Provider Details - Forest Grove Post Acute | Licensed Long-Term Care Settings Search

Forest Grove Post Acute

3900 PACIFIC AVENUE
Forest Grove, OR 97116

(503) 359-0449

Administrator name: Kayla Van Roekel

ID: 385155
Status: Open
Type: Nursing Facility
Licensed beds: 114
Accepts Medicaid: Yes
Memory Care: No

Owner: Providence Group NH c/o PACS Holdings, LLC

Owner since: 9/1/2024

If you have questions about this provider or its inspection and compliance history, please contact the provider at the phone number listed above.

Review Consumer Statements

This tab displays five years of inspection history. For inspection information older than five years, please visit ODHS Records Request .
To learn more about inspections see: Provider Information

Records that are highlighted and show the icon, occurred under the current provider owner.

Inspections
Date Date From To	Event ID	Inspection type(s) Inspection type(s)	Deficiencies cited Deficiencies cited Between And
7/1/2026	25C3D9	Complaint, Re-Licensure	0
6/11/2026	235095	Complaint, Re-Licensure	3
4/6/2026	22C3E5	Complaint, Re-Licensure	0
10/16/2025	1D9373	Complaint, Re-Licensure	0
10/1/2025	1D7F8C	Complaint, Re-Licensure	0
7/25/2025	1D13B7	Complaint, Licensure Complaint, Re-Licensure, Recertification	4
1/28/2025	HNKQ	Complaint, Licensure Complaint, State Licensure	0
12/18/2024	3WRO	Complaint, Licensure Complaint	2
6/14/2024	GSGA	Complaint, Licensure Complaint, Re-Licensure, Recertification, State Licensure	8
10/6/2023	EXPY	Complaint, Licensure Complaint, State Licensure	2

13 records found | Page 1 of 2

The information on this tab comes from a database called iQIES, which is managed by the Centers for Medicare & Medicaid Services (CMS). Sometimes CMS changes how the data is organized. When that happens, the information may not show up here until our system is updated to match those changes. If this tab is empty and you have questions about a facility’s survey, please email nf.licensing@odhs.oregon.gov for help.

This list shows confirmed (substantiated) instances of abuse from 2010 onward. Open investigations and complaints that are being appealed by the provider are not listed. To learn more about abuse definitions, see: Definitions of Abuse

Records that are highlighted and show the icon, occurred under the current provider owner.

Abuse violations
Date Date From To	Report number Report number	Allegation Allegation Failed to adequately care plan related to falls Failed to administer medication as ordered Failed to assure proper hydration Failed to assure resident rights Failed to assure resident was safe Failed to follow care plan Failed to protect resident from financial exploitation Failed to protect resident from verbal abuse Failed to provide appropriate pain control Failed to provide oversight and monitoring of change of condition Failed to provide safe environment Failed to provide service	Level Level Between And	Type Type Abuse: Financial abuse Abuse: Neglect Abuse: Verbal/Mental abuse
1/3/2024	OR0004727000	Failed to provide service	2	Abuse: Neglect
3/21/2022	OR0003744600	Failed to assure resident rights	3	Abuse: Neglect
11/16/2018	OR0001641800	Failed to assure resident was safe	3	Abuse: Neglect
1/4/2018	HB185409	Failed to provide safe environment	2	Abuse: Neglect
11/17/2017	HB175213	Failed to provide safe environment	2	Abuse: Financial abuse
8/4/2017	OR0001342000	Failed to provide service	2	Abuse: Neglect
3/22/2017	HB170360	Failed to protect resident from verbal abuse	2	Abuse: Verbal/Mental abuse
1/10/2017	HB179175	Failed to administer medication as ordered	3	Abuse: Neglect
2/14/2016	HB164692	Failed to protect resident from financial exploitation	2	Abuse: Financial abuse
1/5/2016	OR0001047100	Failed to adequately care plan related to falls	3	Abuse: Neglect

28 records found | Page 1 of 3

This list shows confirmed (substantiated) licensing violations from 2010 onward. Open investigations and complaints that are being appealed by the provider are not listed.

Records that are highlighted and show the icon, occurred under the current provider owner.

Licensing violations
Date Date From To	Report number Report number	Allegation Allegation Failed to address resident's behavior Failed to answer call light in a timely manner Failed to assist with transfer Failed to assure resident rights Failed to assure resident was safe Failed to assure that a qualified caregiver was present Failed to follow care plan Failed to keep medication record current or accurate Failed to maintain a safe physical environment Failed to perform adequate screening or assessment Failed to protect resident from verbal abuse Failed to provide a safe medication administration system Failed to provide appropriate staffing Failed to provide medical treatment as ordered Failed to provide or assist with hygiene Failed to provide oversight and monitoring of change of condition Failed to provide proper food/nutrition Failed to provide service	Level Level Between And	Type Type Licensing Violation
10/30/2025	CALMS - 00098638	Failed to provide appropriate staffing	2	Licensing Violation
4/8/2025	CALMS - 00088818	Failed to provide appropriate staffing	2	Licensing Violation
1/7/2025	CALMS - 00083948	Failed to provide appropriate staffing	2	Licensing Violation
4/10/2024	OR0004968500	Failed to assure resident rights	1	Licensing Violation
2/5/2024	OR0004798701	Failed to provide service	2	Licensing Violation
2/1/2024	CALMS - 00055111	Failed to provide appropriate staffing	2	Licensing Violation
9/1/2023	OR0004494800	Failed to assure resident rights	2	Licensing Violation
9/2/2022	OR0003800201	Failed to answer call light in a timely manner	2	Licensing Violation
5/4/2022	OR0002980600	Failed to assure resident rights	2	Licensing Violation
5/1/2022	OR0003601803	Failed to answer call light in a timely manner	2	Licensing Violation

49 records found | Page 1 of 5

Formal regulatory actions can range from a condition placed upon a license due to non-compliance or a notice to revoke a license. This section of the website currently displays only license conditions dating back to 2010 and no other types of regulatory action. Additional records will be added over time as resources allow.

Regulatory actions
	Sanction Sanction	Allegation Allegation	Type Type	Effective date Effective date From To	End date End date From To	Actions
No Results Found

0 records found

Provider Details - Forest Grove Post Acute

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