Evansville Manor Nursing And Rehab, Llc
EVANSVILLE MANOR NURSING AND REHAB, LLC in EVANSVILLE, WI — inspection on May 15, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
F-F804: Each resident receives, and the facility provides food that is palatable and at the proper temperature .
Procedure: .
2. TCF (Time/Temperature Control for Safety Food) foods such as meat, poultry, fish and eggs should be cooked to the minimum internal temperature specified below:
Pork, Beef, or Veal
(Steaks or Chops)- 145* F for 15 seconds
(Roasts)- 145* F for 4 minutes
Poultry- 165* F for 15 seconds
Fish- 145* F for 15 seconds
Ground meats (except poultry)- 160* F for 15 seconds
Ground chicken or turkey- 165* F for 15 seconds
Casseroles- 165* F for 15 seconds
Egg dishes- 160* F for 15 seconds
3.
Foods not listed above must be cooked to a minimum of 135* F and transferred to holding equipment.
4.
Hot foods must be held at a minimum of 135* F .
525418
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 525418 B.
Wing 05/15/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Evansville Manor Nursing and Rehab, LLC 470 Garfield Ave Evansville, WI 53536
Procedure: .
- TCF (Time/Temperature Control for Safety Food) foods such as meat, poultry, fish and eggs should be
- Foods not listed above must be cooked to a minimum of 135* F and transferred to holding equipment.
- Hot foods must be held at a minimum of 135* F .
cooked to the minimum internal temperature specified below: Pork, Beef, or Veal (Steaks or Chops)- 145* F for 15 seconds (Roasts)- 145* F for 4 minutes Poultry- 165* F for 15 seconds Ground meats (except poultry)- 160* F for 15 seconds Ground chicken or turkey- 165* F for 15 seconds Casseroles- 165* F for 15 seconds Egg dishes- 160* F for 15 seconds
08/27/2025
N o. 0938-0391
IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
05/15/2025 Evansville Manor Nursing and Rehab, LLC 470 Garfield Ave Evansville, WI 53536
potential for actual harm
Example 1: R16's Minimum Data Set (MDS) dated [DATE] indicates R16 has a Brief Interview of Mental Status (BIMS) of 15 out of 15, indicating R16 is cognitively intact.
On 5/13/25 at 4:10 PM, Surveyor interviewed R16. R16 reported her only concern was about cold food. R16 stated that the food would be good if it wasn't always cold.
Surveyor asked R16 how often she gets cold food. R16 replied it is pretty much always cold.
Example 2: On 5/13/25 at 8:15 AM, Surveyor received a test tray and recorded the following temperatures: Scrambled eggs- 88.3* F Bacon- 77.5 * F Toast with butter not melted- 74.8* F Oatmeal- 124* F Milk- 34.5 * F Surveyor found the scrambled eggs were cold and tasteless, the bacon was cold and chewy, the toast was cold, and the butter was not melted, and the oatmeal was lukewarm.
On 5/13/25 at 8:19 AM, Surveyor interviewed RN C (Registered Nurse) and asked if it is the expectation the residents are served hot, palatable food and RN C indicated yes. RN C looked at the toast on the test tray with unmelted butter and indicated that does not look good.
On 5/13/25 at 12:23 PM, Surveyor interviewed DM D (Dietary Manager) and asked what his expectation is for food temperatures for hot food being served. DM D indicated meats should be 165* F, vegetables- 149* are not at the temperature they should be. DM D indicated there are no warmers in the carts and the food is served on heated plates with insulated bottoms and tops. DM D indicated he is aware of the issue with cold food. DM D indicated the facility got new carts in December that are insulated. DM D indicated he feels the problem is the nursing staff need to pass the trays out faster. DM D indicated it is expected residents receive hot food and has offered to the residents who have voiced concerns with cold food that they can eat in dining room so the meals reach them faster or they can send the trays back to the kitchen for a new tray.
08/27/2025