Evergreen Polson Health & Rehabilitation

Total Number of Beds: 110	Percent of Occupied Beds: 38%
Total Number of Residents: 42	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: 02/05/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.44

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.25

Number of CNA Hours per Nursing Home Resident per Day: 1.76

Number of Staff Hours per Nursing Home Resident per Day: 2.45

Nursing Home Resident Information**:

** Details Last Reported on: 2/5/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2000-04-27	2000-07-06	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Pattern	Minimal harm or potential for actual harm
2000-04-27	2000-07-06	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2000-04-27	2000-07-06	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
2000-04-27	2000-07-06	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
2000-04-27	2000-07-06	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Isolated	Minimal harm or potential for actual harm
2000-04-27	2000-07-06	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2000-04-27	2000-07-06	Quality Care Deficiencies	Give the right treatment and services to residents who have mental or social problems adjusting.	Pattern	Minimal harm or potential for actual harm
2000-04-27	2000-07-06	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Isolated	Minimal harm or potential for actual harm
2000-04-27	2000-07-06	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Actual harm
2000-04-27	2000-07-06	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
2000-04-27	2000-07-06	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Potential for minimal harm
2001-06-06	2001-08-01	Resident Rights Deficiencies	Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.	Isolated	Minimal harm or potential for actual harm
2001-06-06	2001-08-01	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
2001-06-06	2001-08-01	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
2001-06-06	2001-08-01	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2001-06-06	2001-08-01	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
2001-06-06	2001-08-01	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Pattern	Minimal harm or potential for actual harm
2001-06-06	2001-08-01	Pharmacy Service Deficiencies	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Pattern	Minimal harm or potential for actual harm
2001-06-06	2001-08-01	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
2003-02-05	2003-04-02	Mistreatment Deficiencies	1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.	Pattern	Potential for minimal harm
2003-02-05	2003-04-23	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
2003-02-05	2003-04-23	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
2003-02-05	2003-04-02	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
2003-02-05	2003-04-02	Resident Assessment Deficiencies	Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.	Isolated	Minimal harm or potential for actual harm
2003-02-05	2003-04-23	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Pattern	Minimal harm or potential for actual harm
2003-02-05	2003-04-23	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2003-02-05	2003-04-02	Quality Care Deficiencies	Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.	Isolated	Minimal harm or potential for actual harm
2003-02-05	2003-04-02	Quality Care Deficiencies	Make sure that each resident's nutritional needs were met.	Isolated	Actual harm
2003-02-05	2003-04-02	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Minimal harm or potential for actual harm
2003-02-05	2003-04-02	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Pattern	Potential for minimal harm
2003-02-05	2003-04-02	Administration Deficiencies	Make sure that nurse aides show they have the skills to be able to care for residents.	Pattern	Minimal harm or potential for actual harm

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