Print Violation: 00350742-AP-301059

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 8/11/2024
Report number: 00350742-AP-301059
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to administer medication as ordered
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: 411-054-0030(1)(f)
External site: 411-054-0036(2)(g)
External site: 411-054-0055(1)(a) and(f)
Findings: On or about August 11, 2024, at 8:00 AM, 12:00 PM, 8:00 PM, 0.5 mg of anxiety medication was given to AV instead of 1 mg. On or about August 12, 2024, August 13, 2024, and August 15, 2024,, at 8:00 PM, 0.5 mg of anxiety medication was given instead of 1 mg. August 21, 2024,, at 6:00 AM AV's pain medication was missed and not administered. The facility had a responsibility to provide medication administration to AV. The facility is to administer one 1 mg tablet by mouth three times daily and one 0.5 mg tablet by mouth every two hours as needed for anxiety or agitation. The facility is to administer one tablet of pain medication by mouth three times daily for generalized pain. There was no indication of increased agitation, behaviors, or reaction due to AV receiving the incorrect dose of anxiety medication. The facility failed to administer medication as ordered which is a violation of Oregon Administrative Rules.