EVERGREEN HEALTHCARE CENTER
924 CHARLIE'S WAY
MONTPELIER, OH, 43543
4194858307
CCN: 365495
2
Overall2
Health2
Staffing2
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
OIG Federal Exclusion Matches (2)
This facility's name matches one or more entities on the OIG List of Excluded Individuals/Entities (LEIE). Excluded parties are prohibited from participation in Medicare and Medicaid programs.
CHRIS-JEN HEALTHCARE, INC
1128b8
Excluded 2004-10-20
CROSS HEALTHCARE, INC
1128b8
Excluded 2004-10-20
Ownership
| Name | Role | % |
|---|---|---|
| SXCY MSTR LSCO, LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% |
| C.R. STOLTZ FAMILY INVESTMENT COMPANY INC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| C.R. STOLTZ IRREVOCABLE TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| HEALTH CARE LEASE FACILITIES, LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| I. ROSEDALE IRREVOCABLE TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| R.S. WILHEIM IRREVOCABLE TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| RONALD S WILHEIM 2012 SPOUSAL TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| ROSEDALE FAMILY INVESTMENT COMPANY, INC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| RRW, LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| S.L. ROSEDALE IRREVOCABLE TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| SXCY HOLDINGS, LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| WILHEIM FAMILY INVESTMENT COMPANY, INC. | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| SKILLED HC HOLDINGS, LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED |
| ROMEO, DOMINIC | CORPORATE OFFICER | NOT APPLICABLE |
| STOLTZ, CHARLES | CORPORATE OFFICER | NOT APPLICABLE |
| WILHEIM, RONALD | CORPORATE OFFICER | NOT APPLICABLE |
| PARK, KEVIN | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| ROBINAIR MGT CO., LLC | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| ROMEO, DOMINIC | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| GROVES, DONNA | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| GUTIERREZ, YVETTE | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Health Deficiencies (18)
2023-01-18 · Health
D
F881 · Infection Control Deficiencies
Implement a program that monitors antibiotic use.
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F835 · Administration Deficiencies
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
D
F760 · Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
D
F756 · Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
D
F692 · Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
G
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
J
F600 · 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.
D
F580 · Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
2021-12-21 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
D
F759 · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
D
F698 · Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
D
F655 · Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
D
F625 · Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
D
F623 · Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
3.18
RN Hrs/Resident/Day0.54
0.53
LPN Hrs/Resident/Day0.81
0.95
CNA Hrs/Resident/Day2.33
1.70
PT Hrs/Resident/Day0.12
0.03
Data as of 2026-03-01