Evergreen Nursing Home
1991 Carroll St, Alamosa, CO 81101 · Alamosa County · 60 certified beds · avg 46 residents/day · certified since Apr 1, 1987
Abuse citation flag (CMS)
Part of chain: LIFE CARE CENTERS OF AMERICA (194 facilities, chain avg rating 3.4★)
The abuse flag means inspectors cited this facility for abuse that caused harm to a resident within the past year, or potential for harm in each of the last two years. Source: CMS.
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 2/5
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 · Feb 5, 2026 · F-0600 · triggered by a complaint
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.
Why it matters: Abuse and neglect cause direct physical and emotional harm and are among the most serious failures a nursing home can have.
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: Mar 5, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Feb 5, 2026 · 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: Mar 5, 2026 (Deficient, Provider has date of correction)
All citations in the current public record (13)
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 |
|---|---|---|
| Feb 5, 2026 | ▲ G · Actual 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 |
| Feb 5, 2026 | ▲ 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 |
| Aug 29, 2024 | D · Potential for harm, one-off | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. · from a complaint |
| Aug 29, 2024 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. · from a complaint |
| Aug 29, 2024 | D · Potential for harm, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. |
| Aug 29, 2024 | 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. |
| Aug 29, 2024 | D · Potential for harm, one-off | 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. |
| Aug 29, 2024 | D · Potential for harm, one-off | The facility did not develop and follow policies and procedures for offering residents flu and pneumonia vaccinations. |
| Feb 2, 2023 | F · Potential for harm, facility-wide | The facility did not make sure its nurses and nurse aides had the skills and training needed to properly care for every resident. |
| Feb 2, 2023 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Feb 2, 2023 | 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. |
| Feb 2, 2023 | D · Potential for harm, one-off | The facility did not provide the right treatment and services for residents with dementia or signs of dementia. Dementia care requires specific approaches, training, and patience. |
| Oct 21, 2021 | D · Potential for harm, one-off | The facility did not provide safe, appropriate care for residents who need dialysis — the treatment that filters the blood when kidneys fail. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (4 → 6).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2021 | 1 | 0 | D |
| 2023 | 4 | 0 | F |
| 2024 | 6 | 0 | D |
| 2026 | 2 | 2 | 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)
1 fine totaling $20,150.
| Date | Type | Amount / length |
|---|---|---|
| Feb 5, 2026 | Fine | $20,150 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Colorado avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.76 | 3.89 | 3.95 | top 48% in Colorado; bottom 50% in the U.S. |
| Registered Nurse hours | 0.72 | 0.86 | 0.69 | bottom 41% in Colorado; top 34% in the U.S. |
| Weekend total nurse staffing | 3.05 | 3.44 | 3.50 | bottom 34% in Colorado; bottom 34% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.14 | 0.61 | 0.48 | bottom 1% in Colorado; bottom 4% in the U.S. |
| Total nursing staff turnover (%) | 30.0 | 47.1 | 45.8 | top 10% in Colorado; top 14% in the U.S. |
| RN turnover (%) | 44.4 | 44.6 | 42.9 | bottom 50% in Colorado; bottom 45% 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 3.34, RN 0.64, weekend 2.71. Staffing rating: 1/5.
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: 3/5 · short-stay residents: 5/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Developers Investment Company INC | Organization | Direct Ownership Interest | NOT APPLICABLE | 05/07/1996 |
| Preston, Forrest | Individual | Direct Ownership Interest | NOT APPLICABLE | 08/07/1996 |
| Preston, Forrest | Individual | Indirect Ownership Interest | NOT APPLICABLE | 05/07/1996 |
| Colorado Medical Investors LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 08/01/1996 |
| Colorado Medical Investors LLC | Organization | ADP of the SNF | NOT APPLICABLE | 08/31/2000 |
| Cross, Cindy | Individual | Corporate Officer | NOT APPLICABLE | 08/01/1996 |
| Developers Investment Company INC | Organization | Operational/Managerial Control | NOT APPLICABLE | 01/01/2006 |
| Fletcher, Todd | Individual | Operational/Managerial Control | NOT APPLICABLE | 12/13/2024 |
| Franco, Mark | Individual | Corporate Director | NOT APPLICABLE | 09/12/2025 |
| Guttierrez, Yestly | Individual | Managing Control - Governing Body | NOT APPLICABLE | 10/02/2025 |
| Guttierrez, Yestly | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/02/2025 |
| Henry, Terry | Individual | Corporate Officer | NOT APPLICABLE | 08/16/1999 |
| Lay, Lisa | Individual | Corporate Director | NOT APPLICABLE | 04/24/2017 |
| Lay, Lisa | Individual | Corporate Officer | NOT APPLICABLE | 02/09/2018 |
| Life Care Centers of America, INC. | Organization | Operational/Managerial Control | NOT APPLICABLE | 08/01/1996 |
| Life Care Centers of America, INC. | Organization | ADP of the SNF | NOT APPLICABLE | 02/21/2025 |
| Preston, Aubrey | Individual | Operational/Managerial Control | NOT APPLICABLE | 12/13/2024 |
| Preston, Forrest | Individual | ADP of the SNF | NOT APPLICABLE | 08/31/2000 |
| Schmidt, Derek | Individual | Managing Control - Governing Body | NOT APPLICABLE | 10/18/2012 |
| Schmidt, Derek | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/18/2012 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
- "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
- "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
- "Can you show me how medications are stored and secured on the units, including controlled drugs?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "What percentage of your residents and staff are vaccinated against flu and pneumonia, and how do you offer the vaccines?"
- "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 |
|---|---|---|---|---|---|
| San Luis Care Center | 0.6 mi | Alamosa, CO | ★★★★☆ | 4/5 | |
| Colorado Veterans Community Living Ctr at Homelake | 13.6 mi | Monte Vista, CO | ★★★★★ | 5/5 | |
| Rock Creek Rehabilitation and Healthcare Center | 14.7 mi | Monte Vista, CO | ★☆☆☆☆ | 2/5 | abuse |
| Rio Grande Rehabilitation and Healthcare Center | 15.9 mi | La Jara, CO | ★☆☆☆☆ | 1/5 | abuse |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 065234.