Print Violation: 00219369-AP-178269

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 9/2/2022
Report number: 00219369-AP-178269
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide safe environment
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: Witness 1 (W1) has history of arguing and being aggressive with another roommate, and staff. Alleged Victim (AV) and W1 have history of a previous physical altercation resulting in AV sustaining an injury. The facility failed to adjust the service plan for W1’s continued aggressive behavior. On or about September 02, 2022, W1 and AV were involved in a verbal altercation which led to a physical altercation resulting in AV being hit with an assistive device sustaining a skin tear to h/h. The Facility failed to provide a safe environment for AV, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: RCFCP23-00197 $250.00 fine assessed