SNF

EVERGREEN COMMUNITY OF JOHNSON COUNTY

CCN: 175355 · OLATHE, KS 66061 · Johnson County

ℹ CCRC

Overview

Address
11875 S SUNSET DRIVE, SUITE 100, OLATHE, KS 66061
Phone
9134778227
Certified beds
86
Avg daily residents
77 (89% of beds filled)
Ownership
Non-profit corporation
Provider type
Medicare and Medicaid
Medicare/Medicaid since
1996-01-01
Setting
Urban
3 /5
★★★★★
CMS Overall Rating

CMS 5-Star Ratings

CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.

Overall Rating
Composite of Health Inspection, Staffing, and Quality Measures.
★★★★★ 3/5
Health Inspection
Based on the three most recent standard surveys, with more weight on recent results.
★★★★★ 3/5
Staffing
Weighted combination of RN and total nurse staffing hours per resident per day, case-mix adjusted.
★★★★★ 4/5
Quality Measures
15 resident-level quality measures split between long-stay and short-stay (post-acute) residents.
★★★★★ 2/5
Quality Measures breakdown
Long-Stay Quality Measures ★★★★★ 2/5
Short-Stay Quality Measures — Data not available.

Staffing & Workforce

Direct-care staffing is the strongest operational driver of quality in nursing homes. Values are hours per resident per day, derived from payroll-based journal (PBJ) submissions. "Case-mix" adjusts for resident acuity; "Adjusted" is the CMS rating-input value.

Role Reported Case-mix expected Adjusted Federal floor
Total nurse
All nursing staff combined: RN + LPN + Aide
 4.96 3.57 5.36 ≥ 3.48
Registered Nurse (RN)
Licensed RN hours. Strongest driver of clinical outcomes.
 0.79 0.63 0.85 ≥ 0.55
Licensed Practical Nurse (LPN)
LPN/LVN hours. Often handles medication administration.
 0.78 0.79 0.84 —
Nurse aide
CNA hours. Bulk of direct resident care — bathing, feeding, mobility.
 3.40 2.16 3.67 —
Licensed (RN + LPN)
Combined licensed nurse coverage.
 1.56 — — —
Physical therapist
Rehabilitation therapist hours — important for post-acute / rehab admissions.
 0.03 — — —

Federal minimums (phasing in under the CMS 2024 minimum staffing rule) shown for reference. RN: 0.55 hrs/resident/day. Total nurse: 3.48 hrs/resident/day.

Weekend staffing

Total nurse (weekend)
4.23
hrs / resident / day
RN (weekend)
0.58
hrs / resident / day
Total nurse (adjusted, weekend)
4.57
hrs / resident / day

Weekend under-staffing is a common quality-of-care concern — adverse events are more frequent when licensed coverage drops.

Staff turnover

Total nursing staff turnover
50.0%
annual
RN turnover
55.0%
annual
Administrators departed
0
last 12 months

Resident acuity

Nursing Case-Mix Index
1.27
higher acuity than avg
Case-Mix Index Ratio
0.92
facility / state ratio

Health Inspections

CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.

Cycle Date Total defs. Standard Complaint Deficiency score Revisits Total score
Cycle 1 (most recent) 2024-05-01 7 7 7 56 1 56
Cycle 2/3 (prior) 2022-09-19 15 14 1 80 1 80
Total weighted health score
62.0
lower is better

Deficiencies (29)

Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).

27 D/E/F Actual harm — potential for minor
2 G/H/I Actual harm
Tag Description Scope/Severity Survey date Corrected
0558 Reasonably accommodate the needs and preferences of each resident. D 2024-05-01 2024-05-31
0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. D 2024-05-01 2024-05-31
0679 Provide activities to meet all resident's needs. D 2024-05-01 2024-05-31
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. G 2024-05-01 2024-05-31
0758 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. D 2024-05-01 2024-05-31
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2024-05-01 2024-05-31
0849 Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. D 2024-05-01 2024-05-31
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. G 2023-10-03 2023-09-29
0550 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. D 2022-09-19 2022-10-31
0558 Reasonably accommodate the needs and preferences of each resident. D 2022-09-19 2022-10-31
0661 Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. D 2022-09-19 2022-10-31
0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. D 2022-09-19 2022-10-31
0688 Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. D 2022-09-19 2022-10-31
0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. D 2022-09-19 2022-10-31
0690 Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. D 2022-09-19 2022-10-31
0692 Provide enough food/fluids to maintain a resident's health. D 2022-09-19 2022-10-31
0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. D 2022-09-19 2022-10-31
0756 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. D 2022-09-19 2022-10-31
0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. D 2022-09-19 2022-10-31
0758 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. D 2022-09-19 2022-10-31
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. E 2022-09-19 2022-10-31
0880 Provide and implement an infection prevention and control program. D 2022-09-19 2022-10-31
0641 Ensure each resident receives an accurate assessment. D 2021-04-29 2021-05-21
0688 Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. D 2021-04-29 2021-05-21
0695 Provide safe and appropriate respiratory care for a resident when needed. D 2021-04-29 2021-05-21
0756 Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. E 2021-04-29 2021-05-21
0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. E 2021-04-29 2021-05-21
0758 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. D 2021-04-29 2021-05-21
0880 Provide and implement an infection prevention and control program. E 2021-04-29 2021-05-21

Penalties (3)

Fines issued
2
last 3 years
Total fines
$22,913
Payment denials
1
Date Type Fine amount
2023-10-03 Fine $10,059
2024-05-01 Fine $12,854
2024-05-01 Payment Denial —

Source: CMS Nursing Home Penalties.

Financial Health (FY 2023)

Payer mix (share of resident days)

Medicare 0.8% Medicaid 74.7% Other 24.4%

Operating performance

Operating Margin
-20.0%
Total Margin
48.1%
Occupancy Rate
68.5%

Revenue & costs

Net Patient Revenue
$9.6M
Total Costs
$310K
Net Income
$10.6M

Balance sheet

Total Assets
$13.3M
Total Liabilities
$664K
Fund Balance
$12.7M
Current Ratio
19.83

Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.

Ownership & Corporate Structure

Owner / manager organizations (1)

Organization Role Association
EVERGREEN LIVING INNOVATIONS INC 5% OR GREATER DIRECT OWNERSHIP INTEREST since 01/01/2003

Owner / manager individuals (22)

Name Role Association
DAUGHERTY, DIANNE OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
DWYER, MARK OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
GALLAGHER, LINDA OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
GASH, MARK OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
GASH, MARY OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
HOLLAND, CHRIS OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
PARISE, BRETT OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
ROBERTS, CHARLA OPERATIONAL/MANAGERIAL CONTROL since 10/09/2023
SWEARINGEN-LYLES, DEBRA OPERATIONAL/MANAGERIAL CONTROL since 01/06/2025
DAUGHERTY, DIANNE CORPORATE DIRECTOR since 10/01/2018
DWYER, MARK CORPORATE DIRECTOR since 01/01/2024
GALLAGHER, LINDA CORPORATE DIRECTOR since 08/20/2020
GASH, MARK CORPORATE DIRECTOR since 04/01/2018
GASH, MARY CORPORATE DIRECTOR since 10/18/2018
PARISE, BRETT CORPORATE DIRECTOR since 01/01/2022
SWEARINGEN-LYLES, DEBRA CORPORATE DIRECTOR since 04/23/2024
AMOS, PATRICK CORPORATE OFFICER since 01/01/2022
DUPRIEST, JESSICA CORPORATE OFFICER since 01/01/2024
HOLLAND, CHRIS CORPORATE OFFICER since 08/19/2019
OSBORN, CHRISTOPHER CORPORATE OFFICER since 05/01/2011
PLOWMAN, ANDREA CORPORATE OFFICER since 01/01/2024
ROBERTS, CHARLA CORPORATE OFFICER since 10/09/2023

Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.

Facility Features

CCRC
Yes
Hospital-based
No
Resident / family council
Resident
Sprinkler systems
Yes
Abuse citation flag
No
Methodology & sources

Full methodology →

All Data

Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.

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Show 112 rows
Source Metric Value Raw key
Cost Report Current Ratio 19.83 metrics.current_ratio
Cost Report fiscal_year 2,023 fiscal_year
Cost Report Medicaid Day Share (%) 74.7% metrics.medicaid_day_share
Cost Report Medicare Day Share (%) 0.8% metrics.medicare_day_share
Cost Report Net Income ($) $10,627,983 metrics.net_income
Cost Report Net Patient Revenue ($) $9,563,628 metrics.net_patient_revenue
Cost Report Occupancy Rate (%) 68.5% metrics.occupancy_rate
Cost Report Operating Margin (%) -20.0% metrics.operating_margin
Cost Report Total Assets ($) $13,333,554 metrics.total_assets
Cost Report Total Costs ($) $310,411 metrics.total_costs
Cost Report Total Fund Balances ($) $12,669,768 metrics.fund_balance
Cost Report Total Liabilities ($) $663,786 metrics.total_liabilities
Cost Report Total Margin (%) 48.1% metrics.total_margin
Provider Information Abuse Icon N Abuse Icon
Provider Information Adjusted LPN Staffing Hours per Resident per Day 0.84008 Adjusted LPN Staffing Hours per Resident per Day
Provider Information Adjusted Nurse Aide Staffing Hours per Resident per Day 3.67244 Adjusted Nurse Aide Staffing Hours per Resident per Day
Provider Information Adjusted RN Staffing Hours per Resident per Day 0.84785 Adjusted RN Staffing Hours per Resident per Day
Provider Information Adjusted Total Nurse Staffing Hours per Resident per Day 5.36037 Adjusted Total Nurse Staffing Hours per Resident per Day
Provider Information Adjusted Weekend Total Nurse Staffing Hours per Resident per Day 4.57096 Adjusted Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Administrator turnover footnote — Administrator turnover footnote
Provider Information Automatic Sprinkler Systems in All Required Areas Yes Automatic Sprinkler Systems in All Required Areas
Provider Information Average Number of Residents per Day 76.5 Average Number of Residents per Day
Provider Information Average Number of Residents per Day Footnote — Average Number of Residents per Day Footnote
Provider Information Case-Mix LPN Staffing Hours per Resident per Day 0.79337 Case-Mix LPN Staffing Hours per Resident per Day
Provider Information Case-Mix Nurse Aide Staffing Hours per Resident per Day 2.15620 Case-Mix Nurse Aide Staffing Hours per Resident per Day
Provider Information Case-Mix RN Staffing Hours per Resident per Day 0.62535 Case-Mix RN Staffing Hours per Resident per Day
Provider Information Case-Mix Total Nurse Staffing Hours per Resident per Day 3.57491 Case-Mix Total Nurse Staffing Hours per Resident per Day
Provider Information Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day 3.15091 Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Chain Average Health Inspection Rating — Chain Average Health Inspection Rating
Provider Information Chain Average Overall 5-star Rating — Chain Average Overall 5-star Rating
Provider Information Chain Average QM Rating — Chain Average QM Rating
Provider Information Chain Average Staffing Rating — Chain Average Staffing Rating
Provider Information Chain ID — Chain ID
Provider Information Chain Name — Chain Name
Provider Information City/Town OLATHE City/Town
Provider Information CMS Certification Number (CCN) 175355 CMS Certification Number (CCN)
Provider Information Continuing Care Retirement Community Y Continuing Care Retirement Community
Provider Information County/Parish Johnson County/Parish
Provider Information Date First Approved to Provide Medicare and Medicaid Services 1996-01-01 Date First Approved to Provide Medicare and Medicaid Services
Provider Information Geocoding Footnote 22 Geocoding Footnote
Provider Information Health Inspection Rating 3 Health Inspection Rating
Provider Information Health Inspection Rating Footnote — Health Inspection Rating Footnote
Provider Information Latitude 38.8841 Latitude
Provider Information Legal Business Name EVERGREEN LIVING INNOVATIONS INC Legal Business Name
Provider Information Location 11875 S SUNSET DRIVE, SUITE 100,OLATHE,KS,66061 Location
Provider Information Long-Stay QM Rating 2 Long-Stay QM Rating
Provider Information Long-Stay QM Rating Footnote — Long-Stay QM Rating Footnote
Provider Information Longitude -94.871 Longitude
Provider Information Most Recent Health Inspection More Than 2 Years Ago N Most Recent Health Inspection More Than 2 Years Ago
Provider Information Number of administrators who have left the nursing home 0 Number of administrators who have left the nursing home
Provider Information Number of Certified Beds 86 Number of Certified Beds
Provider Information Number of Citations from Infection Control Inspections — Number of Citations from Infection Control Inspections
Provider Information Number of Facilities in Chain — Number of Facilities in Chain
Provider Information Number of Fines 2 Number of Fines
Provider Information Number of Payment Denials 1 Number of Payment Denials
Provider Information Nursing Case-Mix Index 1.26643 Nursing Case-Mix Index
Provider Information Nursing Case-Mix Index Ratio 0.91927 Nursing Case-Mix Index Ratio
Provider Information Overall Rating 3 Overall Rating
Provider Information Overall Rating Footnote — Overall Rating Footnote
Provider Information Ownership Type Non profit - Corporation Ownership Type
Provider Information Physical Therapist Staffing Footnote — Physical Therapist Staffing Footnote
Provider Information Processing Date 2026-03-01 Processing Date
Provider Information Provider Address 11875 S SUNSET DRIVE, SUITE 100 Provider Address
Provider Information Provider Changed Ownership in Last 12 Months N Provider Changed Ownership in Last 12 Months
Provider Information Provider Name EVERGREEN COMMUNITY OF JOHNSON COUNTY Provider Name
Provider Information Provider Resides in Hospital N Provider Resides in Hospital
Provider Information Provider SSA County Code 450 Provider SSA County Code
Provider Information Provider Type Medicare and Medicaid Provider Type
Provider Information QM Rating 2 QM Rating
Provider Information QM Rating Footnote — QM Rating Footnote
Provider Information Rating Cycle 1 Health Deficiency Score 56 Rating Cycle 1 Health Deficiency Score
Provider Information Rating Cycle 1 Health Revisit Score 0 Rating Cycle 1 Health Revisit Score
Provider Information Rating Cycle 1 Number of Complaint Health Deficiencies 7 Rating Cycle 1 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 1 Number of Health Revisits 1 Rating Cycle 1 Number of Health Revisits
Provider Information Rating Cycle 1 Number of Standard Health Deficiencies 7 Rating Cycle 1 Number of Standard Health Deficiencies
Provider Information Rating Cycle 1 Standard Survey Health Date 2024-05-01 Rating Cycle 1 Standard Survey Health Date
Provider Information Rating Cycle 1 Total Health Score 56 Rating Cycle 1 Total Health Score
Provider Information Rating Cycle 1 Total Number of Health Deficiencies 7 Rating Cycle 1 Total Number of Health Deficiencies
Provider Information Rating Cycle 2 Number of Standard Health Deficiencies 14 Rating Cycle 2 Number of Standard Health Deficiencies
Provider Information Rating Cycle 2 Standard Health Survey Date 2022-09-19 Rating Cycle 2 Standard Health Survey Date
Provider Information Rating Cycle 2/3 Health Deficiency Score 80 Rating Cycle 2/3 Health Deficiency Score
Provider Information Rating Cycle 2/3 Health Revisit Score 0 Rating Cycle 2/3 Health Revisit Score
Provider Information Rating Cycle 2/3 Number of Complaint Health Deficiencies 1 Rating Cycle 2/3 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 2/3 Number of Health Revisits 1 Rating Cycle 2/3 Number of Health Revisits
Provider Information Rating Cycle 2/3 Total Health Score 80 Rating Cycle 2/3 Total Health Score
Provider Information Rating Cycle 2/3 Total Number of Health Deficiencies 15 Rating Cycle 2/3 Total Number of Health Deficiencies
Provider Information Registered Nurse hours per resident per day on the weekend 0.58050 Registered Nurse hours per resident per day on the weekend
Provider Information Registered Nurse turnover 55.0 Registered Nurse turnover
Provider Information Registered Nurse turnover footnote — Registered Nurse turnover footnote
Provider Information Reported Licensed Staffing Hours per Resident per Day 1.56289 Reported Licensed Staffing Hours per Resident per Day
Provider Information Reported LPN Staffing Hours per Resident per Day 0.77785 Reported LPN Staffing Hours per Resident per Day
Provider Information Reported Nurse Aide Staffing Hours per Resident per Day 3.40038 Reported Nurse Aide Staffing Hours per Resident per Day
Provider Information Reported Physical Therapist Staffing Hours per Resident Per Day 0.02793 Reported Physical Therapist Staffing Hours per Resident Per Day
Provider Information Reported RN Staffing Hours per Resident per Day 0.78504 Reported RN Staffing Hours per Resident per Day
Provider Information Reported Staffing Footnote — Reported Staffing Footnote
Provider Information Reported Total Nurse Staffing Hours per Resident per Day 4.96327 Reported Total Nurse Staffing Hours per Resident per Day
Provider Information Short-Stay QM Rating — Short-Stay QM Rating
Provider Information Short-Stay QM Rating Footnote 2 Short-Stay QM Rating Footnote
Provider Information Special Focus Status — Special Focus Status
Provider Information Staffing Rating 4 Staffing Rating
Provider Information Staffing Rating Footnote — Staffing Rating Footnote
Provider Information State KS State
Provider Information Telephone Number 9134778227 Telephone Number
Provider Information Total Amount of Fines in Dollars 22913.00 Total Amount of Fines in Dollars
Provider Information Total number of nurse staff hours per resident per day on the weekend 4.23234 Total number of nurse staff hours per resident per day on the weekend
Provider Information Total Number of Penalties 3 Total Number of Penalties
Provider Information Total nursing staff turnover 50.0 Total nursing staff turnover
Provider Information Total nursing staff turnover footnote — Total nursing staff turnover footnote
Provider Information Total Weighted Health Survey Score 62.000 Total Weighted Health Survey Score
Provider Information Urban Y Urban
Provider Information With a Resident and Family Council Resident With a Resident and Family Council
Provider Information ZIP Code 66061 ZIP Code