Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: 00439459-AP-391276
Provider Information
Emerald Gardens
1890 NEWBERG HWY
Woodburn, OR 97071
- Provider ID
- 50M019
- Administrator
- TERESA SMITH
- Phone
- (503) 982-4000
- tsmith@egseniorliving.com
Violation Details
- Date
- 8/27/2025
- Report number
- 00439459-AP-391276
- Type
- Abuse: Neglect
- Level
- 4 - Serious harm, death, imminent danger or chronic regulatory noncompliance
- Allegation
- Failed to provide service
- Result
- Substantiated
- Rule(s) Violated
-
411-054-0025(1)(a) and (b)
411-054-0027(1)(g) and (s)
411-054-0028(2)
411-054-0036(2)(g)
411-054-0040(2)
411-054-0055(1)(f)
- Findings
- The Alleged Victim (AV) relied on the facility for care and medication management and had a history of recurrent urinary tract infections (UTI). According to an investigation, on or about August 25, 2025, facility staff were told that AV's confusion was worse than normal, and a UTI was suspected. The facility took no action, despite there being a standing physician order that indicates if AV is off baseline the facility should take a urinalysis and start AV on an antibiotic immediately. On August 27, 2025, AV developed a high fever and their pulse was elevated, facility staff gave AV pain medication. On August 28, 2025, AV was unable to take medications, pale, shaking and ultimately not responsive, and was transferred to the hospital. The next morning, August 29, 2025, AV passed away. AV's cause of death was Septic shock due to UTI. The facility failed to provide appropriate services, to include following AV's care plan, following physician orders, and ensuring AV was monitored for a change of condition, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP26-00439 $15000.00 fine assessed