Evergreen Center for Health & Rehabilitation
205 Chestnut Hill Road, Stafford Springs, CT 06076 · Capitol County · 180 certified beds · avg 170 residents/day · certified since Oct 26, 1989
Part of chain: NATIONAL HEALTH CARE ASSOCIATES (42 facilities, chain avg rating 3.2★)
2/5
Health inspection rating (on-site)
1
Serious findings on record
$0
Fines, last 3 years
3.75
Nurse hours/resident/day (adjusted)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 3/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Actual harm, one-off · Aug 6, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Jul 31, 2025 (Past Non-Compliance)
All citations in the current public record (44)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Aug 6, 2025 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| May 14, 2025 | D · Potential for harm, one-off | The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint |
| May 14, 2025 | D · Potential for harm, one-off | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint |
| Nov 22, 2024 | F · Potential for harm, facility-wide | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Nov 22, 2024 | E · Potential for harm, repeated | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Nov 22, 2024 | E · Potential for harm, repeated | The facility did not keep its building and grounds safe, functional, clean, and comfortable for residents, staff, and visitors. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility has more than 120 beds but did not hire a qualified full-time social worker as required. · from a complaint |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Nov 22, 2024 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Nov 22, 2024 | B · Minimal risk, repeated | The facility did not reassess a resident after a significant change in their condition, such as a sudden decline in health. A full new assessment is required when a resident's condition changes in a major way. |
| Jul 31, 2024 | D · Potential for harm, one-off | The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not honor residents' right to form and take part in resident or family groups, such as a resident council. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not observe each nurse aide's job performance or provide regular training as required. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not provide appropriate treatment and services to residents with a mental health condition, difficulty adjusting emotionally, or a history of trauma or post-traumatic stress disorder (PTSD). · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not provide timely, quality laboratory tests to meet residents' needs. · from a complaint |
| Jun 6, 2024 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · from a complaint |
| Apr 22, 2024 | D · Potential for harm, one-off | The facility did not allow residents to take their own medications when a clinical review showed they could do so safely. Residents have this right if their care team determines it's appropriate. · from a complaint |
| Apr 22, 2024 | D · Potential for harm, one-off | The facility transferred or discharged a resident without a valid reason, or failed to provide the required documentation and information when moving a resident out. · from a complaint |
| Apr 22, 2024 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Apr 22, 2024 | D · Potential for harm, one-off | The facility did not make sure its nurses and nurse aides had the skills and training needed to properly care for every resident. · from a complaint |
| Feb 7, 2024 | D · Potential for harm, one-off | The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away. · from a complaint |
| Feb 7, 2024 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · from a complaint |
| Jun 23, 2022 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. |
| Jun 23, 2022 | D · Potential for harm, one-off | The facility did not make sure the resident's doctor reviewed their care and wrote, signed, and dated progress notes and orders at each required visit. |
| Oct 3, 2019 | E · Potential for harm, repeated | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. |
| Oct 3, 2019 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. |
| Oct 3, 2019 | D · Potential for harm, one-off | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. |
| Oct 3, 2019 | D · Potential for harm, one-off | The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (2 → 13).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2019 | 4 | 0 | E |
| 2022 | 2 | 0 | D |
| 2024 | 35 | 0 | F |
| 2025 | 3 | 1 | G ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
No fines or payment denials in the published 3-year window.
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Connecticut avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.75 | 3.80 | 3.95 | top 45% in Connecticut; bottom 49% in the U.S. |
| Registered Nurse hours | 0.51 | 0.70 | 0.69 | bottom 34% in Connecticut; bottom 39% in the U.S. |
| Weekend total nurse staffing | 3.45 | 3.43 | 3.50 | top 38% in Connecticut; top 45% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.29 | 0.46 | 0.48 | bottom 28% in Connecticut; bottom 29% in the U.S. |
| Total nursing staff turnover (%) | 45.2 | 37.4 | 45.8 | bottom 20% in Connecticut; bottom 49% in the U.S. |
| RN turnover (%) | 47.6 | 38.6 | 42.9 | bottom 32% in Connecticut; bottom 40% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.55, RN 0.48, weekend 3.27. Staffing rating: 3/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 5/5 · long-stay residents: 5/5 · short-stay residents: 4/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Cedar Hill Capital Associates LLC | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Ehrenfeld, Mindy | Individual | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Gilmartin, Thomas | Individual | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Ilana Ostreicher Family Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Juniper Capital Associates LLC | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Marc Ephram Ostreicher Family Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Mydert Holdings LLC | Organization | 5% or Greater Direct Ownership Interest | 51% | 06/07/2024 |
| Oak Management Capital LLC | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Ysro Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 06/07/2024 |
| Zadun Holdings LLC | Organization | 5% or Greater Direct Ownership Interest | 49% | 06/07/2024 |
| Baker Tilly Advisory Group LP | Organization | ADP of the SNF | NOT APPLICABLE | 06/07/2024 |
| David Ostreicher Family Trust | Organization | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Ehrenfeld, Mindy | Individual | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Gilmartin, Thomas | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/10/2024 |
| Gilmartin, Thomas | Individual | ADP of the SNF | NOT APPLICABLE | 03/04/2025 |
| Goodsell, Andrew | Individual | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Ilana Ostreicher Family Trust | Organization | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Lopiansky, Rebecca | Individual | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Marc Ephram Ostreicher Family Trust | Organization | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
| Michelle Ostreicher Family Trust | Organization | ADP of the SNF | NOT APPLICABLE | 01/07/2025 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
- "How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "Can we tour the whole building today, including resident bathrooms and common areas, not just the lobby?"
- "What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
- "Can you show me an example care plan, and how are families included when it's created and updated?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Vantage at Hampden LLC | 6.0 mi | Hampden, MA | ★★★☆☆ | 4/5 | |
| Woodlake at Tolland | 7.4 mi | Tolland, CT | ★★★☆☆ | 3/5 | |
| Chestnut Hill Health and Rehabilitation Center LLC | 7.9 mi | East Longmeadow, MA | ★★★☆☆ | 3/5 | |
| Complete Care at Fox Hill | 8.5 mi | Vernon, CT | ★★☆☆☆ | 2/5 | |
| Care One at Redstone | 8.8 mi | East Longmeadow, MA | ★★☆☆☆ | 2/5 | |
| East Longmeadow Skilled Nursing Center | 9.3 mi | East Longmeadow, MA | ★★★★☆ | 4/5 | |
| Vernon Rehabilitation and Healthcare Center | 9.7 mi | Vernon, CT | ★★★★★ | 5/5 | |
| Sixteen Acres Health and Rehabilitation Center LLC | 10.2 mi | Springfield, MA | ★★★★☆ | 4/5 | |
| Julian J Levitt Family Nursing Home | 10.2 mi | Longmeadow, MA | ★★★★☆ | 3/5 | |
| St Joseph's Residence | 10.3 mi | Enfield, CT | ★★★★★ | 5/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 075326.