Print Violation: 00302828-AP-255886

Provider Information

Santiam Gardens Residential Care

1625 CENTER ST NE
Salem, OR 97301

Date: 12/16/2023
Report number: 00302828-AP-255886
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to properly plan care
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
Findings: The facility failed to appropriately care plan related to the Alleged Victim's (AV) fall history. The facility's failure resulted AV experiencing multiple falls between October 22, 2023, and December 20, 2023. Based on facility documentation and interviews, AV was dropped during a transfer on December 16, 2023, and there was no Temporary Service Plan (TSP) put into place after this incident. On December 20, 2023, staff helped AV on the commode and staff were unable to hold onto AV during the transfer. The facility updated AV's care plan to be a two person transfer after the December 20, 2023, incident. The facility's failure to properly care plan caused AV repeated unreasonable discomfort, which is a violation of resident rights, is considered neglect of care which constitutes abuse.
Sanction: RCFCP24-01000 $450.00 fine assessed