Print Violation: 00471892-AP-424224

Provider Information

Waterford Grand Memory Care

600 WATERFORD WAY
Eugene, OR 97401

Date: 4/19/2026
Report number: 00471892-AP-424224
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to use restraint properly
Result: Substantiated
Rule(s) Violated: 411-054-0025(1)(a) and (b)
411-054-0027(1)(a)(g)(l) and (s)
411-054-0028
Findings: On or about April 19, 2026, Alleged Perpetrator #2 (AP2) attempted to move the Alleged Victim's (AV) wheelchair, however, AV put his/her feet down to the ground. AP2 tipped back AP2's wheelchair to move AV to the dining room. Upon placing AV at the table, AP2 locked AV's wheels to his/her wheelchair. This action upset AV. AP2's actions are considered neglect of care and constitute wrongful restraint, which is a violation of OAR 411-020-0002(1)(h)(A)(iii). The facility's failure to ensure AV was safe from wrongful restraint is a violation of Oregon Administrative Rules.