Print Violation: 00217843-AP-176861

Provider Information

The Atrium at Mcloughlin Place

1153 MOLALLA AVE
Oregon City, OR 97045

Date: 8/24/2022
Report number: 00217843-AP-176861
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to properly plan care
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) requires staff assistance to complete all ADLs and requires staff to assist with ambulation due to AV being a “high risk” for falls. AV suffered an unwitnessed fall on or about August 15, 2022. A fall risk re-evaluation was not performed following the fall on August 15, 2022. AV sustained additional falls on August 17th, 21st, and 23rd, 2023. On or about August 24, 2022, AV suffered an unwitnessed fall, AV was found on the ground face first near bedside. The facility failed to care plan appropriately and implement interventions to mitigate AV’s risk of falls, which is a violation of resident rights, is neglect of care and constitute abuse.
Sanction: RCFCP23-00463 $1125.00 fine assessed