Inspection Reports for Evergreen Place Assisted Living – Champaign
IL, 61822
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Inspection Report
Annual Inspection
Deficiencies: 0
Dec 23, 2025
Visit Reason
Annual licensure survey to assess 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 to be in compliance with the applicable assisted living regulations and licensing requirements.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jul 24, 2025
Visit Reason
The inspection was conducted as a complaint investigation identified as IL195202 to assess 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 to be in compliance with the applicable assisted living regulations and administrative codes during this complaint investigation.
Complaint Details
Complaint Investigation IL195202; the establishment was found in compliance.
Inspection Report
Annual Inspection
Deficiencies: 8
Nov 27, 2024
Visit Reason
Annual review conducted on 11/20/24 to assess compliance with residency requirements, disaster preparedness, personnel qualifications, physician assessments, service plans, mandatory services, resident rights, and environmental requirements.
Findings
The facility failed to comply with residency requirements by admitting a resident with a severe mental illness without proper staff training or signed physician assessments. The service plan was unsigned and incomplete, failing to address the resident's needs including daily housekeeping, showers, and safety. The facility did not conduct required tornado drills in February 2024. The resident's room was initially unsanitary and unsafe, with feces and cigarette butts noted, but was cleaned by 11/26/24 after notification. These deficiencies created a substantial probability of severe harm to the resident.
Severity Breakdown
general violation: 4
Type 1: 4
Type 2: 1
Deficiencies (8)
| Description | Severity |
|---|---|
| Failure to comply with residency requirements for admitting a person with severe mental illness. | general violation |
| Failure to conduct tornado drills on each shift during February 2024. | Type 1 |
| Insufficient staff qualifications and training to meet resident needs. | general violation |
| Physician's comprehensive assessment not signed. | Type 2 |
| Service plan unsigned and incomplete, failing to address level of service, negotiated risks, and specific resident needs. | Type 1 |
| Failure to provide adequate housekeeping services to resident's room. | general violation |
| Failure to provide an environment that promotes and supports resident dignity. | general violation |
| Facility not kept clean, safe, orderly, and free of odors in resident's room. | general violation |
Report Facts
Date of annual review: Nov 20, 2024
Date of survey completion: Nov 27, 2024
Date of medical exam: Oct 10, 2024
Date of resident admission: Oct 22, 2024
Date of room cleaning improvement: Nov 26, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 interviewed multiple times regarding admission knowledge, staff training, and service plan development |
Inspection Report
Complaint Investigation
Deficiencies: 8
Nov 26, 2024
Visit Reason
The inspection was conducted as a complaint investigation regarding the facility's compliance with residency requirements, disaster preparedness, personnel qualifications, physician assessments, service plans, mandatory services, resident rights, and environmental conditions.
Findings
The facility failed to comply with regulations related to admitting a resident with a severe mental illness without proper staff training and service plans, failed to conduct required tornado drills, lacked a signed physician assessment, did not provide adequate housekeeping and supervision for a resident with a psychotic disorder, and failed to maintain a clean, safe, and odor-free environment. The resident's room was initially found in poor condition with feces and cigarette butts, but was noted to be clean by the last day of the investigation.
Complaint Details
The investigation was complaint-driven, focusing on allegations related to the care and environment provided to a resident with a psychotic disorder, including failure to meet residency requirements, inadequate staff training, lack of proper assessments and service plans, and poor housekeeping and environmental conditions.
Severity Breakdown
general violation: 3
Type 1: 4
Type 2: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Admission of a resident with a severe mental illness without proper compliance with residency requirements. | general violation |
| Failure to conduct tornado drills on each shift during February 2024. | Type 1 |
| Lack of staff with qualifications, skills, and training to meet the needs of a resident with a psychotic disorder. | general violation |
| Physician's comprehensive assessment not signed by a physician. | Type 2 |
| Service plan not signed by all involved and failing to address needed services and negotiated risks. | Type 1 |
| Failure to provide adequate housekeeping services to resident's room. | Type 1 |
| Failure to provide an environment that promotes and supports resident's dignity. | general violation |
| Failure to keep resident's room clean, safe, orderly, and free of odors. | Type 1 |
Report Facts
Date of resident's medical exam: Oct 10, 2024
Date of resident admission: Oct 22, 2024
Date of inspection: Nov 26, 2024
Date of room condition observations: Nov 20, 2024
Date of follow-up room observation: Nov 21, 2024
Date of room cleaning noted: Nov 26, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 interviewed multiple times, acknowledged knowledge of resident's diagnosis and lack of staff training, and failure to update service plans. |
Inspection Report
Complaint Investigation
Deficiencies: 3
Oct 21, 2024
Visit Reason
The inspection was conducted as a complaint investigation regarding failure to follow establishment contracts and service plans for residents R1 and R2 upon admission.
Findings
The establishment failed to ensure that residents R1 and R2 had service plans completed and attached to their contracts upon admission, and failed to provide required assistance and medication supervision. Documentation gaps and communication failures were noted, including medication administration errors and lack of staff awareness of resident admissions.
Complaint Details
Complaint investigation number 2468205/IL179090 was substantiated based on record review and interviews indicating failures in contract adherence, service plan development, and medication supervision for residents R1 and R2.
Severity Breakdown
Type 2 Violation: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to ensure establishment contracts with residents R1 and R2 were followed, including missing service plans and lack of required assistance upon admission. | Type 2 Violation |
| Failure to develop and mutually agree upon written service plans for residents R1 and R2 upon admission. | Type 2 Violation |
| Failure to provide supervision of self-administered medication to resident R1 as prescribed, including medication administration errors with immodium. | Type 2 Violation |
Report Facts
Medication tablets sent: 14
Dates of admission: Aug 22, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 | Executive Director and Wellness Director | Provided statements regarding resident admissions, medication orders, and service plan issues. |
| E2 | Licensed Practical Nurse | Reported lack of staff awareness of resident admissions and medication administration errors. |
| E3 | Signed Standard Interview Assessment for resident R2 on 08/28/2024. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Oct 7, 2024
Visit Reason
The inspection was conducted as a complaint investigation related to complaint number 2467494/IL178142.
Findings
The complaint could not be substantiated and no violations were cited. The facility was found to be in compliance with the applicable Illinois Assisted Living and Shared Housing regulations.
Complaint Details
Complaint 2467494/IL178142 was investigated and found to be unsubstantiated with no violations cited.
Inspection Report
Complaint Investigation
Deficiencies: 0
Sep 12, 2024
Visit Reason
The inspection was conducted as an incident report investigation based on an allegation.
Findings
The allegation could not be substantiated and no violations were cited. The facility was found to be in compliance with the applicable Assisted Living and Shared Housing regulations.
Complaint Details
The allegation was investigated and found to be unsubstantiated.
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