Inspection Detail

Inspection: 309208403 - Evergreen Valley Nursing Home

Inspection Information - Office: Albany Area Office

Inspection Nr: 309208403

Report ID: 0213100

Date Opened: 08/03/2006

Site Address:
Evergreen Valley Nursing Home
8 Bushey Blvd.
Plattsburgh, NY 12901

Mailing Address:
, , 00000

Union Status: Union

SIC:8051

NAICS: 623110/Nursing Care Facilities

Inspection Type: Planned

Scope: Complete

Advanced Notice: N

Ownership: Private

Safety/Health: Health

Close Conference: 08/23/2006

Emphasis: N:Nursing, N:Sstarg05

Case Closed: 11/30/2006

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	7			2		9
Current Violations	7			2		9
Initial Penalty	$7,700	$0	$0	$0	$0	$7,700
Current Penalty	$7,700	$0	$0	$0	$0	$7,700
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Latest Event
1.	01001	Serious	19100132 A	10/12/2006	11/01/2006	$1,100	$1,100	$0	-
2.	01002	Serious	19100147 C04 I	10/12/2006	11/01/2006	$1,100	$1,100	$0	-
3.	01003A	Serious	19100147 C05 I	10/12/2006	11/01/2006	$1,100	$1,100	$0	-
4.	01003B	Serious	19100147 D04 I	10/12/2006	11/01/2006	$0	$0	$0	-
5.	01004	Serious	19100147 C07 I	10/12/2006	11/01/2006	$1,100	$1,100	$0	-
6.	01005	Serious	19100212 A03 II	10/12/2006	11/01/2006	$1,100	$1,100	$0	-
7.	01006A	Serious	19101030 C01 IV	10/12/2006	11/15/2006	$1,100	$1,100	$0	-
8.	01006B	Serious	19101030 H05 I	10/12/2006	11/01/2006	$0	$0	$0	-
9.	01007	Serious	19101030 F01 IID	10/12/2006	11/15/2006	$1,100	$1,100	$0	-
10.	02001	Other	19100036 D01	10/12/2006	11/01/2006	$0	$0	$0	-
11.	02002	Other	19100037 B02	10/12/2006	11/01/2006	$0	$0	$0	-

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