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Evergreen Health Care Centerr Ratings & Violations

Evergreen Health Care Center

Evergreen Health Care Center is a 242 bed nursing home located in Cook County, Illinois at:

Evergreen Health Care Center
10124 South Kedzie
Evergreen Park, IL 60805

According to state nursing home data, the patients at Evergreen Health Care Center are primarily admitted for the care relating to the following areas:

  • Neoplasms
  • Endocrine/Metabolic
  • Blood Disorders
  • Alzheimer Disease
  • Circulatory System
  • Respiratory System
  • Nervous System
  • Digestive System
  • Genitourinary System Disorders
  • Skin Disorders
  • Musculo-Skeletal Disorders
  • Mental Illness
  • Other Medical Conditions

The Appalling Discoveries Regarding Patient Care at Evergreen Health Care Center

The surveys conducted by the Illinois Department of Health and other private health inspection firms discovered different episodes of poor patient care and abuse at the health center which could be interpreted as nursing home negligence. The nursing home attorneys of Rosenfeld Injury Lawyers LLC reviewed the findings of ProPublica and following episodes:

  • Failure to provide proper emergency care: “4/22/10 at 11:15 AM, R3 was observed to be more lethargic. All medications were held and the physician was made aware. At 5:00 PM nursing documents that R3 was lethargic, only verbally responsive at times and would not open her eyes. The order to transport R3 to the hospital. R3 was transported to the hospital at 5:50 PM. There were no assessments of R3’s physical or mental condition documented in the record by nursing from 11:AM and 5:50 PM on 4/22/10, when R3 was transported via regular ambulance to the hospital emergency room. Paramedics document in their report that they arrived at the facility on 5/2/10 at 11:00 AM. R3 was assessed to have a blood pressure of 80/40, pulse 50 and respirations 16. Paramedic report also states that as they entered R3’s room the E11 (nurse) was observed discontinuing R3’s left hand intravenous access. The report further stated that the paramedics were unable to start an intravenous or intubate R3 in the ambulance, R3 went into a full [MEDICAL CONDITION]. The emergency room record documents that R3 arrived at the hospital at 11:32 AM and was observed to be
    in full [MEDICAL CONDITION] and expired at 11:41 AM. Z5 (physician) stated when interviewed on 5/21/10 at 2:15 PM, that when he received a call from nursing in regards to R3’s medical status, nursing failed to provide an in-depth report on R3’s condition. Nursing stated that R3 was unresponsive and short of breath. Nursing should have called 911 and not have transported R3 via a regular ambulance.”
  • Failure to prevent a resident’s transfer to the hospital without physician’s order: “A review of R6 record indicates that R6 is a [AGE] year old male who is alert and oriented to person, place, and time, was transported to the local hospital by fire department paramedics on 7-24-10 at 6:45am. The fire department paramedics were supposed to transfer the roommate of R6, (R7), to the hospital because of [MEDICAL CONDITION] Evidence indicates that when the fire department paramedics arrived at 6:40am, they proceeded to enter the room of R6 and R7. They proceeded to assess and prepare R6 to be transported to the hospital. During this process, R6 was repeatedly telling the fire department paramedics that he was not in any distress, and that they have the wrong patient. Despite R6 actions, the fire department paramedics proceeded to transfer R6, from the bed, to the cart, and out of the facility. There is no evidence to indicate that during the actions of the fire department paramedics, that staff interventions were implemented to prevent R6 from being taken to the hospital. Evidence indicates that no Licensed staff were present in the room when R6 was being prepared for transport by the fire department paramedics. Interview with E9 (Licensed Practical Nurse), on 8-12-10 at 1:45pm stated that she was assigned to R7. When asked at any time was she present in the room with the paramedics? E9 stated” no, but a nurse should have been present.”
  • Failure to follow a physician’s order to transfer a resident to the hospital via 911: “On 7-24-10 at 6:35am, Z1 (Attending Physician), was informed by staff that R7 heart rate was at 128 beats per minute. Z1 instructed the facility to transfer R7 to the local hospital “911”. At 6:35am, E9 (Licensed Practical Nurse), called 911. The fire department arrived at 6:40am. The fire department left the facility at 6:45am. Evidence indicates that at 7:05am, it was discovered that R7 was still in the facility. The fire department transported R7 roommate (R6), instead of transporting R7. At 7:25am, R7 was taken to the hospital. Review of the hospital emergency room report indicates that R7 arrived at 8:04am, 89 minutes after
    the initial 911 call. Evidence indicates that no Licensed staff were present in the room when R6 was being prepared for transport by the fire department paramedics.”
  • Failure to supervise residents at risk for falls: “R12 requires 1 person assist with all ADL’s (Activities of Daily Living). R12 is receiving physical therapy to improve weight bearing, stability, transfers, and knee flexion and extension. R12 is identified as at risk for falls. Evidence indicates that on 8-3-10 at 7:00am, R12 was receiving a shower, accompanied by E12 (Certified Nursing Assistant). During the shower, R12 informed E12 that she wanted to use her personal shampoo to wash her hair. The personal shampoo belonging to R12 was located in R12’s room. At one point during the shower, E12 left the shower room to obtain R12 shampoo. Once returning to the shower room, R12 was found sitting on the shower room floor. Evidence indicated that R12 attempted to stand up from the shower chair to wet her hair, lost her balance, and fell on to the floor. Interview with E12 on 8-17-10 at 2:05pm, stated that before leaving the shower room, she pulled the call light for assistance with obtaining R12 personal shampoo from R12’s room. After 5 minutes of waiting, E12 proceeded to obtain the shampoo. E12 further stated that she was gone between 5 and 10 seconds, and upon returning, found R12 on the floor.”
  • Failure to accurately identify resident before administering medication: “On 3/25/10 at 11:55am E2 (director of nursing), said that R2 a facility resident currently residing in room [ROOM NUMBER] went to an outpatient appointment the morning of 3/17/10, and that R1 from facility #2, room [ROOM NUMBER] also went out to an outpatient appointment the morning of 3/17/10. E2 said that the outside transportation provider inadvertently returned R1 to the facility instead of taking R1 to facility#2 where R1 resides. E2 said that when the outside transportation provider arrived to the facility with R1, that E3 didn’t check R1’s wrist band for her name, nor did E3 review the name on the outpatient transportation form acknowledging receipt of R1. Also during the interview with E2 on 3/25/10 at 11:55am E2 said that after R1 was accepted into the facility that the outside transportation provider took R1 to room [ROOM NUMBER], and left. E2 said that E3 assessed R1, thinking it was R2. E2 said that E3 gave R1 the scheduled medications prescribed and scheduled for R2. E2 said that the facility was not aware of R1 belonging to facility#2, until the outpatient transportation provider returned around midnight to transport R1 back to facility#2. E2 said that he provided facility#2 with a list of medications that were given to R1 while at the facility. E2 said that he didn’t notify any physician of the event because he gave the information to facility#2 staff, and thought they would follow up with R1’s physician. E3 said that she is currently in school and works part time at the facility. E3 said that she worked a double shift on 3/17/10, first shift from 7:00am to 3:00pm and the second shift 3:00pm until 11:00pm. E3 said as she was performing the 9:00pm medication pass she saw the outpatient transportation bringing a resident down the hall on a gurney. E3 said as they approached she asked the driver if the resident on the gurney was R2, and the driver said yes. E3 said the driver handed her a form and she signed it. E3 admitted that she didn’t look at the name on the form. E3 said that she didn’t check the arm band when identifying R2. E3 said she felt comfortable giving the insulin and the antibiotic because R1 had a slight increase in temperature and blood sugar was high. On 3/26/10 at 10:45 at the nurses station Z1 (physician), said that she was the physician on-call for the physician group covering both facilities the night of 3/17/10 until the morning of 3/18/10. Z1 said that on 3/18/10 at 1:00am she was notified about R1 being inadvertently transported to the facility and medication was administered. Z1 said she had strong concerns regarding R1 may have some allergic reaction to the medication administered. Z1 said she was informed by facility#2 of the incident/medication error. Z1 reviewed the medications with surveyor and said that she was unaware of the [MEDICATION NAME] 23 unit being administered, Z3 said no one informed her of this medication, and had
    some concerns because it could be potentially life threatening if not monitored because R1 could have had a hypoglycemic reaction causing her blood sugar to drop below normal levels.”

Experienced Nursing Home Attorneys Evergreen Park, IL

The Illinois nursing home attorneys at Rosenfeld Injury Lawyers LLC are experienced in providing legal counsel to families and individuals who have suffered any form of nursing home negligence. We have successfully represented patients admitted into any nursing home in Illinois. Many of our nursing home lawsuits involve the following situations:

  • Bed Sores / Pressure Pores
  • Dropped Patients
  • Fractures
  • Medication Errors
  • Physical Abuse
  • Patient Wandering
  • Repeated Falls
  • Wrongful Death

Are you concerned about a loved one? Contact us today

If your loved one has been abused or neglected during an admission to Evergreen Health Care Center, or a different skilled nursing facility in Illinois, you should contact an attorney to determine your legal rights. Our nursing home lawyers have experience getting superior results for all types of nursing home negligence cases. Put our team to work for your family and get the results that you deserve. All of our initial consultations are free and we never charge a fee without a recovery for you. Talk to an experienced attorney today (888) 424-5757

Disclaimer: The above inspection findings are take from public sources including the State Department of Health and from Medicare inspection conducted at the facility at least every fifteen months. Rosenfeld Injury Lawyers LLC cannot confirm that the content on this site is the most recent information related to the facilities mentions.

The inspection findings published are not complete. You may find the most up to date information here: or

The deficiencies/citations listed on this page may have been corrected or substantially corrected after the date of the inspection and date of publishing this material. This page is a legal advertisement and a resource of information for visitors. This material is not endorsed by the facility noted or by any governmental agency. Rosenfeld Injury Lawyers LLC does not have any affiliation with the facility.

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