Inspection Report
Capacity: 64
Deficiencies: 19
Oct 23, 2025
Visit Reason
State-compiled facility profile showing 5 inspections from 2022-2025 with deficiency history and licensing violations.
Findings
Across multiple inspections from 2022 to 2025, the facility exhibited repeated deficiencies primarily related to kitchen sanitation, administration compliance, resident care planning, and health services. Some deficiencies were corrected over time, but several remained uncorrected at the latest visits.
Deficiencies (19)
| Description |
|---|
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to maintain kitchen in good repair and sanitary manner including food spills, water damage, and equipment issues. |
| Z0142 - Administration Compliance: Failed to follow licensing rules for Residential Care and Assisted Living Facilities. |
| C0000 - Comment: Findings documented related to kitchen inspections and compliance with OARs 411-054-0030 and OARs 333-150-0000. |
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to maintain kitchen in good repair and sanitary manner including food debris, temperature control issues, and pest presence. |
| Z0142 - Administration Compliance: Failed to follow licensing rules for Residential Care and Assisted Living Facilities. |
| C0000 - Comment: Findings documented related to kitchen inspections and compliance with OARs 411-054-0030 and OARs 333-150-0000. |
| C0252 - Resident Move-In and Eval: Res Evaluation: Failed to ensure move-in evaluation addressed all required elements for sampled resident. |
| C0260 - Service Plan: General: Failed to ensure service plans reflected residents' needs and provided clear direction for care. |
| C0262 - Service Plan: Service Planning Team: Failed to ensure service plans were developed by a Service Planning Team including required participants. |
| C0270 - Change of Condition and Monitoring: Failed to document and communicate actions for short-term changes of condition for sampled residents. |
| C0280 - Resident Health Services: Failed to ensure significant changes of condition were assessed by RN in a timely manner for sampled residents. |
| C0290 - Res Hlth Srvc: On- and Off-Site Health Srvc: Failed to coordinate care with outside providers and ensure staff were informed of new interventions. |
| C0301 - Systems: Medication Administration: Failed to ensure medications were administered and documented by the same person for sampled resident. |
| C0361 - Acuity-Based Staffing Tool: Failed to update ABST quarterly and following changes of condition to determine appropriate staffing levels. |
| Z0142 - Administration Compliance: Failed to follow licensing rules for Residential Care and Assisted Living Facilities. |
| Z0162 - Compliance With Rules Health Care: Failed to provide health care services in accordance with licensing rules. |
| Z0163 - Nutrition and Hydration: Failed to ensure individualized nutrition and hydration plans were developed and included in service plans. |
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to maintain kitchen in accordance with Food Sanitation Rules including spills, debris, equipment damage, and improper sanitizing. |
| Z0142 - Administration Compliance: Failed to follow licensing rules for Residential Care and Assisted Living Facilities. |
Report Facts
Inspections on page: 5
Total deficiencies: 17
Total licensing violations: 10
Total notices: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| DANIELLE KOEHN | Administrator | Named in multiple findings and acknowledgments of deficiencies |
| Staff 1 | Administrator | Acknowledged findings in multiple inspections |
| Staff 2 | Wellness Coordinator/LPN or Dining Services Director/Manager | Acknowledged findings and involved in monitoring corrections |
| Staff 13 | Regional RN | Acknowledged findings related to resident care and health services |
| Staff 3 | Resident Care Coordinator | Interviewed regarding resident condition and care |
| Staff 11 | Med Tech MC | Interviewed regarding resident condition and medication administration |
| Staff 8 | Care Partner MC | Interviewed regarding resident condition |
| Staff 17 | Care Partner MC | Interviewed regarding resident condition |
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