Print Violation: 00420652-AP-372064

Provider Information

Cedarbrook Place Senior Living

721 NE 27TH ST
Mcminnville, OR 97128

Date: 7/5/2025
Report number: 00420652-AP-372064
Type: Abuse: Neglect
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: 411-054-0036(2)(g)
Findings: According to the documentation, the facility failed to properly care plan for the Alleged Victim’s (AV) increased weakness which led to a fall. On or about July 05, 2025, the AV experienced a fall due to feeling increased weakness. On or about July 08, 2025, the AV fell again while trying to transfer. On approximately July 09, 2025, the AV was transferred to the hospital due to increased weakness. The AV returned to the facility after about a month stay in a skilled facility due to their weakness. The failure to care plan appropriate interventions for increased weakness led to a fall and stay at a skilled facility, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: ALFCP25-00411 $500.00 fine assessed