Print Violation: 00372357-AP-322722

Provider Information

Crystal Terrace Memory Care

320 JADE TERRACE
Klamath Falls, OR 97601

Date: 12/17/2024
Report number: 00372357-AP-322722
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to properly plan care
Result: Substantiated
Rule(s) Violated: 411-054-0027(1)(g) and (s)
411-054-0028(2)
411-054-0036(2)(g)
Findings: The facility has knowledge that prior to moving into the facility, Alleged Victim’s (AV’s) gait was declining. AV had approximately 13 falls between August 7, to November 14, 2024. On or about November 15, 2024, AV went to sit in a chair in the common area: the chair slid out and AV fell. On or about November 23, 2024, AV once again had a fall when he/she tried to get up from a chair into AV’s wheelchair. AV lost his/her footing/slipped and fell on AV’s bottom. The facility failed to put interventions into place that prevented AV from falling, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: RCFCP25-00689 $1313.00 fine assessed