Aging and People with Disabilities
Safety, Oversight and Quality
Print Inspection: BOPE
Provider Information
3334 22ND AVE
Forest Grove, OR 97116
- Provider ID
- 5MA242
- Administrator
- Amanda Hatcher
- Phone
- (503) 359-1002
- mced@pacificgroveslc.com
Inspection Details
- Date
- 7/25/2023
- Event ID
- BOPE
- Inspection type(s)
- Complaint Investig.
- Deficiencies cited
- 8
Citation Details
C0010: Licensing Complaint Investigation
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
The findings of the on-site investigation, conducted 07/25/23 are documented in this report. The investigation was conducted to determine compliance with the OARs 411 Division 54 and 57 for Residential Care and Assisted Living Facilities.
Abbreviations possibly used in this document:
ADL:activities of daily living
bid:twice a day
CBG:capillary blood glucose or
blood sugar
cc:cubic centimeter
CG:caregiver
cm:centimeter
F:Fahrenheit
HH:Home Health
HS or hs:hour of sleep
LPN:Licensed Practical Nurse
MA:Medication Aide
MAR:Medication Administration
Record
MCCMemory Care Community
mg:milligram
ml:milliliter
O2 sats:oxygen saturation in the
blood
OT:Occupational Therapist
PT: Physical Therapist
PRN:as needed
qd:every day or daily
qid:four times a day
RN:Registered Nurse
SP:service plan
TAR:Treatment Administration
Record
tid:three times a day
C0210: Resident Rights and Protection: Personal Rela
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
C0231: Reporting & Investigating Abuse-Other Action
- Scope
- L2 Widespread
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
- Plan of Correction
-
C0241: Resident Services: Laundry
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
C0260: Service Plan: General
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
C0303: Systems: Treatment Orders
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
C0330: Systems: Psychotropic Medication
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-
C0360: Staffing Requirements and Training: Staffing
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 7/26/2023
- Corrected Date
- N/A
- Details
-