Aging and People with Disabilities
Safety, Oversight and Quality
Print Inspection: OGZB
Provider Information
2630 CHURCH ST NE
Salem, OR 97301
- Provider ID
- 50R494
- Administrator
- Cassandra Bracamonte
- Phone
- (503) 334-2275
- admin@everbloommc.com
Inspection Details
- Date
- 10/31/2023
- Event ID
- OGZB
- Inspection type(s)
- Licensure Complaint
- Deficiencies cited
- 3
Citation Details
C0010: Licensing Complaint Investigation
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 10/31/2023
- Corrected Date
- N/A
- Details
-
The findings of the on-site investigation conducted 10/31/23 are documented in this report. The investigation was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities.
Abbreviations possibly used in this document:
ADL:activities of daily living
CBG:capillary blood glucose or blood sugar
CG:caregiver
CS: Compliance Specialist
cm:centimeter
ED:Executive Director
F:Fahrenheit
HH:Home Health
LPN:Licensed Practical Nurse
MT: Medication Tech
MAR:Medication Administration Record
MCC:Memory Care Community
OT:Occupational Therapist
PT: Physical Therapist
PRN:as needed
RCC:Resident Care Coordinator
RN:Registered Nurse
C0361: Acuity-Based Staffing Tool
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 10/31/2023
- Corrected Date
- N/A
- Details
-
Based on interview and record review, conducted during a site visit on 10/31/23, it was confirmed the facility failed to fully implement and update an Acuity Based Staffing Tool (ABST). Findings include, but are not limited to:
In review of the facility's ABST and resident roster on 10/31/23, it was found there were 20 residents listed on the roster and only 19 residents were entered into the ABST.
In an interview on 10/31/23, Staff 1 (ED) stated the current census was 20 residents. S/he also stated they had not updated the ABST in the past 30 days. The last move in was 10/23/23, the last move out 10/29/23, and last service plan update was 10/23/23.
On 10/31/23, findings were reviewed with and acknowledged by Staff 1.
The facility failed to fully implement and update an ABST.
C0513: Doors, Walls, Elevators, Odors
- Scope
- L2 Isolated
- Visit Number
- 1
- Visit Date
- 10/31/2023
- Corrected Date
- N/A
- Details
-