Provider Details

Aging and People with Disabilities

Safety, Oversight and Quality

Oregon Department of Human Services Logo

Print Inspection: HJHV

Provider Information


Deerfield Village Assisted Living

5770 SE KELLOGG CREEK DR
Milwaukie, OR 97222

Provider ID
70M020
Administrator
Elisabeth Waisath
Phone
(503) 653-4064
Email
lisawa@cascadeliving.com

Inspection Details


Date
4/20/2023
Event ID
HJHV
Inspection type(s)
Complaint Investig.
Deficiencies cited
2

Citation Details


C0010: Licensing Complaint Investigation


Scope
L2 Isolated
Visit Number
1
Visit Date
4/20/2023
Corrected Date
N/A
Details

Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes.  This report reflects the findings of the complaint investigation conducted 04/20/2023.  The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57.  The following deficiencies were identified:



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

C0361: Acuity-Based Staffing Tool


Scope
L2 Widespread
Visit Number
1
Visit Date
4/20/2023
Corrected Date
N/A
Details

Based on record review and interview, it was confirmed that the facility failed to fully implement an Acuity Based Staffing Tool (ABST). Findings include but not limited to:


A review of the facility's ODHS ABST revealed that three out of three sampled residents' profiles were not updated in the last quarter.


These findings were reviewed with Staff #1 by phone on 04/20/2023 who was in agreement.


Plan of Correction: Facility will review and update the ABST profiles within 30 days.