Evansville Care Center

In the surveyor’s words

From the most serious findings on record at Evansville Care Center, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF867Jan 21, 2026

  Based on interview and document review the facility failed to ensure the Quality Assessment and Assurance (QAA)/Quality Assurance Process improvement (QAPI) committee was effective in implementing appropriate action plans to correct quality deficiencies identified in previous surveys related to careplans which resulted in deficiencies identified during this survey. This deficient practice had the potential to affect all 24 residents residing in the facility. Findings include:During an interview on 1/21/2026 at 5:12 p.m., administrator confirmed last survey's plan of correction (POC) and indicated the POC had been discussed at QAPI but was not a current QAPI project. Administrator stated after a recertification survey is completed, the results and POC are reviewed. […]

• No harm, potential for more than minimal, widespreadF886May 4, 2022

  Based on interview and document review, the facility failed to ensure routine COVID-19 testing occurred for unvaccinated staff according to the community positivity rates identified in CMS (Centers for Medicare and Medicaid Services) guidelines. In addition, the facility failed to identify if any individuals providing services under arrangement or volunteers who were not up to date with COVID vaccinations were also routinely tested per CMS guidelines. This deficient practice had the potential to affect all 24 residents residing in the facility. […]

• No harm, potential for more than minimal, isolatedF656Jan 21, 2026

  Based on interview, document review, and observation, the facility failed to ensure a comprehensive care plan was developed, and maintained to ensure appropriate care was provided for 2 of 12 (R21, R20) residents reviewed for comprehensive care plan. R20 R20's quarterly Minimum Data Set (MDS) dated [DATE], identified R20 was cognitively intact and had diagnoses which included heart failure, arthritis, and seizure disorder. Indicated R20 was independent with activities of daily living (ADLs). R20s quarterly care area assessment (CAA) dated [DATE], had cognitive lose/dementia, behavioral issues, and issues with psychosocial wellbeing. R20's care plan dated [DATE], indicated resident had the potential for social emotional disturbances related to a diagnosis of cognitive communication deficit. […]

• No harm, potential for more than minimal, isolatedF582Nov 20, 2024

  Based on interview and document review, the facility failed to ensure the required Notice of Medicare Non-coverage (NOMNC) form-10123 was provided 48 hours prior to discharge for 2 of 3 residents (R22 and R78), and Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) form-10055 was provided timely to 1 of 3 residents (R17) reviewed for liability notices and resident rights. Findings include: Review of R22's Physical Therapy (PT) discharge summary and Occupational Therapy (OT) discharge summary dated 5/21/24, indicated R22 no longer required PT and OT services. R22's NOMNC indicated R22's last covered day for Medicare Part A was 5/29/24, and the form-10123 was signed 5/28/24. […]

• No harm, potential for more than minimal, isolatedF641Nov 20, 2024

  Based on observation, interview and document review, the facility failed to ensure accurate coding to reflect resident status on the Minimum Data Set (MDS) for 1 of 1 residents (R17) reviewed for assessments. Findings include: The Centers for Medicare and Medicaid (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual Version 1.18.11 10/23, identified Section J: Health Conditions was to be completed with the intent to document health conditions, such as falls, that impact a resident's functional status and quality of life. The manual indicated Previous falls, especially recurrent falls and falls with injury, are the most important predictor of future falls and injurious falls. […]