Print Violation: 00296409-AP-250021

Provider Information

Waterford Grand Memory Care

600 WATERFORD WAY
Eugene, OR 97401

Date: 10/23/2023
Report number: 00296409-AP-250021
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to properly plan care
Result: Substantiated
Rule(s) Violated: 411-054-0025(1)(a) and (b)
411-054-0027(1)(g) and (s)
411-054-0028(2)
411-054-0036(2)(g)
411-054-0040(1)(b) and (d)
Findings: The Alleged Victim (AV) used to use a walker and changed to using a wheelchair. AV is care planned to use a walker with assistance and reminders, and the care plan does not mention a wheelchair. AV has a history of falling from the wheelchair. On or about October 23, 2024, AV stood up from his/her wheelchair and fell. There was no clear direction to staff in the care plan, as the care plan was not updated. The care plan was not updated when AV had a change of condition in his/her ability to ambulate with a walker to changing to a wheelchair. The facility's failure to ensure proper care planning and have oversight to a change of condition is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: RCFCP24-01040 $1500.00 fine assessed