01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-09-11 | 9 | 2025-09-11 | 5 |
| Cycle 2 | 2024-08-07 | 19 | 2024-08-07 | 1 |
| Cycle 3 | 2023-06-29 | 33 | 2023-06-29 | 0 |
CMS CCN 2355822026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Evergreen Health And Rehabilitation Center
19933 West Thirteen Mile Road · Southfield, MI 48076 · Oakland County
Certified beds172CMS provider file
Recent citation rows67current CMS citation release
Penalty rows1current 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
67 rows in the current release
5 rows carry G–L scope/severity codes; 0 carry J–L. 12 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-07 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2026-04-28 · complaint2026-04-07 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2026-04-28 · complaint2025-09-11 · FIREE0041Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2025-10-022025-09-11 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · HEALTHF0770Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide timely, quality laboratory services/tests to meet the needs of residents.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · HEALTHF0810Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-10-072025-09-11 · FIREK0293Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2025-10-022025-09-11 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-10-022025-09-11 · FIREK0341Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install a fire alarm system that can be heard throughout the facility.
Correction field: Deficient, Provider has date of correction · 2025-10-022025-09-11 · 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 · 2025-10-022025-08-06 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-08-22 · complaint2025-04-08 · HEALTHF0684Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-04-30 · complaint2025-04-08 · HEALTHF0690Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Correction field: Deficient, Provider has date of correction · 2025-04-30 · complaint2025-02-20 · HEALTHF0551Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give the resident's representative the ability to exercise the resident's rights.
Correction field: Deficient, Provider has date of correction · 2025-03-11 · complaint2025-02-20 · HEALTHF0925Severity D · isolated; potential for more than minimal harm
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Correction field: Past Non-Compliance · 2025-02-06 · complaint2024-12-10 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2024-12-30 · complaint2024-12-10 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2024-12-30 · complaint2024-08-07 · HEALTHF0550Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2024-09-172024-08-07 · HEALTHF0555Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to choose his or her attending physician.
Correction field: Deficient, Provider has date of correction · 2024-09-172024-08-07 · HEALTHF0559Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
Correction field: Deficient, Provider has date of correction · 2024-09-172024-08-07 · HEALTHF0563Severity F · widespread; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Correction field: Deficient, Provider has date of correction · 2024-09-1703 / 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 |
|---|---|---|---|
| 2024-03-14 | Fine | $28,815 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SNW LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST30% · since 09/01/2019
- OPTUM MANAGEMENT SOLUTIONS. INCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 09/01/2019
- PATEL, RAJANIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 09/01/2019
- SHARON, ROBERTIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 05/13/2024
- OPTUM MANAGEMENT SOLUTIONS. INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/01/2019
- GOUROV, LYUDMILAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/07/2023
- IMAM, KHALEDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2025
- PATEL, RAJANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/01/2019
- SHARON, ROBERTIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/13/2024
- SIKORA, KERIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/31/2025
- DUNN, CHARLESIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 04/08/2025
- SHAH, HEMANTIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 04/02/2025
- OPTALIS BUSINESS SOLUTIONS LLCOrganization · TRUSTEE OF THE SNFNOT APPLICABLE · since 04/16/2026
- CHARLES FRANKLIN LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 09/01/2019
- CHARLES WESTLAND LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 09/01/2019
- CLIFTONLARSONALLEN LLPOrganization · ADP OF THE SNFNOT APPLICABLE · since 01/01/2025
- HEMANT SHAH 2018 IRREVOCABLE TRUSTOrganization · ADP OF THE SNFNOT APPLICABLE · since 09/01/2019
- OBS OF MI LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 01/28/2026
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 hours3.91per resident day
RN hours0.46per resident day
Weekend nurse hours3.41per resident day
Staff turnover46.0%CMS reported field