Inspection Reports for Avamere Rehabilitation of Clackamas

220 E. Hereford, OR, 97027

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Deficiencies (last 5 years)

Deficiencies (over 5 years) 8.6 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

28% worse than Oregon average
Oregon average: 6.7 deficiencies/year

Deficiencies per year

12 9 6 3 0
2021
2022
2023
2024
2025
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 8 Dec 4, 2025
Deficiencies (8)
Description
F0000 - INITIAL COMMENTS
F0584 - Safe/Clean/Comfortable/Homelike Environment
F0656 - Develop/Implement Comprehensive Care Plan
F0677 - ADL Care Provided for Dependent Residents
F0880 - Infection Prevention & Control
M0000 - Initial Comments
M0183 - Nursing Services: Minimum CNA Staffing
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 4 Sep 24, 2024
Visit Reason
Facility failed to follow care plan interventions related to elopement for 1 sampled resident, resulting in an Immediate Jeopardy situation. The facility submitted an acceptable IJ removal plan and implemented corrective actions including care plan revisions and staff education.
Findings
Facility failed to follow care plan interventions related to elopement for 1 sampled resident, resulting in an Immediate Jeopardy situation. The facility submitted an acceptable IJ removal plan and implemented corrective actions including care plan revisions and staff education.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0689 - Free of Accident Hazards/Supervision/Devices
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 10 Jul 19, 2024
Visit Reason
Facility failed to provide a comfortable and homelike environment, ensure professional standards for glucometer disinfection, implement dementia care interventions, infection prevention, maintain minimum CNA staffing, conduct criminal record checks, and maintain nurse call system. Immediate Jeopardy was identified related to infection control. Multiple corrective actions and plans of correction were implemented.
Findings
Facility failed to provide a comfortable and homelike environment, ensure professional standards for glucometer disinfection, implement dementia care interventions, infection prevention, maintain minimum CNA staffing, conduct criminal record checks, and maintain nurse call system. Immediate Jeopardy was identified related to infection control. Multiple corrective actions and plans of correction were implemented.
Deficiencies (10)
Description
F0000 - INITIAL COMMENTS
F0584 - Safe/Clean/Comfortable/Homelike Environment
F0658 - Services Provided Meet Professional Standards
F0744 - Treatment/Service for Dementia
F0880 - Infection Prevention & Control
M0000 - Initial Comments
M0143 - Employees: Criminal Record Checks
M0183 - Nursing Services: Minimum CNA Staffing
M0481 - Electrical System: Nurse Call System
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 4 Jun 20, 2024
Visit Reason
Facility failed to re-evaluate elopement risks and revise care plans to prevent repeated elopements for 1 sampled resident. Additional deficiencies included failure to meet nursing services problem resolution and preventive care requirements. Immediate Jeopardy was identified and removed after corrective actions.
Findings
Facility failed to re-evaluate elopement risks and revise care plans to prevent repeated elopements for 1 sampled resident. Additional deficiencies included failure to meet nursing services problem resolution and preventive care requirements. Immediate Jeopardy was identified and removed after corrective actions.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0689 - Free of Accident Hazards/Supervision/Devices
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 2 Feb 6, 2024
Deficiencies (2)
Description
F0000 - INITIAL COMMENTS
M0000 - Initial Comments
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 9 May 5, 2023
Visit Reason
Facility failed to maintain safe, clean, comfortable environment including resident rooms, bathrooms, and linen supplies. Deficiencies also included respiratory care, drug regimen review, nutrition, garbage disposal, and nursing services problem resolution. Multiple corrective actions and plans of correction were implemented.
Findings
Facility failed to maintain safe, clean, comfortable environment including resident rooms, bathrooms, and linen supplies. Deficiencies also included respiratory care, drug regimen review, nutrition, garbage disposal, and nursing services problem resolution. Multiple corrective actions and plans of correction were implemented.
Deficiencies (9)
Description
F0000 - INITIAL COMMENTS
F0584 - Safe/Clean/Comfortable/Homelike Environment
F0695 - Respiratory/Tracheostomy Care and Suctioning
F0756 - Drug Regimen Review, Report Irregular, Act On
F0757 - Drug Regimen is Free from Unnecessary Drugs
F0804 - Nutritive Value/Appear, Palatable/Prefer Temp
F0814 - Dispose Garbage and Refuse Properly
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 87 Deficiencies: 4 Dec 2, 2022
Visit Reason
Facility failed to follow the plan of care for a resident resulting in a fall with fracture. Deficiencies related to nursing services problem resolution and preventive care were identified. Corrective actions and staff education were implemented.
Findings
Facility failed to follow the plan of care for a resident resulting in a fall with fracture. Deficiencies related to nursing services problem resolution and preventive care were identified. Corrective actions and staff education were implemented.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0689 - Free of Accident Hazards/Supervision/Devices
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Capacity: 87 Deficiencies: 1 Sep 17, 2021
Deficiencies (1)
Description
M0000 - Initial Comments
Inspection Report Capacity: 87 Deficiencies: 1 Mar 29, 2021
Visit Reason
Facility failed to report complete COVID-19 information to CDC's NHSN during a required seven-day period, potentially causing more than minimal harm to all residents.
Findings
Facility failed to report complete COVID-19 information to CDC's NHSN during a required seven-day period, potentially causing more than minimal harm to all residents.
Deficiencies (1)
Description
F0884 - Reporting - National Health Safety Network

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