Print Violation: 00370913-AP-321254

Provider Information

Pacific Living Centers of Grants Pass at Heidi

2144 NW HEIDI LANE
Grants Pass, OR 97526

Date: 12/7/2024
Report number: 00370913-AP-321254
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: The Alleged Victim (AV) relies on the facility to manage their medications. According to an investigation, beginning on or about December 7, 2024, the Alleged Perpetrator 2 (AP2) did not follow proper procedure for medication administration and gave the AV the incorrect dose of medication on multiple occasions, placing the AV at risk of harm. AP2’s actions are a violation of resident rights, considered neglect, and constitutes abuse. The facility failed to provide a safe medication administration system which violates Oregon Administrative Rules. The allegation that Alleged Perpetrator 3 (AP3) neglected the AV was investigated and determined to be not substantiated.