Evansville, IN

Evansville Protestant Home

3-star overall rating with 2-star inspections with 12 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

3701 Washington Ave, Evansville, IN

(812) 476-3360

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

5 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

Non-Profit

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

2008-06-13

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Staffing

Hours and turnover

RN hours / resident day

1.00

Registered nurse staffing

LPN hours / resident day

1.24

Licensed practical nurse staffing

Aide hours / resident day

2.93

Nurse aide staffing

Weekend hours

4.38

Weekend nurse staffing

RN turnover

46%

Annual RN turnover

Total nurse turnover

49%

Annual nurse turnover

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	2.1	1.6 0.5 pts worse	1.9 0.2 pts worse	Long Stay · 20240701-20250630
Number of outpatient emergency department visits per 1000 long-stay resident days	1.7	1.5 0.2 pts worse	1.8 0.1 pts better	Long Stay · 20240701-20250630
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	92.2%	93.6% 1.4 pts worse	93.4% 1.2 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	100.0%	95.4% 4.6 pts better	95.5% 4.5 pts better	Long Stay · 2024Q3-2025Q2
Percentage of long-stay residents experiencing one or more falls with major injury	4.7%	3.8% 0.9 pts worse	3.3% 1.4 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who have depressive symptoms	7.5%	24.6% 17.1 pts better	11.4% 3.9 pts better	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who lose too much weight	7.5%	5.6% 1.9 pts worse	5.4% 2.1 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antianxiety or hypnotic medication	30.7%	23.5% 7.2 pts worse	19.6% 11.1 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antipsychotic medication	7.0%	14.8% 7.8 pts better	16.7% 9.7 pts better	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who were physically restrained	0.0%	0.0% About the same	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents whose ability to walk independently worsened	23.6%	13.3% 10.3 pts worse	16.3% 7.3 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents whose need for help with daily activities has increased	27.4%	11.7% 15.7 pts worse	14.9% 12.5 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.7%	0.4% 0.3 pts worse	1.0% 0.3 pts better	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with a urinary tract infection	9.8%	1.2% 8.6 pts worse	1.7% 8.1 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	31.4%	24.2% 7.2 pts worse	19.8% 11.6 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with pressure ulcers	10.2%	4.1% 6.1 pts worse	5.1% 5.1 pts worse	Long Stay · 2024Q4-2025Q3
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	73.6%	81.6% 8 pts worse	81.7% 8.1 pts worse	Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who had an outpatient emergency department visit	12.1%	10.5% 1.6 pts worse	12.0% 0.1 pts worse	Short Stay · 20240701-20250630
Percentage of short-stay residents who newly received an antipsychotic medication	1.8%	1.3% 0.5 pts worse	1.6% 0.2 pts worse	Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	60.0%	79.0% 19 pts worse	79.7% 19.7 pts worse	Short Stay · 2024Q3-2025Q2
Percentage of short-stay residents who were rehospitalized after a nursing home admission	34.2%	22.4% 11.8 pts worse	23.9% 10.3 pts worse	Short Stay · 20240701-20250630

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-04-01 · Fire 2025-04-01

12 health deficiencies

Top issue: Resident Assessment and Care Planning (3 deficiencies)

2 fire-safety deficiencies

Top issue: Egress (1 deficiency)

Cycle 2 Health 2024-02-02 · Fire 2024-02-02

3 health deficiencies

Top issue: Infection Control (1 deficiency)

9 fire-safety deficiencies

Top issue: Emergency Preparedness (4 deficiencies)

Cycle 3 Health 2022-05-16 · Fire 2022-05-16

4 health deficiencies

Top issue: Infection Control (1 deficiency)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-04-01

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2025-05-16

B · Minimal harm 2025-04-01

K233 · Egress Deficiencies

Fire Safety

Install resident room doors of proper design and width.

Corrected 2025-05-09

F · Potential for more than minimal harm 2024-02-02

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2024-03-29

F · Potential for more than minimal harm 2024-02-02

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2024-03-29

E · Potential for more than minimal harm 2024-02-02

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-03-29

E · Potential for more than minimal harm 2024-02-02

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2024-03-29

C · Minimal harm 2024-02-02

E13 · Emergency Preparedness Deficiencies

Fire Safety

Develop Emergency Preparedness policies and procedures.

Corrected 2024-03-29

C · Minimal harm 2024-02-02

E29 · Emergency Preparedness Deficiencies

Fire Safety

Develop a communication plan.

Corrected 2024-03-29

C · Minimal harm 2024-02-02

E36 · Emergency Preparedness Deficiencies

Fire Safety

Establish emergency prep training and testing.

Corrected 2024-03-29

C · Minimal harm 2024-02-02

E4 · Emergency Preparedness Deficiencies

Fire Safety

Develop and maintain an Emergency Preparedness Program (EP).

Corrected 2024-03-29

C · Minimal harm 2024-02-02

K233 · Egress Deficiencies

Fire Safety

Install resident room doors of proper design and width.

Corrected 2024-03-29

F · Potential for more than minimal harm 2022-05-16

K374 · Smoke Deficiencies

Fire Safety

Install smoke barrier doors that can resist smoke for at least 20 minutes.

Corrected 2022-07-25

E · Potential for more than minimal harm 2022-05-16

K233 · Egress Deficiencies

Fire Safety

Install resident room doors of proper design and width.

Corrected 2022-07-25

E · Potential for more than minimal harm 2022-05-16

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2022-07-25

Inspection history

Recent health citations

G · Actual harm 2025-04-01

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2025-04-25

F · Potential for more than minimal harm 2025-04-01

F801 · Nutrition and Dietary Deficiencies

Health

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

Corrected 2025-04-25

E · Potential for more than minimal harm 2025-04-01

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F657 · Resident Assessment and Care Planning Deficiencies

Health

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F690 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F712 · Nursing and Physician Services Deficiencies

Health

Ensure that the resident and his/her doctor meet face-to-face at all required visits.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F758 · Pharmacy Service Deficiencies

Health

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F842 · Resident Assessment and Care Planning Deficiencies

Health

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-04-01

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-04-25

D · Potential for more than minimal harm 2024-02-02

F554 · Resident Rights Deficiencies

Health

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2024-03-02

D · Potential for more than minimal harm 2024-02-02

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2024-03-02

D · Potential for more than minimal harm 2024-02-02

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-03-02

E · Potential for more than minimal harm 2022-05-16

F761 · Pharmacy Service Deficiencies

Health

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Corrected 2022-06-15

E · Potential for more than minimal harm 2022-05-16

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2022-06-15

D · Potential for more than minimal harm 2022-05-16

F698 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Corrected 2022-06-15

C · Minimal harm 2022-05-16

F732 · Nursing and Physician Services Deficiencies

Health

Post nurse staffing information every day.

Corrected 2022-06-15

Penalties and ownership

What sits behind the stars

Ownership

Henry County Memorial Hospital

5% Or Greater Direct Ownership Interest · Organization

100% 31 facilities 2024-01-01

Carlisle Higgs, Lorrie