Provider Details - Holladay Park Plaza | Licensed Long-Term Care Settings Search

Holladay Park Plaza

1300 NE 16TH AVENUE
Portland, OR 97232

(503) 288-6671

Administrator name: KATELYNN SAMUELSON NGUYEN

ID: 38L277
Status: Open
Type: Nursing Facility
Licensed beds: 51
Accepts Medicaid: No
Memory Care: No

Owner: Pacific Retirement Services, Inc.

ONE WEST MAIN ST, STE 303
Medford, OR 97501

(541) 857-7486

Owner since: 1/1/2000

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
6/30/2026	236F98	Complaint, Re-Licensure	2
9/5/2025	1D54D8	Re-Licensure, Recertification	3
5/29/2025	DGW5	Complaint, Licensure Complaint, State Licensure	0
6/13/2024	J03I	Complaint, Licensure Complaint, Re-Licensure, Recertification, State Licensure	3
3/13/2023	XHQO	Re-Licensure, Recertification, State Licensure	14
4/29/2022	YE02	Complaint, Licensure Complaint, Re-Licensure, Recertification, State Licensure	3

6 records found

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 assure resident was safe Failed to provide safe environment Failure to provide a system that prevents theft or misuse of medication	Level Level Between And	Type Type Abuse: Neglect
7/23/2018	OR0001547200	Failure to provide a system that prevents theft or misuse of medication	2	Abuse: Neglect
12/27/2015	BC154082	Failed to provide safe environment	3	Abuse: Neglect
5/16/2014	BC147147	Failed to assure resident was safe	3	Abuse: Neglect

3 records found

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 administer ordered medication Failed to provide appropriate staffing Failed to provide safe environment Failed to provide sanitary food service conditions Failed to provide service	Level Level Between And	Type Type Licensing Violation
12/27/2023	OR0004715104	Failed to provide sanitary food service conditions	2	Licensing Violation
4/29/2019	OR0001874200	Failed to provide safe environment	2	Licensing Violation
11/8/2018	OR0001634100	Failed to provide service	2	Licensing Violation
1/13/2017	NAS17024	Failed to provide appropriate staffing	2	Licensing Violation
4/27/2015	NAS15046	Failed to provide appropriate staffing	2	Licensing Violation
10/16/2014	NAS14062	Failed to provide appropriate staffing	2	Licensing Violation
9/27/2013	OR0000854700	Failed to administer ordered medication	2	Licensing Violation
11/29/2010	OR0000650103	Failed to provide appropriate staffing	2	Licensing Violation

8 records found

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 - Holladay Park Plaza

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