Print Violation: 00357708-AP-308122

Provider Information

Powell Valley Memory Care Community

4001 SE 182ND AVE
Gresham, OR 97030

Date: 9/27/2024
Report number: 00357708-AP-308122
Type: Abuse: Neglect
Level: 4 - Serious harm, death, imminent danger or chronic regulatory noncompliance
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)
External site: 411-054-0040(1)(a) and (d)
Findings: The facility failed to implement interventions and appropriately care plan related to the Alleged Victim's (AV) fall history. On or about September 27, 2024, AV suffered an unwitnessed fall, was transferred to the hospital, and was diagnosed with a right hip fracture which required surgery. Based on facility documentation and interviews, AV had previous falls on June 15, 2024, June 21, 2024, June 29, 2024, July 7, 2024, and July 28, 2024. An investigation determined the facility failed to implement sufficient fall interventions to mitigate AV's fall risk. The facility's failure to adequately safety plan and monitor AV for known fall history resulted in AV falling and breaking his/her right hip causing unreasonable discomfort and severe pain, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: RCFCP25-00104 $1500.00 fine assessed