Inspection Report
Renewal
Census: 37
Capacity: 50
Deficiencies: 0
Sep 4, 2025
Visit Reason
The inspection was conducted as a licensing inspection for renewal purposes and included a complaint investigation (Complaint Investigation #CT #2607962).
Findings
No violations of the General Statutes of Connecticut or regulations were identified at the time of this inspection. A referral was made to PHS regarding NA #1.
Complaint Details
Complaint Investigation #CT #2607962 was conducted, but no violations were identified.
Report Facts
Licensed Bed Capacity: 50
Census: 37
Inspection Report
Plan of Correction
Deficiencies: 6
Sep 4, 2025
Visit Reason
The document is a plan of correction submitted in response to state violations identified during a survey concluding on September 4, 2025.
Findings
The plan of correction addresses multiple violations related to resident dignity, abuse policy, staff education, dietary services, and infection control. The facility outlines education, audits, and monitoring responsibilities to ensure compliance.
Deficiencies (6)
| Description |
|---|
| Residents not treated in a dignified manner; lack of education on resident rights for staff. |
| Abuse policy and safe transfers not followed; termination of NA#1. |
| Failure to report abuse allegations by RN#2. |
| Failure to investigate abuse allegations properly; education on abuse policy needed. |
| Kitchen staff not educated on hair restraints. |
| Infection control deficiencies related to handwashing and enhanced barrier precautions. |
Report Facts
Plan of correction audit duration: 3
Plan of correction implementation date: Nov 1, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Amanda Welch | Administrator | Author of the plan of correction and responsible party for monitoring |
| Laura Trombley-Norton | Supervising Nurse Consultant | Recipient of the plan of correction |
Inspection Report
Renewal
Census: 36
Capacity: 50
Deficiencies: 0
Dec 22, 2023
Visit Reason
The inspection was conducted as a renewal licensing inspection to evaluate compliance with Connecticut State regulations and to approve issuance of the facility license.
Findings
Violations of the General Statutes of Connecticut and/or regulations were identified at the time of inspection. Approval for issuance of license was granted.
Report Facts
Licensed Bed/ Bassinet Capacity: 50
Census: 36
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Amy Welch | Administrator | Personnel contacted during inspection |
Inspection Report
Follow-Up
Census: 24
Capacity: 50
Deficiencies: 2
Mar 2, 2022
Visit Reason
The visit was a desk audit conducted on 2/25/22 and 3/2/22 for the purpose of reviewing the Plan of Correction (POC) for the violation letter dated 11/17/21.
Findings
Violation 1(a) was corrected while violation 2 was identified as non-compliant at the time of this desk audit.
Deficiencies (2)
| Description |
|---|
| Violation 1(a) was corrected |
| Violation 2 was identified as non-compliant |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| James Tan | RN, Nurse Consultant | Conducted the desk audit and authored the report |
| Jaclyn Martinelli | Administrator | Personnel contacted during inspection |
| Jean Myers | DNS | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 21
Capacity: 50
Deficiencies: 0
Oct 28, 2021
Visit Reason
The inspection was conducted as a licensing renewal inspection and included review of a complaint investigation CT #000289666.
Findings
The report indicates that the licensing inspection was completed with renewal status and references a complaint investigation. No violations or citations were explicitly noted in the document.
Complaint Details
Complaint investigation CT #000289666 was reviewed as part of this inspection.
Report Facts
Licensed Bed/Bassinet Capacity: 50
Census: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cynthia Delaney | DNS | Personnel contacted during inspection |
Inspection Report
Annual Inspection
Deficiencies: 2
Oct 28, 2021
Visit Reason
Unannounced visits were made to Evergreen Woods to conduct an annual survey with additional information received through October 28, 2021.
Findings
Violations of Connecticut State Agencies regulations were noted during the visits, including failure to notify the Ombudsman timely of hospital transfers and failure to secure medications from non-licensed persons. The facility submitted a plan of correction addressing these deficiencies.
Deficiencies (2)
| Description |
|---|
| Failure to ensure the Ombudsman was notified of a hospital transfer timely for Resident #23. |
| Medication room door was left open and medications were accessible to non-licensed persons. |
Report Facts
Dates of annual survey: October 25, 26, 27, and 28, 2021
Date of plan of correction submission deadline: November 27, 2021
Audit period for hospital transfer notification compliance: 90
Audit period for medication room securing compliance: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maureen Golas-Markure | Supervising Nurse Consultant | Signed the notice letter from the Facility Licensing and Investigations Section |
| Jaclyn Martinelli | Administrator | Named in relation to the facility and plan of correction submission |
Inspection Report
Complaint Investigation
Deficiencies: 4
Jul 19, 2021
Visit Reason
An unannounced visit was made to Evergreen Woods on July 19, 2021, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation related to complaint #30382.
Findings
The facility was found to have multiple violations related to abuse prevention, staff training, timely reporting of abuse allegations, and timely resident assessments after abuse allegations. Specific incidents involving Resident #1 and staff members NA #1 and NA #2 were investigated, revealing failures in ensuring the resident was free from mistreatment and timely reporting and assessment of abuse allegations.
Complaint Details
Complaint #30382 triggered the investigation. The complaint involved allegations of abuse by nursing assistants NA #1 and NA #2 toward Resident #1. The complaint was substantiated with findings that staff were mean and rough, pushed the resident's wheelchair to prevent leaving the room, and engaged in a physical struggle over a TV pillow speaker. Staff failed to report the abuse timely and failed to complete timely resident assessments after the allegation.
Deficiencies (4)
| Description |
|---|
| Facility failed to ensure a resident was free from mistreatment involving staff pushing the resident's wheelchair and verbal abuse. |
| Facility failed to implement the abuse policy and ensure staff received annual abuse prevention training. |
| Facility failed to ensure staff reported an allegation of abuse timely. |
| Facility failed to ensure a resident assessment was completed timely by a registered nurse after an allegation of abuse. |
Report Facts
Compliance Date: Aug 19, 2021
Date of Incident: Jul 1, 2021
Date of Facility Visit: Jul 19, 2021
Date of Resident Care Plan: May 13, 2021
Date of MDS Assessment: Jun 30, 2021
Date of Abuse Prevention Training: Aug 14, 2018
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaclyn Martinelli | Administrator | Administrator of Evergreen Woods named in the report and plan of correction correspondence. |
| Maureen Golas Markure | Supervising Nurse Consultant | Department of Public Health official who authored the notice of violations and complaint investigation. |
Inspection Report
Abbreviated Survey
Deficiencies: 0
May 15, 2020
Visit Reason
A COVID-19 Focused Survey was conducted on 5/15/2020 at Evergreen Woods to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The survey found that Evergreen Woods was compliant with the infection prevention and control requirements related to COVID-19. No deficiencies were cited as a result of this survey.
Inspection Report
Abbreviated Survey
Deficiencies: 0
May 8, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The survey found that the facility was in compliance with the infection prevention and control requirements related to COVID-19. No deficiencies were cited as a result of this survey.
Inspection Report
Annual Inspection
Deficiencies: 4
Oct 3, 2019
Visit Reason
Unannounced visits were made to the facility on 9/30/19 through 10/3/19 for the purpose of conducting a licensure inspection, certification survey, and multiple investigations.
Findings
The facility was found deficient in multiple areas including failure to report and assess resident falls, inadequate behavioral health follow-up after resident altercations, inconsistent weekly skin assessments for pressure ulcer prevention, failure to timely implement dietician recommendations for weight loss, and improper medication storage.
Severity Breakdown
SS=D: 3
SS=E: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to ensure a fall was reported by Nurse Aides to allow RN assessment and failure to conduct/document timely behavioral health follow-up after resident altercation. | SS=D |
| Failure to ensure weekly skin assessments were consistently conducted on a resident at risk for pressure ulcers. | SS=E |
| Failure to implement dietician recommendations timely to address weight loss with variable intake. | SS=D |
| Failure to store medication in a locked and secure manner. | SS=D |
Report Facts
Deficiencies cited: 4
Resident weight loss: 14.8
Pressure ulcer size: 2.7
Pressure ulcer size: 1.9
Fall hematoma size: 3
Fall hematoma size: 9
Fall hematoma size: 4.5
Inspection Report
Follow-Up
Census: 49
Capacity: 50
Deficiencies: 0
Sep 4, 2019
Visit Reason
Visit or revisit for the purpose of review of the violation letters.
Findings
A tour of the facility was conducted including review of policies, documentation, observations, plan of correction documentation, and interviews. Staffing met minimum regulatory requirements and previous violations 1a, 2a, and 3a were identified as corrected.
Report Facts
Licensed Bed Capacity: 50
Census: 49
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cindy Delaney | RN, DNS | Personnel contacted during inspection |
| Jacquelyn Martinelli | ADM | Personnel contacted during inspection |
| Laura Trombley Norton | Nurse Consultant | Report submitted by and involved in findings |
Inspection Report
Plan of Correction
Deficiencies: 3
Jun 13, 2019
Visit Reason
Unannounced visits were made to Evergreen Woods on June 13, 2019, by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a certification survey.
Findings
The facility was found to have multiple violations including failure to notify a resident's representative of an injury, improper medication labeling and storage, and failure to complete a reportable event form following an injury. Licensed nursing staff were re-educated and corrective plans were put in place with audits to ensure compliance.
Deficiencies (3)
| Description |
|---|
| Failure to notify resident representative of an injury to Resident #6's finger. |
| Failure to ensure medications were labeled and/or stored according to facility policy, including open and undated medication vials. |
| Failure to complete a reportable event form following an injury to Resident #6. |
Report Facts
Residents reviewed for accidents: 2
Medication carts reviewed: 1
Dates of physician orders and nursing notes: Physician order dated 6/6/19; nursing progress note dated 6/7/19
Plan of correction completion date: July 1, 2019
Audit duration for compliance: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaclyn Martinelli | Administrator | Addressee of the letter and facility administrator |
| Norma Schubeth | Supervising Nurse Consultant | Signed letter and contact for questions regarding deficiencies |
Inspection Report
Renewal
Census: 41
Capacity: 50
Deficiencies: 36
May 30, 2018
Visit Reason
Unannounced visits were made to Evergreen Woods on May 30, 31 and June 1, 2018 by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation, a licensure and a certification inspection.
Findings
Violations of the Regulations of Connecticut State Agencies and/or General Statutes of Connecticut were noted during the course of the visits. The facility failed to meet requirements in areas including resident dignity during activities, care plan revisions following falls, medication lab work, resident-centered activity programs, medication security, and infection control standards.
Deficiencies (36)
| Description |
|---|
| Facility failed to ensure the resident's dignity was met during an activity for Resident #22. |
| Facility failed to review and/or revise the plan of care following a fall for Resident #2 and failed to review and revise the plan of care for pressure ulcers for Resident #7. |
| Facility failed to obtain lab work as per pharmacy recommendation and/or physician's order for Resident #8. |
| Facility failed to ensure a resident-centered activity program for Resident #22. |
| Facility failed to ensure pharmacy recommendations were acted upon in a timely manner for Resident #8. |
| Facility failed to ensure medication security for Resident #195. |
| Facility failed to verify the treatment plan with the physician according to policy for Outpatient Physical Therapy. |
| Facility failed to secure clinical records in accordance with facility policy. |
| Facility failed to follow infection control standards per facility policy. |
| Facility failed to follow infection control standards for hand hygiene for residents receiving wound care for pressure ulcers. |
| Facility failed to follow infection control standards for hand hygiene between tasks. |
| Facility failed to follow infection control standards for hand hygiene following completion of wound care. |
| Facility failed to follow infection control standards for hand hygiene when soiled from any source. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
| Facility failed to follow infection control standards for hand hygiene as expected by staff during wound care and other tasks. |
Report Facts
Licensed Bed Capacity: 50
Census: 41
Inspection Dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaclyn Martinelli | Administrator | Named in relation to plan of correction and inspection correspondence |
| Maria M. LaRocco | Supervising Nurse Consultant | Signed inspection report and correspondence |
| Anthony M. Bruno | Building Construction & Fire Safety Unit Supervisor | Signed fire safety inspection correspondence |
| Blair Quasnitschka | Executive Director | Signed plan of correction letter |
| Gregory Shahum | Healthcare Administrator | Signed plan of correction letter for Edgehill Health Center |
Inspection Report
Renewal
Census: 41
Capacity: 50
Deficiencies: 9
May 30, 2018
Visit Reason
Unannounced visits were made to Evergreen Woods on May 30, 31 and June 1, 2018 by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation, a licensure and a certification inspection.
Findings
Violations of the Regulations of Connecticut State Agencies and/or General Statutes of Connecticut were noted during the course of the visits. The facility failed to ensure compliance in areas including resident dignity during activities, care planning following falls, medication lab work, resident-centered activity programs, medication security, treatment plan verification, and infection control standards.
Deficiencies (9)
| Description |
|---|
| Facility failed to ensure the resident's dignity was met during an activity for Resident #22. |
| Facility failed to review and/or revise the plan of care following a fall for Resident #7. |
| Facility failed to obtain lab work as per pharmacy recommendation and/or physician's order for Resident #8. |
| Facility failed to ensure a resident centered activity program for Resident #22. |
| Facility failed to ensure pharmacy recommendations were acted upon in a timely manner for Resident #8. |
| Facility failed to ensure medication security for Resident #195. |
| Facility failed to verify the treatment plan with the physician according to policy for outpatient physical therapy. |
| Facility failed to secure clinical records in accordance with facility policy. |
| Facility failed to follow infection control standards per facility policy. |
Report Facts
Licensed Bed Capacity: 50
Census: 41
Inspection Dates: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria M. LaRocco | Supervising Nurse Consultant | Signed the letter reporting violations and findings. |
| Jaclyn Martinelli | Administrator | Named in the report as facility administrator and signed the plan of correction letter. |
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