The Evergreens - Admission/Retention Criteria 

Admission/Retention Criteria

1. Do not have an ambulatory or cognitive status that is inconsistent with Facility's license classification of class "C" (CNA) CBRF for the elderly and the handicapped.
2. Are not destructive of property or self, or physically or mentally abusive to others, unless Facility has sufficient resources to care for such an individual and is able to protect the Resident and others.
3. Do not require more than three (3) hours of nursing care per week except for a temporary condition needing more than three (3) hours of nursing care per week for no more than thirty (30) days, or unless the Department of Health Services grants a waiver from this requirement.
4. Do not require twenty-four (24) hour supervision by a registered nurse or a licensed practical nurse.
5. Do not have chronic personal care needs that cannot be met by Facility or a community agency.
6. Do not require chemical or physical restraints, except as may be authorized by law.
7. Do not require care above intermediate level nursing care.
8. Residents with activated POA’s or guardianship can be admitted, with proper paperwork
9. Have physical, mental, psychiatric and social needs that are compatible with Facility's client group as described in Facility's program statement.
10. Have entered an Individualized Service Plan and agree to revise the Individualized Service Plan when there is a documented and significant medical reason for doing so
11. Able to eat independently or willing to accept minimal assistance to maintain safety.
12. Perform activities of daily living or accept assistance as needed to maintain safety and hygiene.
13. Walk safely or use support equipment (cane, walker, wheelchair) safely and independently or accept assistance as needed.
14. Able to maintain or accept assistance to maintain a safe and sanitary environment, free from hazards.
15. Not at risk of injury to self or others.
16. Provide documentation of physical and TB test, within 90 days prior to admission.  A positive TB test will necessitate a follow-up chest x-ray.  
    • Annually, documentation shall be submitted consisting of a yearly physical or documentation of visits that occurred since last physical.
17. Provide a copy of advanced directives that are in place, such as, Power of Attorney for Health Care, Durable Power of Attorney for Finances, Living Will and Do Not Resuscitate form
18. Participate in an admission face-to-face assessment.


Discharge or Transfer Initiated by The Evergreens:  The Evergreens retains the right to involuntarily discharge a resident with a 30-day written advance notice.  The notice will list the need for and possible alternatives to the discharge.  Assistance with relocation to ensure suitable arrangements are made to meet the needs of the Tenant will be available.
1. Nonpayment of charges, following a reasonable opportunity to do so.
2. Is destructive of property or self, or physically or mentally abusive to others, unless sufficient resources to care for such an individual are utilized to protect the resident and others
3. There is imminent risk of serious harm to the health, care, well- being or safety of the resident, other resident’s or employees, as documented in the Tenant’s record. Or which substantially interferes with the orderly operation of the facility as documented in the resident’s record.
4. Has physical, mental, psychiatric or social needs that are not compatible with care, treatment or services as described in this Program Statement.
5. Inconsiderate or inappropriate behavior to other residents or Facility staff.
6. Care is required beyond that of the CBRF license classification or program statement or under the terms of the admission agreement.  No resident needing more than 3 hours of nursing care per week. Exceptions are made for a temporary condition with a duration period of no longer than 30 days.
7. Medical care is required that the CBRF cannot provide.  Has a medical condition which is unstable, and which requires continual skilled observation of symptoms and reactions or accurate recording of such skilled observation for the purpose of reporting to the resident’s physician.
8. Refuses or is unable to comply with a prescribed treatment program, including but not limited to a prescribed medications regimen when such failure causes, or is likely to cause, in the judgment of a physician, life-threatening danger to the resident or others.
9. The resident or family/responsible party is unable or unwilling to cooperate in attaining mutually agreed upon service objectives
10. Is chronically bedfast-chairfast and unable to transfer or chronically requires the physical assistance of more than 1 staff member.
11. Has a chronic unmanageable urinary or bowel incontinence, unless there are sufficient services provided to ensure that cleanliness, sanitation, and skin integrity are maintained; and provided that the Resident is cooperative, not resistive to the provision of assistance with this personal care needed.
12. If Resident engages in alcohol or drug use, conditions must be met which do not result in aggressive or destructive behavior towards self or others.
13. Medical reasons as ordered by a physician.
14. In the case of a medical emergency or disaster.
15. Requires a chemical or physical restraint except as authorized under s.50.09 (1) (k), Stats.
16.  Resident must be free of communicable disease or health conditions which constitute a danger to other residents and staff.
17. Resident fails to follow the rules, policies, and guidelines of Facility, Federal, State, County and City laws, rules, regulations, statutes or ordinances.