Print Violation: 00288921-AP-243093

Provider Information

St Andrews Memory Care Community

7617 SE MAIN ST
Portland, OR 97215

Date: 10/3/2023
Report number: 00288921-AP-243093
Type: Licensing Violation
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: 411-054-0036(2)(g)
Findings: The Alleged Victim (AV) and Witness 6 (W6) rely on the facility for their care. W6 was care planned to be redirected away from other residents when he/she is agitated. On or about October 2, 2023, W6 became agitated when Alleged Perpetrator 2 (AP2) removed W6’s dinner plate. W6 began chasing AP2, so AP2 went into another room and shut the door. W6 then turned to AV and pulled their hair. AP2 failed to follow the temporary care plan for W6 resulting in unreasonable discomfort for AV, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to ensure W6’s care plan was followed and provide a safe environment for AV, which is a violation of Oregon Administrative Rules.