Evergreen Independence Health and Rehabilitation

Total Number of Beds: 80	Percent of Occupied Beds: 59%
Total Number of Residents: 47	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 01/22/2004

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.4

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.63

Number of CNA Hours per Nursing Home Resident per Day: 1.78

Number of Staff Hours per Nursing Home Resident per Day: 2.81

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 7%
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: 24%
Percent of Residents Who Were Physically Restrained: 18%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 6%
Percent of Residents With a Urinary Tract Infection: 15%
** Details Last Reported on: 1/22/2004

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-01-31	2002-02-19	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Isolated	Actual harm
2002-01-31	2002-02-19	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
2002-01-31	2002-02-19	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2002-01-31	2002-02-19	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Actual harm
2002-01-31	2002-02-19	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2002-01-31	2002-02-19	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm
2002-01-31	2002-02-19	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Potential for minimal harm

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