Evergreen Nursing Home

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Provide safe, appropriate pain management for a resident who requires such services.

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Resident Rights Deficiencies

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

Nursing and Physician Services Deficiencies

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Emergency Preparedness Deficiencies

Develop and maintain an Emergency Preparedness Program (EP).

Emergency Preparedness Deficiencies

Establish policies and procedures for medical documentation.

Emergency Preparedness Deficiencies

Establish methods for sharing information.

Emergency Preparedness Deficiencies

Establish emergency prep training and testing.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Quality of Life and Care Deficiencies

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Emergency Preparedness Deficiencies

List the names and contact information of those in the facility.

Emergency Preparedness Deficiencies

Provide primary/alternate means for communication.

Emergency Preparedness Deficiencies

Provide a means of sharing information on occupancy/needs.

Emergency Preparedness Deficiencies

Establish staff and initial training requirements.

Quality of Life and Care Deficiencies

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Based on observation it was determined that the facility failed to maintain the kitchen hood suppression system as required by NFPA 96, (Chapter 12, Section 12.1.2.3.1) and cooking appliance restraint as required by NFPA 54, 9.6.1.2. 1.Kitchen equipment on casters needs to have a system for returning under suppression system after moving NFPA 96, 12.1.2.3 The fire-extinguishing system shall not require reevaluation where the cooking appliances are moved for the purposes of maintenance and cleaning, provided the appliances are returned to approved design location prior to cooking operations.NFPA 96, 12.1.2.3.1 An approved method shall be provided that will ensure the appliance is returned to an approved design location.This deficiency has the potential to affect occupants, who might include residents, staff, and visitors within the entire facility. Deficient items were discussed with the Administrator and Maintenance director at the exit conference. INITIAL COMMENTS (ID Prefix Tag #K000) are informational only and a representation of the facility' s general characteristics. This survey was conducted in accordance with the Federal Register at Section 42 CFR 483.70(a).The facility is one story, Type V (111), wood framed structure with no basement and is protected by an NFPA 13 automatic fire sprinkler system. The attic is protected by a dry-pipe automatic sprinkler system. The 60 bed facility was surveyed on Sep 19, 2024 using the National Fire Protection Association, (NFPA) Life Safety Code (2012) Chapter 19, Existing Health Care Occupancies and is classified as Fully Sprinklered.The deficiencies cited were discussed with the Maintenance Director during the exit conference conducted at the end on-site survey.

A recertification survey with complaint #CO36649 and Incident #34301 was completed on 8/26/24 to 8/29/24. Six deficiencies were cited. An Emergency Preparedness survey was conducted from 8/26/24 to 8/29/24. No deficiencies were cited. Based on observations and interviews, the facility failed to ensure medications and biologicals were stored and labeled properly according to professional standards in one of one medication storage rooms.Specifically the facility failed to:-Ensure expired medications were removed from the medication refrigerator; and, -Ensure medications were labeled with open dates. Findings include: I. Professional ReferenceAccording to the Aplisol (Tuberculin .. Based on observations and interviews, the facility failed to provide a functional, comfortable and homelike environment for residents on two of two units.Specifically, the facility failed to:-Ensure the residents residing in room #205, room #207 and room #203 were provided with appropriate hot water in the bathroom sinks; and,-Ensure high back dining room chairs in the secure unit dining room and the main dining room were free from cracks and tears.Fin.. Based on observations, record review and interviews, the facility failed to ensure one (#4) of two residents reviewed for pain out of 26 sample residents had an effective pain management regimen in a manner consistent with professional standards of practice, resident-centered care plans and resident preferences.Specifically, the facility failed to ensure Resident #4 was offered effective pain management to include non-pharmacological interventions an.. Based on observations, record review and interviews, the facility failed to establish a sanitary environment to help prevent the transmission of communicable diseases and infections.Specifically, the facility failed to ensure Resident #33' s catheter drainage bag was not touching the floor. Findings include:I. Facility policy and procedureThe Indwelling Urinary Catheter (Foley) Management policy, revised June 2023, was provided by the director of nursing (DON) on 8/.. Based on record review and interviews, the facility failed to ensure one (#18) of three residents out of 26 sample residents reviewed for assistance with activities of daily living (ADL) received appropriate treatment and services to maintain or improve his or her abilities. Specifically, for Resident #18, the facility failed to:-Ensure a wheelchair positioning device was care planned; and,-Ensure the wheelchair positioning device was positioned appropriately and.. Based on record review and interviews, the facility failed to implement policies and procedures related to pneumococcal immunizations for two (#33 and #346) of five residents reviewed for immunizations out of 26 sample residents.Specifically, the facility failed to offer Resident #33 and Resident #346 additional recommended doses of the pneumococcal vaccination.Findings include:I. Professional referenceAccording to the Centers for Disease Control and..

Based on record review, the facility failed to report complete information about COVID-19 to the Centers for Disease Control and Prevention' s (CDC) National Healthcare Safety Network (NHSN) during a seven-day period that reporting was required by regulation.The CDC submitted data from the NHSN to the Centers for Medicare and Medicaid Services (CMS). Based on review of that data, CMS determined that between 04/08/2024 and 04/14/2024, the facility did not report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC. This failure to report has the potential to cause more than minimal harm to all residents residing in the facility.