit issued on 08/23/2019 by Nebraska State Fire Marshal.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cheri Wingert | Administrator | Named as facility administrator in the renewal application. |
| Soon Burnam | Treasurer | Listed as Treasurer of Lindahl Healthcare, Inc., the ownership entity. |
| Craig Fitch | Secretary | Listed as Secretary of Lindahl Healthcare, Inc., the ownership entity. |
| Tara Helenthal | President | Listed as President of Lindahl Healthcare, Inc., the ownership entity. |
| Spencer Burton | Director | Listed as Director of Lindahl Healthcare, Inc. and President of Gateway Healthcare, Inc. |
| Barry Port | CEO | Listed as CEO of The Ensign Group, Inc., the 100% shareholder of Gateway Healthcare, Inc. |
| Robert Folck | Deputy State Fire Marshal | Inspected the facility for the occupancy permit. |
Notice
Capacity: 32
Deficiencies: 0
APP2021
Visit Reason
The document serves as a renewal application for the assisted-living facility license for Country View Assisted Living and includes related licensing and occupancy permit information.
Findings
The documents confirm that Country View Assisted Living meets statutory requirements for licensure renewal and includes an occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 32
Notice
Capacity: 32
Deficiencies: 0
APP2023
Visit Reason
This document serves as a renewal application and license verification for Country View Assisted Living, confirming licensure through the indicated expiration date and providing occupancy permit details.
Findings
The documents confirm that Country View Assisted Living is licensed as an assisted-living facility with a maximum capacity of 32 beds, and includes an occupancy permit approved by the State Fire Marshal.
Report Facts
Total licensed beds: 32
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cheri Wingert | Administrator | Named in the renewal application as facility administrator |
| Soon Burnam | Treasurer | Listed as officer in corporate organization chart |
| Craig Fitch | Secretary | Listed as officer in corporate organization chart and signed renewal application |
| Tara Helenthal | President | Listed as officer in corporate organization chart |
| Spencer Burton | Director and President | Listed as officer in corporate organization chart |
| Barry Port | Manager and CEO | Listed as officer in corporate organization chart |
| Robert Folck | Deputy State Fire Marshal | Approved the occupancy permit |
Notice
Capacity: 32
Deficiencies: 0
APP2024
Visit Reason
The document serves to verify that Country View Assisted Living is licensed through the indicated renewal date and includes a renewal application for the assisted-living facility license.
Findings
The document confirms the facility meets statutory requirements for assisted-living licensing and provides ownership and organizational information. It also includes a Nebraska State Fire Marshal occupancy permit indicating a maximum occupancy of 47 beds.
Report Facts
Total licensed beds: 32
Maximum occupancy beds: 47
Renewal expiration date: 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Craig Fitch | Authorized Representative | Signed the renewal application on page 2 |
| Soon Burnam | Authorized Representative | Signed the renewal application on page 2 |
| Tara Helenthal | President | Listed as officer of Lindahl Healthcare, Inc. on page 3 |
| Craig Fitch | Secretary | Listed as officer of Lindahl Healthcare, Inc. on page 3 |
| Soon Burnam | Treasurer | Listed as officer of Lindahl Healthcare, Inc. on page 3 |
| Dave Jorgensen | Director | Listed as officer of Lindahl Healthcare, Inc. on page 3 |
| Barry Port | Manager | Listed as officer of Gateway Healthcare, LLC on page 3 |
| Spencer Burton | President | Listed as officer of The Ensign Group, Inc. on page 3 |
| Barry Port | CEO | Listed as officer of The Ensign Group, Inc. on page 3 |
| Robert Folck | Deputy State Fire Marshal | Inspected and approved the occupancy permit on page 4 |
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