- Date
- 2/1/2026
- Report number
- CALMS - 00106581
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to follow care plan
- Result
- Substantiated
- Findings
- AV relies on the facility staff for AV's care needs. AV"s service plan dated on January 22, 2026, indicates staff are to check residents briefs four times per shift and on night shift. If AV's brief is wet, assist with changing. A review of Staff 6 (Caregiver) corrective action dated 03/05/26 indicated Staff 6 was not consistently meeting his/her responsibilities to the residents. The residents had been frequently discovered wet and unchanged in the morning. During the night shift on 03/03/26 and 03/08/26, for instance, the residents in Staff 6’s section were observed to need care, including changes. A review of Resident 1’s activities of daily living sheets from 12/01/25 through 02/28/26 indicated staff had not been completing his/her services as required. The facility allegedly failed to follow the care plan for the Alleged Victim. An investigation determined this is a violation of Oregon Administrative Rules.