01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-01-21 | 2 | 2026-01-21 | 3 |
| Cycle 2 | 2024-11-20 | 3 | 2024-11-20 | 2 |
| Cycle 3 | 2023-12-19 | 3 | 2023-12-19 | 6 |
CMS CCN 2455102026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Evansville Care Center
649 State Street Northwest · Evansville, MN 56326 · Douglas County
Certified beds27CMS provider file
Recent citation rows19current CMS citation release
Penalty rows0current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
19 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-01-21 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2026-02-202026-01-21 · HEALTHF0867Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Correction field: Deficient, Provider has date of correction · 2026-02-202026-01-21 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-01-222026-01-21 · FIREK0372Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2026-01-222026-01-21 · FIREK0741Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2026-01-222024-11-20 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2024-12-172024-11-20 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2024-12-172024-11-20 · HEALTHF0656Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Correction field: Deficient, Provider has date of correction · 2024-12-172024-11-20 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-11-252024-11-20 · FIREK0918Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-12-162023-12-19 · FIREE0041Severity C · widespread; potential for minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2024-01-31 · complaint2023-12-19 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2024-01-312023-12-19 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-01-312023-12-19 · HEALTHF0883Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2024-01-312023-12-19 · FIREK0281Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Install proper backup exit lighting.
Correction field: Deficient, Provider has date of correction · 2024-01-312023-12-19 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2024-01-122023-12-19 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-12-202023-12-19 · FIREK0372Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2023-12-282023-12-19 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-01-3103 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- JOHNSON, SHAWNIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 04/08/2024
- BORGSTROM, BRANDONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/15/2010
- EVINK, BRUCEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2017
- HOVLAND, SANDYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/23/2024
- LENARZ, JENNIFERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/02/2017
- REQUE, DAWNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2024
- ROSTEN, BRADLEYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2024
- RUPP, NICOLEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2024
- STERNS, ARDELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2024
- WHITE, ERICAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/20/2024
- JOHNSON, LANCEIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 02/23/2026
- AJ & SJ PROPERTIES LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 09/23/2009
- BORGSTROM, BRANDONIndividual · ADP OF THE SNFNOT APPLICABLE · since 03/15/2010
- EVINK, BRUCEIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/29/2025
- JOHNSON, SHAWNIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/20/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.92per resident day
RN hours1.29per resident day
Weekend nurse hours3.25per resident day
Staff turnover16.0%CMS reported field
06 / LOCAL RECORDS
Open the Minnesota ledger →Other published facilities nearby
No second facility in the same city met the directory rule.