Evergreen Manor

Total Number of Beds: 42	Percent of Occupied Beds: 100%
Total Number of Residents: 42	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 08/14/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.7

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.32

Number of CNA Hours per Nursing Home Resident per Day: 2.79

Number of Staff Hours per Nursing Home Resident per Day: 3.81

Nursing Home Resident Information**:

Percent of Short-Stay Residents With Pressure Sores: 0%
Percent of High-Risk Residents Who Have Pressure Sores: 13%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 15%
Percent of Residents Who Have Moderate to Severe Pain: 0%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 17%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 19%
Percent of Residents Who are More Depressed or Anxious: 36%
Percent of Short-Stay Residents With Delirium: 0%
Percent of Residents Who Were Physically Restrained: 3%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 15%
Percent of Residents With a Urinary Tract Infection: 17%
** Details Last Reported on: 8/14/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-07-18	2001-08-17	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2002-09-05	2002-10-11	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
2002-09-05	2002-10-11	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
2002-09-05	2002-10-11	Resident Assessment Deficiencies	Keep assessments completed in the preceding 15 months in the resident's active record.	Pattern	Minimal harm or potential for actual harm
2002-09-05	2002-10-11	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2003-08-14	2003-09-26	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
2003-08-14	2003-09-26	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
2003-08-14	0000-00-00	Resident Assessment Deficiencies	1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.	Isolated	Minimal harm or potential for actual harm
2003-08-14	0000-00-00	Quality Care Deficiencies	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
2003-08-14	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
2003-08-14	0000-00-00	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2003-08-14	0000-00-00	Resident Assessment Deficiencies	Make sure that doctors visit residents regularly, as required.	Pattern	Minimal harm or potential for actual harm
2003-08-14	0000-00-00	Administration Deficiencies	Follow all laws and professional standards.	Isolated	Minimal harm or potential for actual harm
2003-08-14	2003-11-19	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm

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