Provider Details - Nicki Douglas
Nicki Douglas
(541) 330-6009
nickidouglas123@icloud.com
20873 SE GREENMONT DR
Bend, OR 97702
(541) 330-6009
nickidouglas123@icloud.com
- Administrator name
- Nicki Douglas
- ID
- 507243
- Status
- Open
- Type
- Adult Foster Home
- Classification
- 3
- Licensed beds
- 5
- Accepts Medicaid
- Yes
- Memory Care
- No
If you have questions about this provider or its inspection and compliance history, please contact the provider at the phone number listed above.
Licensing inspections evaluate a provider’s compliance with rules and laws.
Licensing surveyors look at a variety of factors, including quality of care and services provided, as
well as the condition of the provider’s physical structure, equipment, staffing levels, policies,
procedures and finances. Under federal requirements, nursing facilities receive recertification inspections
and inspections following a complaint investigation. The inspections represent a snapshot of the provider’s
compliance with regulatory requirements at the time the inspection took place.
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Event ID | Inspection type(s) Inspection type(s) | Deficiencies cited | Actions | |
|---|---|---|---|---|---|
| 4/7/2026 | RL010316 | Re-Licensure | 5 | ||
| 10/1/2025 | MON007110 | Monitoring | 1 | ||
| 4/3/2025 | RL003421 | Re-Licensure | 2 | ||
| 10/30/2024 | MON001021 | Monitoring | 3 | ||
| 9/18/2024 | MON000387 | Monitoring | 7 | ||
| 4/2/2024 | NVFQ | Re-Licensure | 4 | ||
| 4/6/2023 | USP5 | Re-Licensure | 3 | ||
| 4/12/2022 | 56IW | Re-Licensure | 9 |
8
records found
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
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| No Results Found | ||||||
0
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.
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| 10/30/2024 | CALMS - 00066245 | Failed to provide a safe medication administration system | 3 | Licensing Violation | ||
| 10/30/2024 | CALMS - 00066246 | Failed to keep medication record current or accurate | 3 | Licensing Violation | ||
| 10/30/2024 | CALMS - 00066247 | Failed to provide a safe medication administration system | 3 | Licensing Violation | ||
| 9/18/2024 | CALMS - 00062709 | Failed to make facility or resident records accessible | 3 | Licensing Violation | ||
| 9/18/2024 | CALMS - 00062710 | Failed to properly plan care | 3 | Licensing Violation | ||
| 9/18/2024 | CALMS - 00062711 | Failed to keep resident record current or accurate | 3 | Licensing Violation | ||
| 9/18/2024 | CALMS - 00062712 | Failed to properly plan care | 3 | Licensing Violation | ||
| 9/18/2024 | CALMS - 00062713 | Failed to keep medication record current or accurate | 3 | Licensing Violation | ||
| 4/2/2024 | CALMS - 00055878 | Failed to keep medication record current or accurate | 1 | Licensing Violation | ||
| 4/6/2023 | CALMS - 00048701 | Failed to provide a safe medication administration system | 2 | Licensing Violation |
13
records found
| Page
1 of 2
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.
Records that are highlighted and show the icon, occurred under the current provider owner.
| Sanction Sanction | Allegation | Type | Effective date | End date | Actions | |
|---|---|---|---|---|---|---|
| AFHCD24-00271 | Failed to provide safe environment | License Condition | 10/2/2024 | 11/7/2024 |
1
record found