Print Violation: 00358253-AP-308595

Provider Information

Gilman Grove Assisted Living

2205 GILMAN DRIVE
Oregon City, OR 97045

Date: 9/29/2024
Report number: 00358253-AP-308595
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to follow care plan
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)(e)(A) and (G)
External site: 411-054-0036(2)(g)
Findings: The Alleged Victim (AV) requires assistance to and from the bathroom and also requires stand by assist while toileting. On or about September 29, 2024, Alleged Perpetrator #2 (AP2) was assisting AV in the bathroom and left AV alone. While alone, AV attempted to stand by him/herself and fell backwards onto the toilet. When AV fell backwards, the tank to the toilet broke. When staff were checking AV for injury, they found a skin tear on AV's arm. AP2's failure to follow the care plan is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility's failure is a violation of Oregon Administrative Rules.