Print Violation: 00107154-AP-082003

Provider Information

Hawthorne Gardens Memory Care Community

2828 SE TAYLOR ST
Portland, OR 97214

Date: 10/14/2020
Report number: 00107154-AP-082003
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to follow care plan
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
Findings: Alleged Victim (AV) relies on the facility for his/her care. On or about October 14, 2020, AV had an unwitnessed fall from his/her wheelchair and had a fracture to his/her head. Alleged Perpetrator 2 (AP2) denied being told by swing shift that AV was still up in his/her wheelchair but AP2 knew AV required 2-hour checks. AV still had the same clothing from the day before, and it appeared staff left AV sitting in his/her chair overnight. AV was taken to the hospital and received three (3) staples to the laceration on his/her head. The facility and AP2 failed to follow AV’s care plan, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: RCFCP21-02348 $1125.00 fine assessed