Print Violation: 00255692-AP-211212

Provider Information

Jefferson Lodge Memory Care Community

664 SE JEFFERSON ST
Dallas, OR 97338

Date: 4/2/2023
Report number: 00255692-AP-211212
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: 411-054-0025(1)(a) and (b)
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 a safe environment. Witness 1 (W1) and AV have history of aggressive behaviors towards staff and other residents. W1 service plan requires staff to provide 1:1 care to prevent W1 from harming others during episodes of heightened agitation. AV TSP requires staff to monitor non-consensual touching and intervene and redirect when interacting with other residents in a non-consensual manner. On or about April 02, 2023, AV was tugging at W1 and would not stop when W1 asked. W1 threw a cup at AV mouth causing unreasonable pain to AV. The Facility failed to provide a safe environment for AV and failed to follow the interventions and care plans for W1 and AV, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: RCFCP23-00845 $500.00 fine assessed