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PRINTED: 05/31/2022 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:EVERGREEN VILLAGE AT BLOOMINGTON
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How to fill out nursing home report cards

01
Obtain the nursing home report card form from the appropriate authority.
02
Fill in the name and contact information of the nursing home.
03
Provide information on the nursing home's staff, such as number of nurses, aides, and other personnel.
04
Detail the services provided by the nursing home, including medical assistance, therapy, and social activities.
05
Include information on the nursing home's safety and cleanliness measures.
06
Submit the completed nursing home report card to the relevant authority.

Who needs nursing home report cards?

01
Government agencies responsible for regulating nursing homes.
02
Healthcare providers looking to refer patients to a nursing home.
03
Families researching nursing homes for their loved ones.
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Nursing home report cards provide information on the quality of care provided by nursing homes.
Nursing homes are required to file nursing home report cards.
Nursing home report cards can be filled out by providing information on the quality of care, staff qualifications, and resident satisfaction.
The purpose of nursing home report cards is to provide transparency and accountability in the quality of care provided by nursing homes.
Information such as quality measures, staffing levels, and resident satisfaction must be reported on nursing home report cards.
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