Inspection Report
Re-Inspection
Capacity: 16
Deficiencies: 22
Jan 6, 2025
Visit Reason
State-compiled facility profile showing 4 inspections from 2022-2025 with deficiency history and enforcement violations.
Findings
Across all inspections, the facility exhibited multiple deficiencies including failures in staff training and orientation, food sanitation and kitchen maintenance, resident care documentation, abuse investigation, medication administration, and life safety training. Some deficiencies were corrected in follow-up visits while others remained uncorrected as of the latest inspections.
Deficiencies (22)
| Description |
|---|
| C0370 - Staffing Requirements and Training – Pre-service: Failed to ensure newly hired staff completed all required pre-service orientation and dementia training within required timeframes. |
| C0374 - Annual and Biennial Inservice for All Staff: Failed to ensure sampled long-term direct care staff completed minimum required annual in-service training including dementia and infectious disease training. |
| C0000 - Comment: Kitchen inspection findings documented; facility was in substantial compliance on revisit. |
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to maintain kitchen in good repair and sanitary manner; multiple food safety and sanitation issues observed. |
| C0000 - Comment: Findings of re-licensure survey and revisit documented. |
| C0152 - Facility Administration: Required Postings: Failed to ensure all required postings were displayed conspicuously for residents and visitors. |
| C0160 - Reasonable Precautions: Failed to ensure reasonable precautions against conditions threatening resident health, safety, or welfare. |
| C0231 - Reporting & Investigating Abuse-Other Action: Failed to thoroughly investigate incidents of abuse or suspected abuse for sampled residents. |
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to ensure kitchen was clean and in good repair; food preparation procedures not in accordance with rules. |
| C0252 - Resident Move-In and Eval: Res Evaluation: Failed to ensure new move-in evaluations addressed all required elements for sampled residents. |
| C0280 - Resident Health Services: Failed to ensure timely RN significant change of condition assessment for sampled resident. |
| C0305 - Systems: Resident Right to Refuse: Failed to notify physician or practitioner when resident refused medication or treatment order. |
| C0310 - Systems: Medication Administration: Failed to ensure MARs were accurate and included medication-specific parameters for PRN medications for sampled residents. |
| C0330 - Systems: Psychotropic Medication: Failed to ensure PRN psychotropic medications had written resident-specific parameters and documentation of non-pharmaceutical interventions. |
| C0340 - Restraints and Supportive Devices: Failed to ensure supportive devices were assessed, caregivers instructed, and use included in service plan for sampled resident. |
| C0370 - Staffing Requirements and Training – Pre-Serv: Failed to ensure newly hired staff completed pre-service orientation and dementia training in required timeframe. |
| C0374 - Annual and Biennial Inservice For All Staff: Failed to ensure sampled long-term staff completed minimum dementia care in-service training annually. |
| C0420 - Fire and Life Safety: Safety: Failed to provide life safety instruction to staff on alternate months as required by Oregon Fire Code. |
| C0422 - Fire and Life Safety: Training For Residents: Failed to ensure residents were instructed on fire and life safety procedures within 24 hours of admission and annually. |
| C0510 - General Building Exterior: Failed to maintain exterior environment in good repair; tripping hazards observed. |
| C0513 - Doors, Walls, Elevators, Odors: Failed to maintain interior of building clean and in good repair; multiple hazards and stains observed. |
| C0530 - Housekeeping and Laundry: Failed to ensure washing machines had minimum rinse temperature of 140°F or used chemical disinfectant. |
Report Facts
Inspections on page: 4
Total deficiencies: 20
Total surveys: 4
Licensing violations: 15
Abuse violations: 0
Notices: 0
Licensed beds: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff 1 | Administrator | Named in multiple findings including staffing, abuse investigation, kitchen sanitation, and resident care deficiencies |
| Staff 2 | Co-Administrator / Assistant Administrator | Named in multiple findings including staffing, kitchen sanitation, abuse investigation, and resident care deficiencies |
| Staff 3 | RCC / Manager / Cook / Person in charge | Named in findings related to staffing, kitchen sanitation, and resident care |
| Staff 4 | RN | Named in findings related to abuse investigation and resident care |
| Staff 5 | CG / Chef | Named in staffing and kitchen sanitation findings |
| Staff 6 | CG | Named in staffing and training deficiencies |
| Staff 7 | MT | Named in staffing and laundry room findings |
| Staff 8 | Cook / CG | Named in staffing and training deficiencies |
| Staff 9 | Activity Director / Chef / CG | Named in staffing and training deficiencies |
| Staff 10 | CG | Named in training deficiencies |
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