Provider Details

Aging and People with Disabilities

Safety, Oversight and Quality

Oregon Department of Human Services Logo

Print Violation: 00027306AP-019320

Provider Information


Countryside Living Memory Care

390 NW 2ND AVE
Canby, OR 97013

Provider ID
50R283
Administrator
STACY ZIMMERMAN
Phone
(503) 266-3031
Email
ed@countrysidelivingcanby.com

Violation Details


Date
4/17/2019
Report number
00027306AP-019320
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Findings
Facility, in not preventing an altercation involving AV, actively or passively failed to provide the basic care or services necessary to maintain the health and safety of an adult, when that failure results in physical harm, significant emotional harm, unreasonable discomfort, or serious loss of personal dignity to the adult, as defined on OAR 4110200002 (1) (b) (A) (i).