Print Violation: 00276057-AP-230684

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 7/25/2023
Report number: 00276057-AP-230684
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. AV has a history of wandering into other residents’ rooms. Witness #1 (W1) has history of behaviors and altercations when other residents head towards or go into W1’s room. W1's service plan indicates if other residents head towards W1's room, facility staff need to immediately intervene due to W1 past physical behaviors. On or about July 25, 2023, AV wandered into W1 room and W1 followed AV in telling h/h to get out. Both W1 and AV grabbed each other and tumbled to the ground, resulting in AV having redness to ear, knee areas, and redness, tearing to arm area, with bruising to facial area. The facility failed to provide a safe environment and redirect AV. The facility failed to follow W1 care plan, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: RCFCP23-01528 $375.00 fine assessed