Inspection Reports for Gresham Post Acute Care and Rehab

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Deficiencies (last 4 years)

Deficiencies (over 4 years) 19.3 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

188% worse than Oregon average
Oregon average: 6.7 deficiencies/year

Deficiencies per year

28 21 14 7 0
2022
2023
2024
2025
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 4 Nov 24, 2025
Visit Reason
Facility failed to timely administer anti-seizure medication to a resident due to pharmacy delays and staff oversight. Multiple doses were missed causing risk to resident health. Facility implemented staff education and audits to prevent recurrence.
Findings
Facility failed to timely administer anti-seizure medication to a resident due to pharmacy delays and staff oversight. Multiple doses were missed causing risk to resident health. Facility implemented staff education and audits to prevent recurrence.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0684 - Quality of Care
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 2 Sep 10, 2025
Visit Reason
Two deficiencies cited but not corrected related to initial comments and other unspecified issues. Facility failed to correct identified problems during revisit.
Findings
Two deficiencies cited but not corrected related to initial comments and other unspecified issues. Facility failed to correct identified problems during revisit.
Deficiencies (2)
Description
F0000 - INITIAL COMMENTS
M0000 - Initial Comments
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 4 Jun 17, 2025
Visit Reason
Facility failed to ensure residents received necessary treatment to prevent constipation, resulting in emergency hospitalization. Multiple deficiencies related to care planning and nursing services were partially corrected but some remained uncorrected on revisit.
Findings
Facility failed to ensure residents received necessary treatment to prevent constipation, resulting in emergency hospitalization. Multiple deficiencies related to care planning and nursing services were partially corrected but some remained uncorrected on revisit.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0684 - Quality of Care
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 2 May 7, 2025
Visit Reason
Two deficiencies cited related to initial comments but not corrected. Facility failed to address identified issues during revisit.
Findings
Two deficiencies cited related to initial comments but not corrected. Facility failed to address identified issues during revisit.
Deficiencies (2)
Description
F0000 - INITIAL COMMENTS
M0000 - Initial Comments
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 21 Aug 30, 2024
Visit Reason
Multiple deficiencies related to resident rights, transfer notices, assessments, care plans, medication administration, wound care, respiratory care, staffing, and training. Many deficiencies were corrected on revisit but several remained uncorrected.
Findings
Multiple deficiencies related to resident rights, transfer notices, assessments, care plans, medication administration, wound care, respiratory care, staffing, and training. Many deficiencies were corrected on revisit but several remained uncorrected.
Deficiencies (21)
Description
F0000 - INITIAL COMMENTS
F0552 - Right to be Informed/Make Treatment Decisions
F0623 - Notice Requirements Before Transfer/Discharge
F0625 - Notice of Bed Hold Policy Before/Upon Trnsfr
F0641 - Accuracy of Assessments
F0655 - Baseline Care Plan
F0657 - Care Plan Timing and Revision
F0658 - Services Provided Meet Professional Standards
F0686 - Treatment/Svcs to Prevent/Heal Pressure Ulcer
F0695 - Respiratory/Tracheostomy Care and Suctioning
F0758 - Free from Unnec Psychotropic Meds/PRN Use
F0812 - Food Procurement,Store/Prepare/Serve-Sanitary
F0947 - Required In-Service Training for Nurse Aides
M0000 - Initial Comments
M0143 - Employees: Criminal Record Checks
M0182 - Nursing Services:Minimum Licensed Nurse Staff
M0185 - Bariatric Criteria and Services
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
V0000 - Initial Comments
V0160 - Staffing
V0170 - Staff Training
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 2 Apr 24, 2024
Visit Reason
Two deficiencies cited related to initial comments but not corrected. Facility failed to address identified issues during revisit.
Findings
Two deficiencies cited related to initial comments but not corrected. Facility failed to address identified issues during revisit.
Deficiencies (2)
Description
F0000 - INITIAL COMMENTS
M0000 - Initial Comments
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 4 Oct 31, 2023
Visit Reason
Deficiencies related to incontinence care, bowel/bladder care, and nursing services. Some deficiencies corrected but others remained uncorrected on revisit. Facility failed to provide timely incontinence care and follow physician orders.
Findings
Deficiencies related to incontinence care, bowel/bladder care, and nursing services. Some deficiencies corrected but others remained uncorrected on revisit. Facility failed to provide timely incontinence care and follow physician orders.
Deficiencies (4)
Description
F0000 - INITIAL COMMENTS
F0690 - Bowel/Bladder Incontinence, Catheter, UTI
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
Inspection Report Annual Inspection Capacity: 78 Deficiencies: 26 May 23, 2023
Visit Reason
Multiple deficiencies across a wide range of areas including resident rights, quality of care, wound care, staffing, medication management, and specialized services. Some deficiencies were corrected on revisit, others remained uncorrected. Immediate jeopardy situation related to aspiration risk and staffing was abated.
Findings
Multiple deficiencies across a wide range of areas including resident rights, quality of care, wound care, staffing, medication management, and specialized services. Some deficiencies were corrected on revisit, others remained uncorrected. Immediate jeopardy situation related to aspiration risk and staffing was abated.
Deficiencies (26)
Description
F0000 - INITIAL COMMENTS
F0550 - Resident Rights/Exercise of Rights
F0578 - Request/Refuse/Dscntnue Trmnt;Formlte Adv Dir
F0582 - Medicaid/Medicare Coverage/Liability Notice
F0677 - ADL Care Provided for Dependent Residents
F0679 - Activities Meet Interest/Needs Each Resident
F0684 - Quality of Care
F0686 - Treatment/Svcs to Prevent/Heal Pressure Ulcer
F0687 - Foot Care
F0689 - Free of Accident Hazards/Supervision/Devices
F0690 - Bowel/Bladder Incontinence, Catheter, UTI
F0698 - Dialysis
F0725 - Sufficient Nursing Staff
F0730 - Nurse Aide Peform Review-12 hr/yr In-Service
F0757 - Drug Regimen is Free from Unnecessary Drugs
F0761 - Label/Store Drugs and Biologicals
F0825 - Provide/Obtain Specialized Rehab Services
F0842 - Resident Records - Identifiable Information
F0865 - QAPI Prgm/Plan, Disclosure/Good Faith Attmpt
M0000 - Initial Comments
M0182 - Nursing Services:Minimum Licensed Nurse Staff
M0183 - Nursing Services: Minimum CNA Staffing
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
V0000 - Initial Comments
V0160 - Staffing
V0170 - Staff Training
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 9 Feb 13, 2023
Visit Reason
Deficiencies related to grievances, quality of care, staffing, and resident rights. Some deficiencies corrected on revisit but many remained uncorrected. Facility failed to timely respond to call lights and address resident grievances.
Findings
Deficiencies related to grievances, quality of care, staffing, and resident rights. Some deficiencies corrected on revisit but many remained uncorrected. Facility failed to timely respond to call lights and address resident grievances.
Deficiencies (9)
Description
F0000 - INITIAL COMMENTS
F0585 - Grievances
F0684 - Quality of Care
F0725 - Sufficient Nursing Staff
F0732 - Posted Nurse Staffing Information
M0000 - Initial Comments
M9999 - STATE OF OREGON ADMINISTRATIVE RULES
V0000 - Initial Comments
V0160 - Staffing
Inspection Report Complaint Investigation Capacity: 78 Deficiencies: 3 Oct 26, 2022
Visit Reason
Three deficiencies cited related to initial comments and infection control but not corrected. Facility failed to address identified issues during revisit.
Findings
Three deficiencies cited related to initial comments and infection control but not corrected. Facility failed to address identified issues during revisit.
Deficiencies (3)
Description
E0000 - Initial Comments
F0000 - INITIAL COMMENTS
M0000 - Initial Comments

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