Evergreen Health & Rehab Center

Total Number of Beds: 76	Percent of Occupied Beds: 42%
Total Number of Residents: 32	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: 04/25/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.57

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.48

Number of CNA Hours per Nursing Home Resident per Day: 2.05

Number of Staff Hours per Nursing Home Resident per Day: 3.1

Nursing Home Resident Information**:

** Details Last Reported on: 4/25/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-06-14	2001-08-24	Resident Rights Deficiencies	Send and promptly deliver unopened mail to residents.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Potential for minimal harm
2001-06-14	2001-08-24	Environmental Deficiencies	Keep sound levels comfortable.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-31	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Pattern	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Actual harm
2001-06-14	2001-08-31	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-31	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Actual harm
2001-06-14	2001-08-24	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Actual harm
2001-06-14	2001-08-31	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2001-06-14	2001-08-24	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Minimal harm or potential for actual harm
2001-06-14	2001-08-31	Quality Care Deficiencies	Have enough nurses to care for every resident in a way that maximizes the resident's well being.	Pattern	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Nutrition and Dietary Deficiencies	Offer other nutritional food to each resident who will not eat the food served.	Pattern	Minimal harm or potential for actual harm
2001-06-14	2001-08-24	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2001-06-14	2001-08-24	Administration Deficiencies	Give or get lab tests to meet the needs of residents.	Pattern	Potential for minimal harm
2002-06-27	0000-00-00	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Pattern	Potential for minimal harm
2002-06-27	0000-00-00	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
2003-04-25	2003-06-02	Resident Rights Deficiencies	Send and promptly deliver unopened mail to residents.	Pattern	Potential for minimal harm
2003-04-25	2003-06-02	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-02	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-02	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-02	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
2003-04-25	2003-06-02	Quality Care Deficiencies	Make sure that each residents' abilities to take care of themselves does not lessen, unless a change cannot be avoided.	Isolated	Actual harm
2003-04-25	2003-06-02	Quality Care Deficiencies	Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.	Pattern	Minimal harm or potential for actual harm
2003-04-25	2003-06-02	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Immediate jeopardy to resident health or safety
2003-04-25	2003-06-02	Administration Deficiencies	Follow all laws and professional standards.	Pattern	Potential for minimal harm

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