Print Violation: CALMS - 00083411

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 10/21/2024
Report number: CALMS - 00083411
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to administer medication as ordered
Result: Substantiated
Rule(s) Violated: External site: 411-054-0055(1)(f)
Findings: Based on observation, interview, and record review, conducted during a site visit on 10/21/24 the facility’s failure to carry out medication and treatment orders as prescribed was substantiated for 1 of 1 sampled resident (# 1). Resident 1’s physician orders, dated 07/23/24, indicated s/he was to receive a pureed diet and use a “Safestraw” with liquids. On 10/21/24, Resident 1 was observed to be served a mechanical soft diet. Staff were not observed assisting Resident 1 with his/her Safestraw. Staff 5 (LPN) stated staff had “confused” Resident 1’s plate with another resident’s. The facility’s failure to carry out medication and treatment orders as prescribed was substantiated.