Provider Details - Countryside Living Memory Care South
406 NW 2ND AVENUE
Canby, OR 97013
(503) 266-3031
ed@countrysidelivingcanby.com
- Administrator name
- STACY ZIMMERMAN
- ID
- 50R380
- Status
- Open
- Type
- Residential Care Facility
- Licensed beds
- 20
- Accepts Medicaid
- Yes
- Memory Care
- Yes
- Owner
-
Ohana Canby Operations, LLC
325 2ND ST. APT. 403
Lake Oswego, OR 97034
(503) 250-3825
- Owner since
- 10/1/2021
If you have questions about this provider or its inspection and compliance history, please contact the provider at the phone number listed above.
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 | |
|---|---|---|---|---|---|
| 6/12/2024 | Y7Z4 | State Licensure | 2 | ||
| 8/8/2023 | OIZ1 | State Licensure | 0 | ||
| 4/11/2022 | KLZP | Validation | 11 |
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| 12/12/2022 | 00236330-AP-193696 | Failed to properly plan care | 2 | Abuse: Neglect | ||
| 12/5/2022 | 00236286-AP-193655 | Failed to properly plan care | 3 | Abuse: Neglect | ||
| 9/12/2022 | 00220520-AP-179295 | Failed to properly plan care | 2 | Abuse: Neglect | ||
| 9/10/2022 | 00220670-AP-179441 | Failed to properly plan care | 2 | Abuse: Neglect | ||
| 7/25/2022 | 00212931-AP-172356 | Failed to provide a safe medication administration system | 2 | Abuse: Neglect | ||
| 5/26/2022 | 00202031-AP-162686 | Failed to provide safe environment | 2 | Abuse: Neglect | ||
| 9/19/2019 | 00050081-AP-034837 | Failed to properly plan care | 2 | Abuse: Neglect | ||
| 5/16/2014 | CO14110 | Failed to assure resident rights | 3 | Abuse: Neglect |
Records that are highlighted and show the icon, occurred under the current provider owner.
| Date | Report number Report number | Allegation | Level | Type | Actions | |
|---|---|---|---|---|---|---|
| 11/17/2022 | CALMS - 00034392 | Failed to submit timely or adequate staffing documentation | 2 | Licensing Violation | ||
| 10/10/2022 | 00225340-AP-183824 | Failed to provide a safe medication administration system | 2 | Licensing Violation | ||
| 10/1/2022 | CALMS - 00033045 | Failed to submit timely or adequate staffing documentation | 2 | Licensing Violation | ||
| 9/18/2022 | 00222027-AP-180754 | Failed to provide safe environment | 2 | Licensing Violation |
| Sanction Sanction | Allegation | Type | Effective date | End date | Actions | |
|---|---|---|---|---|---|---|
| No Results Found | ||||||
The Oregon Department of Human Services publishes annual reports about assisted living and residential care facilities, including those with memory care endorsements. The reports show how facilities are doing in areas like staffing, safety, and resident experience.
Facilities submit this information once each year using an online reporting tool. The results reflect how each facility operated during that year. The information is self-reported by facilities and is not independently audited by the department. This means the reports show what facilities report about their own performance.
Each year, assisted living and residential care facilities must report information on:
- Retention of direct care staff
- Compliance with staff training requirements
- Number of resident falls that result in injury
- Incidence of use of antipsychotic medications for non-standard purposes
- Results of an annual resident satisfaction survey conducted by an independent entity