Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: 00356039-AP-306359
Provider Information
Heron Pointe Senior Living
504 Gwinn Street East
Monmouth, OR 97361
- Provider ID
- 70M201
- Administrator
- Anna Palomar
- Phone
- (503) 838-6850
- ed@heron-pointesl.com
Violation Details
- Date
- 9/20/2024
- Report number
- 00356039-AP-306359
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to assist with toileting
- Result
- Substantiated
- Rule(s) Violated
-
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(a),(g) and (s)
External site: 411-054-0028(1)(a) and (b)
External site: 411-054-0030(e)(A), (G), (H)
External site: 411-054-0036(2)(b), (c), and (g)
- Findings
- Alleged Victim (AV) needs 2-3 staff to assist with transfers. AV is able to use the call pendant to ask for toileting assistance, and to notify staff when AV is finished using the toilet. Staff remind AV to use the call pendant or call switch in the bathroom to ask for assistance. AV has scheduled toilet checks. The schedule of the toilet checks is unspecified and the scheduled toilet checks are not on AV's Care history. AV has trouble getting staff to take AV to the toilet. AV usually needs 15-30 minutes to toilet. AV reports being left on the toilet for 2 hours. AV did not have h/h call pendant on, and AV could not reach the emergency call switch in the bathroom. Staff did not come back to check on AV. AV's bottom was sore from sitting on the toilet for so long. AV has been left by staff for more than 30 minutes on multiple occasions. AV reports she does not feel cared for by the staff at AP1. Staff report it is possible AV could have been left in the bathroom unattended for an hour or more if AV did not press AV's call pendant. Between July 26, 24, and September 26, 2024, AV’s call log records show, AV had to wait more than 15 minutes 55 times for a call to resolve. 7 of those calls were over 30 minutes with the longest being 52 minutes on September 23, 2024. The facility failed to follow the care plan and assist AV with toileting needs and failed to answer call light in a timely manner, which is a violation of resident rights, is considered neglect of care and constitutes abuse
- Sanction
- ALFCP25-00374 $250.00 fine assessed