Print Violation: CALMS - 00083413

Provider Information

Pacific Grove Senior Living Community

2112 OAK ST
Forest Grove, OR 97116

Date: 3/28/2025
Report number: CALMS - 00083413
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to report potential or suspected abuse
Result: Substantiated
Rule(s) Violated: External site: 411-054-0028(2)(b)
Findings: Based on interview and record review, conducted during a site visit on 04/17/25, the facility’s failure to immediately notify the local Department office, or the local AAA, of any incident of abuse or suspected abuse was substantiated for 1 of 1 sampled resident (# 2). Findings include, but are not limited to: In an interview, Resident 2 stated s/he had bruising on his/her left upper arm because the caregiver assisting him/her wasn’t patient enough to wait until s/he got into bed. Resident 2 stated, 'Staff 3(Caregiver) picked me up and put me in bed and hurt my arm. I had the bruising for a couple of days.” An interview on 04/17/25, Staff 1 (Administrator) stated that no instances occurred between 02/17/25 and 04/17/25 that required an internal investigation regarding whether or not abuse or neglect occurred. A record request for any incident of abuse or neglect for Resident 2 dated between 02/17/25 through 04/17/25 was made. The facility did not provide documentation, and no documentation was available. The facility’s failure to immediately notify the local Department office or the local AAA of any incident of abuse or suspected abuse was substantiated.