Print Violation: 00337855-AP-288737

Provider Information

Pacific Grove Senior Living Community

2112 OAK ST
Forest Grove, OR 97116

Date: 6/19/2024
Report number: 00337855-AP-288737
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide a safe medication administration system
Result: Substantiated
Rule(s) Violated: External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
Findings: On or about June 19, 2024 Alleged Perpetrator (AP2) gave Alleged Victim (AV) another residents medications. AP2 notified the facility LPN who advised AP2 to call 911 and have AV taken to the hospital for evaluation. AV was not initially transported to the hospital but later felt dizzy and was then taken to the hospital. AP2 was trained by the facility on proper medication administration in April 2024. The facility failed to provide a safe medication administration system which is a violation of Oregon Administrative Rules.