Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: 00472529-AP-424890
Provider Information
Powell Valley Assisted Living Community
4001 SE 182ND AVE
Gresham, OR 97030
- Provider ID
- 70M073
- Administrator
- Kelly Grounds
- Phone
- (503) 665-2496
- ed@powellvalley.net
Violation Details
- Date
- 4/1/2026
- Report number
- 00472529-AP-424890
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- 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)
- Findings
- On or about April 23, 2026, Alleged Victim (AV), a resident of Respondent’s facility, suffered an unwitnessed fall in his/her room due to a delayed response to AV’s call light. Approximately 40 minutes after AV activated his/her call pendant seeking assistance with his/her care needs, facility staff arrived to AV's room and found AV on the floor, bleeding from his/her head with cuts on AV's head, right hand and knees. As a result of AV's fall, AV was transported to the hospital for treatment. Based on facility documentation and interviews, AV experienced several falls between January 28, 2026, and April 1, 2026. However, at the time of the investigation, AV’s service plan noted only one fall within the previous 90 days, occurring on December 13, 2025. The facility failed to adequately plan for AV’s safety despite a known fall risk that was not accurately documented in AV’s service plan. The facility's lack of appropriate oversight and care planning regarding AV's known fall risk, caused AV unreasonable discomfort and continued pain which constitutes abuse by neglect as outlined in OAR 411-020-0002(1)(b)(A)(i).
- Sanction
- ALFCP26-00290 $1350.00 fine assessed