Deficiencies (last 4 years)
Deficiencies (over 4 years)
11.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
76% worse than Oregon average
Oregon average: 6.7 deficiencies/yearDeficiencies per year
36
27
18
9
0
Inspection Report
Routine
Capacity: 122
Deficiencies: 2
Jul 22, 2025
Visit Reason
Facility failed to maintain kitchen in good repair and sanitary manner; puree texture meals not nutritious or visually appropriate; multiple sanitation and maintenance issues observed; staff lacked knowledge on food safety and meal preparation.
Findings
Facility failed to maintain kitchen in good repair and sanitary manner; puree texture meals not nutritious or visually appropriate; multiple sanitation and maintenance issues observed; staff lacked knowledge on food safety and meal preparation.
Deficiencies (2)
| Description |
|---|
| OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule — Multiple sanitation and maintenance issues in kitchen areas |
| OAR 411-057-0140(2) Administration Compliance — Failure to comply with licensing rules for memory care community |
Inspection Report
Complaint Investigation
Capacity: 122
Deficiencies: 1
Mar 28, 2025
Visit Reason
Facility failed to ensure safe medication and treatment systems, proper resident care plans, adequate staffing, and compliance with licensing rules; multiple resident care and safety issues identified.
Findings
Facility failed to ensure safe medication and treatment systems, proper resident care plans, adequate staffing, and compliance with licensing rules; multiple resident care and safety issues identified.
Deficiencies (1)
| Description |
|---|
| OAR 411-054-0030 - Systems: Medications and Treatments and related regulations — Multiple deficiencies in medication administration, treatment documentation, resident care plans, and staffing |
Inspection Report
Capacity: 122
Deficiencies: 33
Mar 4, 2024
Visit Reason
Change of ownership survey revealed multiple deficiencies in facility administration, resident care, medication systems, staffing, and safety; many deficiencies not corrected at revisits.
Findings
Change of ownership survey revealed multiple deficiencies in facility administration, resident care, medication systems, staffing, and safety; many deficiencies not corrected at revisits.
Deficiencies (33)
| Description |
|---|
| OAR 411-054-0030 - Comment and related regulations — Multiple administrative and care deficiencies noted during change of ownership survey |
| OAR 411-054-0150 - Facility Administration: Operation and related regulations — Deficiencies in oversight and quality assurance |
| OAR 411-054-0160 - Reasonable Precautions and related regulations — Failure to protect residents from harm and choking risks |
| OAR 411-054-0200 - Resident Rights and Protection - General and related regulations — Failure to ensure dignity and respect for residents |
| OAR 411-054-0231 - Reporting & Investigating Abuse-Other Action and related regulations — Failure to promptly investigate and report incidents |
| OAR 411-054-0242 - Resident Services: Activities and related regulations — Failure to provide adequate social and recreational activities |
| OAR 411-054-0252 - Resident Move-In and Eval: Res Evaluation and related regulations — Failure to complete comprehensive resident evaluations |
| OAR 411-054-0260 - Service Plan: General and related regulations — Failure to maintain accurate and reflective service plans |
| OAR 411-054-0270 - Change of Condition and Monitoring and related regulations — Failure to monitor and document changes of condition |
| OAR 411-054-0280 - Resident Health Services and related regulations — Failure to complete timely RN assessments for significant changes |
| OAR 411-054-0282 - RN Delegation and Teaching and related regulations — Failure to properly delegate and document nursing tasks |
| OAR 411-054-0290 - Resident Health Services: On- and Off-Site Health Services and related regulations — Failure to coordinate and communicate outside provider services |
| OAR 411-054-0295 - Infection Prevention & Control and related regulations — Failure to have designated infection control specialist and protocols |
| OAR 411-054-0300 - Systems: Medications and Treatments and related regulations — Failure to ensure safe medication and treatment systems |
| OAR 411-054-0303 - Systems: Treatment Orders and related regulations — Failure to follow physician orders for medications and treatments |
| OAR 411-054-0304 - Systems: Medication and Treatment Review and related regulations — Failure to ensure medication reviews by pharmacist or RN |
| OAR 411-054-0310 - Systems: Medication Administration and related regulations — Failure to maintain accurate medication administration records |
| OAR 411-054-0315 - Systems: Treatment Administration and related regulations — Failure to document treatments administered |
| OAR 411-054-0330 - Systems: Psychotropic Medication and related regulations — Failure to provide resident-specific parameters and document non-drug interventions |
| OAR 411-054-0360 - Staffing Requirements and Training: Staffing and related regulations — Failure to provide sufficient qualified staff |
| OAR 411-054-0361 - Acuity-Based Staffing Tool and related regulations — Failure to update and staff according to acuity-based staffing tool |
| OAR 411-054-0372 - Training Within 30 Days: Direct Care Staff and related regulations — Failure to ensure timely training for new staff |
| OAR 411-054-0420 - Fire and Life Safety: Safety and related regulations — Failure to conduct and document fire drills and training |
| OAR 411-054-0422 - Fire and Life Safety: Training For Residents and related regulations — Failure to instruct residents on fire safety |
| OAR 411-054-0455 - Inspections and Investigation: Inspection Interval and related regulations — Failure to implement plan of correction |
| OAR 411-054-0510 - General Building Exterior and related regulations — Failure to maintain exterior grounds and pathways in good repair |
| OAR 411-054-0513 - Doors, Walls, Elevators, Odors and related regulations — Failure to maintain interior materials and surfaces in good repair |
| OAR 411-054-0555 - Call System, Exit Door Alarm, Phones, TV, or Cable and related regulations — Failure to maintain effective call and alarm systems |
| OAR 411-054-0570 - Administration Compliance and related regulations — Failure to comply with licensing rules (repeat citation) |
| OAR 411-054-0575 - Staff Training Requirements and related regulations — Failure to complete required training and competency evaluations |
| OAR 411-054-0580 - Compliance With Rules Health Care and related regulations — Failure to follow health care rules (repeat citation) |
| OAR 411-054-0585 - Nutrition and Hydration and related regulations — Failure to develop individualized nutrition and hydration plans |
| OAR 411-054-0590 - Activities and related regulations — Failure to provide meaningful and individualized activities |
Inspection Report
Complaint Investigation
Capacity: 122
Deficiencies: 4
Dec 13, 2023
Visit Reason
Facility failed to post current staffing plan, failed to have service plans readily available, and failed to provide sufficient qualified awake direct care staff; multiple deficiencies acknowledged by staff.
Findings
Facility failed to post current staffing plan, failed to have service plans readily available, and failed to provide sufficient qualified awake direct care staff; multiple deficiencies acknowledged by staff.
Deficiencies (4)
| Description |
|---|
| OAR 411-054-0152 - Facility Administration: Required Postings — Staffing plan not posted or outdated |
| OAR 411-054-0260 - Service Plan: General — Service plans not readily available to staff |
| OAR 411-054-0360 - Staffing Requirements and Training: Staffing — Insufficient qualified awake direct care staff |
| OAR 411-054-0361 - Acuity-Based Staffing Tool — Failed to adopt and implement acuity-based staffing tool |
Inspection Report
Capacity: 122
Deficiencies: 1
May 9, 2023
Visit Reason
Kitchen inspection revealed repeated sanitation and maintenance deficiencies including food contamination risks, equipment damage, and staff hygiene issues; some corrections made at revisits.
Findings
Kitchen inspection revealed repeated sanitation and maintenance deficiencies including food contamination risks, equipment damage, and staff hygiene issues; some corrections made at revisits.
Deficiencies (1)
| Description |
|---|
| OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule — Repeated sanitation and maintenance deficiencies in kitchen areas |
Inspection Report
Complaint Investigation
Capacity: 122
Deficiencies: 3
Apr 19, 2023
Visit Reason
Facility failed to update service plans quarterly and failed to provide sufficient qualified awake direct care staff; staffing levels below required standards.
Findings
Facility failed to update service plans quarterly and failed to provide sufficient qualified awake direct care staff; staffing levels below required standards.
Deficiencies (3)
| Description |
|---|
| OAR 411-054-0260 - Service Plan: General — Service plans not updated quarterly |
| OAR 411-054-0360 - Staffing Requirements and Training: Staffing — Insufficient qualified awake direct care staff |
| OAR 411-054-0361 - Acuity-Based Staffing Tool — Failed to fully implement and update acuity-based staffing tool |
Inspection Report
Capacity: 122
Deficiencies: 3
Nov 15, 2022
Visit Reason
Kitchen inspection found facility kitchens unclean and not following appropriate storage methods; staff lacked food handler certification; administration compliance issues noted.
Findings
Kitchen inspection found facility kitchens unclean and not following appropriate storage methods; staff lacked food handler certification; administration compliance issues noted.
Deficiencies (3)
| Description |
|---|
| OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule — Kitchen sanitation and storage deficiencies |
| OAR 411-054-0370 - Staffing Requirements and Training: Pre-Service — Staff lacked food handler certification |
| OAR 411-054-0570 - Administration Compliance — Failed to follow licensing rules |
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