Print Violation: 00136988-AP-107660

Provider Information

Waverly Place Assisted Living

2853 SE SALEM AVE
Albany, OR 97321

Date: 3/8/2021
Report number: 00136988-AP-107660
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide a safe medication administration system
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
Findings: Alleged Victim (AV) relies on the facility to administer his/her medication. On or about March 8, 2021, AV did not have enough medication for the evening due to a recent increase order of medication. Witness 5 (W5) brought a bottle of medication, that belong to him/her, to the facility and Alleged Perpetrator 2 (AP2) scribbled W5’s name from the label and used a sharpie to write AV’s name on the bottle. The medication was then administered to AV. AP2 failed to provide a safe medication administration system for AV. The facility failed to provide a safe medication administration system for AV, which is a violation of Oregon Administrative Rules.