Inspection Reports for Fallbrook Assisted Living & Memory Care
6600 JULIET COURT, NE, 68521
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
Notice
Capacity: 131
Deficiencies: 0
Date: Mar 28, 2025
Visit Reason
This document serves as a renewal application and verification of licensure for Fallbrook Assisted Living & Memory Care, confirming the facility meets statutory requirements as an assisted-living facility.
Findings
The documents confirm the facility's licensure renewal status, total licensed bed capacity, and operational permits including fire prevention. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 131
Number of special care beds: 23
Renewal license fees: 950
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Katie Mathisen | Administrator | Named as facility administrator on renewal application. |
| Jason Lange | Authorized Representative | Signed renewal application on 03/28/2025. |
| MaryLynne Bolden | Authorized Representative | Signed renewal application on 03/28/2025. |
Inspection Report
Renewal
Capacity: 131
Deficiencies: 0
Date: Jan 23, 2019
Visit Reason
This document is related to the renewal of the assisted living facility license for Fallbrook Assisted Living & Memory Care, verifying that the facility meets statutory requirements and is licensed through the indicated date.
Findings
The facility was issued a license for 131 beds effective January 23, 2019, with no deficiencies or enforcement actions noted. The document includes licensing information, operational permits, zoning approval, evacuation plans, and an Alzheimer's Memory Care Endorsement application detailing facility philosophy, admission criteria, staffing, training, environment, family support, and fees.
Report Facts
Licensed capacity: 131
Licensed beds in Alzheimer's special care unit: 23
Permit maximum occupancy: 131
License issuance date: Jan 23, 2019
License expiration date: Apr 30, 2019
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Virginia Cole | Administrator | Named as facility administrator in licensing documents |
| MaryLynne Bolden | Authorized Representative | Named as authorized representative and contact for the facility owner |
| Bo Botelho | Interim CEO, Interim Director of Public Health | Signed licensing and renewal documents for the Nebraska Department of Health and Human Services |
| Jason Lange | Authorized Representative, Member of MJ Senior Housing, LLC | Named as member of ownership entity and contact in correspondence |
Notice
Capacity: 131
Deficiencies: 0
Date: APP2022
Visit Reason
The document package serves to verify the licensure renewal of Fallbrook Assisted Living & Memory Care facility, including submission of renewal application, confirmation of licensed bed capacity, and related administrative and operational permits.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure renewal, bed capacity, fire prevention permit issuance, and Alzheimer's special care endorsement application details.
Report Facts
Total licensed beds: 131
Maximum endorsed capacity: 23
Renewal license expiration date: License renewal expiration date shown as 4/30/2023 on renewal card (page 1).
Fire permit issue date: Fire prevention operational permit issued on 02/24/2022 (page 4).
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Micha Ives | Administrator | Named as facility administrator in renewal and endorsement applications (pages 2 and 9). |
| Jason Lange | Contact Name / Authorized Representative | Named as contact and authorized representative in renewal and endorsement applications (pages 2, 3, and 9). |
| MaryLynne Bolden | Authorized Representative | Named as authorized representative signing renewal application (page 2). |
Notice
Capacity: 131
Deficiencies: 0
Date: APP2023
Visit Reason
This document serves to verify the assisted-living facility license renewal for Fallbrook Assisted Living & Memory Care and includes the renewal application form.
Findings
The document confirms that Fallbrook Assisted Living & Memory Care meets statutory requirements as an assisted-living facility and provides details about the facility's license renewal, capacity, special populations served, ownership, and staffing.
Report Facts
Total licensed beds: 131
Number of beds for special populations: 23
Renewal Licensure Fee: 1950
Staffing numbers: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Micha Ives | Administrator | Named as facility administrator on renewal application and disclosure form (pages 2 and 9). |
| Jason Lange | Authorized Representative | Signed renewal application and listed as contact name for legal owning entity (pages 2 and 13). |
| MaryLynne Bolden | Authorized Representative | Listed as authorized representative on renewal application (page 2). |
Notice
Capacity: 131
Deficiencies: 0
Date: APP2024
Visit Reason
This document set serves to verify the licensure renewal of Fallbrook Assisted Living & Memory Care facility and includes the renewal application, fire prevention operational permit, and Alzheimer's special care endorsement application.
Findings
The documents confirm that Fallbrook Assisted Living & Memory Care meets statutory requirements for licensure as an assisted-living facility, with a total licensed capacity of 131 beds and 23 beds designated for Alzheimer's/special care. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 131
Alzheimer's/special care beds: 23
Renewal license expiration date: Apr 30, 2025
Fire prevention permit issue date: Dec 5, 2023
Fire prevention permit expiration date: Dec 31, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Micha Ives | Administrator | Named as facility administrator in the renewal application and Alzheimer's special care endorsement application. |
| Jason Lange | Authorized Representative | Signed the renewal application and Alzheimer's special care endorsement application as authorized representative. |
| MaryLynne Bolden | Authorized Representative | Named as authorized representative on the renewal application. |
Notice
Capacity: 131
Deficiencies: 0
Date: APP2020
Visit Reason
The document serves as a renewal application and licensure verification for Fallbrook Assisted Living & Memory Care, including Alzheimer's Memory Care Endorsement and Complex Nursing Intervention services.
Findings
The documents confirm the facility's licensure status, renewal application details, ownership information, and endorsement for Alzheimer's Memory Care with a maximum endorsed capacity of 23 beds. The facility has a total licensed capacity of 131 beds as per the fire permit and renewal application.
Report Facts
Total licensed capacity: 131
Maximum endorsed capacity: 23
Renewal license expiration date: Apr 30, 2021
Renewal application date: Apr 8, 2020
Fire permit issue date: Jan 1, 2020
Fire permit expiration date: Dec 31, 2020
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Virginia Cole | Administrator | Named as facility administrator on renewal application and Alzheimer's Memory Care endorsement application. |
| Jason Lange | Authorized Representative | Signed renewal application and Alzheimer's Memory Care endorsement application. |
| MaryLynne Bolden | Authorized Representative | Named contact and signed renewal application and Alzheimer's Memory Care endorsement application. |
| Gary J. Anthone, MD | Chief Medical Officer, Director, Division of Public Health | Name on licensure verification certificate. |
Document
Capacity: 131
Deficiencies: 0
Date: APP2021
Visit Reason
The document serves to verify licensure renewal, provide operational permits, and disclose facility information for Fallbrook Assisted Living & Memory Care.
Findings
The document contains no inspection findings or deficiencies; it primarily includes licensing and renewal information, facility capacity, ownership details, floor plans, and staffing and care program descriptions.
Report Facts
Total licensed capacity: 131
Maximum endorsed capacity: 23
Renewal licensure fees: 1650
Staffing numbers: 1
Staffing numbers: 1
Staffing numbers: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Magill | Administrator | Named as facility administrator on renewal application and Alzheimer's endorsement application. |
| Jason Lange | Authorized Representative | Signed renewal application and listed as contact name for legal owning entity. |
| MaryLynne Bolden | Authorized Representative | Signed renewal application and listed as member of facility ownership. |
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