Print Violation: CALMS - 00079849

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 4/17/2025
Report number: CALMS - 00079849
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide safe environment
Result: Substantiated
Rule(s) Violated: External site: 411-057-0140(1) and (2)
Findings: The findings contained in this report are in response to Condition No. RCFCD24-00266, following the facility's assertion of compliance on 04/01/25. Based on observation, interview, and record review, conducted during a site visit on 04/17/25, the licensee’s failure to be responsible for the operation of the facility and the quality of services rendered in the facility was substantiated. The facility has been out compliance since 02/07/24 through 04/17/25 in the following areas, findings include, but are not limited to: Reporting and Investigating Abuse- OAR 411-054-0028(2)(b); Staffing Requirements and Training – OAR 411-054-0070; Acuity-Based Staffing Tool – OAR 411-054-0037(1-7); and Service Plans: General – OAR 411-054-0036(2)(g). It was determined the licensee failed to be responsible for the operation of the facility and the quality of services rendered in the facility. An investigation determined this is a violation of Oregon Administrative Rules. The facility was notified of the licensing violation by telephone on 04/22/25.