Print Violation: 00306698-AP-259592

Provider Information

Serenity RCF

15225 SE POWELL BLVD
Portland, OR 97236

Date: 1/6/2024
Report number: 00306698-AP-259592
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate 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)
Findings: The Alleged Victim (AV) relies on the facility for his/her care. Witness 1 (W1) has a history of resident-to-resident altercations. According to an investigation, on or about January 6, 2024, W1 tried multiple times to ram AV with their power chair. Following multiple attempts during the day, W1 hit AV with their powerchair causing AV to fall. resulting in pain and unreasonable discomfort. At the time of the incident, W1's service plan identified a high risk of altercations with residents and misuse of the powerchair, but did not provide specific interventions for staff to implement when behaviors occurred. The facility failed to properly plan care and address resident behaviors, which is a violation of resident’s rights, is neglect of care and constitutes abuse.
Sanction: RCFCP26-00528 $250.00 fine assessed