Inspection Reports for Matelyn Retirement Community
602 O STREET, ST PAUL, NE, 68873
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
0.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
93% better than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
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
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
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
Capacity: 66
Deficiencies: 0
Date: APP2019
Visit Reason
This document package serves as a licensure renewal for Matelyn Retirement Community LLC, an assisted-living facility, including certification of licensure, renewal application, and occupancy permit.
Findings
The documents certify that the facility meets statutory requirements for licensure renewal through the expiration date. The occupancy permit confirms a maximum capacity of 66 beds.
Report Facts
Total licensed beds: 66
Renewal fees: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris | Administrator | Named on the Assisted-Living Facility Licensure Renewal Application. |
| Keith Harris | Authorized Representative | Signed the renewal application as authorized representative. |
| Ramona Harris | Authorized Representative | Signed the renewal application as authorized representative and listed as shareholder. |
| Bo Botelho | Interim CEO, Interim Director of Public Health | Signed the licensure certificate. |
| Brandon Lubke | Deputy State Fire Marshal | Issued the occupancy permit. |
Notice
Capacity: 66
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Matelyn Retirement Community LLC, including renewal fees, ownership information, and occupancy permit details.
Findings
The documents confirm the facility's licensure renewal status, ownership structure, total licensed bed capacity of 66, and occupancy permit issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 66
Renewal fees: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris | Administrator | Named as facility administrator on the licensure renewal application. |
| Keith Harris | Signed the renewal application as an authorized representative. |
Notice
Capacity: 66
Deficiencies: 0
Date: APP2021
Visit Reason
This document serves to verify that Matelyn Retirement Community LLC is licensed as an assisted-living facility through the expiration date on the renewal card and includes the licensure renewal application and occupancy permit.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal as an assisted-living facility and holds an occupancy permit for 66 beds.
Report Facts
Total licensed beds: 66
Renewal expiration date: Apr 30, 2022
Occupancy permit issue date: Sep 14, 2020
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. |
| Brandon Lubke | Deputy State Fire Marshal | Inspected the facility for the occupancy permit. |
| Gary J. Anthone, MD | Chief Medical Officer, Director, Division of Public Health | Signed the licensure verification card. |
Notice
Capacity: 66
Deficiencies: 0
Date: APP2022
Visit Reason
This document serves to verify that Matelyn Retirement Community LLC is licensed as an assisted-living facility through the date indicated on the renewal card and includes a renewal application form and occupancy permit.
Findings
The documents confirm the facility's licensure status, renewal application details including total licensed beds, and occupancy permit issued by the Nebraska State Fire Marshal with a maximum occupancy of 66 beds.
Report Facts
Total licensed beds: 66
Maximum occupancy: 66
Renewal license expiration date: 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris-Bosak | Administrator | Named as the administrator on the renewal application. |
| Gary J. Amihone, MD | Chief Medical Officer, Director, Division of Public Health | Named on the renewal card certifying the facility meets statutory requirements. |
| Todd Brehm | Deputy State Fire Marshal | Named as the inspector on the Nebraska State Fire Marshal occupancy permit. |
Notice
Capacity: 66
Deficiencies: 0
Date: APP2023
Visit Reason
This document serves to verify that Matelyn Retirement Community LLC is licensed as an assisted-living facility through the date indicated on the renewal card and includes the renewal application for the facility license.
Findings
The document confirms the facility's licensure status and renewal application details, including ownership and business organization information. It also includes an occupancy permit with a maximum occupancy of 66 beds.
Report Facts
Total licensed beds: 66
Renewal application date: 2023
Occupancy permit issue date: 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris Bosak | Administrator | Named as administrator on renewal application and signed as authorized representative. |
| Keith Harris | Authorized Representative | Signed renewal application as authorized representative. |
Notice
Capacity: 32
Deficiencies: 0
Date: APP2016
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Matelyn Retirement Community LLC, confirming the facility's license renewal through the indicated expiration date.
Findings
The documents confirm that Matelyn Retirement Community LLC meets statutory requirements as an assisted-living facility with a maximum occupancy of 32 beds. A state fire marshal occupancy permit was issued with a maximum occupancy of 32 beds.
Report Facts
Total licensed beds: 32
Renewal fee: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melissa Miller | Administrator | Named as administrator on the licensure renewal application. |
| Brandon Lubke | Deputy State Fire Marshal | Inspected the facility for the state fire marshal occupancy permit. |
Notice
Capacity: 66
Deficiencies: 0
Date: APP2024
Visit Reason
The document serves to verify the assisted-living facility's license renewal through the indicated date and includes a renewal application form for relicensure of 66 beds.
Findings
The documents confirm the facility meets statutory requirements for assisted-living licensure, provide renewal fees, ownership and shareholder information, and include a Nebraska State Fire Marshal occupancy permit for 66 beds.
Report Facts
Total licensed beds: 66
Renewal license expiration date: 2025
Occupancy maximum: 66
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris-Bosak | Administrator | Named as administrator on renewal application and authorized representative. |
| Keith Harris | Authorized Representative | Signed renewal application as authorized representative. |
Notice
Capacity: 35
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves as a licensure renewal application and verification for the assisted-living facility Matelyn Retirement Community LLC, confirming its licensed status and capacity.
Findings
The document confirms that Matelyn Retirement Community LLC is licensed as an assisted-living facility with a total licensed capacity of 35 beds. It includes ownership information, certification of compliance with state regulations, and a fire marshal occupancy permit.
Report Facts
Total licensed capacity: 35
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Paula Harris | Administrator | Named as facility administrator on licensure renewal application |
Notice
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
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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