Inspection Reports for
Evergreen Place Assisted Living – Champaign

IL, 61822

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8 Reports

2024–2025

Inspection Report — Dec 23, 2025

Annual Inspection
Date: Dec 23, 2025

Visit Reason
Annual Licensure. For this survey, the establishment is in compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.

Findings
The establishment was found in compliance with all applicable regulations during the annual licensure survey.

Inspection Report — Jul 24, 2025

Complaint Investigation
Date: Jul 24, 2025

Visit Reason
Complaint Investigation IL195202. For this survey, the establishment is in compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.

Complaint Details
Complaint IL195202: Complaint cannot be substantiated. No violations cited.
Findings
The establishment was found in compliance with all applicable regulations during this complaint investigation.

Inspection Report — Nov 27, 2024

Annual Inspection
Date: Nov 27, 2024

Visit Reason
Annual Review conducted on 11/20/24.

Findings
The establishment was found to have multiple violations related to admitting a resident with a severe mental illness without proper staff training or signed physician assessments. The facility failed to conduct required tornado drills, maintain adequate service plans, provide housekeeping and supervised showers, and keep the resident's environment clean and odor-free. Improvements were noted by 11/26/24 after notification.

Deficiencies (8)
A2000 (295.2000 Residency Requirements) - The establishment admitted a resident with a severe mental illness without proper compliance, including lack of signed medical exam and poor living conditions.
A2040 (295.2040 Disaster Preparedness) - The establishment failed to conduct tornado drills on each shift during February 2024.
A3000 (295.3000 Personnel Requirements, Qualifications and Training) - The establishment lacked staff with proper training and qualifications to care for a resident with a psychotic disorder.
A4000 (295.4000 Physician's Assessment) - The establishment failed to have a physician sign the comprehensive assessment for the resident.
A4010 (295.4010 Service Plan) - The service plan was not signed by all involved and failed to address the resident's level of service, negotiated risks, daily showers, housekeeping, psychotic disorder, and safety with cigarettes.
A4020 (295.4020 Mandatory Services) - The establishment failed to provide adequate housekeeping services to the resident's room.
A6000 (295.6000 Resident Rights) - The establishment failed to provide an environment that promotes and supports the resident's dignity, including cleanliness and safety.
A9040 (295.9040 Environmental Requirements) - The establishment failed to keep the resident's room clean, safe, orderly, and free of odors.
Report Facts
Residents affected: 1

Inspection Report — Nov 26, 2024

Complaint Investigation
Date: Nov 26, 2024

Visit Reason
Original investigation 180037. Violations cited: 295.2000 c) 6) general violation, 295.2040 d) Type 2, 295.3000 a) general violation, 295.4000 a) Type 2, 295.4010 C g) 1, 2, 4 Type 1, 295.4020 b. general violation, 295.6000 a.) 1.) general violation, 295.9040 a.) b.) general violation.

Complaint Details
Original investigation 180037: Violations cited for multiple sections including 295.2000 c) 6) general violation, 295.2040 d) Type 2, 295.3000 a) general violation, 295.4000 a) Type 2, 295.4010 C g) 1, 2, 4 Type 1, 295.4020 b. general violation, 295.6000 a.) 1.) general violation, 295.9040 a.) b.) general violation.
Findings
The establishment failed to comply with residency requirements by admitting a resident with a severe mental illness without proper staff training or signed physician assessments. The facility did not conduct required tornado drills, failed to maintain adequate service plans, and did not provide necessary housekeeping and supervised showers. The resident's environment was unclean and unsafe, but improvements were noted by the end of the investigation.

Deficiencies (8)
A2000 (295.2000 Residency Requirements) - The establishment admitted a resident with a severe mental illness who was substantially disabled and failed to meet residency requirements.
A2040 (295.2040 Disaster Preparedness) - The establishment failed to conduct tornado drills on each shift during February 2024 for employees.
A3000 (295.3000 Personnel Requirements, Qualifications and Training) - The establishment lacked staff with proper training and qualifications to meet the needs of a resident with a psychotic disorder.
A4000 (295.4000 Physician's Assessment) - The establishment failed to have a physician sign the comprehensive assessment of a resident prior to admission.
A4010 (295.4010 Service Plan) - The service plan was not signed by all involved and failed to address the resident's level of service, negotiated risks, daily showers, housekeeping, psychotic disorder, and safety with cigarettes.
A4020 (295.4020 Mandatory Services) - The establishment failed to provide housekeeping services to the resident's room as needed.
A6000 (295.6000 Resident Rights) - The establishment failed to provide an environment that promotes and supports the resident's dignity, independence, and privacy, resulting in unsanitary and unsafe conditions.
A9040 (295.9040 Environmental Requirements) - The establishment failed to keep the resident's room clean, safe, orderly, and free of odors.
Report Facts
Residents affected: 1 Date of survey: Nov 26, 2024

Inspection Report — Oct 21, 2024

Complaint Investigation
Date: Oct 21, 2024

Visit Reason
Complaint Investigation 2468205/IL179090. Complaint can be substantiated.

Complaint Details
Complaint 2468205/IL179090: Complaint can be substantiated.
Findings
The establishment failed to ensure residents R1 and R2 had service plans developed upon admission, that contracts were properly followed, and that medication supervision was provided as prescribed. Communication failures and medication errors were identified, including administration of discontinued medication.

Deficiencies (3)
A2030 (295.2030 Establishment Contacts) - The establishment failed to ensure contracts with residents R1 and R2 were followed, including absence of service plans attached to contracts and failure to provide required assistance upon admission.
A4010 (295.4010 Service Plan) - The establishment failed to ensure residents R1 and R2 had service plans developed upon admission, with no service plans attached to contracts and delayed service plan initiation.
A5000 (295.5000 Medication Reminders, Supervision of Self Med) - The establishment failed to ensure resident R1 was provided with supervision of medications as prescribed, including administration of discontinued immodium and lack of staff communication.
Report Facts
Residents affected: 2

Inspection Report — Oct 7, 2024

Complaint Investigation
Date: Oct 7, 2024

Visit Reason
Complaint Investigation for Complaint 2467494/IL178142. The complaint cannot be substantiated and no violations were cited.

Complaint Details
Complaint 2467494/IL178142: Complaint cannot be substantiated. No violations cited.
Findings
The establishment was found in compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.

Inspection Report — Sep 12, 2024

Complaint Investigation
Date: Sep 12, 2024

Visit Reason
Incident Report Investigation IL 177231. The allegation cannot be substantiated. No violations cited.

Complaint Details
Incident Report IL 177231: The allegation cannot be substantiated. No violations cited.
Findings
The establishment was found in compliance with Part 295 Assisted Living and Shared Housing Establishment Administrative Code and 210 ILCS 9/1 Assisted Living and Shared Housing Act.

Inspection Report — 6022711 View POC 005 SOC

Plan of Correction
Date: 6022711 View POC 005 SOC

Visit Reason
This plan of correction responds to the Annual and Complaint survey IL180037.

Findings
The facility committed to provide training by January 31, 2025, on multiple sections including Residency Requirements, caring for residents with behavioral symptoms, Resident Rights, and Environmental Requirements. Additional training and monitoring plans were described for Physician's Assessment, Service Plan, Mandatory Services, and tornado drills.

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