Provider Details - Maple Grove Memory Care | Licensed Long-Term Care Settings Search

Maple Grove Memory Care

17309 NE GLISAN
Portland, OR 97230

(503) 253-4920
charity.jammeh@sincerisl.com

Administrator name: Charity Jammeh

ID: 5MA223
Status: Closed
Type: Residential Care Facility
Licensed beds: 0
Accepts Medicaid: Yes
Memory Care: Yes

This provider was closed on 5/30/2025.

Owner: SH1 Pacific Gardens OpCo LLC

17309 NE GLISAN ST
Portland, OR 97206

(360) 254-9442

Owner since: 4/1/2019

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

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.

Provider Details - Maple Grove Memory Care
Date Date From To	Event ID	Inspection type(s) Inspection type(s)	Deficiencies cited Deficiencies cited Between And
2/25/2025	KIT002950	Kitchen	2
12/5/2024	HSM001668	Health & Safety Monitoring	2
10/14/2024	N56G	Complaint Investig.	5
6/25/2024	42S7	Complaint Investig.	8
3/18/2024	H7UE	Validation	27
3/11/2024	8MSN	Complaint Investig.	6
2/20/2024	K98P	State Licensure	0
10/16/2023	FC8K	Complaint Investig.	3
1/31/2023	51X5	State Licensure	0
12/8/2022	7Q66	Complaint Investig.	3

12 records found | Page 1 of 2

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.

Provider Details - Maple Grove Memory Care
Date Date From To	Report number Report number	Allegation Allegation Failed to address resident's behavior Failed to administer medication as ordered Failed to assure resident rights Failed to assure resident was safe Failed to assure timely medical treatment Failed to follow care plan Failed to have medication available Failed to obtain appropriate consultation Failed to perform adequate screening or assessment Failed to properly plan care Failed to protect resident from financial exploitation Failed to protect resident from inappropriate sexual contact Failed to protect resident from verbal abuse Failed to provide a safe medication administration system Failed to provide appropriate pain control Failed to provide appropriate staffing Failed to provide peri care Failed to provide safe environment Failed to provide service	Level Level Between And	Type Type Abuse: Financial abuse Abuse: Neglect Abuse: Sexual abuse
1/24/2025	00308522-AP-261268	Failed to provide service	3	Abuse: Neglect
1/22/2025	00379587-AP-330115	Failed to provide safe environment	2	Abuse: Neglect
1/17/2025	00378444-AP-329029	Failed to provide safe environment	2	Abuse: Neglect
1/7/2025	00375824-AP-326221	Failed to provide a safe medication administration system	2	Abuse: Neglect
1/7/2025	00375824-AP-368743	Failed to have medication available	2	Abuse: Neglect
12/17/2024	00369986-AP-349091	Failed to provide a safe medication administration system	2	Abuse: Neglect
12/5/2024	00369986-AP-320302	Failed to provide a safe medication administration system	2	Abuse: Neglect
11/29/2024	00369639-AP-320047	Failed to provide safe environment	2	Abuse: Neglect
11/29/2024	00369804-AP-320094	Failed to provide safe environment	2	Abuse: Neglect
11/15/2024	00367009-AP-317245	Failed to protect resident from inappropriate sexual contact	3	Abuse: Neglect

146 records found | Page 1 of 15

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.

Provider Details - Maple Grove Memory Care
Date Date From To	Report number Report number	Allegation Allegation Failed to administer medication as ordered Failed to administer ordered medication Failed to assist with toileting Failed to assure a qualified caregiver was present Failed to assure resident rights Failed to assure resident was safe Failed to assure that a qualified caregiver was present Failed to care plan in accordance with assessment Failed to comply with nursing delegation requirement Failed to follow care plan Failed to have medication available Failed to hire according to administrative rules Failed to intervene when resident's condition changed Failed to keep medication record current or accurate Failed to keep resident record current or accurate Failed to maintain a safe physical environment Failed to meet the scheduled and unscheduled needs of residents Failed to properly plan care Failed to protect resident from financial exploitation Failed to protect resident from mental or emotional abuse Failed to protect resident from verbal abuse Failed to provide a safe medication administration system Failed to provide appropriate activities Failed to provide appropriate housekeeping services Failed to provide appropriate staffing Failed to provide infection control Failed to provide inservice Failed to provide medical treatment as ordered Failed to provide or assist with hygiene Failed to provide or maintain resident care equipment Failed to provide oversight and monitoring of change of condition Failed to provide safe environment Failed to provide service Failed to report potential or suspected abuse Failed to staff as indicated by ABST Failed to submit timely or adequate staffing documentation Failed to use an ABST	Level Level Between And	Type Type Licensing Violation
4/15/2025	00395774-AP-346470	Failed to protect resident from verbal abuse	2	Licensing Violation
1/9/2025	CALMS - 00076491	Failed to staff as indicated by ABST	2	Licensing Violation
1/7/2025	CALMS - 00079750	Failed to use an ABST	2	Licensing Violation
12/23/2024	CALMS - 00076482	Failed to staff as indicated by ABST	2	Licensing Violation
12/16/2024	CALMS - 00079822	Failed to administer medication as ordered	2	Licensing Violation
12/13/2024	CALMS - 00079805	Failed to administer ordered medication	2	Licensing Violation
12/5/2024	CALMS - 00075873	Failed to use an ABST	2	Licensing Violation
12/4/2024	CALMS - 00075613	Failed to use an ABST	2	Licensing Violation
12/4/2024	CALMS - 00075615	Failed to use an ABST	2	Licensing Violation
12/1/2024	CALMS - 00079828	Failed to have medication available	2	Licensing Violation

184 records found | Page 1 of 19

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.

Records that are highlighted and show the icon, indicate being a part of APD's Providers with Enhanced Oversight and Supervision program due to a history of being out of compliance with licensing requirements.

Provider Details - Maple Grove Memory Care
Sanction Sanction	Allegation Allegation Failed to meet the scheduled and unscheduled needs of residents Failed to provide safe environment Failed to provide service Failed to use an ABST	Type Type Condition Enhanced Oversight and Supervision License Condition	Effective date Effective date From To	End date End date From To
RCFCD24-01200	Failed to provide safe environment	License Condition	11/27/2024	12/19/2024
RCFCD24-01129	Failed to use an ABST	License Condition	11/15/2024	5/30/2025
RCFCD24-01129	Failed to provide service	License Condition	11/15/2024	5/30/2025
RCFCD24-01129	Failed to provide service	License Condition	11/15/2024	5/30/2025
RCFFEOS24-00777	Failed to provide safe environment	Enhanced Oversight and Supervision	8/13/2024	5/30/2025
RCFCD24-00361	Failed to provide safe environment	License Condition	4/5/2024	7/16/2024
RCFCD23-00380	Failed to meet the scheduled and unscheduled needs of residents	License Condition	3/23/2023	5/11/2023
RCFCD23-00380	Failed to use an ABST	License Condition	3/23/2023	5/11/2023
RCFCD22-00638	Failed to provide safe environment	License Condition	3/25/2022	12/16/2022
RCFCD16-020	Failed to provide safe environment	Condition	9/21/2016	12/21/2016

10 records 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

Facilities submit this information electronically each year. Reporting began in 2020. Instructions and definitions are updated annually and published on the Residential Care Quality Metrics Program web page

Provider Details - Maple Grove Memory Care

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Provider Details - Maple Grove Memory Care

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