Evergreen Clancy Health & Rehab

Total Number of Beds: 70	Percent of Occupied Beds: 61%
Total Number of Residents: 43	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 01/16/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.46

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.45

Number of CNA Hours per Nursing Home Resident per Day: 2.12

Number of Staff Hours per Nursing Home Resident per Day: 3.03

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 20%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 10%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 12%
Percent of Residents Who are More Depressed or Anxious: 16%
Percent of Residents Who Were Physically Restrained: 0%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 31%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 8%
Percent of Residents With a Urinary Tract Infection: 2%
** Details Last Reported on: 1/16/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-11-16	2001-01-18	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2000-11-16	2001-01-18	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Pattern	Minimal harm or potential for actual harm
2000-11-16	2001-01-18	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2000-11-16	2001-01-18	Quality Care Deficiencies	Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.	Isolated	Minimal harm or potential for actual harm
2000-11-16	2001-01-18	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
2000-11-16	2001-01-18	Quality Care Deficiencies	Use a registered nurse at least 8 hours a day, 7 days a week.	Widespread	Minimal harm or potential for actual harm
2000-11-16	2001-01-18	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
2002-02-13	2002-04-13	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Isolated	Minimal harm or potential for actual harm
2002-02-13	2002-04-02	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Pattern	Potential for minimal harm
2002-02-13	2002-05-09	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2002-02-13	2002-05-09	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Isolated	Minimal harm or potential for actual harm
2003-01-16	2003-03-31	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
2003-01-16	2003-03-31	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Isolated	Minimal harm or potential for actual harm

*** All violations listed are based on federal government records.