Print Violation: 00433619-AP-385837

Provider Information

St Andrews Memory Care Community

7617 SE MAIN ST
Portland, OR 97215

Date: 10/7/2025
Report number: 00433619-AP-385837
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to administer ordered medication
Result: Substantiated
Rule(s) Violated: External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(g)
External site: 411-054-0055(1)(f)
Findings: The Alleged Victim (AV) relies on the facility for care and medication administration. On or about October 7, 2025, the AV returned from a doctor appointment with an after-visit summary and a new narcotic pain medication that was already filled at a local pharmacy. According to an investigation, the Alleged Perpetrator 2 (AP2) did not follow-up to ensure the new narcotic pain medication was added to the Medication Administration Record (MAR). There are multiple documented instances when AV was in pain and the facility only had over the counter medications available. The over-the-counter pain medications did not fully eliminate AV's pain, resulting in pain and unreasonable discomfort. AP2's actions are considered neglect of care and constitutes abuse. The facility failed to ensure medications were administered as ordered which is a violation of Oregon Administrative Rules.